Background: Enhanced recovery after surgery(ERAS) protocol is a multimodal, multidisciplinary and evidence-based approach to reduce surgical stress and enhance recovery in the postoperative period. This study aimed to...Background: Enhanced recovery after surgery(ERAS) protocol is a multimodal, multidisciplinary and evidence-based approach to reduce surgical stress and enhance recovery in the postoperative period. This study aimed to analyze the outcome of ERAS protocol in patients after pancreaticoduodenectomy(PD). Methods: A total of 50 consecutive patients with pancreatic/periampullary cancer who underwent PD between January 2016 to August 2017 were included in the study. As per the institute ERAS protocol, nasogastric tube(NGT) was removed on postoperative day(POD) 1 if output was less than 200 mL and oral sips were allowed; oral liquids were allowed on POD2; semisolid diet by POD3; abdominal drain was removed on POD 4 if output was less than 100 mL with no evidence of postoperative pancreatic fistula(POPF); normal diet was allowed on POD5. Discharge criteria on POD6 were afebrile, tolerating oral normal diet, pain free and no surgery related complications(defined as per the ISGPS definitions). Results: NGT was removed on POD1 in 45(90%) patients, abdominal drain removed by POD4 in 41(82%) and 43(86%) patients were discharged on POD6. There was no 30-day postoperative mortality. Three(6%) patients had delayed gastric emptying(DGE). None had postoperative hemorrhage and POPF. Readmission rate was 8%. A significant relation was found between the length of hospital stay(LOS) with age( P < 0.05) and a marginal relation between LOS and postoperative albumin( P = 0.05). Conclusions: ERAS protocol can be safely followed in the perioperative care of patients who undergo PD. Early removal of NGT and allowing oral diet restore bowel function early. ERAS decreases the LOS and postoperative complications.展开更多
为研究油浸纸套管尾部绝缘受潮的故障检测及诊断方法,设计并制作了透明护套的油浸纸套管模型,模拟水分从套管头部进入并在尾部沉积的典型受潮故障,研究额定电压和阶梯升压下套管尾部受潮的局部放电、介质损耗角正切值tanδ、电容及频域...为研究油浸纸套管尾部绝缘受潮的故障检测及诊断方法,设计并制作了透明护套的油浸纸套管模型,模拟水分从套管头部进入并在尾部沉积的典型受潮故障,研究额定电压和阶梯升压下套管尾部受潮的局部放电、介质损耗角正切值tanδ、电容及频域介电谱特征的变化规律。研究结果表明:额定电压下套管尾部受潮早期,电容随受潮时间呈现增长趋势,而局部放电、tanδ基本不变;1.5 Um工频电压下的局部放电试验使得套管尾部早期受潮的沉积水分运动引发放电;频域介电谱1 m Hz,tanδ随受潮时间呈现增长趋势。现有10 k V电压下测试tanδ、额定电压测局部放电的方法可能会因水分沉积状态而产生误判。建议对疑似尾部受潮套管离线试验中增加1.5 Um工频电压测局部放电试验、1 m Hz频域介电谱测试,在线监测中增加电容的检测,以便早诊断和识别尾部受潮的套管。展开更多
Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyz...Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare systems.The practice of direct discharge from the ICU presents both opportunities and complexities.While it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support mechanisms.Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition.Through critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery.The insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare processes.Ultimately,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.展开更多
Background: Cesarean section is one of the most common surgeries performed worldwide and its consequences and complications represent a major public health concern. The policy of enhanced recovery after surgery has be...Background: Cesarean section is one of the most common surgeries performed worldwide and its consequences and complications represent a major public health concern. The policy of enhanced recovery after surgery has been implemented after cesarean section to optimize perioperative care. Enhanced recovery also aims to reduce the length of hospital stay, which might imply substantial healthcare savings. Rising hospital costs are one of the factors in early discharge. Patients & Methods: This was a prospective cohort study. 