Why measuring outcomes is important in health care

A new strategy has been introduced in human health care, namely, achieving the best outcomes for the lowest cost and thus maximizing value for patients. In value‐based care, the only true measures of quality are the outcomes that matter to patients. When outcomes are measured and reported, it fosters improvement and adoption of best practices, thus further improving outcomes. Understanding outcomes is central in providing value and represents an opportunity for redefining veterinary patient care. Value is created by improving the outcomes of patients with a particular clinical condition over the full cycle of care, which normally involves multiple specialties and care sites. To be successful, a key aspect of value based care is working as teams (integrated practice units) centered around the patient's clinical condition. As veterinary medicine has become more specialized and more complex, multidisciplinary communication and trust among the care team are paramount in providing value to patients (and clients). Use of patient‐reported outcomes is an essential aspect for improving clinical care, because it enhances the connections among doctors and with patients. Designing and implementing owner‐reported outcomes in veterinary clinical practice will lead to an understanding of the effects of treatments on outcomes and quality of life (QOL) of our patients from the owner's perspective, a key way to assess a veterinary patient's QOL.     

One Health in Practice: A Pilot Project for Integrated Care of Zoonotic Infections in Immunocompromised Children and Their Pets in Chile

Although pets provide physiological and psychological benefits to their owners, they are a potential source of zoonotic infections, especially for vulnerable individuals such as immunocompromised patients. During 1 year, we therefore performed a pilot project, which included 32 immunocompromised Chilean children and their family pets (35 dogs and 9 cats) with the aim of detecting, treating and preventing zoonotic infections. Children were examined by Infectious Diseases paediatricians and demographical and clinical information related to zoonotic infections were recorded. Pets were examined and sampled by veterinarians, who also administered missing routine vaccines and anti‐parasitics. During family visits, all members were informed and educated about zoonoses and a satisfaction survey was performed. Visits also included vector control and indoor residual spraying with pyrethroids. Children were re‐examined and re‐tested according to the findings of their pets, and all detected zoonotic infections were treated both in children and pets. Physical examination revealed abnormalities in 18 dogs (51.4%) and three cats (33.3%). Twenty‐eight (63.6%) of the pets were diagnosed with a zoonotic pathogen, and seven (15.9%) with a facultative pathogen. Most zoonotic agents were isolated from the pet's external ear and intestine. Bacteria with the highest pathogenic potential were Campylobacter jejuni and Brucella canis. In two children and their respective pets, the same zoonotic diseases were diagnosed (toxocariasis and giardiasis). Arthropods serving as potential vectors of zoonotic infections were found in 49% of dogs and 44% of cats. The pilot project was positively evaluated by the participating families. Our pilot project confirmed that pets are reservoir for various zoonotic agents in Chile and that the implementation of an integrated multidisciplinary programme was a valuable tool to prevent, diagnose and treat such zoonotic infections in vulnerable patients such as immunocompromised children.     

Molecular phenotyping of malignant canine mammary tumours: Detection of high-risk group and its relationship with clinicomolecular characteristics

Canine mammary gland tumours (CMTs) constitute the most common cancer in female dogs and comprise approximately 50% of all canine cancers. With the advent of high-throughput technologies such as microarray and next-generation sequencing, the molecular phenotyping (classification) of various cancers has been extensively developed. The present study used a canine RNA-sequencing dataset, namely GSE119810, to classify 113 malignant CMTs and 64 matched normal samples via an unsupervised hierarchical algorithm with a view to evaluating the association between the resulting subtypes (clusters) (n = 4) and clinical and molecular characteristics. Finally, a molecular classifier was developed, and it detected 1 high-risk molecular subtype in the training dataset (GSE119810) and 2 independent validation datasets (GSE20718 and GSE22516). Our results revealed four molecular subtypes (C2–C5) in malignant CMTs. Furthermore, the normal samples constituted a distinct group in the clustering analysis. Marked significant associations were observed between the molecular subtypes (especially C5) and clinical/molecular features, including positive lymphatic invasion, high tumour grades, histopathology diagnoses, short survival and high TP53 mutation rates (ps <.05). The high-risk subtype (C5) was further characterized through the development of a cell cycle-based gene signature, which comprised 37 proliferation-related genes according to the support vector machine algorithm. This signature identified the high-risk group in both training and validation datasets (ps <.001). In the validation analysis, our potential classifier robustly predicted patients with positive lymphatic invasion, metastases and short survival.     

