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OBJECTIVE To explore the role of clinical pharmacists participating in the standardized perioperative nutritional management process for pancreaticoduodenectomy （PD） on improving postoperative recovery in patients. METHODS The clinical data of 100 patients undergoing PD in the Department of Biliary and Pancreatic Surgery， Drum Tower Hospital Affiliated to Nanjing University School of Medicine from November 2019 to February 2021 were analyzed retrospectively. According to the different perioperative nutrition management plans， they were divided into clinical pharmacist intervention group （n＝51， clinical pharmacists intervened according to the standardized nutrition management process） and control group （n＝49， clinical pharmacists only performed preoperative nutrition evaluation， and clinical physicians took nutrition support according to the patient’s condition）. The differences in postoperative recovery index， economic evaluation index， hospitalization length， postoperative complications， and postoperative enteral nutrition support route were compared between 2 groups. RESULTS The time of postoperative diet， the first postoperative ventilation， the first postoperative defecation， and postoperative drainage time of abdominal drain were significantly earlier in the clinical pharmacist intervention group than in the control group （P＜0.05）； the hospitalization cost， medication cost， nutritional support cost， parenteral nutrition cost， albumin preparation cost， and the length of postoperative hospitalization were significantly lower/shorter in the clinical pharmacist intervention group than in the control group （P＜0.05）； there was no statistically significant difference in the incidence of postoperative complications between the two groups （P＞0.05）； there was statistically significant difference in the perioperative enteral nutrition support pathways between two groups （P＜0.05）. CONCLUSIONS Clinical pharmacists’ participation in perioperative nutritional management for PD can significantly reduce hospitalization costs and nutritional support costs， improve patients’ perioperative nutritional status， and shorten hospital stays. wanglina668@163.com
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Objective:To investigate the clinical efficacy and mechanism of Ganoderma lucidum hypoglycemic formula in the treatment of insulin resistance in patients with type 2 diabetes mellitus (T2DM) with liver and kidney yin deficiency. Methods:A total of 86 patients with T2DM with liver and kidney yin deficiency who were diagnosed and treated at Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine from January 2021 to February 2022 were included in this study. These patients were divided into a control group and a treatment group, with 43 patients in each group using a 1:1 ratio using the sealed envelope method. Both groups were treated with standardized Western medicine. The treatment group was also treated with the Ganoderma lucidum hypoglycemic formula. All patients were followed up for 12 weeks. The clinical symptoms, curative effect, glucose and lipid metabolism, inflammatory factors, oxidative stress change, and safety were compared between the two groups. Results:The total response rate in the treatment group was 88.4% (38/43), which was significantly higher than 53.5% (23/43) in the control group ( χ2 = 12.69, P < 0.001). After treatment, the traditional Chinese medicine syndrome score, fasting blood glucose, 2-hour postprandial blood glucose, glycosylated hemoglobin, insulin resistance index, total cholesterol, triglyceride, tumor necrosis factor α, and interleukin-6 decreased in each group. The amplitudes of decrease of the above indexes were greater in the treatment group compared with the control group (all P < 0.05). C-peptide in the fasting state, C-peptide at 2 hours after a diet, and superoxide dismutase increased in each group. The amplitudes of increase of the three indexes were greater in the treatment group compared with the control group (all P < 0.05). Conclusion:Ganoderma lucidum hypoglycemic formula can greatly improve insulin resistance and glucose and lipid metabolism in T2DM patients with liver and kidney yin deficiency. The underlying mechanism may be to further reduce the inflammatory response and anti-oxidative stress by down-regulating tumor necrosis factor α and interleukin-6 levels and up-regulating superoxide dismutase level, thereby effectively alleviating insulin resistance in T2DM.
