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简介：AbstractObjective:Unplanned 30-day readmissions result in increased costs and decreased patient satisfaction. The objective of this study was to compare readmission rates before and after a multidisciplinary quality improvement initiative that focused on patient and staff education, use of targeted skilled nursing facilities, and appropriate use of patient observation status.Methods:This was a quality improvement study of all unplanned admissions to the Head and Neck Oncology service at a tertiary care facility during a 3-year period between October 2015 and September 2018. In October 2016, the Head and Neck Oncology service revised its discharge practices for patients undergoing extirpative and/or reconstructive surgery. These changes included enhancing patient education, increasing the use of a skilled nursing facility with directed staff education and patient handoffs by advanced practice nurses, and appropriate utilization of 23-h observation status for returning patients. The readmission rate from the pre-intervention era (October 2015 through September 2016) was compared to the readmission rate from the post-intervention era (October 2016 through September 2018). Secondary outcomes were the rates of 23-h observation within 30 days of the discharge as well as emergency room visits within 30 days of discharge.Results:In this sample of 449 patients, 161 (35.9%) were observed before the change-in-practice (before October 2016), and 288 (64.1%) were observed following the change-in-practice (after September 2016). On univariable analysis, the risk of readmission declined by approximately 41.4% from the pre-intervention era, though this conclusion was not statistically significant (P= 0.06). On multivariable analysis, patients at moderate or high risk of death were 2.31 times more likely than those at minor risk of death to readmit within 30 days (P = 0.03). Similarly, those with recurrent or persistent cancer were 3.33 times more likely than those undergoing initial curative surgical management of cancer to readmit within 30 days (P= 0.001). No patient characteristics were associated with a 23-h observation following discharge (all P > 0.05). Conclusions were similar for emergency room visits following discharge.Conclusions:A three-part quality improvement strategy resulted in a clinically important decrease in 30-day readmissions, though the decline was not statistically significant. There were no significant changes in 23-h observation within 30 days of discharge or emergency room visits within 30 days of discharge.

简介：AbstractThe World Health Organization’s first roadmap and the London Declaration on neglected tropical diseases (NTDs) have allowed an unprecedented expansion of interventions to control and eliminate this group of infectious diseases that primarily affects vulnerable or marginalised communities. The 2021-2030 NTD roadmap sustains a further acceleration of interventions but also introduces a broader and more ambitious agenda, calling to be accompanied by a new political declaration. Sponsored by the Government of Rwanda, the Kigali Declaration on neglected tropical diseases will be launched in 2022 to renew and reinvigorate commitments to end NTDs, also in the wake of the current setback caused by the COVID-19 pandemic. Starting on World NTD Day 2022, a global campaign "100% Committed" will call on a broad range of stakeholders to sign the declaration and make bold financial and political commitments towards achieving the 2030 roadmap and Sustainable Development Goals' targets for NTDs.

简介：AbstractBackground:Gastroparesis is a debilitating medical condition with limited treatment options. Gastric per-oral pyloromyotomy (G-POEM) has emerged as a promising treatment option with remarkable short-term clinical success shown in multiple studies. While the post-procedure protocol is not standardized across many centers, the majority of the centers observes these patients in the hospital after the procedure for monitoring. In this single-center prospective study, we evaluated the safety and feasibility of same day discharge after the G-POEM procedure.Methods:All the patients with refractory gastroparesis undergoing G-POEM from October 2019 to March 2020 were enrolled. A total of 25 patients were enrolled in the procedure. Based on the pre-defined criteria, patients were either discharged on the same day after the procedure or admitted to the hospital for further observation. The patient and procedure-related data were extracted from the chart review. Univariate analysis was performed (chi-squared test) on categorical variables after organizing categorical variables as numeric counts or percentages. The student t test was performed on continuous variables after reporting as mean and standard deviation. For analysis with a smaller sample size, Fisher exact and Mann–Whitney tests were used.Results:A total of 25 patients were enrolled. The technical success of G-POEM was 100% and clinical success was 80% (20/25) at 1-month follow-up. Of the 25 patients, 9 patients (36%) were discharged on the same day according to the procedure from the recovery unit. Of the remaining 16 patients who were admitted to the hospital post-procedure, 10 (40%) were admitted due to procedure-related causes while other admissions were either pre-planned or due to social reasons. The average Charlson comorbidity index was lower in the same day discharge group (P < 0.05). The number of patients requiring double myotomy was higher in the same day discharge group (P < 0.05). The overall complication rate of G-POEM in the study cohort was 12% (3/25) with all complications being mild without any severe adverse events.Conclusion:G-POEM is a safe and effective method of treatment for refractory GP with higher clinical success in short-term follow-up. The same day discharge after G-POEM is safe and feasible in >50% of patients with close periprocedural monitoring.

