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Isolated femoral head destruction 孤立的股骨头破坏
Pub Date : 2024-11-14 DOI: 10.1136/bmj-2024-080572
Jiahao Meng, Shuguang Gao
A previously well woman in her 60s presented with left hip pain, limited mobility, and unintentional weight loss of 5 kg. Her full blood count, C reactive protein, and alkaline phosphatase results were within normal limits, but erythrocyte sedimentation rate was raised, at 120 mm in the first …
一名 60 多岁的妇女因左髋部疼痛、活动受限和体重意外下降 5 公斤而前来就诊。她的全血细胞计数、C反应蛋白和碱性磷酸酶结果均在正常范围内,但红细胞沉降率升高,第一次升高到120毫米。
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引用次数: 0
One hundred years of electroencephalography . . . and other stories 脑电图一百年......及其他故事
Pub Date : 2024-11-14 DOI: 10.1136/bmj.q2451
British Medical Journal Publishing Group
Data from nearly 30 000 participants in a Canadian longitudinal study of ageing suggest that people with epilepsy are around twice as likely to experience cardiovascular events (stroke, transient ischaemic attack, or myocardial infarction) as people of similar age without epilepsy ( JAMA Neurol doi:10.1001/jamaneurol.2024.3210). Exposure to drugs such as carbamazepine, phenytoin, and primidone, which induce cytochrome P450 enzymes, might be part of the explanation. This year marks the centenary of the first human electroencephalography (EEG) recording, made in 1924 by the German psychiatrist Hans Berger. EEG has made a substantial contribution to the diagnosis and classification of sleep disorders and epilepsy, but it hasn’t revolutionised neurology in …
加拿大一项老龄化纵向研究中近 30,000 名参与者的数据表明,癫痫患者发生心血管事件(中风、短暂性脑缺血发作或心肌梗塞)的几率大约是年龄相仿的无癫痫患者的两倍(JAMA Neurol doi:10.1001/jamaneurol.2024.3210)。卡马西平、苯妥英和骁悉等药物会诱导细胞色素 P450 酶,接触这些药物可能是部分原因。今年是德国精神病学家汉斯-伯杰(Hans Berger)于 1924 年首次记录人类脑电图(EEG)一百周年。脑电图为睡眠障碍和癫痫的诊断和分类做出了巨大贡献,但它并没有彻底改变神经学的现状。
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引用次数: 0
Speaking up for science in an era of disinformation 在虚假信息时代为科学发声
Pub Date : 2024-11-14 DOI: 10.1136/bmj.q2503
Juliet Dobson
On 6 November Donald Trump was re-elected president of the United States after an election campaign characterised by fear, lies, and disinformation. Trump’s campaign featured his insistence that he was cheated out of winning in 2020—a lie that has left many Americans distrustful of their voting system. Martin McKee and colleagues describe how the rapid spread of such disinformation, particularly on social media, poses a threat to societies and democracies everywhere (doi:10.1136/bmj.q2485). They argue that it can be countered only if social media platforms are adequately regulated and if we can effectively expose disinformation and not be afraid to speak out.1 Trump’s pre-election threats that he would curb press freedoms and target journalists suggest that speaking out may become harder (www.theguardian.com/us-news/2024/nov/10/trump-journalist-media-press-freedom …
11 月 6 日,唐纳德-特朗普在经历了一场以恐惧、谎言和虚假信息为特征的竞选活动后,再次当选美国总统。特朗普在竞选活动中坚称自己在 2020 年获胜是被骗了--这个谎言让许多美国人对他们的投票系统产生了不信任。马丁-麦基(Martin McKee)及其同事描述了此类虚假信息的快速传播,尤其是在社交媒体上的传播,如何对各地的社会和民主构成威胁(doi:10.1136/bmj.q2485)。他们认为,只有对社交媒体平台进行充分监管,只有我们能够有效揭露虚假信息并不惧怕直言不讳,才能应对这种威胁。1 特朗普在大选前威胁说他将限制新闻自由并将矛头指向记者,这表明直言不讳可能会变得更加困难(www.theguardian.com/us-news/2024/nov/10/trump-journalist-media-press-freedom ...
