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Compassion 同情
Pub Date : 2023-07-19 DOI: 10.12746/swrccc.v11i48.1201
C. Nugent
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引用次数: 0
ChatGPT and Medicine: Fears, Fantasy, and the Future of Physicians 聊天技术与医学:医生的恐惧、幻想和未来
Pub Date : 2023-07-19 DOI: 10.12746/swrccc.v11i48.1193
Christopher Peterson
The generative artificial intelligence (AI) ChatGPT has attracted media attention for its ability to answer a wide variety of questions with a human-like writing style, including questions from the USMLE licensing examination. Some wonder if this indicates physicians’ eventual demise at AI’s hands. On the contrary, physicians contribute a unique skill set that technology cannot reproduce or replicate. ChatGPT also has critical limitations that will likely prevent it from replacing human operators or thinkers. Furthermore, the challenges from and worries over new technology are nothing new, with professionals and industries historically adapting to these changes.
生成式人工智能(AI) ChatGPT因其能够以类似人类的写作风格回答各种问题而吸引了媒体的关注,包括USMLE执照考试中的问题。一些人想知道,这是否意味着医生最终会在人工智能的手中消亡。相反,医生提供了一套技术无法复制或复制的独特技能。ChatGPT也有一些关键的限制,可能会阻止它取代人类操作员或思考者。此外,来自新技术的挑战和担忧并不是什么新鲜事,专业人士和行业一直在适应这些变化。
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引用次数: 2
Percutaneous tracheostomy in patients with COVID-19 infection and acute respiratory failure COVID-19感染合并急性呼吸衰竭患者的经皮气管造瘘术
Pub Date : 2023-07-19 DOI: 10.12746/swrccc.v11i48.1205
T. Singh, Hasham Sarwar, A. Hurtado, Ebtesam Islam
Background: Tracheostomy is often performed in patients who need prolonged intubation. COVID -19 brought unforeseen challenges, thus altering previously established norms. In this study, the outcomes of the patients undergoing tracheostomy for respiratory failure due to COVID -19 were studied. Methods: This is a single center retrospective observational cohort study of patients who underwent percutaneous tracheostomies between March 1, 2020, and September 30, 2021, due to respiratory failure secondary to COVID-19. Inclusion criteria included performance of percutaneous tracheostomies on patients with confirmed diagnosis of COVID-19. Exclusion criteria included patients undergoing surgical tracheostomies, extubation prior to the performance of a tracheotomy, and death prior to the performance of the tracheotomy. Results: The study included 49 patients after reviewing the records of 101 patients who underwent tracheostomies during the study period. The average age of the population was 59 ± 11years; 33 patients (67%) were men. The median Sequential Organ Failure Assessment (SOFA) score on admission was 2.  The median duration of mechanical ventilation prior to tracheostomy was 18 days; the median positive end expiratory pressure was 10 cm H2O and the median fraction of inspired oxygen (FiO2) was 0.45. Two patients died during the procedure, one secondary to cardiac arrest and one secondary to bleeding. Eighteen patients (38%) died after the procedure during hospitalization; the median length of mechanical ventilation for all patients was 32.5 days.  Eleven patients (22%) were eventually decannulated. Twenty patients (40%) were discharged to rehabilitation, and nine patients (18%) were discharged home. Eighteen patients (36%) were alive at the end of 90 days. Twelve patients (26%) were lost to follow up after discharge from the hospital. At the time of the tracheostomy, 16 patients (32%) had moderate ARDS as per the Berlin definition, and 12 (24%) had severe ARDS. Conclusion: Tracheostomy is an important therapeutic intervention in critically ill patients requiring mechanical ventilation.  The COVID-19 pandemic raised important concerns and uncertainties about the management of these patients and the safety of healthcare workers.  In this study, 29 patients (59%) undergoing tracheostomies recovered enough to be discharged to rehabilitation or to their homes.  The risks to patients and to healthcare workers seem reasonable, but the optimal timing is uncertain and is best tailored to each patient based on his/her clinical status and prognosis.   Keywords: COVID-19, tracheostomy, mechanical ventilation, acute respiratory failure
