Transporting the adult critically ill patient

More than 10,000 intensive care patients are transferred each year in the UK, of whom the vast majority are accompanied by staff from the referring hospital. The high frequency of transfers of critically ill patients is primarily due to the escalating complexity of healthcare, the concentration of skills into specialized regional centres, and the relative lack of availability of intensive care unit (ICU) beds. The care practised during the constraints of patient transfer (whether within or between hospitals) should mirror the detailed attention to detail provided in the hospital ICU, and it is the responsibility of the transport team to ensure the efficacy of the process and safety of the patient. This is achieved through careful preparation and planning. Preparation starts with adequate and appropriate training of transfer personnel as well as selection of equipment which is fit for purpose. Success is based on anticipation and prevention of potential complications and hazards to the patient and transfer team. This article gives an overview of the hazards, organization and planning of patient transfers, and highlights the importance of interdisciplinary teamwork, good communications and appropriate decision making. It also discusses special situations encountered in the transfer or retrieval of patients with complex needs.     

Transporting the adult critically ill patient

More than 10,000 intensive care patients are transferred each year in the UK, of whom the vast majority are accompanied by staff from the referring hospital. The high frequency of transfer of critically ill patients is primarily due to the escalating complexity of healthcare, the concentration of skills into specialized regional centres, and the relative lack of availability of intensive care unit (ICU) beds. The care practised during the constraints of patient transfer (whether within or between hospitals) should attempt to mirror the detailed attention provided in the hospital ICU, and it is the responsibility of the transport team to ensure the efficacy of the process and safety of the patient. This is achieved through careful preparation and planning and preparation starts with adequate and appropriate training of transfer personnel as well as selection of equipment which is fit for purpose. Success is based on anticipation and prevention of potential complications and hazards to the patient and transfer team. This article gives an overview of the hazards, organization, and planning of patient transfers, and highlights the importance of interdisciplinary teamwork, good communications, and appropriate decision-making. It also discusses special situations encountered in the transfer or retrieval of patients with complex needs, such as those requiring intra-aortic balloon counterpulsation or extracorporeal membrane oxygenation.     

15例游离足趾再造手指失败原因的分析及改进方法

目的 对15例游离足趾拇手指再造失败的原因进行分析并提出改进的方法。方法 1988年5月至2000年3月，利用游离足趾移植再造拇、手指351例。对其中15例拇、手指再造失败者进行了分析。结果 15例移植的均为第二足趾。足趾组织中第一跖背、跖底动脉吻合处及吻合后发出分支的形式和发至第二足趾趾动脉的管径细小是引起手术失败的主要原因(9／15)。结论 术中保留第二套供血系统，是解决第一跖背动脉和受动脉常规吻合后引起“顽固性痉挛”的最佳方法。     

组合肌移位重建屈肘功能

目的 对传统的胸大肌代肱二头肌的手术方法加以改进,进行组合肌移位,寻找重建屈肘功能的最佳治疗方法.方法 切断胸大肌在肱骨的止点,在肱骨结节间沟顶端切断肱二头肌长头腱,然后向远端分离,显露至长头腱桡骨结节止点处,将前臂屈肌起点从肱骨内髁下方分离;将肱二头肌长头腱从前臂屈肌下方深面穿过,反折后穿过胸大肌止点,调整好张力再返回远端编结缝合.结果 术后随访时间为1～5年,平均28.6个月.36例术前肘关节屈曲角度平均为7.2°,术后改善至106.6°,优良率达94.4%.结论 组合肌移位重建屈肘功能,使整个屈肘肌力臂得到延长,杠杆力量加大.屈肘力量得到加强是重建屈肘功能较理想的治疗方法.     

