Eficacia y seguridad de tres esquemas para la preparación del colon para colonoscopia (polietilenglicol (PEG) 4 litros (4 L) (dosis única) vs. PEG 4 L dividido (2 L + 2 L) vs. PEG 2 L dividido de volumen bajo (1 L + 1 L): ensayo clínico controlado aleatorizado / A randomized controlled clinical trial of the efficacy and safety of colonoscopy preparation using a single four liter dose of polyethylene glycol (PEG) vs. two 2 liter doses of PEG vs. two low volume (1L + 1L) doses of PEG

Resumen Introducción: la colonoscopia es el examen estándar de oro para evaluar la mucosa del colon. De la limpieza del colon en la preparación intestinal para colonoscopia depende el hallazgo de pólipos, que pueden ser adenomatosos con potencial maligno y con la posibilidad de degenerarse en cáncer de colon. Objetivo: comparar la eficacia y la seguridad de tres tipos de preparaciones para la limpieza del colon: dosis única de polietilenglicol (PEG) 4 litros (4 L) y dosis divididas: PEG 4 L dividido (2 L + 2 L) y PEG 2 L dividido (1 L + 1 L) de volumen bajo. Métodos: en pacientes con una colonoscopia electiva de una clínica universitaria, se realizó un ensayo clínico controlado aleatorizado y ciego (para el médico que evaluó la limpieza del colon). Se asignaron 74 pacientes para cada grupo. El parámetro principal de eficacia fue la preparación integral de calidad adecuada medida con la escala de Boston, y los parámetros secundarios fueron el porcentaje de eventos adversos, la tolerabilidad y la tasa de detección de pólipos. Resultados: la preparación completa de todo el colon fue significativamente de mayor la calidad en la alternativa de 4 L divididos (2 L + 2 L), seguida de la otra alternativa dividida (1 L + 1 L) y menor en la dosis única (79,7 %, 75,7 % y 63,5 %, respectivamente, p = 0,019); también se encontraron diferencias en la detección de pólipos (13,5 %, 24,3 % y 9,5 %, p = 0,037) y sin diferencias en la presentación de al menos un evento adverso (p = 0,254) ni en la tolerabilidad (p = 0,640). Conclusiones: las dos preparaciones de dosis dividida tienen una mayor eficacia en la limpieza del colon en comparación con la dosis única de 4 L y en la detección de pólipos, mientras que no se evidencian diferencias en las preparaciones para la ocurrencia de eventos adversos y la tolerabilidad. La dosis de PEG 2 L dividido puede ser una muy buena opción para las preparaciones de colonoscopia electiva.

Abstract Introduction: Colonoscopy is the gold standard for evaluation of the colonic mucosa. Colon cleansing in preparation for colonoscopy depends on finding of polyps which can be adenomatous with malignant potential and the possibility of degenerating into colon cancer. Objective: This study's objective was to compare the efficacy and safety of three types of preparations for colon cleansing: a single four liter dose of polyethylene glycol (PEG) vs. two 2 liter doses of PEG vs. two low volume (1L + 1L) doses of PEG. Methods: This is a randomized controlled clinical trial of patients who underwent elective colonoscopy at a University clinic. It was blinded for the doctor who evaluated colon cleansing. Seventy four patients 74 patients were randomized into each group. The main parameter of effectiveness was integral preparation of adequate quality measured on the Boston scale. Secondary parameters were the percentage of adverse events, tolerability and detection rate of polyps. Results: Complete preparation of the entire colon was achieved significantly more often with 4 liters divided into two 2 liter doses followed by the other divided alternative (1 L + 1 L). It was achieved least frequently with in the single dose: 79.7%, 75.7% and 63.5%, respectively, p = 0.019. Differences were also found in the detection of polyps (13.5%, 24.3% and 9.5%, respectively, p = 0.037). ) There were no differences in presentation of at least one adverse event (p = 0.254) or in tolerability (p = 0.640). Conclusions: The two divided dose preparations had higher colon cleansing and polyp detection efficacies than did the single 4L dose while there were no differences in occurrence of adverse events and tolerability. The divided PEG 2L dose could be a very good option for elective colonoscopy preparation.

