Spinal subarachnoid hemorrhage(SSAH)is a relatively uncommon but significant cause of acute and progressive neurological impairment.It represents less than 1.5%of all instances of bleeding within the subarachnoid spac...Spinal subarachnoid hemorrhage(SSAH)is a relatively uncommon but significant cause of acute and progressive neurological impairment.It represents less than 1.5%of all instances of bleeding within the subarachnoid space.[1]The early stages of SSAH often present atypical clinical symptoms,making diagnosis challenging and potentially leading to treatment delays,which further result in irreversible neurological damage.Lower back pain is a common complaint in the emergency department(ED).[2]Common causes include overuse resulting in back strain.展开更多
Objective:Lung cancer has the highest incidence and mortality of all malignant tumors in China.Cancer pain dramatically affects patients’comfort level,causing insomnia,anorexia,anxiety,fear,depression,and a decline i...Objective:Lung cancer has the highest incidence and mortality of all malignant tumors in China.Cancer pain dramatically affects patients’comfort level,causing insomnia,anorexia,anxiety,fear,depression,and a decline in the quality of life(QOL).The literature suggests a shortage of adequate cancer pain management for 59.1% of patients in China.The quality control circle(QCC)activity reflects the people-oriented core idea of management.This study aimed to assess the efficacy of QCC in enhancing the effectiveness of drug interventions in lung cancer patients with moderate to severe pain.Methods:From January 2019 to July 2019,lung cancer patients with moderate to severe pain were treated with drugs.The total number of drug interventions was 3072.A QCC activity was performed following the ten steps of the plan-do-check-act(PDCA)model.The reasons for the poor effectiveness of drug intervention in lung cancer patients with moderate to severe pain were analyzed.Countermeasures were designed to improve the effectiveness of drug intervention,including setting up a pain college,writing a medication education manual,and formulating operational rules for the administration of narcotic drugs.The effectiveness of drug intervention in lung cancer patients with moderate to severe pain and activity ability scores of QCC members were analyzed statistically before and after QCC activity.The effectiveness of drug intervention was investigated and compared before and after establishing the QCC.Results:After establishing the PDCA model,the effectiveness of drug intervention for moderate to severe pain in lung cancer patients increased from 56.28% to 85.29%.Members had significant improvement in problem-solving ability,responsibility,communication,coordination,self-confidence,team cohesion,enthusiasm,QCC skills,and harmony.Conclusion:QCC activity can significantly improve the efficiency of drug intervention in lung cancer patients with moderate to severe pain and their quality of life.展开更多
BACKGROUND Osteoarthritis(OA)is a common degenerative joint disease that considerably affects the quality of life(QoL)of individuals,especially the elderly.The Kellgren-Lawrence(KL)grading system assesses the severity...BACKGROUND Osteoarthritis(OA)is a common degenerative joint disease that considerably affects the quality of life(QoL)of individuals,especially the elderly.The Kellgren-Lawrence(KL)grading system assesses the severity of OA through radiographic evaluation,whereas the Knee Injury and Osteoarthritis Outcome Score(KOOS)measures clinical symptoms and functional status.AIM To analyze the relationship between KL grades and KOOS to elucidate the association between radiographic severity and clinical manifestations of knee OA.METHODS A cross-sectional study was performed at King Fahd Hospital of the University,involving 164 adult patients diagnosed with knee OA.Patients were evaluated using the KL system,based on standing knee X-rays performed within the last six months.The KOOS questionnaire was utilised for clinical assessment,evaluating five domains:(1)Pain;(2)Symptoms;(3)Activities of daily living;(4)Sport and recreation function;and(5)Knee-related QoL.Analysis of variance was utilised to examine variations in KOOS domain scores among different patient variables.The correlations between KOOS domains were determined using Pearson's correlation.RESULTS KOOS scores demonstrated a significant decline in patients with elevated KL grades,with Grade 4 exhibiting the lowest scores and grade 1 the highest(P<0.001).The correlation between pain and activities of daily living was strong(r=0.871,P<0.001),as was the correlation with knee-related QoL(r=0.754,P<0.001).Notable age-related disparities were observed,as older patients(≥60 years)indicated poorer pain and functional outcomes.Gender differences were noted exclusively in symptoms,with females exhibiting lower scores than males(P=0.022).CONCLUSION The association between radiographic severity and clinical impact is shown by the substantial correlation between KL grading and KOOS results,especially in later stages of OA.The results highlight the necessity for thorough assessments that integrate radiographic and clinical evaluations for individualized therapy choices for OA patients.展开更多