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Objective To observe the clinical effect of gifitinib combined with hydroxylcamptothecin pericardial perfusion in the treatment of patients with advanced non-small cell lung cancer(NSCLC) with pericardial effusion. Methods From January 2016 to September 2017,eighty-four cases of late NSCLC with pericardial effusion treated in the People′s Hospital of Jiaozhou were randomly divided into two groups according to the digital table,with 42 cases in each group.The control group was treated with gefitinib,and the observation group was treated with hydroxylcampto-thecin on the basis of the control group.The curative effect was evaluated after two courses of treatment in the two groups,and the clinical efficacy and adverse reactions were observed.Results The effective rates of the control group and the observation group were 47.6% (20/42) and 66.7% (28/42),respectively.The effective rate of the observa-tion group was significantly higher than that of the control group(χ2 =4.525,P<0.05).The effective rate of pericar-dial effusion was 33.3% (14/42) in the control group and 69.1% (29/42) in the observation group,the difference between the two groups was statistically significant( χ2 =10.720,P <0.05).There was no ststistically significant difference in the incidence rate of adverse reactions between the two groups during treatment(P<0.05).Conclusion Combination of gefitinib and hydroxylcamptothecin pericardial perfusion in the treatment of NSCLC with pericardial effusion has good tolerance and good safety for the patients.
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Objective To discuss appropriate strategies of site visits in ethical committees ,to enhance the supervision of clinical trials effectively ,and standardize the implementation of clinical research .Methods In consideration of the lack of de-tailed normative description of site visit in ethical guidelines and relevant articles ,as well as the varying degrees of implementa-tion and understanding of site visits among different ethical committees .This article discussed the procedures ,contents and considerations of site visit based on the analysis of numerous site visits cases conducted .Results Site visit is one of the crucial procedures to more comprehensive ,in-depth and truly understanding of the implementation of clinical trials .It is helpful to help sponsors/investigators enhance awareness and compliance with the good clinical practice .It also helps to correct problems time-ly during the implementation process to assure the standardized implementation of follow-up studies ,and finally ,effectively protect the rights and interests and safety of subjects .Conclusions Standardized and efficient site visit strategy of the ethical committee is one of the important regulatory strategies in the implementation of clinical trials and is an effective supplement to the regular review of ethical materials .
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Objective To explore the clinical application of renal replacement therapy in renal transplan-tation from donation after citizen's death(DCD).Methods A total of 41 cases of the patients with renal replace-ment therapy after renal transplantation from DCD from January 2013 to December 2016 were involved,of which 14 cases received peritoneal dialysis,21 intermittent hemodialysis(IHD)and 6 continuous renal replacement ther-apy(CRRT).The therapeutic effect and complications of three renal replacement therapies were retrospectively ana-lyzed. Results After dialysis treatment,the concentration of blood BUN,Crea,and potassium was significantly lower than that before the treatment(P<0.05);the difference of Crea and BUN before and after the treatment in IHD and CRRT group was higher than that in peritoneal dialysis group(P<0.05)but there was no statistically sig-nificant difference between IHD and CRRT group(P > 0. 05). Conclusion The renal replacement after kidney transplantation from DCD should be based on the patient's condition,which is the key to protect their kidneys even to save patients'lives.