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引用次数: 0
Tackling heat stress: the urgent need for medical education reform 应对热应激:迫切需要进行医学教育改革
Pub Date : 2024-11-13 DOI: 10.1136/bmj.q2467
Giovanni Ghirga
As global temperatures rise, the risks of heat stress are becoming a critical concern. The International Labour Organization reports that 2.4 billion people, or 71% of the global workforce, are exposed to excessive heat, resulting in millions of injuries and nearly 19 000 deaths annually.12 Tackling this “invisible killer” is imperative, including enhancing healthcare …
随着全球气温的升高,热应激风险正成为一个令人严重关切的问题。国际劳工组织报告称,全球有 24 亿人(占全球劳动力的 71%)暴露在过热环境中,每年造成数百万人受伤,近 19 000 人死亡。
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引用次数: 0
Scarlett McNally: GPs and geriatricians can help to improve shared decision making for surgical patients 斯嘉丽-麦克纳利全科医生和老年病学家可以帮助改善手术患者的共同决策
Pub Date : 2024-11-13 DOI: 10.1136/bmj.q2478
Scarlett McNally
At one of my first meetings as an elected council member of the Royal College of Surgeons of England, we approved a report called Access All Ages . It encouraged less ageist thinking and bias among healthcare staff that might lead to them denying older people surgery.1 But sometimes an operation isn’t the best option. Among patients who have surgery, 14% express regret and 15% experience complications, which are at least four times as likely if they’re frail or physically inactive.2 The Centre for Perioperative Care has published information on the importance of exercise before surgery,3 but that alone may not be enough. We need shared decision making,4 including asking patients what matters to them. The public should be primed to ask about BRAN—the benefits, risks, and alternatives to surgery and the likely result from doing nothing.4 A slew of data …
在我当选英国皇家外科学院理事会成员后的第一次会议上,我们通过了一份名为《Access All Ages》的报告。该报告鼓励医护人员减少可能导致他们拒绝为老年人进行手术的年龄歧视思想和偏见。在接受手术的患者中,14% 的人表示遗憾,15% 的人遭遇并发症,如果他们身体虚弱或缺乏运动,出现并发症的几率至少是前者的四倍2 。我们需要共同决策4 ,包括询问患者什么对他们最重要。我们应该让公众了解 BRAN--手术的益处、风险、替代方案以及什么都不做的可能结果4。
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引用次数: 0
How outsourcing has contributed to England’s social care crisis 外包如何导致英格兰的社会医疗危机
Pub Date : 2024-11-13 DOI: 10.1136/bmj-2024-080380
Benjamin Goodair, Adrienne McManus, Michelle Degli Esposti, Anders Bach-Mortensen
Benjamin Goodair and colleagues argue that growth of private provision in adult social care in England has resulted in worse care and should be rolled back Adult social care in England is in crisis. Chronically underfunded services are struggling to accommodate unmet need, and inequalities are widening. The number of people applying and being rejected for care provision is rising year on year, and unmet need is twice as high in the most economically deprived areas compared with the least deprived.12 Meanwhile, 9 in 10 adult social service directors in England did not believe there was adequate funding or workforce to meet care needs of older and disabled people in their area.3 These deficiencies have seen the social care sector brought “to its knees.”4 Care for older people and people with physical and mental disabilities is facing record demand but performing worse than any time in recent history. One contributor to this is the outsourcing of care provision to the private sector. Although competition from private sector provision was championed as a solution to achieve cheaper and better quality care, evidence from the past few decades in the UK and elsewhere challenges this view.567 In England, in particular, adult social care now faces a reality where reform is needed but the capacity for change is constrained by a model of care where most providers are run by for-profit companies. Social care in England, sometimes referred to as community, residential, or personalised care, constitutes services that support people with activities of daily living and maintaining independence. In England, care services are largely divided between healthcare and social care, with local government responsible for organising and funding social care and the NHS a distinct service directly funded by central government. All health and social care …
本杰明-古戴尔(Benjamin Goodair)及其同事认为,英格兰成人社会护理中私人提供服务的增长导致护理质量下降,应予以缩减 英格兰的成人社会护理正处于危机之中。长期资金不足的服务正在努力满足未得到满足的需求,不平等现象正在扩大。12 同时,英格兰每 10 名成人社会服务主管中就有 9 人认为没有足够的资金或劳动力来满足本地区老年人和残障人士的护理需求。4 老年人以及身体和精神残障人士面临着创纪录的护理需求,但其表现却比近代历史上任何时候都要糟糕。造成这种情况的一个原因是护理服务外包给了私营部门。567 尤其是在英格兰,成人社会护理现在面临的现实是,需要进行改革,但改革的能力受到了护理模式的限制,因为大多数护理提供者都是由营利性公司经营的。在英格兰,社会护理有时也被称为社区护理、寄宿护理或个性化护理,是指为人们的日常生活和保持独立提供支持的服务。在英格兰,护理服务主要分为医疗护理和社会护理,地方政府负责组织和资助社会护理,而国家医疗服务体系则是一项由中央政府直接资助的独特服务。所有的医疗和社会护理服务 ...