158 patients met the inclusion criteria of the study, 81 patients were discharged after 48 hours and 77 patients were discharged after 24 hours. All patients received the same postoperative care and instructions. All the study participants received a phone call 1, 3, and 5 days after discharge to objectively assess the activities of daily living through Katz index of independence in activities of daily living. All patients were offered a postpartum visit 1 week after discharge during which the wound was assessed by the Southampton wound assessment scale. Moreover, other maternal complications such as mastitis, puerperal sepsis, or pyelonephritis were assessed and cases who were readmitted were documented. Initiation of successful breastfeeding and neonatal readmission were reported as well. Results: 158 patients met the inclusion/exclusion criteria of the study. There was no significant difference between the two arms of the study regarding baseline characteristics. Katz index of independence showed that the resumption of activities of daily living after CS was similar in both arms of the study on days 1, 3 and 5 after discharge. Time till the passage of flatus and stool after the cesarean section was significantly shorter among the early discharge arm (9.31 VS 14.68, p value < 0.001 & 13.25 VS 24.82, p value < 0.001 respectively). Maternal readmission was not significantly higher among the early discharge arm and at the 1-week postpartum visit, objective wound assessment by Southampton wound scor展开更多
Objectives: Length of hospital stay after cesarean section is today much shorter than previously, and a stay of only 1 day is used in many departments. However, complications requiring immediate treatment must be diag...Objectives: Length of hospital stay after cesarean section is today much shorter than previously, and a stay of only 1 day is used in many departments. However, complications requiring immediate treatment must be diagnosed before leaving hospital. We assessed the time interval from planned cesarean section to diagnosis of major complications in low-risk women to estimate a safe time of discharge. Methods: We performed a retrospective observational study among 5633 women undergoing planned cesarean section from 2001-2017 at Aarhus University Hospital, Denmark. The inclusion criterion was postoperative complication graded as Clavien-Dindo ≥ II. Exclusion criteria were preoperative comorbidity or problems during surgery indicative of need for prolonged stay. Time from cesarean section to suspicion of a postoperative complication was the primary endpoint. Results: The study population consisted of 116 women with unexpected postoperative complications, 47 classified as Clavien-Dindo II and 69 as Clavien-Dindo III-IV. In 63 of the 116, the diagnoses were suspected within 24 hours (Clavien-Dindo II: 25, Clavien-Dindo III-IV: 38). These included all cases of relaparotomy and uterine atony with immediate need of medical treatment. Acute colonic pseudo-obstruction was diagnosed within 2 days, while other complications were suspected and treated 2 to 10 days postoperatively. Conclusions: Among low-risk women with a postoperative complication, all cases requiring relaparotomy and medically treated uterine atony were suspected within 24 hours after surgery. Discharge 24 hours after planned cesarean section seems safe in low-risk patients.展开更多