A Study of Desired Work Conditions of Nurses in Small-Medium Hospitals / 간호행정학회지

PURPOSE: This study was done to analyze the problems and desired work conditions of nursing organizations in small-medium hospitals. METHODS: Delphi Technique was used. In the first stage, the work conditions of nurses in small-medium hospitals were identified through a literature review. In the second stage, through 3 consultations with 20 nurse advisory groups, feedback was received on the desired work conditions for nurses in small-medium hospitals. In the third stage, 415 nurses and nurse managers were selected to examine the content validity and importance of the desired work conditions identified in the second stage. RESULTS: Sixty-four items were developed along eight domains of desired work conditions for nurses in small-medium hospitals. The survey on the desired work conditions revealed the following in order of importance: ‘wages’, ‘personnel’, ‘job’, ‘work hours’, ‘welfare’, ‘education’, ‘culture’, and and ‘other incentives’. CONCLUSION: The results of this study suggest that small-medium hospitals need to recognize the desired work conditions desired by nurses and accordingly change policies through the efforts of hospitals and professional groups.

Evaluation of therapeutic effect and safety of bilirubin absorption combined with low volume plasma exchange in treating severe hepatitis / 重庆医学

Objective To evaluate the therapeutic effect and safety of bilirubin absorption(BA) combined with low volume plasma exchange(PE) in the treatment of severe hepatitis.Methods Forty-five inpatients with severe hepatitis in this hospital from January 1,2015 to December 31,2016 were performed the prospective study.All cases were given the therapy of BA combined with low volume PE.The indicators of liver function (ALT,AST,TBIL,CHE,ALB),coagulation function (PTA,INR),blood routine (WBC,Hb,PLT),electrolytes(K+,Na+,Cl-,Ca2+) and renal function(BUN,Cr) were collected before and after treatment.The changes of clinical symptoms and signs(weak,anorexia,abdominal distension,etc.) before and after treatment were recorded in all cases.The complications during the treatment process were also observed and recorded.The t-test was used for the inter-group comparison of the measurement data and the abnormal distribution adopted the Wilcoxon rank sum test.Results After the treatment of BA and low volume PE,the clinical symptoms of the patients were improved in different levels.The levels of ALT,AST and TBIL were decreased(P＜0.01),the CHE level was increased(P＜0.01),ALB level was decreased(P＜0.01);PTA was increased(P＜0.05),INR was decreased(P＜0.01);WBC,HGB and PLT were decreased(P＜0.05).Nineteen cases(31.1％) developed adverse reactions,which were recovered to normal after general symptomatic treatment.The treatment compliance was good without influence on artificial liver therapy.Conclusion BA combined low volume PE for treating severe hepatitis can significantly improve the liver function with safety and effectiveness.

The Impact of Volume on Cataract Surgery Visual Outcome

Background: To compare High Vs. Low Volume SIC Surgery Outcomes in tertiary Institute in Central India,in terms of Quality as gauged by Visual acuity parameters at 1 month follow-up. Methods: A prospective, randomized, observational study done on 230 eyes of 230 patients at a tertiary Institute In Central India, with a total duration of 4 months. Patients underwent MSICS by 3 experienced surgeons & were divided into 2 groups:(A) patients coming in low volume season (summer month) & (B)patients in the high volume season (winter month). BCVA in these 2 groups were compared at 1 month follow up. Independent T test was used for analysis. Results: In high vs. low volume setting Best Corrected Visual Acuity (p=0.06) was not statistically significant at 1 month follow up. Conclusions: Gauged in Visual Acuity parameters, High Volume MSICS  does  not  affect  the quality  when  compared with Low Volume MSICS Surgery over a 30-days period in a tertiary institute in Central India.

