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简介：Therehasbeenaparadigmshiftinmedicineawayfromtradition,anecdoteandtheoreticalreasoningfromthebasicsciencestowardsevidence-basedmedicine(EBM).Inpalliativecarehowever,statisticallysignificantbenefitsmaybemarginalandmaynotberelatedtoclinicalmeaningfulness.Thetypicaltreatmentvs.placebocomparisonnecessitatedby‘goldstandard'randomisedcontrolledtrials(RCTs)isnotnecessarilyapplicable.Thecomplexmultimorbidityofendoflifecareinvolvesconsiderationsofthepatient'sphysical,psychological,socialandspiritualneeds.Inaddition,thefieldofpalliativecarecoversaheterogeneousgroupofchronicandincurablediseasesnolongerlimitedtocancer.Adequatesamplesizescanbedifficulttoachieve,reducingthepowerofstudiesandhighattritionratescanresultininadequatefollowupperiods.Thisreviewusesexamplesofthemanagementofcancer-relatedfatigueanddeathrattle(noisybreathing)todemonstratethecurrentstateofEBMinpalliativecare.ThefutureofEBMinpalliativecareneedstobeasdiverseasthepatientswhoultimatelyderivebenefit.Non-RCTmethodologiesofequivalentquality,validityandsizeconductedbycollaborativeresearchnetworksusinga‘mixedmethodsapproach'arelikelytoposethecorrectclinicalquestionsandderiveevidencebasedyetclinicallyrelevantoutcomes.

简介：WiththeagingofChina'spopulation,old-agecareserviceraisedmoreandmoreconcerns.Firstly,thepaperstudiedpopulationageingwithChinesecharacteristics.Secondly,macroandmicroanalysiswasperformedontheproblemsofserviceforagedwithrapidageingspeed.Atlast,thepaperraisedtoconstructold-agecareservicepatternswithChinesecharacteristics,whicharegovernmentguidance,community-support,publicwelfare-basisandcognitionchangepremise.

简介：AccordingtothedataoftheChineseLongitudinalHealthyLongevitySurvey(CLHLS)andapplyingmethodsofSullivanandmultistatelifetable,thispaperexaminesthetimeexpectancyofcarefordailylivingofChineseelderlyanditsproportionintheirelderlylife.Theresultsfindthatthereexistsasignificantgendergapoftheexpectancy,whichthemaleat65averagelyareexpectedtohavefourtofivecareyearswhilethefemaleat65averagelyareexpectedtohaveseventoeightcareyears.Thetimeexpectancyforslightcareofdailylivingislongerthanthatforsevercare.Additionally,thereisnosignificantdifferencebetweenurbanelderlyandruralelderly.However,asageincreases,thetimeexpectancyforslightcaregoesdownwhilethatforsevercarestabilitiesataconstantatdifferentages.Thetimeexpectancyfordifferenttypesofcareanditsproportionintherestoflifearesignificantlyvarious.Thestudypointsoutthattheestablishmentandimprovementofcareinsurancesystemandtheelderlycareserviceareverynecessary.

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简介：AIM:Todescribetheclinicalfeatures,systemicassociations,treatmentandvisualoutcomesinSaudipatientswithscleritis.·METHODS:AretrospectivechartreviewwasperformedforpatientswithscleritispresentingtotwotertiarycareeyehospitalsinRiyadh,SaudiArabia,from2001to2011.Datawerecollectedontheclinicalfeaturesofscleritis,subtypesofscleritis,associatedsystemicdisease,historyofpreviousocularsurgeryandmedicaltherapy,includingtheuseofimmunosuppressants.Treatmentoutcomeswereevaluatedbasedonbest-correctedvisualacuity(BCVA)andresponsetotreatment.·RESULTS:Ofthe52patientsincludedinthestudy,non-necrotizinganteriorscleritiswasthemostcommontypeofscleritisin22patients(42.3%),followedbyposteriorscleritisin14patients(26.9%).Themajorityofcases,31patients(59.6%),wereidiopathicinnature.Systemicassociationswerepresentin12patients(23.1%).Infectiousscleritiswasconfirmedin6patients(11.5%):3withbacterialscleritisafterpterygiumexcision,2patientswithscleritisrelatedtotuberculosisand1patientwithscleritisresultingfromherpessimplexinfection.Forthevarioussubtypesofscleritis,BCVAvaluesaftertreatmentandtimetoremissionsignificantlydiffered(P<0.05,allcases).Systemicimmunosuppressivetherapiesinadditiontosteroidswereadministeredto46.2%ofallpatients.TheT-signwaspresentonB-scanultrasonographyin9(64.3%)ofthe14posteriorscleritispatients.·CONCLUSION:Non-necrotizinganteriorscleritiswasthemostcommonsubtypeofscleritis.Finalvisualoutcomeandtimetoremissiondifferedamongthevariousscleritissubtypes.

