摘要：背景:急诊医疗(EMS)工作人员常常不被允许按照家属意愿终止临终时刻复苏,尤其是在缺少书面不予复苏(DNR)志愿书的时候。目的:观察实施新指南医疗机构的EMS人员是否比未实施新指南医疗机构的EMS人员更可能终止院外心脏停搏患者的复苏抢救。设计:

摘要：目的:系统评价已发表的疾病治疗方案中各种干预措施的特点和疗效相关证据。 设计:汇总分析。 数据来源:从计算机数据库中检索到的1987-2001年间发表的英文文献。 入选文献:评价118种疾病治疗方案的102篇文献。

摘要：背景：尽管血管近距离放射治疗是唯一批准用于治疗裸金属支架植入后再狭窄的方法，但是药物洗脱支架目前亦用于再狭窄的治疗。比较上述两种治疗方法各自优势的资料还很有限。目的：与血管近距离放射治疗裸金属支架内再狭窄比较，评价西罗莫司（雷帕霉素）洗脱支架的安全性及有效性。设计、地点及研究对象：于384例支架内再狭窄患者中进行前瞻性、多中心、随机试验。患者于2003年2月2004年7月入选自26家学院及社区医疗中心。本文资料均随访至2005年6月30日。干预：血管近距离放射治疗（n=125）或植入西罗莫司洗脱支架（n=259）。主要观测指标：术后9个月靶血管治疗失败（心源性死亡、心肌梗死或靶血管血运重建）。结果：两组患者的基线特征匹配良好。血管近距离放射治疗组与西罗莫司洗脱支架组患者病变长度相似（均值[SD]分别为16．76[8．55]laln和17．22[7．97]mln；P=0．61）。血管近距离放射治疗组手术成功率为99．2％（124／125），西罗莫司（雷帕霉素）洗脱支架组为97．3％（250／257）（P=0．28）。血管近距离放射治疗组靶血管治疗失败率为21．6％（27／125），西罗莫司洗脱支架组为12．4％（32／259）（相对危险度[relativerisk，RR]，1．7；95％可信区间[confidence interval，CI]，1．1～2．8；P=0．02）。血管近距离放射治疗组靶病变需要血运重建发生率为19．2％（24／125），西罗莫司洗脱支架组为8．5％（22／259）（RR，2．3；95％CI，1．3～3．9；P=0．004）。在血管造影随访中，血管近距离放射治疗组分析节段血管造影再狭窄率为29．5％（31／105），西罗莫司洗脱支架组为19．8％（45／227）（RR，1.5；95％CI，1.0—2．2；P=007）。6个月随访时，西罗莫司洗脱支架组最小管腔直径大于血管近距离放射治疗组（均值[SD]，1．52[0．63]mm比1．80[0．63]mm；P〈0．001），表明前者分析节段血管管腔净获益更大，其主要原因是植入支架以及无边缘再狭窄（0．68[0．60]mm比1．0[0．61]mm；P〈0．001）。结论：与血管近距离放射治疗裸金属支架内再狭窄比较，西罗莫司洗脱支架具有更好的临床及血管造影效果。

摘要：Objective:The purpose of this study was to investigate the safety and efficacy of alvimopan,a novel peripherally acting mu-opioid receptor antagonist,in patients who undergo simple total abdominal hysterectomy. Study design:Women (n = 519)-were randomized (4:1) to receive alvimopan 12 mg (n = 413) or placebo (n = 106)≥2 hours before the operation then twice daily for 7 days (hospital and home). Adverse events were monitored up to 30 days after the last dose of study drug was administered. Efficacy was assessed for 7 postoperative days. Results:Overall,the most common adverse events were nausea,vomiting,and constipation; < 5%of patients discontinued use because of adverse events. Alvimopan significantly accelerated the time to first bowel movement (hazard ratio,2.33; P < .001). Average time to first bowel movement was reduced by 22 hours,with more frequent bowel movement and better bowel movement quality found in the treatment cohort. Conclusion:Alvimopan has a safety profile that is similar to that of placebo and provides significantly improved lower gastrointestinal recovery in women who undergo simple total abdominal hysterectomy.

