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  • 文章类型: Journal Article
    高钾血症是一种普遍的电解质紊乱,与血清钾水平升高有关,导致不同的异常心电图结果和相关的临床体征和症状,通常需要特殊的治疗。然而,在一些患者中,即使血清钾水平升高,这些异常发现也可能不会出现在心电图上。这项研究旨在确定哥伦比亚西南部急诊科与高钾血症严重程度和临床结果相关的心电图异常。
    这是一项回顾性的横断面描述性研究。我们描述了心电图检查结果,临床特征,治疗,结果与高钾血症的程度有关。评估了高钾血症的严重程度与心电图结果之间的潜在关联。
    共纳入494例患者。钾水平的中位数为6.6mEq/L。61.5%的病例报告了异常的心电图结果。轻度和重度高钾血症组报告的异常分别为59.9%和61.2%,分别。最常见的心电图异常为峰值T波36.2%,其次是广泛的QRS83(16.8%)。只有1.4%的患者有不良结局。61.5%的异常发现。死亡率为11.9%。峰值T波是不同程度的高钾血症严重程度中最常见的发现。
    高血清钾水平与心电图异常有关。然而,不同程度的高钾血症患者无法描述异常的心电图表现.在肾脏慢性疾病和高钾血症的患者中,ECG的异常可能很小或没有。
    UNASSIGNED: Hyperkalemia is a prevalent electrolyte disorder related to elevated serum potassium levels, resulting in diverse abnormal electrocardiographic findings and associated clinical signs and symptoms, often necessitating specific treatment. However, in some patients, these abnormal findings may not be present on the electrocardiogram even in elevated serum potassium levels. This study aims to identify electrocardiographic abnormalities related to the severity of hyperkalemia and the clinical outcomes in an emergency department in southwestern Colombia.
    UNASSIGNED: This is a retrospective cross-sectional descriptive study. We described the electrocardiographic findings, clinical characteristics, treatment, and outcomes related to the degrees of hyperkalemia. The potential association between the severity of hyperkalemia and electrocardiographic findings was evaluated.
    UNASSIGNED: A total of 494 patients were included. The median of the potassium level was 6.6 mEq/L. Abnormal electrocardiographic findings were reported in 61.5% of the cases. Mild and severe hyperkalemia groups reported abnormalities in 59.9% and 61.2%, respectively. The most common electrocardiography abnormalities were the peaked T wave 36.2%, followed by wide QRS 83 (16.8%). Only 1.4% of patients had adverse outcomes. The abnormal findings were registered in 61.5%. Mortality was 11.9%. The peaked T wave was the most common finding across different levels of hyperkalemia severity.
    UNASSIGNED: High serum potassium levels are related with abnormal ECG. However, patients with different degrees of hyperkalemia could not describe abnormal ECG findings. In a high proportion of patients with renal chronic disease and hyperkalemia, the abnormalities in the ECG could be minimal or absent.
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  • 文章类型: Journal Article
    背景:在英国的医生中,关于推迟专业培训的情绪越来越高,移民到国外行医,或者完全离开这个行业。这一趋势可能对英国职业的未来产生重大影响。这种情绪在医学生群体中的存在程度尚不清楚。
    目的:我们的主要结果是确定当前医学生毕业后和完成基础课程后的职业意向,并确定这些意向背后的动机。次要结果包括确定哪些,如果有的话,人口因素改变了医学毕业生追求不同职业道路的倾向,确定医学生计划追求哪些专业,并了解目前对在国家卫生局(NHS)工作的前景的看法。
    方法:确定医学生的职业意向(AIMS)研究是一项全国性的,多机构,和横断面研究,英国所有医学院的所有医学生都有资格参加。它是通过一本小说管理的,混合方法,和基于网络的问卷,并通过为此目的招募的大约200名学生的合作网络进行传播。将进行定量分析和主题分析。
    结果:该研究于2023年1月16日在全国范围内启动。数据收集于2023年3月27日关闭,数据分析已经开始。预计结果将在今年晚些时候公布。
    结论:NHS中的医生职业满意度是一个经过充分研究的话题;但是,缺乏能够为医学生提供对未来职业前景的洞察力的高能研究。预计这项研究的结果将使这个问题变得清晰。确定的医疗培训或NHS内部的改进领域可以有针对性地改善医生的工作条件,并帮助留住医学毕业生。结果也可能有助于未来的劳动力规划工作。
    DERR1-10.2196/45992。
    BACKGROUND: Among doctors in the United Kingdom, there is growing sentiment regarding delaying specialist training, emigrating to practice medicine abroad, or leaving the profession altogether. This trend may have substantial implications for the future of the profession in the United Kingdom. The extent to which this sentiment is also present in the medical student population is not well understood.