The Paediatric Observation Priority Score (POPS) is a bespoke assessment tool for use in Paediatric Emergency Departments incorporating traditional physiological parameters alongside more subjective observational crit...The Paediatric Observation Priority Score (POPS) is a bespoke assessment tool for use in Paediatric Emergency Departments incorporating traditional physiological parameters alongside more subjective observational criteria. Initial performance characteristics of POPS were analysed in a convenience sample of 936 presentations to ED. Triage on the basis of gut instinct parameters identified an additional 261 patients deemed of lowest acuity compared to analysis by physiology scores. Resource consumption increased with increasing acuity on presentation. POPS shows promise in assisting in the assessment process of children presenting to Emergency Departments. Inclusion of subjective triage criteria helps contextualise the physiological parameter scoring by using the experience of staff conducting triage. Initial interpretation of presenting physiology gives a more informed assessment of initial acuity, and thus is better able to identify a child who can be safely managed in the community. The system also allows for rapid detection of those most unwell.展开更多
Early discharge policy, common in the developed countries, refers to the reduction of hospital length of stay as a way of reducing the cost of care. The effect of the policy on quality of care has received a lot of at...Early discharge policy, common in the developed countries, refers to the reduction of hospital length of stay as a way of reducing the cost of care. The effect of the policy on quality of care has received a lot of attention in the literature. Some of the earlier papers have ignored the endogeneity of length of stay in the readmission equation, an approach that could lead to inconsistent estimation. This study develops a statistical technique for the consistent estimation of the effect of the early discharge policy. An instrument that can be used extensively across different diagnostic groups is provided, hence solving the difficult problem of finding an instrument for length of stay. The exogeneity test in Gorgger (1990), the test for weak instruments in Staiger and Stock (1997) as well as the Hensen (1982) for over identification confirmed respectively that length of stay is endogenous the instrument is strong and the valid.展开更多
BACKGROUND Currents trends in pediatric orthopaedics has seen an increase in surgeries being successfully completed in an outpatient setting.Two recent examples include slipped capital femoral epiphysis(SCFE)and Bloun...BACKGROUND Currents trends in pediatric orthopaedics has seen an increase in surgeries being successfully completed in an outpatient setting.Two recent examples include slipped capital femoral epiphysis(SCFE)and Blount’s disease.Surgical indications are well-studied for each pathology,but to our knowledge,there is an absence in literature analyzing safety and efficacy of inpatient vs outpatient management of either condition.We believed there would be no increase in adverse outcomes associated with outpatient treatment of either conditions.AIM To investigate whether outpatient surgery for SCFE and Blount’s disease is associated with increased risk of adverse outcomes.METHODS The 2015-2017 American College of Surgeons National Surgical Quality Improvement Program Pediatric Registries were used to compare patient characteristics,rates of complications,and readmissions between outpatient and inpatient surgery for SCFE and Blount’s disease.RESULTS Total 1788 SCFE database entries were included,30%were performed in an outpatient setting.In situ pinning was used in 98.5%of outpatient surgeries and 87.8%of inpatient surgeries(P<0.0001).Inpatients had a greater percent of total complications than outpatients 2.57%and 1.65%respectively.Regarding Blount’s disease,outpatient surgeries constituted 41.2%of the 189 procedures included in our study.The majority