摘要：尽管假体设计有所进展，但包膜挛缩仍是基于假体的乳房美容手术的有挑战的并发症。以聚氨酯泡沫塑料包被的假体可降低包膜挛缩发生率，这使我们进一步认识到假体表面与乳房组织之间生物学反应的重要性。有新证据显示，正如聚氨酯泡沫塑料，无细胞真皮基质同样可以改变接触面的生物学反应，形成更多的血管及更少的胶原沉积紧缩。本研究中，我们将报道Strattice再造组织基质（LifeCell公司，美国新泽西州布兰斯堡）治疗已确诊的包膜挛缩，及其在避免首次隆乳术或隆乳术／乳房固定术包膜挛缩中应用的临床经验。所有应用Strattice的80例患者（154只乳房）中，只有3只乳房（3．75％）出现临床显著的包膜挛缩（Bakerm／1V级），且该3只乳房均为先前包膜挛缩治疗组。此外，笔者发现2例血清肿需取出假体者（2例患者如上文所述出现包膜挛缩），2例血肿患者需行修复手术，因此，Strattice辅助手术的总体失败率为6．25％。研究资料证实，应用Strattice可显著降低假体置人乳房手术的包膜挛缩发生率。（循证医学证据等级：疗法，Ⅳ级）

摘要：Background: The ADHERE is designed to study characteristics, management, and outcomes in a broad sample of patients hospitalized with acute decompensated heart failure. Heart failure is a leading cause of hospitalization for adults older than 65 years in the United States. Most available data on these patients are limited by patient selection criteria and study design of clinical trials and single- center studies. Methods: Participating hospitals identify patients with a primary or secondary discharge diagnosis of heart failure. Medical history, management, treatments, and health outcomes data are collected through review of medical records and entered into a database via secure web browser technology. Results: As of January 2004, data on 107 362 patients have been received from 282 participating hospitals. Of enrollees with available analyzable data(N=105 388 from 274 hospitals), the mean age was 72.4(± 14.0), and 52% were women. The most common comorbid conditions were hypertension(73% ), coronary artery disease(57% ), and diabetes(44% ). Evidence of mild or no impairment of systolic function was found in 46% of patients. Inhospital mortality was 4.0% and the median hospital length of stay was 4.3 days. Conclusions: The ADHERE demonstrates both the feasibility and significant implications of gathering representative data on large numbers of patients hospitalized with heart failure. Initial data provided important insights into the clinical characteristics and patterns of care of these patients. Ongoing registry work will provide the framework for improved treatment strategies for patients hospitalized with decompensated heart failure.

摘要：Background: Although studies have examined the incidence of stroke in heart failure(HF), their findings are inconsistent and difficult to interpret because of heterogeneity in study design and population. Although HF remains a highly fatal disease, the excess mortality imparted from stroke is unknown. Methods: A random sample of cases of HF from 1979 to 1999 was identified and validated according to Framingham criteria. Strokes were identified by screening medical diagnoses and subsequent physician validation. Stroke risk in HF was compared with the risk in the general population with standardized morbidity ratios. Associations between selected characteristics and stroke were examined using proportional hazards regression. Results: The study cohort included 630 persons with incident HF. During a median of 4.3 years of follow-up, 102(16%) experienced an ischemic stroke. Heart failure was associated with a 17.4-fold increased risk for stroke compared with the general population in the first 30 days after HF diagnosis and remained elevated during 5 years of follow-up. Older persons with prior stroke or diabetes were more likely to experience stroke after HF diagnosis. Persons with stroke after HF were 2.31 times more likely to die compared with persons without stroke. Conclusions: In the community, persons with HF have a large increase in the risk for ischemic stroke compared with the general population. Stroke results in a >2-fold increase in mortality. Thus, prevention of stroke has the potential to improve survival among patients with HF, particularly among the elderly and those with diabetes or prior stroke.