BACKGROUND Carotid blowout syndrome(CBS)is a rupture of the carotid artery and is mainly caused by radiation and resection of head and neck cancers or direct tumor invasion of the carotid artery wall.It is a life-thre...BACKGROUND Carotid blowout syndrome(CBS)is a rupture of the carotid artery and is mainly caused by radiation and resection of head and neck cancers or direct tumor invasion of the carotid artery wall.It is a life-threatening clinical situation.There is no established and effective mode of management of CBS.Furthermore,there is no established preceding sign or symptom;therefore,preventive efforts are not clinically meaningful.CASE SUMMARY We described two cases of CBS that occurred in patients with head and neck cancer after definitive chemoradiotherapy(CRT)using three-dimensional conformal intensity-modulated radiation therapy.Two men aged 61 and 56 years with locally advanced head and neck cancer were treated with definitive CRT.After completing CRT,both of them achieved complete remission.Subsequently,they had persistent severe pain in the oropharyngeal mucosal region and the irradiated neck despite the use of opioid analgesics and rehabilitation for relief of contracted skin.However,continuous follow-up imaging studies showed no evidence of cancer recurrence.Eleven to twelve months after completing CRT,the patients visited the emergency room complaining about massive oronasal bleeding.Angiograms showed rupture of carotid artery pseudoaneurysms on the irradiated side.Despite attempting to secure hemostasis with carotid arterial stent insertion and coil embolization,both patients died because of repeated bleeding from the pseudoaneurysms.CONCLUSION In patients with persistent pain in irradiated sites,clinicians should be suspicious of progressing or impending CBS,even in the three-dimensional conformal intensity-modulated radiation therapy era.展开更多
基金National Natural Science Foundation of China(82472218)National Key Clinical Specialist Construction Project(Z155080000004)+4 种基金National Key Research and Development Program of China(2024YFC3044400)Noncommunicable Chronic Diseases-National Science and Technology Major Project(2023ZD0506502)the Science and Technology of Shanghai Committee(23Y31900100)Shen Kang Hospital Development Center Project for Technical Standardization Management and Promotion(SHDC22023239)Key Supporting Discipline of Shanghai Healthcare System(2023ZDFC0102).
文摘Spinal subarachnoid hemorrhage(SSAH)is a relatively uncommon but significant cause of acute and progressive neurological impairment.It represents less than 1.5%of all instances of bleeding within the subarachnoid space.[1]The early stages of SSAH often present atypical clinical symptoms,making diagnosis challenging and potentially leading to treatment delays,which further result in irreversible neurological damage.Lower back pain is a common complaint in the emergency department(ED).[2]Common causes include overuse resulting in back strain.
基金supported by the National Key Research and Development Plan of China(No.2017YFC0909900).
文摘Objective:Lung cancer has the highest incidence and mortality of all malignant tumors in China.Cancer pain dramatically affects patients’comfort level,causing insomnia,anorexia,anxiety,fear,depression,and a decline in the quality of life(QOL).The literature suggests a shortage of adequate cancer pain management for 59.1% of patients in China.The quality control circle(QCC)activity reflects the people-oriented core idea of management.This study aimed to assess the efficacy of QCC in enhancing the effectiveness of drug interventions in lung cancer patients with moderate to severe pain.Methods:From January 2019 to July 2019,lung cancer patients with moderate to severe pain were treated with drugs.The total number of drug interventions was 3072.A QCC activity was performed following the ten steps of the plan-do-check-act(PDCA)model.The reasons for the poor effectiveness of drug intervention in lung cancer patients with moderate to severe pain were analyzed.Countermeasures were designed to improve the effectiveness of drug intervention,including setting up a pain college,writing a medication education manual,and formulating operational rules for the administration of narcotic drugs.The effectiveness of drug intervention in lung cancer patients with moderate to severe pain and activity ability scores of QCC members were analyzed statistically before and after QCC activity.The effectiveness of drug intervention was investigated and compared before and after establishing the QCC.Results:After establishing the PDCA model,the effectiveness of drug intervention for moderate to severe pain in lung cancer patients increased from 56.28% to 85.29%.Members had significant improvement in problem-solving ability,responsibility,communication,coordination,self-confidence,team cohesion,enthusiasm,QCC skills,and harmony.Conclusion:QCC activity can significantly improve the efficiency of drug intervention in lung cancer patients with moderate to severe pain and their quality of life.