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Objective To explore the clinical effect of traditional Chinese medicine on lipid metabolism dis-orders in hemodialysis patients.Methods 70 patients with hemodialysis received in the hospital from Novem-ber 2015 to April 2017 were enrolled in the study.They were randomly divided into control group and treat-ment group with 35 cases in each group.The control group was treated with simvastatin and and the treatment group was treated with self-made fat recipe combined with simvastatin.The levels of serum lipid ,serum in-flammatory cytokines ,renal function and liver function ,the total effective rate of treatment and the incidence of adverse reactions were compared between the two groups before and after treatment.Results There were no statistical significances in serum lipid indexes such as triglyceride (TG) ,total cholesterol (TC) ,high densi-ty lipoprotein cholesterol (HDL-C) ,low density lipoprotein cholesterol (LDL-C) ,C reactive protein (CRP) , interleukin 6 (IL-6) ,tumor necrosis factor α(TNF-α) and other serum inflammatory factors ,and renal func-tion indexes ,including urea nitrogen (BUN) ,creatinine (Scr) ,liver function indexes ,including alanine amin-otransferase (ALT) ,aspartate aminotransferase (AST) between two groups before treatment (P＞0.05) ;af-ter treatment ,the TG ,TC ,LDL-C ,CRP ,IL-6 ,TNF-α ,BUN ,Scr ,ALT and AST levels of the patients in the treatment group were significantly lower than those in the control group ;the HDL-C level of the patients in the treatment group was significantly higher than that in the control group ;the total effective rate of the treat-ment group was significantly higher than that in the control group ;the incidence of adverse reactions was sig-nificantly lower than that of the control group ,and the differences were statistically significant (P＞0.05). Conclusion The lipid-lowering effect of treatment of hemodialysis patients with traditional Chinese medicine lipid-lowering treatment is remarkable ,and worthy of promotion.
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ABSTRACT:Objective To compare the short-term efficacy of hand-assisted laparoscopic surgery and laparoscopy-assisted radical operation,and evaluate the safety of hand-assisted laparoscopic surgery and its effect on systemic stress inflammation in colorectal cancer.Methods Totally 100 patients who had colorectal cancer and underwent radical operation from September 2012 to March 2016 were selected and divided into hand-assisted laparoscopy group (Group A,n=6 3 )and laparoscopy-assisted group (Group B,n=3 7 )according to the random number table.We compared operation index,postoperative complications and systemic inflammatory response levels in the two groups.Results Group B outperformed Group A in operation time,bleeding volume and drainage volume (P0 .0 5 ).Systemic inflammatory reaction index of neutral granulocyte number and C reactive protein (CRP)showed no significant differences between the two groups (P>0 .0 5 ),but inflammatory cytokine IL-6 level in Group B was significantly higher than the that in Group A (P<0.05).Conclusion Hand-assisted laparoscopic surgery has shorter operation time,lower bleeding volume than laparoscopy-assisted operation in the treatment of colorectal cancer,but the latter one has more advantages in postoperative gastrointestinal function recovery.The inflammatory cytokine IL-6 level in hand-assisted laparoscopic surgery is higher than that in laparoscopy,suggesting that the choice of operation methods should be based on the actual situation in clinical application.
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Objective To explore the application of the evidence-based case report method in the standardization training of resident physicians in the department of endocrinology. Methods Fifty-one resi-dents recruited from the endocrinology department were randomly divided into the experiment group (26 cases) and control group (25 cases). The evidence-based case report method was conducted in the ex-peri-mental group, while the traditional clinical teaching mode was applied in the control group. The re-sults of the examination of two groups including the theoretical test and skill test were compared and the question-naire survey was conducted to find out the differences of students' interest in learning, clinical skills and satisfaction. All data were compared using t test. Results There was no significant difference in theoretical test between the two groups (P>0.05). The total score of the skill test in the experimental group was (85.13 ±4.63) and the control group was (76.79 ±3.11) (P=0.000). The students in the experimental group showed that the teaching method had more significant effects on improving their learning interest and initiative, clinical thinking ability, clinical work ability, literature review ability and medical article writing ability. Scores of satisfaction with teaching methods (total score was 10) for experimental group were (9.69 ±0.34), which was also significantly higher than those in the control group (8.01 ±0.39) (P=0.000). Conclusion The application of evidence-based case report teaching method in the standardized training of resident physicians in department of endocrinology is worthy of being perfected and further popularized in clinical teaching work.