of inpatients were treated with a tibial osteotomy,while the majority of outpatients had a physeal arrest(P<0.0001).Complications were encountered in 7.4%of patients,with superficial surgical site infections and wound dehiscence being the most common.1.6%of patients had a readmission.No differences in complication and readmission risks were found between inpatients and outpatients.CONCLUSION The current trend is shifting towards earlier discharges and performing procedures in an outpatient setting.This can be safely performed for a large portion of children with SCFE and Blount’s disease without increasing the risk of complications or readmissions.Osteotomies a展开更多
Background: Vaginal discharge syndrome is a common condition across the world with the main causes being infectious. Rare causes include obstructed hemivagina with ipsilateral renal agenesis (OHVIRA syndrome). Case Pr...Background: Vaginal discharge syndrome is a common condition across the world with the main causes being infectious. Rare causes include obstructed hemivagina with ipsilateral renal agenesis (OHVIRA syndrome). Case Presentation: This case involves an 18-year-old woman with a 9-year history of vaginal discharge treated unsuccessfully by multiple physicians and different health facilities. After she presented to our hospital gynecology clinic with the same complaint she investigated with blood, urine, discharge wet-mount, pelvic ultrasound, and abdominopelvic computed tomography at different times. Preoperatively she was suspected to have OHVIRA syndrome which was successfully surgically treated with a full return of function. Conclusion: This case emphasizes the need to consider non-infectious causes commonly congenital mullerian anomaly in young women presented with long-time vaginal discharge symptoms soon after menarche and which are nonresponding to different multiple medical treatments. In peripheral health institutions like ours, it is best to consider computed tomography if available but better not to forget at least abdominopelvic ultrasound to look for congenital Mullerian anomalies.展开更多
目的客观评价早期出院支持策略对脑卒中患者的干预效果。方法检索Pubmed、Cochrane临床对照试验中心注册数据库、EMBase、Web of Science、中国学术期刊全文数据库、重庆维普中文科技期刊数据库、万方数据知识服务平台。评价证据质量,...目的客观评价早期出院支持策略对脑卒中患者的干预效果。方法检索Pubmed、Cochrane临床对照试验中心注册数据库、EMBase、Web of Science、中国学术期刊全文数据库、重庆维普中文科技期刊数据库、万方数据知识服务平台。评价证据质量,提取资料并进行数据分析。结果共纳入17篇研究论文,由多学科医疗团队对轻、中度脑卒中患者提供早期出院支持策略。脑卒中早期出院支持组首次住院时间〔MD=9.98,95%CI(7.55,12.42),P<0.00001〕和总住院时间显著缩短〔MD=11.64,95%CI(7.38,15.90),P<0.00001〕,人均医疗费支出相对于对照组降低4.34%～29.65%。两组患者的病死率和照顾者压力差异无统计学意义(P>0.05)。结论多学科早期干预支持方案在脑卒中卫生服务提供过程中发挥积极作用,是一种可行的治疗模式。展开更多
目的:探讨早期全程护理联合出院后延续性护理在大面积深度烧伤Meek植皮术中的应用效果,并观察其对患者生活质量的影响。方法:选取2017年6月-2020年9月笔者医院收治的大面积深度烧伤患者78例作为研究对象,将其随机分为对照组和观察组,每...目的:探讨早期全程护理联合出院后延续性护理在大面积深度烧伤Meek植皮术中的应用效果,并观察其对患者生活质量的影响。方法:选取2017年6月-2020年9月笔者医院收治的大面积深度烧伤患者78例作为研究对象,将其随机分为对照组和观察组,每组各39例。对照组予以常规护理,观察组采用早期全程护理联合出院后延续性护理。比较两组疗效,采用疼痛视觉模拟评分(Visual analogue scale,VAS)和烧伤健康专用量表(Burn specific health scale,BSHS-A)对患者疼痛程度和生活质量进行评分,并调查患者满意度。结果:护理后,对照组总有效率为79.49%低于观察组的94.87%,差异有统计学意义(P<0.05)。两组VAS评分均低于护理前,躯体功能、社会关系、一般健康状况、心理功能评分均高于护理前,且观察组VAS评分低于对照组,躯体功能、社会关系、一般健康状况、心理功能评分均高于对照组,差异有统计学意义(P<0.05)。观察组总满意率(92.31%)高于对照组(74.36%),差异有统计学意义(P<0.05)。结论:早期全程护理联合出院后延续性护理在大面积深度烧伤Meek植皮术中的应用效果好,能够有效提高护理效果,降低患者疼痛程度,改善生活质量,且患者满意率高,值得推广。展开更多
