加速康复外科(enhanced recovery after surgery,ERAS)是指使用标准化、多模式的围手术期策略来减少手术引起的生理应激和器官功能障碍.自ERAS理念提出以来,其在外科领域广受推崇.它在外科领域对于绝大部分患者,医务人员和医疗保健系统...加速康复外科(enhanced recovery after surgery,ERAS)是指使用标准化、多模式的围手术期策略来减少手术引起的生理应激和器官功能障碍.自ERAS理念提出以来,其在外科领域广受推崇.它在外科领域对于绝大部分患者,医务人员和医疗保健系统的益处是显而易见的.然而,对于某些特定的接受手术的人群来说,其益处则并不确定,这就是所谓的手术相关差异.本文将近年来不同外科领域有关不同种族人群出现手术相关差异的研究进行分析,综述了大量有关ERAS的实施对手术相关差异的正面影响,并阐述了其可能的发生机制.最终得出结论,ERAS一种解决手术相关差异的标准化模式,应该成为外科围手术期管理的金标准.展开更多
Background: Age- related differences in patients with an acute coronary syndrome(ACS) have not been well characterized in prior observational studies that often included only certain age groups or subjects with myocar...Background: Age- related differences in patients with an acute coronary syndrome(ACS) have not been well characterized in prior observational studies that often included only certain age groups or subjects with myocardial infarction(MI). Methods: We stratified 4627 patients admitted with an ACS across 9 provinces between 1999 and 2001 enrolled in the Canadian ACS Registry into 3 age groups(< 65, 65- 74, and ≥ 75 years)to evaluate differences in clinical characteristics, management, and 1- year outcome. Results: Older patients more frequently had previous angina,MI, or heart failure and were less likely to have positive cardiac markers, ST elevation, and Q- wave MI or to receive thrombolytics, β - blockers, and cholesterol- lowering and antiplatelet agents in hospital, at discharge, and at 1 year. In multivariable analyses controlling for patient factors, every decade increase in age was independently associated with reduced use of coronary angiography(odds ratio [OR] 0.79, 95% CI 0.74- 0.84, P< .001) and percutaneous coronary intervention(OR 0.88, 95% CI 0.81- 0.95, P=.001). When adjusted for validated clinical prognosticators and differences in management, every decade of age increment independently predicted an increased risk of death at 1 year(OR 1.87, 95% CI 1.66- 2.12, P< .001). Conclusions: Across the broad spectrum of ACS, elderly patients had more complex comorbidities and worse outcome, yet they were less likely to undergo revascularization or to receive acute and long- term evidence- based medications. Our findings emphasize the ongoing need to better define and promote optimal therapeutic regimens for elderly patients with ACS.展开更多
城乡间收入差异和经济增长的课题缺乏定量的实证研究,本文基于我国城乡收入差异现状,利用地级市的经济数据,分别采用O L S和空间计量模型进行回归分析,空间计量的引入是考虑到经济增长和城乡差异的空间自相关特征。结论表明在我国当前...城乡间收入差异和经济增长的课题缺乏定量的实证研究,本文基于我国城乡收入差异现状,利用地级市的经济数据,分别采用O L S和空间计量模型进行回归分析,空间计量的引入是考虑到经济增长和城乡差异的空间自相关特征。结论表明在我国当前发展状态下,经济增长和城乡收入差异均有较为明显的空间自相关性,且二者之间存在着负相关:城乡收入差异对经济增长呈现出较为明显的阻碍作用,而随着经济的增长,城乡收入差异水平也逐渐下降,城乡间收入差距呈现出缩小的趋势。展开更多
文摘加速康复外科(enhanced recovery after surgery,ERAS)是指使用标准化、多模式的围手术期策略来减少手术引起的生理应激和器官功能障碍.自ERAS理念提出以来,其在外科领域广受推崇.它在外科领域对于绝大部分患者,医务人员和医疗保健系统的益处是显而易见的.然而,对于某些特定的接受手术的人群来说,其益处则并不确定,这就是所谓的手术相关差异.本文将近年来不同外科领域有关不同种族人群出现手术相关差异的研究进行分析,综述了大量有关ERAS的实施对手术相关差异的正面影响,并阐述了其可能的发生机制.最终得出结论,ERAS一种解决手术相关差异的标准化模式,应该成为外科围手术期管理的金标准.
文摘Background: Age- related differences in patients with an acute coronary syndrome(ACS) have not been well characterized in prior observational studies that often included only certain age groups or subjects with myocardial infarction(MI). Methods: We stratified 4627 patients admitted with an ACS across 9 provinces between 1999 and 2001 enrolled in the Canadian ACS Registry into 3 age groups(< 65, 65- 74, and ≥ 75 years)to evaluate differences in clinical characteristics, management, and 1- year outcome. Results: Older patients more frequently had previous angina,MI, or heart failure and were less likely to have positive cardiac markers, ST elevation, and Q- wave MI or to receive thrombolytics, β - blockers, and cholesterol- lowering and antiplatelet agents in hospital, at discharge, and at 1 year. In multivariable analyses controlling for patient factors, every decade increase in age was independently associated with reduced use of coronary angiography(odds ratio [OR] 0.79, 95% CI 0.74- 0.84, P< .001) and percutaneous coronary intervention(OR 0.88, 95% CI 0.81- 0.95, P=.001). When adjusted for validated clinical prognosticators and differences in management, every decade of age increment independently predicted an increased risk of death at 1 year(OR 1.87, 95% CI 1.66- 2.12, P< .001). Conclusions: Across the broad spectrum of ACS, elderly patients had more complex comorbidities and worse outcome, yet they were less likely to undergo revascularization or to receive acute and long- term evidence- based medications. Our findings emphasize the ongoing need to better define and promote optimal therapeutic regimens for elderly patients with ACS.
文摘城乡间收入差异和经济增长的课题缺乏定量的实证研究,本文基于我国城乡收入差异现状,利用地级市的经济数据,分别采用O L S和空间计量模型进行回归分析,空间计量的引入是考虑到经济增长和城乡差异的空间自相关特征。结论表明在我国当前发展状态下,经济增长和城乡收入差异均有较为明显的空间自相关性,且二者之间存在着负相关:城乡收入差异对经济增长呈现出较为明显的阻碍作用,而随着经济的增长,城乡收入差异水平也逐渐下降,城乡间收入差距呈现出缩小的趋势。