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Multidisciplinary team is the basic model of modern head and neck oncology treatment. We try to integrated multimedia presentation in multidisciplinary head and neck oncology clinical teaching. Through building a multidisciplinary platform for discussion , on the basis of teacher's instruction and student's self-learning, we integrate the related knowledge with multimedia presentation and computer net-work to guide the learning of core knowledge and key problems of head and neck cancer, thus forming a new clinical teaching mode combining theory study with practice training. In the process of implementation, we should pay attention to arranging the learning tasks in advance, and highlight the key learning content in the multidisciplinary discussion, so as to improve the students' interest and enthusiasm in learning.
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OBJECTIVE:To observe clinical efficacy and safety of salmeterol and fluticasone propionate in the treatment of mod-erate and severe bronchial asthma. METHODS:98 patients with moderate and severe bronchial asthma were selected from our hospi-tal were included in the study and were randomly divided into control group(49 cases,3 cases withdrew from the test and 46 cases completed the test)and observation group(49 cases,2 cases withdrew from the test and 47 cases completed the test). Control group was given Budesonide aerosol preparation,1 dose,bid;observation group was given Salmeterol and fluticasone propionate inhala-tion,1 dose,bid. The treatment course lasted for 2 months. Clinical efficacy,lung function indexes,the time of clinical symptom disappearance,FEV1,PD20,ACT score,asthma attack times within half an year,EO%and ECP in serum and sputum,and the oc-currence of ADR were compared between 2 groups. RESULTS:After treatment,total effective rate of observation group was signifi-cantly higher than that of control group(95.73% vs. 76.09%);FVC,FEV1 and PEF and other indexes of 2 groups were increased significantly,and the observation group was significantly higher than the control group;the disappearance time of pulmonary rales, wheezing,dyspnea and cough in observation group were significantly shorter than in control group;PD20 and ACT score of 2 groups were significantly increased,ACT score of observation group was significantly higher than that of control group;EO% and ECP in serum and sputum of observation group were significantly lower than those of control group,there was statistical significance (P0.05). All ADRs disappeared after drug withdrawal. CONCLUSIONS:Therapeutic efficacy of salmeterol and fluticasone propio-nate is better than budesonide in the treatment of moderate and severe bronchial asthma,and can effectively improve lung function, shorten the time of clinical symptoms disapperance and reduce the level of inflammatory factor with and good safety.
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Objective To observe the effect of ejiao huangqi koufuye and iron sucrose injection in the treat-ment of postpartum anemia,to provide reference for clinical treatment.Methods 100 postpartum anemia women met the inclusion were randomly divided into 50 cases of observation group and 50 cases of control group.The control group was given iron sucrose injection 200mg for 3d,the observation group was given ejiao huangqi koufuye for 30d, twice daily and 10ml once.The blood was exsanguinated for detecting RBC,Hb,HCT,SF,TIBC.The improvement of symptoms and signs were observed and the effect was assessed.Results The RBC,Hb,HCT,SF of the observation group and control group after treatment were (2.14 ±0.74)×10 12 /L and (3.32 ±1.15 )×10 12 /L,(97.85 ± 22.44)g/L and (109.72 ±18.54)g/L,(36.42 ±8.39)% and (41.10 ±7.38)%,(22.26 ±1.76)mg/L and (32.2 ±2.1)mg/L,which were significantly higher than before treatment (t =3.065 and 5.614,3.411 and 3.961, 3.317 and 5.062,6.448 and 9.332,both P 0.05).Conclusion The ejiao huangqi kou-fuye and iron sucrose injection has exact clinical efficacy in the treatment of postpartum iron deficiency anemia,can effectively promote bone marrow erythropoiesis,anemia symptoms,it is worthy of clinical use.
