BACKGROUND:Consenting to do-not-resuscitate(DNR)orders is an important and complex medical decision-making process in the treatment of patients at the end-of-life in emergency departments(EDs).The DNR decision in EDs ...BACKGROUND:Consenting to do-not-resuscitate(DNR)orders is an important and complex medical decision-making process in the treatment of patients at the end-of-life in emergency departments(EDs).The DNR decision in EDs has not been extensively studied,especially in the Chinese mainland.METHODS:This retrospective chart study of all deceased patients in the ED of a university hospital was conducted from January 2017 to December 2019.The patients with out-of-hospital cardiac arrest were excluded.RESULTS:There were 214 patients’deaths in the ED in the three years.Among them,132 patients were included in this study,whereas 82 with out-of-hospital cardiac arrest were excluded.There were 99(75.0%)patients’deaths after a DNR order medical decision,64(64.6%)patients signed the orders within 24 hours of the ED admission,68(68.7%)patients died within 24 hours after signing it,and 97(98.0%)patients had DNR signed by the family surrogates.Multivariate analysis showed that four independent factors infl uenced the family surrogates’decisions to sign the DNR orders:lack of referral(odds ratio[OR]0.157,95%confi dence interval[CI]0.047–0.529,P=0.003),ED length of stay(ED LOS)≥72 hours(OR 5.889,95%CI 1.290–26.885,P=0.022),acute myocardial infarction(AMI)(OR 0.017,95%CI 0.001–0.279,P=0.004),and tracheal intubation(OR 0.028,95%CI 0.007–0.120,P<0.001).CONCLUSIONS:In the Chinese mainland,the proportion of patients consenting for DNR order is lower than that of developed countries.The decision to sign DNR orders is mainly affected by referral,ED LOS,AMI,and trachea intubation.展开更多
Objective: To retrospectively analyze the clinical data of 275 cases of cervical cancer (CC) in our hospital, and investigate the clinicopathological parameters of cervical cancer based on the expression of p16INK4A p...Objective: To retrospectively analyze the clinical data of 275 cases of cervical cancer (CC) in our hospital, and investigate the clinicopathological parameters of cervical cancer based on the expression of p16INK4A proteins. Methods: The clinical information of 275 patients with cervical cancer were retrospectively analyzed between 2006 and 2011, including the patients' age, clinical FIGO stage, differentiation, histologic grade, infiltration depth, treatment, pathological diagnosis after surgery, and results of following-up.Immunohistochemistry was also done on sections of confirmed cancer specimens without prior chemotherapy/radiotherapy. Results: Among various clinicopathological parameters, the median age was 48 years old. The grade was significantly associated with histological type, HPV infection and with lymph node invasion. FIGO stage was strongly correlated to the infiltration depth and lymph node metastasis. P16INK4A expression was significantly correlated with histologic grade. However, there were no differences between p16INK4A staining and patient's age, histopathology and lymph node metastases. Conclusion: The incidence of cervical cancer becomes increasingly younger. Additionally, p16INK4A can function as a diagnostic marker of cervical carcinomas.展开更多
基金The study protocol was reviewed and approved by the Institutional Review Board of the Second Affiliated Hospital of Zhejiang University School of Medicine(IRB number:IR2020001036).
文摘BACKGROUND:Consenting to do-not-resuscitate(DNR)orders is an important and complex medical decision-making process in the treatment of patients at the end-of-life in emergency departments(EDs).The DNR decision in EDs has not been extensively studied,especially in the Chinese mainland.METHODS:This retrospective chart study of all deceased patients in the ED of a university hospital was conducted from January 2017 to December 2019.The patients with out-of-hospital cardiac arrest were excluded.RESULTS:There were 214 patients’deaths in the ED in the three years.Among them,132 patients were included in this study,whereas 82 with out-of-hospital cardiac arrest were excluded.There were 99(75.0%)patients’deaths after a DNR order medical decision,64(64.6%)patients signed the orders within 24 hours of the ED admission,68(68.7%)patients died within 24 hours after signing it,and 97(98.0%)patients had DNR signed by the family surrogates.Multivariate analysis showed that four independent factors infl uenced the family surrogates’decisions to sign the DNR orders:lack of referral(odds ratio[OR]0.157,95%confi dence interval[CI]0.047–0.529,P=0.003),ED length of stay(ED LOS)≥72 hours(OR 5.889,95%CI 1.290–26.885,P=0.022),acute myocardial infarction(AMI)(OR 0.017,95%CI 0.001–0.279,P=0.004),and tracheal intubation(OR 0.028,95%CI 0.007–0.120,P<0.001).CONCLUSIONS:In the Chinese mainland,the proportion of patients consenting for DNR order is lower than that of developed countries.The decision to sign DNR orders is mainly affected by referral,ED LOS,AMI,and trachea intubation.
基金Supported by Research Project for Traditional Chinese Medicine of Shaanxi Administration of Traditional Chinese Medicine (jc87)Program for Changjiang Scholars and Innovative Research Team in University (PCSIRT: 1171)
文摘Objective: To retrospectively analyze the clinical data of 275 cases of cervical cancer (CC) in our hospital, and investigate the clinicopathological parameters of cervical cancer based on the expression of p16INK4A proteins. Methods: The clinical information of 275 patients with cervical cancer were retrospectively analyzed between 2006 and 2011, including the patients' age, clinical FIGO stage, differentiation, histologic grade, infiltration depth, treatment, pathological diagnosis after surgery, and results of following-up.Immunohistochemistry was also done on sections of confirmed cancer specimens without prior chemotherapy/radiotherapy. Results: Among various clinicopathological parameters, the median age was 48 years old. The grade was significantly associated with histological type, HPV infection and with lymph node invasion. FIGO stage was strongly correlated to the infiltration depth and lymph node metastasis. P16INK4A expression was significantly correlated with histologic grade. However, there were no differences between p16INK4A staining and patient's age, histopathology and lymph node metastases. Conclusion: The incidence of cervical cancer becomes increasingly younger. Additionally, p16INK4A can function as a diagnostic marker of cervical carcinomas.
