Objective To evaluate the efficacy and safety of low molecular weight heparin (LMWH) prophylaxis for venous thromboembolism (VTE) after lumbar decompression surgery. Methods Patients at high or the highest risk of VTE...Objective To evaluate the efficacy and safety of low molecular weight heparin (LMWH) prophylaxis for venous thromboembolism (VTE) after lumbar decompression surgery. Methods Patients at high or the highest risk of VTE who underwent lumbar spine surgery in Peking Union Medical College Hospital from January 2004 to April 2011 were included in the present study. All the patients received a half dose of LMWH 6 hours after surgery followed by a full dose LMWH once per day until discharge. We recorded incidences of deep venous thrombosis (DVT), pulmonary embolism (PE), bleeding complications, and medication side effects. Results Seventy-eight consecutive patients were eligible and enrolled in this study. The mean hospital stat was 8.5±4.5 days. No symptomatic DVT, PE, or major bleeding events were observed. One patient developed wound ecchymosis, another developed wound bleeding, four had mild hepatic aminotransferase level elevation, and one developed a suspicious allergic reaction. Conclusion LMWH may be applied as an effective and safe prophylaxis for VTE in high-risk patients undergoing lumbar decompression surgery.展开更多
The outbreak of Ebola virus disease(EVD) continues to spread through West Africa. Since the first reported EVD in March 2014, the number of cases has increased rapidly, with the fatality rate of >50%. The most prev...The outbreak of Ebola virus disease(EVD) continues to spread through West Africa. Since the first reported EVD in March 2014, the number of cases has increased rapidly, with the fatality rate of >50%. The most prevalent Ebola virus belongs to the species of Zaire ebolavirus, with a mortality rate as high as 90%. Although there were introduced cases in other continents, Africa is the endemic area where fruit bats and apes are suspected to be Ebola virus carriers. The virus might be transmitted from the host animals to humans if humans consume relative raw and contaminated meats; however, human-to-human transmission via close contact is the major route of current outbreaks. EVD happens at any seasons and affected people of any race in any age groups. Direct contact with body fluids of EVD patients and living in the contaminated environment greatly increase the risk of being infected. Transmission viaaerosol is less possible but the transmission via droplet is possible in humans. Thus, health care providers are facing danger of getting Ebola virus infection. So far, there are limited vaccines, drugs and/or therapies to prevent Ebola virus infection or treat EVD. Medical workers should follow the current standard prophylactic procedures. Military forces can orchestrate efficient care to mass EVD casualties. Although it is necessary to speed up the pace of developing effective vaccine and therapeutics for the prevention and treatment of EVD, public health prophylaxis is the most important issue at present to control the spread of this disease cost-effectively.展开更多
Background: Pre-exposure prophylaxis(PrEP) prevents human immunodeficiency virus(HIV) infection, but its use remains low among U.S. military men who have sex with men(MSM), likely due to mis-matching with personal pre...Background: Pre-exposure prophylaxis(PrEP) prevents human immunodeficiency virus(HIV) infection, but its use remains low among U.S. military men who have sex with men(MSM), likely due to mis-matching with personal preferences. We conducted a study to characterize preferences to PrEP measures within this population.Methods: HIV-negative military MSM were recruited through a closed, Lesbian, Gay, Bisexual, and Transgendered(LGBT) military social media group. The survey was anonymous, and consisted of five experimentally varied attributes in service delivery: dosing method, provider type, visit location, lab work evaluation location, and dispensing venue.Relative importance and part-worth utility scores were generated using hierarchical bayes(HB) estimation, and the randomized first choice model was used to examine participation interest across eight possible PrEP program scenarios.Results: A total of 429 participants completed the survey. Among the eight scenarios with varying attributes, the most preferred scenario featured a daily tablet, PrEP injection or implant, along with a military provider, smartphone/telehealth visit, and on-base locations for lab evaluation and medication pick-up. The results also emphasized the importance for providers to be familiar with PrEP prescription knowledge, and to provide interactions sensitive to sexual identity and mental health.Conclusions: A PrEP program consisting of daily tablet is preferred in military healthcare settings is preferred. Longacting implants and injections are also desired.展开更多