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简介：摘要目的比较导航下经皮空心螺钉与后路经皮重建钢板内固定治疗DayⅡ型骨盆新月形骨折脱位（CFDP）的临床疗效。方法采用回顾性队列研究分析2012年1月至2021年6 月解放军中部战区总医院收治的40例DayⅡ型CFDP患者临床资料，其中男23例，女17例；年龄42~73岁［（54.2±7.8）岁］。19例采用导航下经皮空心螺钉内固定治疗（导航组），21例采用后路经皮重建钢板内固定治疗（钢板组）。比较两组切口长度、手术时间、术中出血量及住院时间。术后2 d采用Matta影像学标准评定骨盆复位质量，术后3, 6个月采用Majeed功能评分评价功能恢复情况。观察术后并发症发生情况。结果患者均获随访10~24个月［（13.6±2.9）个月］。导航组切口长度、手术时间、术中出血量、住院时间分别为（2.4±0.3）cm、（43.1±5.2）min、（48.4±18.4）ml、（14.4±1.9）d，钢板组分别为（8.8±0.4）cm、（132.2±19.4）min、（302.9±57.5）ml、（18.9±3.7）d（P均<0.01）。术后2 d Matta影像学标准评定，导航组优13例，满意4例，可2例，优良率为89%；钢板组优15例，满意5例，可1例，优良率为95%（P>0.05）。术后3个月Majeed功能评分，导航组优12例，良5例，可2例，优良率为89%；钢板组优15例，良5例，可1例，优良率为95%（P>0.05）。术后6个月Majeed功能评分，导航组优14例，良4例，可1例，优良率为95%；钢板组优17例，良3例，可1例，优良率为95%（P>0.05）。患者未出现医源性神经血管损伤。导航组1枚骶髂螺钉出现松动，1枚髂骨后螺钉穿出骨内侧皮质，并发症发生率为11%（2/19）；钢板组2例出现钢板处皮肤压痛，2例出现下肢深静脉血栓形成，2例出现切口感染，并发症发生率为29%（6/21）（P<0.05）。结论对于DayⅡ型CFDP，导航下经皮空心螺钉与后路经皮重建钢板内固定均可获得满意疗效，但前者具有手术时间短、创伤小、术中出血量少、住院时间短及并发症发生率低等优点。

简介：【摘要】伴随着课标的修订和核心素养的提出，广大英语教师对听说教学展开了新一轮的实践研究，探索如何有效开展听说教学，促进学生听说能力。针对目前初中听说课活动设计可能存在的一些问题，笔者从单元教学设计的视角，结合一节听说课的教学案例，阐述如何从活动设计路径，活动设计方式和活动反馈评价三个方面来进行活动设计。

简介：摘要：文化是语言的一部分，国内外早已形成一种共识，那就是文化与语言学习密不可分。在课标视域下，在“立德树人”目标引领下，通过小学英语课堂教学帮助学生了解中西方文化差异，加深对中华文化的理解和认同自然成为了重要课题。