    OBJECTIVE: Our primary outcome is to determine current medical students\' career intentions after graduation and upon completing the foundation program and to establish the motivations behind these intentions. Secondary outcomes include determining which, if any, demographic factors alter the propensity to pursue different career paths available to a medical graduate, determining which specialties medical students plan on pursuing, and understanding current views on the prospect of working in the National Health Service (NHS).
    METHODS: The Ascertaining the Career Intentions of Medical Students (AIMS) study is a national, multi-institution, and cross-sectional study in which all medical students at all medical schools in the United Kingdom are eligible to participate. It was administered via a novel, mixed methods, and web-based questionnaire and disseminated through a collaborative network of approximately 200 students recruited for this purpose. Both quantitative and thematic analyses will be performed.
    RESULTS: The study was launched nationally on January 16, 2023. Data collection was closed on March 27, 2023, and data analysis has commenced. The results are expected to be available later in the year.
    CONCLUSIONS: Doctors\' career satisfaction within the NHS is a well-researched topic; however, there is a shortage of high-powered studies that are able to offer insight into medical students\' outlook on their future careers. It is anticipated that the results of this study will bring clarity to this issue. Identified areas of improvement in medical training or within the NHS could be targeted to improve doctors\' working conditions and help retain medical graduates. Results may also aid future workforce-planning efforts.
    UNASSIGNED: DERR1-10.2196/45992.
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  • 文章类型: Journal Article
    为了实地测试弱势群体eGFR流行病学(DEGREE)协议,户外现场护理(POC)检测血清肌酐,和一个新的危险因素模块在美国户外西班牙裔工人的慢性肾病不明起源(CKDu)。
    在休斯敦(TX)采访了50名工人。DEGREE和CKDu问卷在室内完成。用于POC和实验室测定的人体测量和配对血液样本在两个时期(2017年11月至12月,2018年4月至5月)在户外完成。
    Degree和CKDu问卷的管理平均为10和5分钟,分别,所有的问题都很容易理解。我们观察到POC与IDMS肌酐(r=0.919)和BUN(r=0.974)之间存在高度相关性。当室外温度高于85°F或低于65°F时,POC设备将禁用测试;这是可调的。
    Degree和新的CKDu模块的实现很简单,很容易理解。POC装置在现场表现良好,当温度读数超出范围时,方法会有一些调整。
    To field test the Disadvantaged Populations eGFR Epidemiology (DEGREE) protocol, outdoor point-of-care (POC) testing for serum creatinine, and a new risk factor module on chronic kidney disease of undetermined origin (CKDu) in U.S. outdoor Hispanic workers.
    Fifty workers were interviewed in Houston (TX). DEGREE and CKDu questionnaires were completed indoors. Anthropometrics and paired blood samples for POC and laboratory assay were completed outdoors over two periods (November-December 2017, April-May 2018).
    Administration of DEGREE and CKDu questionnaires averaged 10 and 5 min, respectively, with all questions easily understood. We observed high correlations between POC and IDMS creatinine (r = 0.919) and BUN (r = 0.974). The POC device would disable testing when outdoor temperatures were above 85 °F or below 65 °F; this was adjustable.
    Implementation of DEGREE and the new CKDu module was straightforward and well understood. The POC device performed well in the field, with some adjustment in methods when temperature readings were out of range.