Anesthetic Experiences of Liver Transplantation in a New Low Volume Hospital: Ewha Womans University Mokdong Hospital / 이화의대지

OBJECTIVES: Liver transplantation (LT) is the only treatment for end stage of liver failure. In Korea, annually it has been performed 1,300 cases. Most of LTs are performed in large volumes centers. More than half of centers performing LT in Korea are low volume hospital and started a LT program recently. We present our four-year experiences and outcomes of anesthesia for LT since 2013. METHODS: Anesthetic and surgical outcomes of 49 consecutive patients who received LT (living donor LT, 21 cases; deceased donor LT, 28 cases) between April 2013 and April 2017 were analyzed retrospectively. RESULTS: All patients were adult, with the mean age of 53.5±9.2 years. The most common cause of original liver diseases was hepatitis B virus-related liver cirrhosis (40.8%). The mean MELD (Model for End-stage Liver Disease) score was 18.8±10.7. Postreperfusion syndrome was observed in 34.7%, which were all controlled by calcium, norepinephrine, ephedrine and epinephrine. The mean postoperative intensive care unit stay of deceased donor LT recipients (13.6±9.0 days) was significantly longer than that of living donor LT recipients (8.0±3.3 days). There was no intraoperative mortality in patients receiving LT. Thirty-day post-transplant survival rate was 93.8% and 3-year survival rate was 88.6 %. The most common postoperative complication was pneumonia. CONCLUSION: We have started LT successfully with multidisciplinary team's steady effort. Adaptation and setting up LT protocol, adequate equipment, proper training at established transplant centers are essential to begin a successful LT program.

¿Existen diferencias en el impacto de la atención de salud en hospitales de alto y bajo volumen?: síntesis rápida de evidencia / Are there differences in the impact of health care in high- and low-volume hospitals?: rapid evidence synthesis

ANTECEDENTES Y OBJETIVO Se desea conocer si el número de pacientes atendidos en un establecimiento de salud tendría un impacto sobre la calidad de la atención recibida por parte de los pacientes. En esa línea, se comparan hospitales de alto y bajo volumen para ver sus resultados en cuanto a mortalidad y sobrevida en pacientes con cáncer e infarto al miocardio. Esta síntesis fue solicitada por la División de Prevención y Control de Enfermedades. METODOLOGÍA Se formuló una estrategia de búsqueda para ser utilizada en las bases de datos PDQ-Evidence, Health Systems Evidence, Health Evidence, Cochrane y PubMed con el objetivo de identificar revisiones sistemáticas del tema. Para realizar la búsqueda, se excluyeron estudios que analizaban volumen en cuanto al número de cirugías. Consultando al solicitante, se decidió considerar pacientes con cáncer o infarto al miocardio, excluyendo poblaciones con VIH/SIDA, diabetes, trasplantes o población en general. RESULTADO Se utilizan 3 revisiones sistemáticas, de las cuales se obtuvieron los siguientes resultados: -Los pacientes con cáncer que se atienden en hospitales de alto volumen tendrían una sobrevida mayor que pacientes que son atendidos en hospitales de bajo volumen. -Los pacientes con cáncer de cuello o cabeza que se atienden en hospitales de alto volumen no tendrían diferencia en la mortalidad con los pacientes que son atendidos en hospitales de bajo volumen. -Los pacientes pediátricos con tumores cerebrales que se atienden en hospitales de alto volumen tendrían una menor mortalidad que pacientes que son atendidos en hospitales de bajo volumen. -Los pacientes con infarto al miocardio que se atienden en hospitales de alto volumen no tendrían diferencia en la mortalidad con los pacientes que son atendidos en hospitales de bajo volumen. -Los pacientes con cáncer (sarcoma de Erwing) que se atienden en hospitales de alto volumen tendrían una sobrevida mayor que pacientes que son atendidos en hospitales de bajo volumen. -No está clara la certeza de la evidencia, puesto que esta no fue evaluada en este resumen.