文摘BACKGROUND Osteoarthritis(OA)is a common degenerative joint disease that considerably affects the quality of life(QoL)of individuals,especially the elderly.The Kellgren-Lawrence(KL)grading system assesses the severity of OA through radiographic evaluation,whereas the Knee Injury and Osteoarthritis Outcome Score(KOOS)measures clinical symptoms and functional status.AIM To analyze the relationship between KL grades and KOOS to elucidate the association between radiographic severity and clinical manifestations of knee OA.METHODS A cross-sectional study was performed at King Fahd Hospital of the University,involving 164 adult patients diagnosed with knee OA.Patients were evaluated using the KL system,based on standing knee X-rays performed within the last six months.The KOOS questionnaire was utilised for clinical assessment,evaluating five domains:(1)Pain;(2)Symptoms;(3)Activities of daily living;(4)Sport and recreation function;and(5)Knee-related QoL.Analysis of variance was utilised to examine variations in KOOS domain scores among different patient variables.The correlations between KOOS domains were determined using Pearson's correlation.RESULTS KOOS scores demonstrated a significant decline in patients with elevated KL grades,with Grade 4 exhibiting the lowest scores and grade 1 the highest(P<0.001).The correlation between pain and activities of daily living was strong(r=0.871,P<0.001),as was the correlation with knee-related QoL(r=0.754,P<0.001).Notable age-related disparities were observed,as older patients(≥60 years)indicated poorer pain and functional outcomes.Gender differences were noted exclusively in symptoms,with females exhibiting lower scores than males(P=0.022).CONCLUSION The association between radiographic severity and clinical impact is shown by the substantial correlation between KL grading and KOOS results,especially in later stages of OA.The results highlight the necessity for thorough assessments that integrate radiographic and clinical evaluations for individualized therapy choices for OA patients.
文摘BACKGROUND Carotid blowout syndrome(CBS)is a rupture of the carotid artery and is mainly caused by radiation and resection of head and neck cancers or direct tumor invasion of the carotid artery wall.It is a life-threatening clinical situation.There is no established and effective mode of management of CBS.Furthermore,there is no established preceding sign or symptom;therefore,preventive efforts are not clinically meaningful.CASE SUMMARY We described two cases of CBS that occurred in patients with head and neck cancer after definitive chemoradiotherapy(CRT)using three-dimensional conformal intensity-modulated radiation therapy.Two men aged 61 and 56 years with locally advanced head and neck cancer were treated with definitive CRT.After completing CRT,both of them achieved complete remission.Subsequently,they had persistent severe pain in the oropharyngeal mucosal region and the irradiated neck despite the use of opioid analgesics and rehabilitation for relief of contracted skin.However,continuous follow-up imaging studies showed no evidence of cancer recurrence.Eleven to twelve months after completing CRT,the patients visited the emergency room complaining about massive oronasal bleeding.Angiograms showed rupture of carotid artery pseudoaneurysms on the irradiated side.Despite attempting to secure hemostasis with carotid arterial stent insertion and coil embolization,both patients died because of repeated bleeding from the pseudoaneurysms.CONCLUSION In patients with persistent pain in irradiated sites,clinicians should be suspicious of progressing or impending CBS,even in the three-dimensional conformal intensity-modulated radiation therapy era.