The seeds of Lamb＇s Quarters （Chenopodium album agg.） were stimulated by low- pressure discharge. The tested seeds were exposed to plasma discharge for different time durations （from 6 minutes to 48 minutes）. Ger...The seeds of Lamb＇s Quarters （Chenopodium album agg.） were stimulated by low- pressure discharge. The tested seeds were exposed to plasma discharge for different time durations （from 6 minutes to 48 minutes）. Germination tests were performed under specified laboratory conditions during seven days in five identical and completely independent experiments. Significant differences between the control and plasma-treated seeds were observed. The treated seeds showed structural changes on the surface of the seat coat. They germinated faster and their sprout accretion on the first day of seed germination was longer. Germination rate for the untreated seeds was 15% while it increased approximately three times （max 55%） for seeds treated by plasma from 12 minutes to 48 minutes.展开更多
特高压直流GIL运行可靠性取决于内绝缘设计的可靠性。此外,导电元件直流电流密度的取值、弹簧触头的定位设计、GIL各元件中的绝缘件与金具连接处的楔形气隙的处理以及母线中支撑件的结构设计细节,都会对产品运行可靠性产生重大影响,不...特高压直流GIL运行可靠性取决于内绝缘设计的可靠性。此外,导电元件直流电流密度的取值、弹簧触头的定位设计、GIL各元件中的绝缘件与金具连接处的楔形气隙的处理以及母线中支撑件的结构设计细节,都会对产品运行可靠性产生重大影响,不能忽视。对于运行环境十分严酷的UHV DC GIL为保证内绝缘工作可靠性和减少气体维护工作量,文中还提出了高气密性结构设计。为适应-50℃低温运行要求,产品选用了液化温度很低的N_(2)/SF_(6)混合气体,对两种气体的配比,压力特性和绝缘特性进行了讨论与计算。还有产品的局放、气体密度及微水含量的监视系统的可靠性设计,都会对产品运行可靠性产生直接影响。文中对上述问题的研究成果作了介绍,可供高压直流产品设计使用。对其中未解的新技术如基于冷镜露点测试原理、微机电技术制作的智能气体湿度和密度监测装置、高压直流复合绝缘套管伞面局放起始场强提出了研究方案。文中提出的诸多GIL运行可靠性设计要点,对于其他超/特高压直流气体绝缘电器可参考选用。展开更多
文摘Background: Enhanced recovery after surgery(ERAS) protocol is a multimodal, multidisciplinary and evidence-based approach to reduce surgical stress and enhance recovery in the postoperative period. This study aimed to analyze the outcome of ERAS protocol in patients after pancreaticoduodenectomy(PD). Methods: A total of 50 consecutive patients with pancreatic/periampullary cancer who underwent PD between January 2016 to August 2017 were included in the study. As per the institute ERAS protocol, nasogastric tube(NGT) was removed on postoperative day(POD) 1 if output was less than 200 mL and oral sips were allowed; oral liquids were allowed on POD2; semisolid diet by POD3; abdominal drain was removed on POD 4 if output was less than 100 mL with no evidence of postoperative pancreatic fistula(POPF); normal diet was allowed on POD5. Discharge criteria on POD6 were afebrile, tolerating oral normal diet, pain free and no surgery related complications(defined as per the ISGPS definitions). Results: NGT was removed on POD1 in 45(90%) patients, abdominal drain removed by POD4 in 41(82%) and 43(86%) patients were discharged on POD6. There was no 30-day postoperative mortality. Three(6%) patients had delayed gastric emptying(DGE). None had postoperative hemorrhage and POPF. Readmission rate was 8%. A significant relation was found between the length of hospital stay(LOS) with age( P < 0.05) and a marginal relation between LOS and postoperative albumin( P = 0.05). Conclusions: ERAS protocol can be safely followed in the perioperative care of patients who undergo PD. Early removal of NGT and allowing oral diet restore bowel function early. ERAS decreases the LOS and postoperative complications.
文摘为研究油浸纸套管尾部绝缘受潮的故障检测及诊断方法,设计并制作了透明护套的油浸纸套管模型,模拟水分从套管头部进入并在尾部沉积的典型受潮故障,研究额定电压和阶梯升压下套管尾部受潮的局部放电、介质损耗角正切值tanδ、电容及频域介电谱特征的变化规律。研究结果表明:额定电压下套管尾部受潮早期,电容随受潮时间呈现增长趋势,而局部放电、tanδ基本不变;1.5 Um工频电压下的局部放电试验使得套管尾部早期受潮的沉积水分运动引发放电;频域介电谱1 m Hz,tanδ随受潮时间呈现增长趋势。现有10 k V电压下测试tanδ、额定电压测局部放电的方法可能会因水分沉积状态而产生误判。建议对疑似尾部受潮套管离线试验中增加1.5 Um工频电压测局部放电试验、1 m Hz频域介电谱测试,在线监测中增加电容的检测,以便早诊断和识别尾部受潮的套管。
文摘Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare systems.The practice of direct discharge from the ICU presents both opportunities and complexities.While it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support mechanisms.Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition.Through critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery.The insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare processes.Ultimately,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.
