目的探究前瞻性评估联合分级预防对急诊患者应激性溃疡发病的影响.方法选取2011-01/2013-06玉环县坎门街道社区卫生服务中心门诊急诊科收治的142例急诊患者为对照组,给予普通干预,选取2013-07/2016-01收治的163例急诊患者为观察组,给予...目的探究前瞻性评估联合分级预防对急诊患者应激性溃疡发病的影响.方法选取2011-01/2013-06玉环县坎门街道社区卫生服务中心门诊急诊科收治的142例急诊患者为对照组,给予普通干预,选取2013-07/2016-01收治的163例急诊患者为观察组,给予前瞻性评估联合分级预防干预.比较2组患者应激性溃疡发病率、出血时间、住院时间和对干预的满意率.结果观察组和对照组患者应激性溃疡发病率分别为13.49%和32.39%,差异具有统计学意义(P<0.05).观察组患者的出血时间和住院时间短于对照组患者,差异具有统计学意义(2.65 d±2.43 d vs 4.27 d±2.01 d,17.44 d±8.67 d vs 22.67 d±7.95 d,P<0.05).观察组163例患者中97例非常满意,57例满意,4例一般,5例不满意,对照组142例患者中59例非常满意,55例满意,18例一般,10例不满意,观察组和对照组患者对干预的满意率分别为94.46%和80.27%,观察组显著高于对照组,差异具有统计学意义(P<0.05).结论给予急诊患者前瞻性评估联合分级预防能够显著降低应激性溃疡发病率,缩短出血时间和住院时间,提高患者对干预的满意率,可以在临床上进一步推广和使用.展开更多
Abstract Abstract Background: Ileoscopy is the criterion standard for mucosal lesions of terminal ileum but is performed in 5% of colonoscopy activity, and the need for training is undefined. Objective: To assess the ...Abstract Abstract Background: Ileoscopy is the criterion standard for mucosal lesions of terminal ileum but is performed in 5% of colonoscopy activity, and the need for training is undefined. Objective: To assess the learning curve and skill-keeping line of ileoscopy. Design: Prospective randomized study. Setting: Single GI endoscopy unit. Patients: Adult outpatients referred for colonoscopy. Interventions: Patient randomization to ileocolonoscopy by trainees and seniors. Main outcome measurements: Ileoscopy skill was divided into the following: ileocecal valve (ICV) intubation (success rate, time) and ileal exploration (length, time). Consecutive blocks of 10 procedures were used to calculate the learning curve and the skill-keeping line. Variables considered to influence ICV intubation were the following: endoscopist experience, ICV morphology, patient age, gender, body mass index, diverticular disease, and preceding abdominal/pelvic surgery. Results: Learning curve showed that competency in ICV intubation (80% success rate) and ileal exploration (16 cm) was achieved after 50 procedures. The skillkeeping line showed that ileoscopy was easy (97% success rate), fast (1 minute), and well accepted up to 45 cm of the ileum. Thin-lipped and volcanic ICV are the most difficult and easiest to intubate, respectively. Crohn’ s disease and adenomas of the proximal edge of ICV were diagnosed in 2.2% . Conclusions: Training in ileoscopy is recommended to achieve competency, and endoscopists should consider practicing ICV intubation to maintain and increase their skill. Ileoscopy can be difficult when the ICV is thin lipped or single bulged, and easy when it has a volcanic morphology.展开更多
Objectives - The aim of this prospective study was to evaluate the feasibility of radiofrequency ablation of hepatic tumors. We studied the rates of mortality, morbidity, and recurrence and recorded overall and diseas...Objectives - The aim of this prospective study was to evaluate the feasibility of radiofrequency ablation of hepatic tumors. We studied the rates of mortality, morbidity, and recurrence and recorded overall and disease-free survival. Methods - All patients aged over 18 years with histologically proven malignant liver disease inaccessible to surgical treatment (one to four tumor localizations) were eligible for inclusion in the study. Child-Pugh score > B9, platelets count ≤ 50× 103/mm3, prothrombin index ≤ 50% and pregnancy were exclusion factors. Results - Between July 2001 and June 2004, 51 patients (13 women, 38 men, mean age 66 ± 9 years) were included and underwent 61 radiofrequency thermal ablation procedures for 82 hepatic lesions: hepatocarcinoma (N = 44), cholangiocarcinoma (N = 1), metastasic tumors (N = 37). Hospital morbidity and mortality were 11.5% and 2% respectively. Recurrence rate at 3 years was 20.6% . In multivariate analysis, only tumor size > 3 cm was correlated significantly with recurrence (P = 0.03). Actuarial 1- , 2- and 3- year survival rates in the hepatocarcinoma group (N = 31) were 84.7% , 57.7% and 34.6% respectively. Actuarial 1- , 2- and 3- year survival rates in the metastasis from colorectal adenocarcinoma group (N = 14) were 90% , 54% and 54% respectively (P = 0.72). Conclusion - Radiofrequency thermal ablation is an effective treatment for hepatic tumors measuring less than 3 cm. There is a low risk of complications and open surgery can be associated. However in the Absence of randomized studies comparing radiofrequency and surgery, respective indications cannot be defined in detail.展开更多
文摘目的探究前瞻性评估联合分级预防对急诊患者应激性溃疡发病的影响.方法选取2011-01/2013-06玉环县坎门街道社区卫生服务中心门诊急诊科收治的142例急诊患者为对照组,给予普通干预,选取2013-07/2016-01收治的163例急诊患者为观察组,给予前瞻性评估联合分级预防干预.比较2组患者应激性溃疡发病率、出血时间、住院时间和对干预的满意率.结果观察组和对照组患者应激性溃疡发病率分别为13.49%和32.39%,差异具有统计学意义(P<0.05).观察组患者的出血时间和住院时间短于对照组患者,差异具有统计学意义(2.65 d±2.43 d vs 4.27 d±2.01 d,17.44 d±8.67 d vs 22.67 d±7.95 d,P<0.05).观察组163例患者中97例非常满意,57例满意,4例一般,5例不满意,对照组142例患者中59例非常满意,55例满意,18例一般,10例不满意,观察组和对照组患者对干预的满意率分别为94.46%和80.27%,观察组显著高于对照组,差异具有统计学意义(P<0.05).结论给予急诊患者前瞻性评估联合分级预防能够显著降低应激性溃疡发病率,缩短出血时间和住院时间,提高患者对干预的满意率,可以在临床上进一步推广和使用.