简介：INTRODUCTIONPulmonaryarteriovenousfistula(PAVF)isararecongenitalpulmonaryvascularmalformationwiththeincidenceof2-3/100,000.Itistheabnormalcommunicationbetweenthepulmonaryarteryandpulmonaryvein.Theclinicalmanifestationsofthisdiseasearevarioussothatitiseasytobemisdiagnosed1.Atpresent,DSAisthegoldstandardforthediagnosisof

简介：BackgroundThevideo-assistedthoracoscopicsurgicaltechniquesarewidelyusedinthetreatmentofpatientswithcongenitalheartdiseaseswithgoodoutcomes.However,thefeasibilityandsignificanceofnursebasedearlycardiacrehabilitationincardiacintensivecareunit(ICU)forpatientswithtotallythoracoscopiccardiacoperationhasbeenseldomstudied.MethodsThirty-sixpatientswithtotallythoracoscopiccardiacoperationundertheconditionofthecardiacICUinGuangdongGeneralHospitalwererandomallocatedtotheinterventiongroupandthecontrolgroupbetweenJanuary2012toDecember2014.Thecontrolgroupreceivedstandardnursingcare,andtheinterventiongroupreceivedearlycardiacrehabilitationnursingcareinadditiontostandardcare.Theoutcomemeasuresincludedtheoxygensaturation(SpO2%),vitalcapacity,forcedexpiratoryvolumein1second(FEV1),andpaininthethoracicwound(visualanaloguescale,VAS),whichweremeasuredatthebaselineandwithin2-dayafter4-weeknursingcare.Forsafetyreason,wealsomonitoredtherateofperceivedexertion(RPE),heartrate,systemicbloodpressure.ResultsTherewerenon-significantdifferencesbetweenthegroupsinage,sex,totalnumberofcomorbidconditions,totalnumberofmedications,surgicaltime,andanesthetictime(P>0.05).Following4weekstreatment,thecardiopulmonaryfunctionsandVASscorewereimproved(P<0.05)inallgroups.Inaddition,theimprovementsweremoreintheearlycardiacrehabilitationnursecaregroupthaninthecontrolgroup(P<0.05).ConclusionTheearlycardiacrehabilitationnursingcareincardiacICUissafe,feasibleandbeneficialforpatientswithtotallythoracoscopiccardiacoperation.

简介：BackgroundAcuterespiratorydistresssyndrome(ARDS)causedbyH7N9influenzainpregnantwomanisalife-threateningeventwithanincreasedriskformaternalandbaby'sdeath.Theaimofthisstudywastoevaluatetheimpactofpoint-of-careultrasonography(POCUS)onthemanagementandprognosisofthesepatients.MethodsAcaseof31-yr-oldpregnantwomaninourhospital,whowasunderwentPOCUSforevaluatingcardiopulmonaryfunctions,volumestate,fluidresponsivenessandultrasound-guidedprocedureswasadmittedtoIntensiveCareUnit(ICU).Weperformedultrasonographydailyformonitoringorganfunctions.Reviewofrelatedliteratureswasalsoconducted.ResultsWiththehelpofPOCUS,wemadequicklydiagnosisofseverepneumoniaandARDScausedbyH7N9influenza.ThetherapieshadalsobeenchangedafterPOCUSexaminations,suchasrestrictfluidadministrationrelyingontheassessmentsoftheinferiorvenacava(IVC)toestimatepreloadandlungultrasoundmonitoringtoidentifytheearlypresenceofextravascularlungwater(EVLW)andavoidfluidoverresuscitation,ultrasound-guidedrecruitmentmaneuvertoimprovedrespiratorydistresssyndrome,andsoon.ConclusionsPOCUShasasignificantimpactondecision-makingandtherapeuticmanagementandshouldbecomeaclinicalroutineinthemanagementofARDSpatientscausedbyH7N9influenzainpregnancy.