文摘Background: Cesarean section is one of the most common surgeries performed worldwide and its consequences and complications represent a major public health concern. The policy of enhanced recovery after surgery has been implemented after cesarean section to optimize perioperative care. Enhanced recovery also aims to reduce the length of hospital stay, which might imply substantial healthcare savings. Rising hospital costs are one of the factors in early discharge. Patients & Methods: This was a prospective cohort study. 158 patients met the inclusion criteria of the study, 81 patients were discharged after 48 hours and 77 patients were discharged after 24 hours. All patients received the same postoperative care and instructions. All the study participants received a phone call 1, 3, and 5 days after discharge to objectively assess the activities of daily living through Katz index of independence in activities of daily living. All patients were offered a postpartum visit 1 week after discharge during which the wound was assessed by the Southampton wound assessment scale. Moreover, other maternal complications such as mastitis, puerperal sepsis, or pyelonephritis were assessed and cases who were readmitted were documented. Initiation of successful breastfeeding and neonatal readmission were reported as well. Results: 158 patients met the inclusion/exclusion criteria of the study. There was no significant difference between the two arms of the study regarding baseline characteristics. Katz index of independence showed that the resumption of activities of daily living after CS was similar in both arms of the study on days 1, 3 and 5 after discharge. Time till the passage of flatus and stool after the cesarean section was significantly shorter among the early discharge arm (9.31 VS 14.68, p value < 0.001 & 13.25 VS 24.82, p value < 0.001 respectively). Maternal readmission was not significantly higher among the early discharge arm and at the 1-week postpartum visit, objective wound assessment by Southampton wound scor
文摘Objectives: Length of hospital stay after cesarean section is today much shorter than previously, and a stay of only 1 day is used in many departments. However, complications requiring immediate treatment must be diagnosed before leaving hospital. We assessed the time interval from planned cesarean section to diagnosis of major complications in low-risk women to estimate a safe time of discharge. Methods: We performed a retrospective observational study among 5633 women undergoing planned cesarean section from 2001-2017 at Aarhus University Hospital, Denmark. The inclusion criterion was postoperative complication graded as Clavien-Dindo ≥ II. Exclusion criteria were preoperative comorbidity or problems during surgery indicative of need for prolonged stay. Time from cesarean section to suspicion of a postoperative complication was the primary endpoint. Results: The study population consisted of 116 women with unexpected postoperative complications, 47 classified as Clavien-Dindo II and 69 as Clavien-Dindo III-IV. In 63 of the 116, the diagnoses were suspected within 24 hours (Clavien-Dindo II: 25, Clavien-Dindo III-IV: 38). These included all cases of relaparotomy and uterine atony with immediate need of medical treatment. Acute colonic pseudo-obstruction was diagnosed within 2 days, while other complications were suspected and treated 2 to 10 days postoperatively. Conclusions: Among low-risk women with a postoperative complication, all cases requiring relaparotomy and medically treated uterine atony were suspected within 24 hours after surgery. Discharge 24 hours after planned cesarean section seems safe in low-risk patients.
文摘The Paediatric Observation Priority Score (POPS) is a bespoke assessment tool for use in Paediatric Emergency Departments incorporating traditional physiological parameters alongside more subjective observational criteria. Initial performance characteristics of POPS were analysed in a convenience sample of 936 presentations to ED. Triage on the basis of gut instinct parameters identified an additional 261 patients deemed of lowest acuity compared to analysis by physiology scores. Resource consumption increased with increasing acuity on presentation. POPS shows promise in assisting in the assessment process of children presenting to Emergency Departments. Inclusion of subjective triage criteria helps contextualise the physiological parameter scoring by using the experience of staff conducting triage. Initial interpretation of presenting physiology gives a more informed assessment of initial acuity, and thus is better able to identify a child who can be safely managed in the community. The system also allows for rapid detection of those most unwell.