High resurgence of dengue vector populations after space spraying in an endemic urban area of Thailand: A cluster randomized controlled trial

Objective: To examine the resurgence rate, house density index (HDI) and parous rate of the Aedes aegypti vector after space spraying carried out by the routine spraying team, and compare with the rates after standard indoor ultra low volume (SID-ULV) spraying carried out by the trained research spraying team. Methods: Between March and September 2014, a cluster randomized controlled trial including 12 clusters (6 regular ULV, 6 SID-ULV) with totally 4. 341 households was conducted, and around 20-31 houses in each cluster were selected for assessment. The parous rate and HDI of collected mosquitoes 2 days before and 1, 2 and 6 days after spraying were obtained and compared. Results: The HDI dropped significantly from the baseline 1 and 2 days after spraying to a non-zero value in the SID-ULV treated locations but not in the regular ULV group locations. However, by 6 days after spraying, the HDI of both groups had returned to the base value measured 2 days before spraying. There were no statistically significant differences in the parous rate between groups. Conclusions: SID-ULV is more effective in reducing Aedes aegypti populations. However, rapid resurgence of dengue vector after spraying in urban areas was observed in both groups.

High resurgence of dengue vector populations after space spraying in an endemic urban area of Thailand:A cluster randomized controlled trial

Objective:To examine the resurgence rate, house density index (HDI) and parous rate of the Aedes aegypti vector after space spraying carried out by the routine spraying team, and compare with the rates after standard indoor ultra low volume (SID-ULV) spraying carried out by the trained research spraying team. Methods:Between March and September 2014, a cluster randomized controlled trial including 12 clusters (6 regular ULV, 6 SID-ULV) with totally 4 341 households was conducted, and around 20–31 houses in each cluster were selected for assessment. The parous rate and HDI of collected mosquitoes 2 days before and 1, 2 and 6 days after spraying were obtained and compared. Results:The HDI dropped significantly from the baseline 1 and 2 days after spraying to a non-zero value in the SID-ULV treated locations but not in the regular ULV group locations. However, by 6 days after spraying, the HDI of both groups had returned to the base value measured 2 days before spraying. There were no statistically significant differences in the parous rate between groups. Conclusions: SID-ULV is more effective in reducing Aedes aegypti populations. However, rapid resurgence of dengue vector after spraying in urban areas was observed in both groups.

New progress in different doses of continuous blood purification therapy in sepsis / 中华实用儿科临床杂志

Spesis/severe sepsis remains a serious problem in pediatric intensive care unit.The mortality of sepsis/severe sepsis is still very high.The waterfall cascade reaction of cell factors is the main reason leading to the continued deterioration of the condition.Continuous blood purification technology can not only remove inflammatory mediators by adsorption and filtration function,but also improve the immune function,even reduce the mortality rate.But there is a controversial topic on the selection of the appropriate dose.This review not only introduces the effects of high-volume hemofiltration and low-volume hemofiltration from different aspects,but also analyses the influencing factors of different effects.

Feasibility of Gastric Cancer Surgery at Low Volume Hospitals

PURPOSE: Most gastric cancer patients undergo operations at large tertiary hospitals in Korea. However, some patients are treated at low volume hospitals. We investigated patient outcomes after gastric surgery at a secondary hospital and compared with outcomes of large volume centers. MATERIALS AND METHODS: We included 184 patients who underwent gastric surgery for gastric cancer at our hospital from January 2003 to December 2008. We conducted a retrospective study and evaluated the clinicopathological characteristics, clinical outcomes and survival rate of patients. RESULTS: Mean age was 61.7 years old. Male to female ratio was 2.2 : 1. Proportion of early gastric cancer was 38.6% and that of advanced gastric cancer was 61.4%. The 5 year overall survival rate of 184 patients was 66.3%. The overall survival rate was significantly lower for people over 62 years old. The morbidity rate and mortality at our hospital were 10.3% and 0.5%, respectively. CONCLUSIONS: The overall survival rate, morbidity and mortality were similar to those of the previous reports from Korea. Treatment of gastric cancer at a secondary hospital is feasible and safe. Standardization of operations and management of gastric cancer patients of the Korean Gastric Cancer Association is the most important factor to achieve these outcomes.