背景:气管切开术常用于需要长时间插管的患者。COVID -19带来了无法预料的挑战,从而改变了先前建立的规范。本研究对新冠肺炎所致呼吸衰竭患者行气管切开术的结果进行研究。方法:这是一项单中心回顾性观察队列研究,研究对象是2020年3月1日至2021年9月30日期间因COVID-19继发呼吸衰竭接受经皮气管切开术的患者。纳入标准包括确诊为COVID-19的患者行经皮气管切开术。排除标准包括接受气管切开术、气管切开术前拔管和气管切开术前死亡的患者。结果:在回顾研究期间101例气管切开术患者的记录后,该研究纳入了49例患者。人口平均年龄59±11岁;33例(67%)为男性。入院时序贯器官衰竭评估(SOFA)评分中位数为2分。气管切开术前机械通气的中位持续时间为18天;中位呼气末正压为10 cm H2O,中位吸入氧分数(FiO2)为0.45。两名患者在手术过程中死亡,一名继发于心脏骤停,一名继发于出血。18例患者(38%)在住院期间手术后死亡;所有患者机械通气的中位时间为32.5天。11例患者(22%)最终进行了脱管。20例患者(40%)出院康复,9例患者(18%)出院回家。在90天结束时,18例患者(36%)存活。出院后失访12例(26%)。在气管切开术时,16例(32%)患者为中度ARDS(柏林定义),12例(24%)患者为重度ARDS。结论:气管切开术是需要机械通气的危重病人重要的治疗干预措施。COVID-19大流行引发了对这些患者管理和医护人员安全的重大担忧和不确定性。在本研究中,29名接受气管切开术的患者(59%)康复到可以出院或回家。对患者和医护人员的风险似乎是合理的,但最佳时机是不确定的,最好根据每个患者的临床状况和预后量身定制。关键词:COVID-19,气管造口术,机械通气,急性呼吸衰竭
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引用次数: 0
Pregnancy outcomes in patients with COVID-19: A retrospective chart review and literature review COVID-19患者的妊娠结局:回顾性图表综述和文献综述
Pub Date : 2023-07-19 DOI: 10.12746/swrccc.v11i48.1203
Christopher Peterson, Mostafa M Abohelwa, Sima Shahbandar, Dylan M. Landis, Nandini Ray, Nabeela Manal, Patrice Lamey, A. Reddy, M. Rizi, D. Payne
Objective: Pregnant women are at a higher risk for severe 2019 novel coronavirus (COVID-19) infection compared to non-pregnant women. Because of this, careful monitoring and studies of this population should be carried out. Here we identify the clinical characteristics, neonatal outcomes, and population demographics of COVID-positive pregnant women admitted to the University Medical Center in Lubbock, Texas. Methods: This retrospective study reviewed a cohort of pregnant patients with confirmed COVID-19 admitted to Texas Tech University Health Sciences Center and its affiliated University Medical Center between April 12, 2020, and January 25, 2021 Results: Thirty-six patients met inclusion criteria. The average patient age was 29 ± 4.8 years, and 61.1% of patients identified their ethnicity as Hispanic or Latino origin.  The mean length of stay was 3.3 ± 3.6 days, and the remaining number of weeks of pregnancy at delivery was 37.8 ± 2.3 weeks. No deaths occurred in the mothers; three pregnancies did not result in a live birth. Notable findings included an increased rate of pre-term births (18.2%), an increased rate of NICU admissions (16.7%), and an increased rate of gestational diabetes (13.9%) compared to national averages in pregnant women. Conclusions: Many of our findings confirmed the existing literature concerning pregnancy outcomes among COVID-19-positive pregnant women, including relatively high preterm birth and NICU admission rates. The number of women who identified their ethnicity as Hispanic or Latino was high, which may reflect the overall demographics in West Texas. Furthermore, our gestational diabetes rate was also higher than the national average, possibly reflecting the high obesity rates in this area. We recommend further research on the mechanisms of preterm birth in COVID-19 illness and on ways to improve the health and healthcare outcomes in West Texas residents.
目的:与非孕妇相比,孕妇感染2019年新型冠状病毒(COVID-19)的风险更高。因此,应该对这一人群进行仔细的监测和研究。在这里,我们确定了在德克萨斯州拉伯克大学医学中心入院的covid - 19阳性孕妇的临床特征、新生儿结局和人口统计数据。方法:本回顾性研究回顾了2020年4月12日至2021年1月25日期间在德克萨斯理工大学健康科学中心及其附属大学医学中心收治的确诊COVID-19孕妇队列。结果:36例患者符合纳入标准。患者平均年龄为29±4.8岁,61.1%的患者认为自己的种族是西班牙裔或拉丁裔。平均住院时间3.3±3.6天,分娩剩余妊娠周数37.8±2.3周。没有母亲死亡;三次怀孕都没有活产。值得注意的发现包括与全国平均水平相比,早产率增加(18.2%),新生儿重症监护病房入院率增加(16.7%),妊娠糖尿病发生率增加(13.9%)。结论:我们的许多发现证实了现有文献中关于covid -19阳性孕妇妊娠结局的研究,包括相对较高的早产率和新生儿重症监护病房入院率。认为自己的种族是西班牙裔或拉丁裔的女性人数很高,这可能反映了西德克萨斯州的整体人口结构。此外,我们的妊娠糖尿病发病率也高于全国平均水平,这可能反映了该地区的高肥胖率。我们建议进一步研究新冠肺炎患者早产的机制,以及改善西德克萨斯州居民健康和医疗保健结果的方法。
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引用次数: 0
Interpretable artificial intelligence (AI) – saliency maps 可解释的人工智能(AI) -显著性地图
Pub Date : 2023-07-19 DOI: 10.12746/swrccc.v11i48.1209
Shengping Yang, G. Berdine
explainability of AI models to consumers of the predictions, and to possibly improve how experts interpret the difficult examples. In biomedical imaging, the best practice may require preliminary sorting of radiographic images by interpretive AI with follow-up review by a human expert for the difficult cases.