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引用次数: 0
Surgical adverse events in the US 美国的手术不良事件
Pub Date : 2024-11-13 DOI: 10.1136/bmj.q2437
Helen Haskell
After all these years, why has patient safety not improved? In late 1999, the US Institute of Medicine’s report “To Err is Human: Building a Safer Health System” galvanized the nascent patient safety movement into action with its assertion that as many as 98 000 Americans died annually from medical error.1 That alarming statistic was derived from the 1991 Harvard Medical Practice Study, a randomized chart review undertaken to create an evidence base for the controversy then raging around litigation against medical malpractice.2 That study found that 3.7% of patients in a sample of hospital admissions in New York state had experienced serious adverse events, more than one fourth of which the researchers considered legally compensable. Overall, 48% of the events were associated with surgical procedures. A related study in Colorado and Utah a few years later showed similar percentages of surgical error, whereas a targeted follow-up study found that surgery accounted for two thirds of adverse events in hospitals in the same two states.3 …
这么多年过去了,为什么患者安全状况没有改善?1999 年末,美国医学研究所的报告《To Err is Human: Building a Safer Health System》指出,每年有多达 98 000 名美国人死于医疗失误,1 这份报告激发了刚刚兴起的患者安全运动。2 该研究发现,在纽约州的入院抽样调查中,3.7%的患者经历了严重的不良事件,研究人员认为其中超过四分之一可依法赔偿。总体而言,48%的事件与外科手术有关。几年后,在科罗拉多州和犹他州进行的一项相关研究也显示了类似的手术错误比例,而一项有针对性的后续研究发现,在这两个州的医院中,手术占不良事件的三分之二。
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引用次数: 0
Safety of inpatient care in surgical settings: cohort study 外科住院护理的安全性:队列研究
Pub Date : 2024-11-13 DOI: 10.1136/bmj-2024-080480
Antoine Duclos, Michelle L Frits, Christine Iannaccone, Stuart R Lipsitz, Zara Cooper, Joel S Weissman, David W Bates
Objectives To estimate the frequency, severity, and preventability of adverse events associated with perioperative care, and to describe the setting and professions concerned. Design Multicenter retrospective cohort study. Setting 11 US hospitals. Participants 1009 patients from a randomly selected sample of 64 121 adults admitted for surgery during 2018. Main outcome measures Adverse events during inpatient perioperative care were assessed using a trigger method, identifying information previously associated with similar events, and from a comprehensive review of electronic health records. Trained nurses reviewed all records and flagged admissions with possible adverse events, which were then adjudicated by physicians, who confirmed the occurrence and characteristics of the events. Adverse events were classified as major if they resulted in serious harm requiring substantial intervention or prolonged recovery, involved a life threatening event, or led to a fatal outcome. Potentially preventable events included those definitively, probably, or possibly preventable. Results Among 1009 patients reviewed, adverse events were identified in 38.0% (95% confidence interval 32.6 to 43.4), with major adverse events occurring in 15.9% (12.7 to 19.0). Of 593 identified adverse events, 353 (59.5%) were potentially preventable and 123 (20.7%) were definitely or probably preventable. The most common adverse events were related to surgical procedures (n=292, 49.3%), followed by adverse drug events (n=158, 26.6%), healthcare associated infections (n=74, 12.4%), patient care events (n=66, 11.2%), and blood transfusion reactions (n=3, 0.5%). Adverse events were most frequent in general care units (n=289, 48.8%), followed by operating rooms (n=155, 26.1%), intensive care units (n=77, 13.0%), recovery rooms (n=20, 3.3%), emergency departments (n=11, 1.8%), and other in-hospital locations (n=42, 7.0%). Professions most involved were attending physicians (n=531, 89.5%), followed by nurses (n=349, 58.9%), residents (n=294, 49.5%), advanced level practitioners (n=169, 28.5%), and fellows (n=68, 11.5%). Conclusions Adverse events were identified in more than one third of patients admitted to hospital for surgery, with nearly half of the events classified as major and most potentially preventable. These findings emphasize the critical need for ongoing improvement in patient safety, involving all health professionals, throughout perioperative care. Supplementary method S3 shows the SAS code for data preparation and analysis. Owing to confidentiality requirements, the data for this project are primarily reserved for the immediate research team at Mass General Brigham. However, deidentified data can be accessed on secured servers by contacting the principal investigator (DWB). Additionally, the protocol and adverse events chart review training manual used for the project, along with further details about data management and analysis, are available to interested researchers.