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OBJECTIVE:To investigate the role of clinical pharmacists in the therapy for acute exacerbation of chronic obstruc-tive pulmonary diseases (AECOPD) complicated with pulmonary infection. METHODS:Clinical pharmacists participated in the therapy for a case of acute exacerbation of AECOPD complicated with pulmonary infection. According to the patients’signs,assis-tant examination and disease condition,clinical pharmacists provided suggestions,i.e. Piperacillin sodium and sulbactam sodium for injection (4∶1) 5.0 g,ivgtt,q12 h,for anti-infective treatment;Bisacodyl enteric-coated tablet 5 mg,po,qd,for promoting defecation;Clostridium butyricum viable bacteria tablet 20 mg,po,tid,for regulating gastrointestinal flora;Pinaverium bromide tablet 50 mg,po,tid,for regulating gastrointestinal smooth muscle tension;Shexiang baoxin pills 22.5 mg,po,tid,instead of flu-id infusion for protecting heart,and isosorbide 5-mononitrate 20 mg,po,tid,for preventing angina pectoris;Cefminox capsule 100 mg,po,tid,for anti-infective treatment;fluconazol 0.4 g,ivgtt,qd,for antifungal treatment,and Bacillus licheniformis 500 mg,po, tid,for preventing alteration of intestinal flora. RESULTS:The physicians adopted clinical pharmacist’s suggestions. No ADR was found during treatment,and the patients transferred to ordinary ward after the disease condition had been controlled. CONCLU-SIONS:The participating of clinical pharmacists in pharmaceutical care can promote rational drug use in the clinic and guarantee the safety of drug use.
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Teaching information retrieval course in two phases for students of 8-year clinical medicine was de-scribed in aspects of its contents, organization, teaching material construction and examination methods.Its results were analyzed according to the written examination score, report on a special topic, group report and feedback of students.Measures were put forward for further improving the classroom teaching results, namely effective linking of teaching contents, careful section of retrieval topics, selection and training of teachers.
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Objective To explore the clinical effect of excision of peripheral sympathetic nerve network in common carotid artery on children with cerebral palsy (CP)and the effect on their cognitive function. Methods A ret-rospective study method was admitted to preschool children with CP in 69 cases in Center of Brain Disease,the Third Hospital Affiliated to Xinxiang Medical University from July 2008 to August 2014, the common carotid artery sympathetic with the surrounding network stripping off resection treatment of 43 cases ( surgery group) ,without the use of surgery in the treatment of children with 26 cases ( no operation group) . The muscle tension improved, movement to improve the ability of 2 groups before and after treatment 6 months were detected and compared. Developmental quotient ( DQ) ,intelligence quotient ( IQ) ,bilateral middle cerebral artery ( MCA) hemodynamic index difference were deter-mined between 2 groups before and after treatment 6 months. Results After treatment 6 months,the muscle tension score and walking ability score of the surgery group were significantly better than those of no operation group [(2. 2± 1. 1) scores vs (4. 5±0. 6)scores,(3. 5±0. 7) scores vs (2. 7±0. 8) scores,all P<0. 05],and significantly improved compared with before treatment[(4. 8±0. 6)scores,(2. 2±0. 9)scores,all P<0. 05]. After treatment 6 months,the IQ score,fine motor, social adaptation, personal social, language score and MCA mean velocity ( MV ) , peak velocity ( PV) ,resistance index ( RI) ,pulsatility index ( PI) determination value of the surgery group were significantly higher than those of no operation group and before treatment (all P<0. 05). Conclusions Excision of peripheral sympathetic nerve network on common carotid artery has a good clinical effect in the treatment of CP , and can significantly improve the cognitive function of children with CP .
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Objective To explore effect of daily clearance and improvement mode application in man-agement of clinical nursing responsible group. Methods 200 patients from hand and foot surgery department of our hospital between January to June, 2007 were included into the control group, and 200 patients who were in hospital between July to December, 2007 were included into the experimental group. Then quality of care and satisfaction of patients were compared respectively between the two groups to study application effect of daffy clearance and improvement mode. Results After six months application of daily clearance and improvement mode, significant difference was seen in the two groups. Condusions Application of daffy clearance and improvement mode in management of clinical nursing responsible group is an effective method in nursing supervision.