文摘Early discharge policy, common in the developed countries, refers to the reduction of hospital length of stay as a way of reducing the cost of care. The effect of the policy on quality of care has received a lot of attention in the literature. Some of the earlier papers have ignored the endogeneity of length of stay in the readmission equation, an approach that could lead to inconsistent estimation. This study develops a statistical technique for the consistent estimation of the effect of the early discharge policy. An instrument that can be used extensively across different diagnostic groups is provided, hence solving the difficult problem of finding an instrument for length of stay. The exogeneity test in Gorgger (1990), the test for weak instruments in Staiger and Stock (1997) as well as the Hensen (1982) for over identification confirmed respectively that length of stay is endogenous the instrument is strong and the valid.
文摘BACKGROUND Currents trends in pediatric orthopaedics has seen an increase in surgeries being successfully completed in an outpatient setting.Two recent examples include slipped capital femoral epiphysis(SCFE)and Blount’s disease.Surgical indications are well-studied for each pathology,but to our knowledge,there is an absence in literature analyzing safety and efficacy of inpatient vs outpatient management of either condition.We believed there would be no increase in adverse outcomes associated with outpatient treatment of either conditions.AIM To investigate whether outpatient surgery for SCFE and Blount’s disease is associated with increased risk of adverse outcomes.METHODS The 2015-2017 American College of Surgeons National Surgical Quality Improvement Program Pediatric Registries were used to compare patient characteristics,rates of complications,and readmissions between outpatient and inpatient surgery for SCFE and Blount’s disease.RESULTS Total 1788 SCFE database entries were included,30%were performed in an outpatient setting.In situ pinning was used in 98.5%of outpatient surgeries and 87.8%of inpatient surgeries(P<0.0001).Inpatients had a greater percent of total complications than outpatients 2.57%and 1.65%respectively.Regarding Blount’s disease,outpatient surgeries constituted 41.2%of the 189 procedures included in our study.The majority of inpatients were treated with a tibial osteotomy,while the majority of outpatients had a physeal arrest(P<0.0001).Complications were encountered in 7.4%of patients,with superficial surgical site infections and wound dehiscence being the most common.1.6%of patients had a readmission.No differences in complication and readmission risks were found between inpatients and outpatients.CONCLUSION The current trend is shifting towards earlier discharges and performing procedures in an outpatient setting.This can be safely performed for a large portion of children with SCFE and Blount’s disease without increasing the risk of complications or readmissions.Osteotomies a
文摘Background: Vaginal discharge syndrome is a common condition across the world with the main causes being infectious. Rare causes include obstructed hemivagina with ipsilateral renal agenesis (OHVIRA syndrome). Case Presentation: This case involves an 18-year-old woman with a 9-year history of vaginal discharge treated unsuccessfully by multiple physicians and different health facilities. After she presented to our hospital gynecology clinic with the same complaint she investigated with blood, urine, discharge wet-mount, pelvic ultrasound, and abdominopelvic computed tomography at different times. Preoperatively she was suspected to have OHVIRA syndrome which was successfully surgically treated with a full return of function. Conclusion: This case emphasizes the need to consider non-infectious causes commonly congenital mullerian anomaly in young women presented with long-time vaginal discharge symptoms soon after menarche and which are nonresponding to different multiple medical treatments. In peripheral health institutions like ours, it is best to consider computed tomography if available but better not to forget at least abdominopelvic ultrasound to look for congenital Mullerian anomalies.