人工智能模型的可解释性,并可能提高专家如何解释困难的例子。在生物医学成像中,最佳做法可能需要通过解释性人工智能对放射图像进行初步分类,并由人类专家对困难病例进行后续审查。
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引用次数: 0
Dysphagia and dyspnea due to osteophyte formation in the cervical spine 颈椎骨赘造成的吞咽困难和呼吸困难
Pub Date : 2023-07-19 DOI: 10.12746/swrccc.v11i48.1199
W. Derrick, A. Motes
intrusion seem to be more common. 4 Treatment for airway obstruction due to an osteophyte includes surgical resection without fusion, but some patients are not candidates due to other comorbidity.
入侵似乎更常见。由于骨赘引起的气道阻塞的治疗包括手术切除而不融合,但由于其他合并症,一些患者不适合手术。
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引用次数: 0
The COVID-19 pandemic and births in Lubbock county COVID-19大流行和拉伯克县的出生
Pub Date : 2023-07-19 DOI: 10.12746/swrccc.v11i48.1195
G. Berdine, Shengping Yang
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引用次数: 0
Nasopharyngeal adenoid cystic carcinoma metastasis to the liver 鼻咽腺样囊性癌转移至肝脏
Pub Date : 2023-07-19 DOI: 10.12746/swrccc.v11i48.1173
W. Jang, Akshay Raghuram, D. Arif
Adenoid cystic carcinoma (ACC) is a malignancy of the secretory epithelial cells of the salivary glands and constitutes less than 1% of all head and neck tumors. Metastasis occurs frequently and most commonly affects the lungs at a rate of 35 to 50%. In this case report, we present a rare case of nasopharyngeal ACC with distant metastasis to the liver. Our patient initially presented to the hospital with dental and sinus pain with initial imaging suggesting nasopharyngeal carcinoma invading the temporal lobe laterally and the cavernous sinus and clivus medially. The foramen ovale and the optic nerve were also involved, leading to loss of vision bilaterally. Immunohistochemical staining of the biopsy eventually led to the correct diagnosis of high-grade ACC, solid type. The patient’s hospital course was complicated, with pulmonary thrombosis eventually leading to hypoxic respiratory failure and death. Although this patient was initially diagnosed with nasopharyngeal carcinoma, thorough pathologic investigations allowed for a clearer understanding of the disease, primarily ACC’s eventual distal metastasis in the patient. In the future, providers should continue to keep ACC in their differential diagnosis list when evaluating patients with head and neck tumors, with the goal of maintaining locoregional control of the tumor.Keywords: adenoid cystic carcinoma, liver metastasis, nasopharyngeal salivary glands, head and neck cancer
腺样囊性癌(ACC)是一种涎腺分泌性上皮细胞的恶性肿瘤,占头颈部肿瘤的不到1%。转移发生频繁,最常影响肺部,发生率为35%至50%。在这个病例报告中,我们提出了一个罕见的鼻咽部ACC远处转移到肝脏的病例。我们的病人最初以牙齿和鼻窦疼痛就诊,最初的影像学显示鼻咽癌向外侧侵犯颞叶,向内侧侵犯海绵窦和斜坡。卵圆孔和视神经也受累,导致双侧视力丧失。活检的免疫组化染色最终正确诊断为高级别ACC,实型。患者的住院过程很复杂,肺部血栓形成最终导致缺氧呼吸衰竭和死亡。虽然该患者最初被诊断为鼻咽癌,但彻底的病理检查使我们对该疾病有了更清晰的认识,主要是ACC最终在患者体内的远端转移。未来,在评估头颈部肿瘤患者时,医生应继续将ACC纳入其鉴别诊断清单,以维持肿瘤的局部控制。关键词:腺样囊性癌,肝转移,鼻咽唾液腺,头颈癌
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引用次数: 0
The impact of a “Back to Bedside” initiative on resident education “回到床边”倡议对住院医师教育的影响
Pub Date : 2023-07-19 DOI: 10.12746/swrccc.v11i48.1183
Nikhil Seth, M. Riaz, Anika Sikka, G. Martinez