Feasibility of Gastric Cancer Surgery at Low Volume Hospitals

PURPOSE: Most gastric cancer patients undergo operations at large tertiary hospitals in Korea. However, some patients are treated at low volume hospitals. We investigated patient outcomes after gastric surgery at a secondary hospital and compared with outcomes of large volume centers. MATERIALS AND METHODS: We included 184 patients who underwent gastric surgery for gastric cancer at our hospital from January 2003 to December 2008. We conducted a retrospective study and evaluated the clinicopathological characteristics, clinical outcomes and survival rate of patients. RESULTS: Mean age was 61.7 years old. Male to female ratio was 2.2 : 1. Proportion of early gastric cancer was 38.6% and that of advanced gastric cancer was 61.4%. The 5 year overall survival rate of 184 patients was 66.3%. The overall survival rate was significantly lower for people over 62 years old. The morbidity rate and mortality at our hospital were 10.3% and 0.5%, respectively. CONCLUSIONS: The overall survival rate, morbidity and mortality were similar to those of the previous reports from Korea. Treatment of gastric cancer at a secondary hospital is feasible and safe. Standardization of operations and management of gastric cancer patients of the Korean Gastric Cancer Association is the most important factor to achieve these outcomes.

A study on low volume of ropivacaine used in epidural anaesthesia during microendoscopic discectomy(MED) / 中国微创外科杂志

Objective To compare the clinical effects of different concentrations of low volumn of ropivacaine during MED. Methods 150 patients performed MED were randomly divided into three groups: in the first group (n=50) 0.8% ropivacaine was used, in the second group (n=61) 0.6% Ropivacaine was used and in the third group 0.4% Ropivacaine was used. First epidural needle was introduced into the epidural space. Then edpidual catheter was introduced into the epidural space and 5ml of 2% lidocaine was injected. After anesthesia planum was obtained, 5ml of ropivacained in different concentrations was iniected through the epidural catheter in different groups. The react time, the resume time and the separate anaesthesia among three groups were compared Results The blockade of sensory nerve was faster than that of motor nerve, and persistent time of sensory nerve was longer than that of motor nerve. Group two had more remarkable separate sensory and motor blockade than group one and group three (P

Low volume peritoneal dialysis in newborns and infants / 영남의대학술지

Peritoneal dialysis has been widely considered to be the dialytic treatment of choice for acute renal failure in infants and young children, because the technique is simple, safe and easily adapted for these patients. Also peritoneal dialysis in infants might have more effective ultrafiltration and clearance than in adults. In certain circumstances associated with hemodynamic instability, ordinary volume peritoneal dialysis (30-50 ml/kg body weight per exchange) or hemodialysis may not be suitable unfortunately. But frequent cycled, low volume, high concentration peritoneal dialysis may be more available to manage the acute renal failure of newborns and infants. Seven infants underwent peritoneal dialysis for hemodynamically unstable acute renal failure with low exchange volume (14.2±4.2 ml/kg), short exchange time (30 to 45 minutes) and hypertonic glucose solution (4.25% dextrose). Age was 1.9±1.3 months and body weight was 4.6±1.6 kg. Etiology of acute renal failure was secondary to sepsis with or without shock (5 cases) and postcardiac operation (2 cases). Catheter was inserted percutaneously with pigtail catheter or Tenkhoff catheter by Seldinger method. Dialysate was commercially obtained Peritosol which contained sodium, chloride, potassium, magnesium, lactate and calcium. Net ultrafiltration (ml/min) showed no difference between low volume dialysis and control (0.27±0.09 versus 0.29±0.09). Blood BUN decreased from 95.7±37.5 to 75.7±25.9 mg/dl and blood pH increased from 7.122±0.048 to 7.326±0.063 after 24 hours of peritoneal dialysis. We experienced hyperglycemia which were controlled by insulin (2 episodes), leakage at the exit site (2), mild hyponatremia (1) and Escherichia coli peritonitis (1). Two children of low volume dialysis died despite the treatment. In our experience, low volume and high concentration peritoneal dialysis with frequent exchange may have sufficient ultrafiltration and clearance without significant complications in the certain risked acute renal failure of infants.