精神专科医院图书馆的服务创新

针对精神专科医院图书馆工作环境和服务对象的特殊性,对医院图书馆的服务创新进行

了探索,使其更好地服务于医院的工作人员、患者和家属,充分实现图书馆的核心价值。

 

     

环孢霉素A与妥布霉素地塞米松联合用药对犬高危穿透性角膜移植术免疫排斥的作用

使用环孢霉素A(CSA)滴眼液和妥布霉素地塞米松滴眼液联合用药,对犬高危穿透性角膜移植手术术后进行抗免疫排斥治疗,以探讨其对该手术术后的疗效.选择30只健康本地犬建立犬角膜高危病理模型,继而行穿透性角膜移植手术,术后将试验犬随即分为2组,生理盐水对照组15只,环孢霉素A滴眼液+妥布霉素地塞米松滴眼液组15只,分别于术后第2天进行滴眼治疗,6次/d,2滴/次,用药组进行交替药物滴眼,两次滴眼间隔2h,并对术眼进行眼压测定、组织病理学检查和裂隙灯检查,观察术后各组角膜免疫排斥情况和角膜组织结构情况.试验结果显示,用药组角膜发生免疫排斥的平均时间为49.33±9.61d,生理盐水组角膜发生免疫排斥的平均时间为10.83±2.93d,两组相比差异性极显著(P＜0.01).术后第5天测定所有术犬术眼眼压,结果均在正常范围内(10～20 mmHg).生理盐水组角膜组织结构发生了严重的变化和破坏,随着时间的推移呈严重发展趋势,用药组整个观察期角膜组织结构未发生明显变化.     

我国肿瘤患者弓形虫感染情况研究进展

弓形虫是一种重要的机会性寄生原虫,可感染人、哺乳动物及鸟类,引起人兽共患弓形虫病。目前,弓形虫感染已经成为一种严重的、全球性的公共卫生安全问题,引起了医学界的广泛关注。肿瘤患者的机体存在免疫功能障碍,对其进行放疗或化疗的过程中,则会进一步的降低肿瘤患者的免疫功能,临床上因抗肿瘤治疗而引起的弓形虫为典型代表的难治愈性寄生虫病的重症化已经愈发明显。肿瘤患者合并弓形虫感染的相关研究逐渐成为弓形虫病研究热点。论文对我国肿瘤患者弓形虫的流行情况﹑基因分型﹑传播途径及防治措施做一概述,旨在为有效防控肿瘤患者弓形虫共感染提供参考。     

Spinal ataxia in a 2-year-old colt caused by a compressive primary vertebral osteosarcoma

Neoplasia is a rare cause of ataxia in horses. This report describes a 2-year-old colt presented with sudden-onset ataxia in which a cervical vertebral osteosarcoma causing severe compression of the spinal cord was diagnosed. Radiological changes included a large osteolytic lesion in the vertebral body, the vertebral arch, the right cranial articular process and the right transverse process of C4, interrupting the borders of the vertebral foramen and the right transverse foramen. Myelography revealed a marked spinal cord compression. Necropsy confirmed the presence of a well-demarcated, invasive and firm mass protruding from the fourth cervical vertebral body that led to severe compression of the spinal cord. In spite of its strongly pleomorphic nature, the detection of osteoid confirmed the diagnosis of a central osteosarcoma of the combined type. To the best of our knowledge, a primary single vertebral osteosarcoma causing ataxia in a juvenile horse has not previously been reported, and findings of this case report could help in the diagnostic work-up of similar cases.     

老年心房颤动患者发生缺血性脑卒中危险因素的研究

目的:了解老年心房颤动(A f)患者发生缺血性脑卒中的危险因素。方法:采用病例对照研究对372例老年慢性A f患者的临床资料,比较发生与不发生缺血性脑卒患者的病因、心室率、年龄、性别、心衰、并发高血压病、糖尿病、心房扩大与心脏瓣膜钙化的差异。结果:A f患者中,发生与不发生缺血性脑卒患者的病因、心室率、并发高血压病、糖尿病、心房扩大、心脏瓣膜钙化的发生情况差异有非常显著性(P均<0.01),但性别、年龄、心衰、A f类型的发生情况差异均无显著性(P均>0.05)。结论:心脏瓣膜病、心室率过缓、高血压病与糖尿病是A f并缺血性脑卒中的高危因素,老年人A f并发上术疾病者容易出现缺血性脑卒中,应予临床干预。