Background: Back to Bedside is an American Council of Graduate Medical Education (ACGME) sponsored program with the goal of giving trainees a chance to find deeper meaning in their clinical work. As technological advances have decreased the amount of time trainees are spending with patients, a program was started that gives residents the opportunity to explore their patient interaction and communication skills. Observations: Residents spent one week on an elective during which they had uninterrupted time during ten patient encounters and were able to address multiple factors. They assisted with goals of care discussions, education on illness, education on medications, and practiced their communication skills.Conclusion: Thirty-one residents participated and completed a survey after the elective. This elective proved to be of great benefit to residents in many areas. They found personal growth in their ability to communicate medical findings in an easy-to-understand format, an improvement in general communication skills, and an improvement in understanding routine and complex pathology. As effective communication is key to patient safety, this study proves that communication curricula can improve physician-patient interactions. Keywords: Communication, medical education, medical curriculum
背景:回到床边是美国研究生医学教育委员会(ACGME)赞助的一个项目,目的是让实习生有机会在他们的临床工作中找到更深层次的意义。由于技术的进步减少了实习生与病人相处的时间,因此开始了一个项目,让实习医生有机会探索他们与病人的互动和沟通技巧。观察:住院医生花了一周的时间进行选修课,在此期间,他们可以不间断地接触10个病人,并能够解决多种因素。他们协助达成护理讨论、疾病教育、药物教育的目标,并练习他们的沟通技巧。结论:选修课结束后,31名住院医师参与并完成了问卷调查。事实证明,这门选修课对许多地区的居民都有很大的好处。他们发现,以易于理解的形式传达医学发现的能力有所提高,一般沟通技巧有所提高,对常规和复杂病理的理解也有所提高。有效的沟通是病患安全的关键,本研究证明沟通课程可以改善医患互动。关键词:传播学,医学教育,医学课程
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引用次数: 0
Health literacy and social determinants of health 卫生知识普及和健康的社会决定因素
Pub Date : 2023-04-25 DOI: 10.12746/swrccc.v11i47.1169
D. Flores, Morgan House, J. Pearson, D. Stuart
Health Literacy and Social Determinants of Health are closely intertwined. Health disparities and inequities, overall health outcomes, understanding health information, and the ability to be fully informed about medical decisions can have long-term consequences. This connection is even more pronounced in rural and underserved urban areas where low health literacy is prevalent. This review seeks to identify correlations between health literacy and social determinants of health. It further proposes to indicate how key constituencies (healthcare organizations, healthcare providers, and patients) can further develop and disseminate health literacy initiatives to improve overall health and wellness. The research team used the Covidence database to screen, review, and extract peer-reviewed research articles for this study. The initial review identified 75 articles based on term harvesting and keyword searches considered relevant to the review. Selection, review, and characterization were performed by three reviewers on a team of four researchers. The articles’focuses are different regarding the observed impact on literacy concerning certain chronic health conditions, rural versus urban population centers, health education, ethnic and racial differentiation, and other variables. There are notable gaps in the current literature that relate to concrete methodologies to address these concerns.
卫生知识普及和健康的社会决定因素密切相关。健康差异和不平等、总体健康结果、理解健康信息以及充分了解医疗决策的能力可能产生长期影响。这种联系在农村和服务不足的城市地区更为明显,这些地区普遍存在卫生知识普及程度低的问题。本综述旨在确定健康素养与健康的社会决定因素之间的相关性。它还建议指出,关键部门(医疗保健组织、医疗保健提供者和患者)如何能够进一步制定和传播卫生知识普及倡议,以改善整体健康和福祉。研究小组使用covid数据库为本研究筛选、审查和提取同行评审的研究文章。最初的审查确定了75篇文章基于术语收集和关键词搜索认为相关的审查。选择、回顾和描述由四名研究人员组成的小组中的三名评论者完成。文章的重点是不同的,关于某些慢性健康状况,农村与城市人口中心,健康教育,民族和种族差异,以及其他变量对识字率的影响。在目前的文献中,有一些与解决这些问题的具体方法有关的显著差距。
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引用次数: 0
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The Southwest Respiratory and Critical Care Chronicles
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