Background Hospitalized elderly patients are at high risk of venous thromboembolism(VTE),and the appropriate use of thromboprophylaxis can significantly reduce the incidence of VTE in high-risk patients.We investigate...Background Hospitalized elderly patients are at high risk of venous thromboembolism(VTE),and the appropriate use of thromboprophylaxis can significantly reduce the incidence of VTE in high-risk patients.We investigated the pattern of VTE prophylaxis administration among elderly medical patients and assessed its appropriateness based on the American College of Chest Physicians(ACCP)recommendations.Methods A cross-sectional single-center study was conducted between October 2019 and March 2020,including hospitalized(>48 h),elderly(≥60 years),medical patients,and excluding patients receiving anticoagulant for other reason,having contraindication to thromboprophylaxis,or had VTE diagnosed within 48 h.The Padua prediction score was used to determine the patients’risk for VTE,and thromboprophylaxis use was assessed against the ACCP recommendations.Results The study included 396 patients with an average age of 75.0±9.01 years,and most patients(71.7%)were classified as high risk for VTE development(Padua score≥4 points).Thromboprophylaxis use was inappropriate in 27.3%of patients,of whom 85.2%were ineligible but still received thromboprophylaxis.Patients who were classified as low risk of VTE were more likely to receive inappropriate thromboprophylaxis(AOR=76.5,95%CI:16.1-363.2),whereas patients with acute infection or rheumatologic disorder were less likely to receive inappropriate thromboprophylaxis(AOR=0.46,95%CI:0.22-0.96).Conclusions Although the use of thromboprophylaxis among high-risk elderly patients was reasonably adequate,a large proportion of low-risk patients were exposed to unnecessary risk through inappropriate overutilization of thromboprophylaxis.Thus,healthcare providers should accurately assess patients’risk before prescribing thromboprophylaxis to ensure patient safety.展开更多
Objective To explore the clinical significance of the combined application of palpebral margin cleaning and antibiotic eye drops in inhibiting bacterial growth in the palpebral margin and conjunctival sacs before cata...Objective To explore the clinical significance of the combined application of palpebral margin cleaning and antibiotic eye drops in inhibiting bacterial growth in the palpebral margin and conjunctival sacs before cataract extraction.Methods In this study,61 patients(97 eyes)with age-related cataract who underwent phacoemulsification and intraocular lens implantation were selected,and randomly grouped.In the experimental group,the combined application of palpebral margin cleaning with cotton pads and levofloxacin eye drops was given for three days before the surgery.In the control group,levofloxacin eye drops alone were applied for three consecutive days.Bacteria samples from the conjunctival sac and eyelid margins were cultivated and identified before and three days after taking antimicrobial measures,respectively.Results In the experimental group,the positive rates of the two bacteria samples were 100%(50/50)and 40%(20/50)before and 10%(5/50)and 0%(0/50)after the treatment.In the control group,the positive rates of the two bacteria samples were 97.9%(46/47)and 29.8%(14/47)before and 40.4%(19/47)and 10.6%(5/47)after the treatment.The positive rates between the two groups were not significantly different before taking antimicrobial measures(P=0.485 and 0.395),while they were significantly different after taking antimicrobial measures(P=0.001 and 0.024).Conclusion Combined application of eyelid and palpebral margin cleaning with cotton pads and antibiotic eye drops before cataract extraction imparted excellent antibacterial effects.展开更多
文摘Objective To evaluate the efficacy and safety of low molecular weight heparin (LMWH) prophylaxis for venous thromboembolism (VTE) after lumbar decompression surgery. Methods Patients at high or the highest risk of VTE who underwent lumbar spine surgery in Peking Union Medical College Hospital from January 2004 to April 2011 were included in the present study. All the patients received a half dose of LMWH 6 hours after surgery followed by a full dose LMWH once per day until discharge. We recorded incidences of deep venous thrombosis (DVT), pulmonary embolism (PE), bleeding complications, and medication side effects. Results Seventy-eight consecutive patients were eligible and enrolled in this study. The mean hospital stat was 8.5±4.5 days. No symptomatic DVT, PE, or major bleeding events were observed. One patient developed wound ecchymosis, another developed wound bleeding, four had mild hepatic aminotransferase level elevation, and one developed a suspicious allergic reaction. Conclusion LMWH may be applied as an effective and safe prophylaxis for VTE in high-risk patients undergoing lumbar decompression surgery.
基金supported by the General Logistics of PLA in China (Grant No. AWS11L009)
文摘The outbreak of Ebola virus disease(EVD) continues to spread through West Africa. Since the first reported EVD in March 2014, the number of cases has increased rapidly, with the fatality rate of >50%. The most prevalent Ebola virus belongs to the species of Zaire ebolavirus, with a mortality rate as high as 90%. Although there were introduced cases in other continents, Africa is the endemic area where fruit bats and apes are suspected to be Ebola virus carriers. The virus might be transmitted from the host animals to humans if humans consume relative raw and contaminated meats; however, human-to-human transmission via close contact is the major route of current outbreaks. EVD happens at any seasons and affected people of any race in any age groups. Direct contact with body fluids of EVD patients and living in the contaminated environment greatly increase the risk of being infected. Transmission viaaerosol is less possible but the transmission via droplet is possible in humans. Thus, health care providers are facing danger of getting Ebola virus infection. So far, there are limited vaccines, drugs and/or therapies to prevent Ebola virus infection or treat EVD. Medical workers should follow the current standard prophylactic procedures. Military forces can orchestrate efficient care to mass EVD casualties. Although it is necessary to speed up the pace of developing effective vaccine and therapeutics for the prevention and treatment of EVD, public health prophylaxis is the most important issue at present to control the spread of this disease cost-effectively.