文摘目的客观评价早期出院支持策略对脑卒中患者的干预效果。方法检索Pubmed、Cochrane临床对照试验中心注册数据库、EMBase、Web of Science、中国学术期刊全文数据库、重庆维普中文科技期刊数据库、万方数据知识服务平台。评价证据质量,提取资料并进行数据分析。结果共纳入17篇研究论文,由多学科医疗团队对轻、中度脑卒中患者提供早期出院支持策略。脑卒中早期出院支持组首次住院时间〔MD=9.98,95%CI(7.55,12.42),P<0.00001〕和总住院时间显著缩短〔MD=11.64,95%CI(7.38,15.90),P<0.00001〕,人均医疗费支出相对于对照组降低4.34%～29.65%。两组患者的病死率和照顾者压力差异无统计学意义(P>0.05)。结论多学科早期干预支持方案在脑卒中卫生服务提供过程中发挥积极作用,是一种可行的治疗模式。
文摘目的:探讨早期全程护理联合出院后延续性护理在大面积深度烧伤Meek植皮术中的应用效果,并观察其对患者生活质量的影响。方法:选取2017年6月-2020年9月笔者医院收治的大面积深度烧伤患者78例作为研究对象,将其随机分为对照组和观察组,每组各39例。对照组予以常规护理,观察组采用早期全程护理联合出院后延续性护理。比较两组疗效,采用疼痛视觉模拟评分(Visual analogue scale,VAS)和烧伤健康专用量表(Burn specific health scale,BSHS-A)对患者疼痛程度和生活质量进行评分,并调查患者满意度。结果:护理后,对照组总有效率为79.49%低于观察组的94.87%,差异有统计学意义(P<0.05)。两组VAS评分均低于护理前,躯体功能、社会关系、一般健康状况、心理功能评分均高于护理前,且观察组VAS评分低于对照组,躯体功能、社会关系、一般健康状况、心理功能评分均高于对照组,差异有统计学意义(P<0.05)。观察组总满意率(92.31%)高于对照组(74.36%),差异有统计学意义(P<0.05)。结论:早期全程护理联合出院后延续性护理在大面积深度烧伤Meek植皮术中的应用效果好,能够有效提高护理效果,降低患者疼痛程度,改善生活质量,且患者满意率高,值得推广。
基金the Institutional Research Plan(No.AVOZ60870520)(erá)grants MSM of Czech Republic 0021620834(Tichy)and 4674788501(patenka)
文摘The seeds of Lamb＇s Quarters （Chenopodium album agg.） were stimulated by low- pressure discharge. The tested seeds were exposed to plasma discharge for different time durations （from 6 minutes to 48 minutes）. Germination tests were performed under specified laboratory conditions during seven days in five identical and completely independent experiments. Significant differences between the control and plasma-treated seeds were observed. The treated seeds showed structural changes on the surface of the seat coat. They germinated faster and their sprout accretion on the first day of seed germination was longer. Germination rate for the untreated seeds was 15% while it increased approximately three times （max 55%） for seeds treated by plasma from 12 minutes to 48 minutes.
文摘特高压直流GIL运行可靠性取决于内绝缘设计的可靠性。此外,导电元件直流电流密度的取值、弹簧触头的定位设计、GIL各元件中的绝缘件与金具连接处的楔形气隙的处理以及母线中支撑件的结构设计细节,都会对产品运行可靠性产生重大影响,不能忽视。对于运行环境十分严酷的UHV DC GIL为保证内绝缘工作可靠性和减少气体维护工作量,文中还提出了高气密性结构设计。为适应-50℃低温运行要求,产品选用了液化温度很低的N_(2)/SF_(6)混合气体,对两种气体的配比,压力特性和绝缘特性进行了讨论与计算。还有产品的局放、气体密度及微水含量的监视系统的可靠性设计,都会对产品运行可靠性产生直接影响。文中对上述问题的研究成果作了介绍,可供高压直流产品设计使用。对其中未解的新技术如基于冷镜露点测试原理、微机电技术制作的智能气体湿度和密度监测装置、高压直流复合绝缘套管伞面局放起始场强提出了研究方案。文中提出的诸多GIL运行可靠性设计要点,对于其他超/特高压直流气体绝缘电器可参考选用。