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  • 文章类型: Journal Article
    目的随着医疗保健领域的变化,神经外科主任的职位不断演变。作者在本文中的目的是表征神经外科系主任的职业属性,以定义神经外科领导者所追求的素质的时间趋势。具体来说,他们调查了这样一个假设,即在最近聘请的椅子上,以额外的高级学位和研究敏锐度的形式增加的资格变得越来越普遍,可能与他们角色的复杂性增加有关。方法作者进行了一项回顾性研究,他们收集了截至2016年12月31日在美国神经外科住院医师项目认可的学术机构担任神经外科主任的105名神经外科医生的数据。关于神经外科椅子职业的描述性数据,例如参加的居留计划,初级亚专业重点,以及他们接受椅子职位的年龄,被收集。结果神经外科主席接受该职位后的中位年龄和实践年限分别为47岁(36-63岁)和14岁(6-33岁),分别,87%(n=91)是第一次坐椅子。截至2016年12月31日,主席担任职务的时间中位数为10年(范围为1-34年)。最常见的亚专科是血管(35%)和肿瘤/颅底(27%),尽管从这些专业招聘的趋势随着时间的推移而减弱(p=0.02)。最近租用的椅子更有可能是旧的(p=0.02),有更多的出版物(p=0.007),并在租用时具有较高的h指数(p<0.001)。在被任命为椅子之前,13%(n=14)拥有博士学位,4%(n=4)拥有MBA学位,23%(n=24)获得了美国国立卫生研究院R01资助,随时间稳定的趋势(p=0.09-0.23),尽管当额外的学位被分析为二进制变量时,2010年或之后聘用的椅子更有可能拥有MBA和/或博士学位,而不是2010年之前聘用的椅子(26%vs10%,p=0.04)。由神经外科椅子参加的3个最常见的住院医师计划是马萨诸塞州总医院(n=8,8%),加州大学,旧金山(n=8,8%),和密歇根大学(n=6,6%)。大多数主席(n=63,61%)在被任命为主席之前曾在该机构居住和/或在该机构任职。随着时间的推移持续存在的趋势(p=0.86)。结论大多数神经外科部门的椅子在50岁之前被纳入该位置,尽管选择过程通常涉及国家搜索,大多数主席以前都与该部门有隶属关系,一种随着时间的推移相对稳定的现象。近年来,拥有更多高级学位和更广泛研究经验的椅子比例大幅增加,强调神经外科领导如何需要科学技能和获得赠款的能力,以及驾驭不断变化的金融医疗保健景观所需的金融技能。
    OBJECTIVEThe position of neurosurgery department chair undergoes constant evolution as the health care landscape changes. The authors\' aim in this paper was to characterize career attributes of neurosurgery department chairs in order to define temporal trends in qualities being sought in neurosurgical leaders. Specifically, they investigated the hypothesis that increased qualifications in the form of additional advanced degrees and research acumen are becoming more common in recently hired chairs, possibly related to the increased complexity of their role.METHODSThe authors performed a retrospective study in which they collected data on 105 neurosurgeons who were neurosurgery department chairs as of December 31, 2016, at accredited academic institutions with a neurosurgery residency program in the United States. Descriptive data on the career of neurosurgery chairs, such as the residency program attended, primary subspecialty focus, and age at which they accepted their position as chair, were collected.RESULTSThe median age and number of years in practice postresidency of neurosurgery chairs on acceptance of the position were 47 years (range 36-63 years) and 14 years (range 6-33 years), respectively, and 87% (n = 91) were first-time chairs. The median duration that chairs had been holding their positions as of December 31, 2016, was 10 years (range 1-34 years). The most common subspecialties were vascular (35%) and tumor/skull base (27%), although the tendency to hire from these specialties diminished over time (p = 0.02). More recently hired chairs were more likely to be older (p = 0.02), have more publications (p = 0.007), and have higher h-indices (p < 0.001) at the time of hire. Prior to being named chair, 13% (n = 14) had a PhD, 4% (n = 4) had an MBA, and 23% (n = 24) were awarded a National Institutes of Health R01 grant, tendencies that were stable over time (p = 0.09-0.23), although when additional degrees were analyzed as a binary variable, chairs hired in 2010 or after were more likely to have an MBA and/or PhD versus those hired before 2010 (26% vs 10%, p = 0.04). The 3 most common residency programs attended by the neurosurgery chairs were Massachusetts General Hospital (n = 8, 8%), University of California, San Francisco (n = 8, 8%), and University of Michigan (n = 6, 6%). Most chairs (n = 63, 61%) attended residency at the institution and/or were staff at the institution before they were named chair, a tendency that persisted over time (p = 0.86).CONCLUSIONSMost neurosurgery department chairs matriculated into the position before the age of 50 years and, despite selection processes usually involving a national search, most chairs had a previous affiliation with the department, a phenomenon that has been relatively stable over time. In recent years, a large increase has occurred in the proportion of chairs with additional advanced degrees and more extensive research experience, underscoring how neurosurgical leadership has come to require scientific skills and the ability to procure grants, as well as the financial skills needed to navigate the ever-changing financial health care landscape.
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