目的 估计与围手术期护理相关的不良事件的频率、严重程度和可预防性,并描述相关环境和专业。设计 多中心回顾性队列研究。地点 11 家美国医院。参与者 1009 名患者,从 2018 年期间入院接受手术的 64 121 名成人中随机抽取。主要结果测量 采用触发法评估住院患者围手术期护理期间的不良事件,识别以前与类似事件相关的信息,并对电子健康记录进行全面审查。接受过培训的护士会查看所有记录,并标记可能发生不良事件的入院患者,然后由医生进行裁定,确认事件的发生和特征。如果不良事件导致严重伤害,需要大量干预或长时间恢复,涉及危及生命的事件,或导致死亡结果,则被归类为重大不良事件。潜在的可预防事件包括确定、可能或可能可预防的事件。结果 在接受复查的 1009 名患者中,38.0%(95% 置信区间为 32.6 至 43.4)的患者发生了不良事件,15.9%(12.7 至 19.0)的患者发生了重大不良事件。在已发现的 593 例不良事件中,353 例(59.5%)可能可以预防,123 例(20.7%)肯定或可能可以预防。最常见的不良事件与外科手术有关(292 例,占 49.3%),其次是药物不良事件(158 例,占 26.6%)、医护相关感染(74 例,占 12.4%)、患者护理事件(66 例,占 11.2%)和输血反应(3 例,占 0.5%)。不良事件最常发生在普通护理病房(289 例,48.8%),其次是手术室(155 例,26.1%)、重症监护病房(77 例,13.0%)、恢复室(20 例,3.3%)、急诊科(11 例,1.8%)和其他院内地点(42 例,7.0%)。涉及最多的职业是主治医师(531 人,占 89.5%),其次是护士(349 人,占 58.9%)、住院医师(294 人,占 49.5%)、高级医师(169 人,占 28.5%)和研究员(68 人,占 11.5%)。结论 在超过三分之一的入院手术患者中发现了不良事件,其中近一半的事件被归类为重大事件,大部分都是可以预防的。这些发现强调,在整个围手术期护理过程中,所有医护人员都必须不断改进患者安全。补充方法 S3 显示了用于数据准备和分析的 SAS 代码。由于保密要求,本项目的数据主要保留给麻省总医院布里格姆分院的直接研究团队。不过,通过联系主要研究人员(DWB),可以在安全的服务器上访问去标识化的数据。此外,有兴趣的研究人员还可获得项目使用的协议和不良事件图表审查培训手册,以及有关数据管理和分析的更多详细信息。
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引用次数: 0
Simple and cost effective solution to applying cold sensation in the assessment of regional anaesthesia 在区域麻醉评估中应用冷感的简单而经济的解决方案
Pub Date : 2024-11-13 DOI: 10.1136/bmj.q2469
Callum H Weller
Nichols and colleagues describe the use of reusable devices for applying cold sensation when assessing regional anaesthesia.1 I find the concept of these reusable devices commendable, but perhaps overly engineered. The financial and environmental costs associated with disposable cold sprays are indeed concerning. But the proposed solution …
Nichols 及其同事介绍了在评估区域麻醉时使用可重复使用的冷感设备的情况1。与一次性冷喷相关的经济和环境成本确实令人担忧。但建议的解决方案...
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引用次数: 0
Time to talk to patients about climate change 是时候与患者讨论气候变化问题了
Pub Date : 2024-11-13 DOI: 10.1136/bmj.q2444
Enrique Falce
The spread of misinformation and disinformation about climate change and health is of great concern to society.1 The healthcare community must engage in climate change education with at least as strong a resolve as it has with other major public health challenges (such as smoking cessation). Piatek …
有关气候变化和健康的错误信息和虚假信息的传播引起了社会的极大关注。1 医疗保健界必须至少以应对其他重大公共卫生挑战(如戒烟)的坚定决心参与气候变化教育。Piatek ...
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引用次数: 0
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