基金supported by the National Institute of Nursing Research (NINR),under award number 1F31NR018620-01A1supported by the National Institute of Mental Health (NIMH),Center for HIV Identification,Prevention,and Treatment Services (CHIPTS) under award number P30MH059107。
文摘Background: Pre-exposure prophylaxis(PrEP) prevents human immunodeficiency virus(HIV) infection, but its use remains low among U.S. military men who have sex with men(MSM), likely due to mis-matching with personal preferences. We conducted a study to characterize preferences to PrEP measures within this population.Methods: HIV-negative military MSM were recruited through a closed, Lesbian, Gay, Bisexual, and Transgendered(LGBT) military social media group. The survey was anonymous, and consisted of five experimentally varied attributes in service delivery: dosing method, provider type, visit location, lab work evaluation location, and dispensing venue.Relative importance and part-worth utility scores were generated using hierarchical bayes(HB) estimation, and the randomized first choice model was used to examine participation interest across eight possible PrEP program scenarios.Results: A total of 429 participants completed the survey. Among the eight scenarios with varying attributes, the most preferred scenario featured a daily tablet, PrEP injection or implant, along with a military provider, smartphone/telehealth visit, and on-base locations for lab evaluation and medication pick-up. The results also emphasized the importance for providers to be familiar with PrEP prescription knowledge, and to provide interactions sensitive to sexual identity and mental health.Conclusions: A PrEP program consisting of daily tablet is preferred in military healthcare settings is preferred. Longacting implants and injections are also desired.
基金the Researcher Supporting Project(RSP-2020/77),King Saud University,Riyadh,Saudi Arabia.
文摘Background Hospitalized elderly patients are at high risk of venous thromboembolism(VTE),and the appropriate use of thromboprophylaxis can significantly reduce the incidence of VTE in high-risk patients.We investigated the pattern of VTE prophylaxis administration among elderly medical patients and assessed its appropriateness based on the American College of Chest Physicians(ACCP)recommendations.Methods A cross-sectional single-center study was conducted between October 2019 and March 2020,including hospitalized(>48 h),elderly(≥60 years),medical patients,and excluding patients receiving anticoagulant for other reason,having contraindication to thromboprophylaxis,or had VTE diagnosed within 48 h.The Padua prediction score was used to determine the patients’risk for VTE,and thromboprophylaxis use was assessed against the ACCP recommendations.Results The study included 396 patients with an average age of 75.0±9.01 years,and most patients(71.7%)were classified as high risk for VTE development(Padua score≥4 points).Thromboprophylaxis use was inappropriate in 27.3%of patients,of whom 85.2%were ineligible but still received thromboprophylaxis.Patients who were classified as low risk of VTE were more likely to receive inappropriate thromboprophylaxis(AOR=76.5,95%CI:16.1-363.2),whereas patients with acute infection or rheumatologic disorder were less likely to receive inappropriate thromboprophylaxis(AOR=0.46,95%CI:0.22-0.96).Conclusions Although the use of thromboprophylaxis among high-risk elderly patients was reasonably adequate,a large proportion of low-risk patients were exposed to unnecessary risk through inappropriate overutilization of thromboprophylaxis.Thus,healthcare providers should accurately assess patients’risk before prescribing thromboprophylaxis to ensure patient safety.
基金supported by the National Natural Science Foundation of China(81970768).
文摘Objective To explore the clinical significance of the combined application of palpebral margin cleaning and antibiotic eye drops in inhibiting bacterial growth in the palpebral margin and conjunctival sacs before cataract extraction.Methods In this study,61 patients(97 eyes)with age-related cataract who underwent phacoemulsification and intraocular lens implantation were selected,and randomly grouped.In the experimental group,the combined application of palpebral margin cleaning with cotton pads and levofloxacin eye drops was given for three days before the surgery.In the control group,levofloxacin eye drops alone were applied for three consecutive days.Bacteria samples from the conjunctival sac and eyelid margins were cultivated and identified before and three days after taking antimicrobial measures,respectively.Results In the experimental group,the positive rates of the two bacteria samples were 100%(50/50)and 40%(20/50)before and 10%(5/50)and 0%(0/50)after the treatment.In the control group,the positive rates of the two bacteria samples were 97.9%(46/47)and 29.8%(14/47)before and 40.4%(19/47)and 10.6%(5/47)after the treatment.The positive rates between the two groups were not significantly different before taking antimicrobial measures(P=0.485 and 0.395),while they were significantly different after taking antimicrobial measures(P=0.001 and 0.024).Conclusion Combined application of eyelid and palpebral margin cleaning with cotton pads and antibiotic eye drops before cataract extraction imparted excellent antibacterial effects.