文摘Abstract Abstract Background: Ileoscopy is the criterion standard for mucosal lesions of terminal ileum but is performed in 5% of colonoscopy activity, and the need for training is undefined. Objective: To assess the learning curve and skill-keeping line of ileoscopy. Design: Prospective randomized study. Setting: Single GI endoscopy unit. Patients: Adult outpatients referred for colonoscopy. Interventions: Patient randomization to ileocolonoscopy by trainees and seniors. Main outcome measurements: Ileoscopy skill was divided into the following: ileocecal valve (ICV) intubation (success rate, time) and ileal exploration (length, time). Consecutive blocks of 10 procedures were used to calculate the learning curve and the skill-keeping line. Variables considered to influence ICV intubation were the following: endoscopist experience, ICV morphology, patient age, gender, body mass index, diverticular disease, and preceding abdominal/pelvic surgery. Results: Learning curve showed that competency in ICV intubation (80% success rate) and ileal exploration (16 cm) was achieved after 50 procedures. The skillkeeping line showed that ileoscopy was easy (97% success rate), fast (1 minute), and well accepted up to 45 cm of the ileum. Thin-lipped and volcanic ICV are the most difficult and easiest to intubate, respectively. Crohn’ s disease and adenomas of the proximal edge of ICV were diagnosed in 2.2% . Conclusions: Training in ileoscopy is recommended to achieve competency, and endoscopists should consider practicing ICV intubation to maintain and increase their skill. Ileoscopy can be difficult when the ICV is thin lipped or single bulged, and easy when it has a volcanic morphology.
文摘2018年5月HIV Medicine在线发表了北京协和医院感染内科李太生教授牵头的一项多中心研究——＂中国人类免疫缺陷病毒感染者依非韦伦浓度前瞻性评估研究＂[Guo F,Cheng X,Hsieh E,et al. Prospective plasma efavirenz concentration assessment in Chinese HIV-infected adults enrolled in a large multicentre study. HIV Medicine,2018,19 （7）：440-451.].该研究在＂十二五＂国家科技重大专项（2012ZX10001003-001）、＂十三五＂国家科技重大专项（2017ZX10202101）和中国医学科学院医学与健康科技创新工程项目（2017-12M-1-014）资助下,在国际上率先报道中国HIV感染者使用依非韦伦（600 mg每日1次）治疗时依非韦伦血药浓度的特点.
文摘Objectives - The aim of this prospective study was to evaluate the feasibility of radiofrequency ablation of hepatic tumors. We studied the rates of mortality, morbidity, and recurrence and recorded overall and disease-free survival. Methods - All patients aged over 18 years with histologically proven malignant liver disease inaccessible to surgical treatment (one to four tumor localizations) were eligible for inclusion in the study. Child-Pugh score > B9, platelets count ≤ 50× 103/mm3, prothrombin index ≤ 50% and pregnancy were exclusion factors. Results - Between July 2001 and June 2004, 51 patients (13 women, 38 men, mean age 66 ± 9 years) were included and underwent 61 radiofrequency thermal ablation procedures for 82 hepatic lesions: hepatocarcinoma (N = 44), cholangiocarcinoma (N = 1), metastasic tumors (N = 37). Hospital morbidity and mortality were 11.5% and 2% respectively. Recurrence rate at 3 years was 20.6% . In multivariate analysis, only tumor size > 3 cm was correlated significantly with recurrence (P = 0.03). Actuarial 1- , 2- and 3- year survival rates in the hepatocarcinoma group (N = 31) were 84.7% , 57.7% and 34.6% respectively. Actuarial 1- , 2- and 3- year survival rates in the metastasis from colorectal adenocarcinoma group (N = 14) were 90% , 54% and 54% respectively (P = 0.72). Conclusion - Radiofrequency thermal ablation is an effective treatment for hepatic tumors measuring less than 3 cm. There is a low risk of complications and open surgery can be associated. However in the Absence of randomized studies comparing radiofrequency and surgery, respective indications cannot be defined in detail.