Nerve Transfer for Elbow Flexion in Radiation-Induced Brachial Plexopathy: A Case Report

Radiation-induced brachial plexopathy is an uncommon but devastating late complication seen in patients receiving radiation therapy to the chest wall and axilla. Treatment options are unfortunately limited. We report a case of a 59-year-old woman treated with radiation therapy for breast cancer 12 years earlier, who presented with loss of elbow flexion and marked shoulder weakness. Electromyogram and intraoperative stimulation of the musculocutaneous nerve branches were consistent with a proximal motor nerve conduction block. Microsurgical transfer of median and ulnar nerve fascicles to the biceps and brachialis branches of the musculocutaneous nerve, respectively, were performed. The patient recovered MRC grade 4/5 elbow flexion after surgery. The characteristics of this disorder and surgical treatment options are reviewed.     

冻融胚胎与新鲜胚胎移植的新生儿结局比较

目的探讨冻融胚胎移植(FET)与新鲜胚胎移植的新生儿出生结局。方法收集2009年1月至2013年12月在我中心行体外受精-胚胎移植(IVF-ET)后单胎活产的3 961例患者的临床资料,根据移植胚胎的不同分为鲜胚移植组(2632例)和FET组(1 329例);随机选取同期在我院自然妊娠分娩单胎活产的1 500例产妇作为对照组。比较FET组和鲜胚移植组的助孕资料,以及3组新生儿的分娩孕周、出生体重、早产率、低出生体重比例、极低出生体重比例及巨大儿比例等。结果 FET组患者的平均年龄[(29.76±4.11)岁]显著低于鲜胚移植组[(30.60±4.22)岁](P0.05)。FET组和鲜胚移植组的新生儿出生体重[分别为(3 329.52±553.95)g和(3 247.89±508.00)g]均显著小于自然分娩组[(3 388.89±461.00)g],但FET组的新生儿出生体重显著高于鲜胚移植组(P均0.05)。FET组的早产率(8.50%)、低出生体重儿发生率(5.79%)显著低于鲜胚移植组(分别为10.22%、7.33%),而巨大儿出生率(11.44%)显著高于鲜胚移植组(6.50%)和自然分娩组(5.33%)(P均0.05)。FET组的早产发生率显著高于自然分娩组(3.60%)(P0.05)。校正年龄因素后,上述差异依然存在。结论 FET助孕后的新生儿结局有优于鲜胚移植周期的趋势,但仍劣于自然妊娠;FET周期巨大儿出生率的增加值得临床关注。     

预移植在胚胎移植中的意义

目的 :评价预移植在胚胎移植中的作用。　方法 :在超声波引导下胚胎移植 114个周期 ,其中 10 1个周期进行预移植。比较预移植与未预移植周期临床妊娠率和胚胎种植率 ;按预移植与实际胚胎放置深度差值分组 ,并比较两组妊娠率和胚胎种植率。　结果 :预移植周期与未预移植周期临床妊娠率和种植率统计学差异无显著性(5 9.4 1%和 6 1.5 4 % ,35 .81%和 31.4 3% ,P均 >0 .0 5 ) ;按预移植与实际胚胎放置深度差值分组后 ,两组妊娠率和种植率统计学差异也无显著性 (6 1.5 4 %和 5 8.6 7% ,4 0 .79%和 34.0 9% ,P均 >0 .0 5 )。　结论 :在胚胎移植技术中 ,预移植不能准确指引胚胎移植深度     

Dynamic correction for forefoot varus in stage II-A adult flatfoot: Technique tip

Posterior tibial tendon dysfunction (PTTD) is a progressive disorder and a common cause of adult acquired flatfoot deformity, and forefoot varus is a frequent component in advanced cases. The author proposes peroneus brevis-to-longus transfer as an additional step to correct the forefoot varus component of stage II-A posterior tibial tendon dysfunction. We have performed this dynamic correction of forefoot varus in 12 patients at our institution, and observed promising clinical and radiographic improvement. It is a soft tissue procedure that avoids additional incisions and represents a favorable alternative to more demanding techniques, such as osteotomy or arthrodesis.     

复苏周期D5单囊胚移植与双囊胚移植对妊娠结局的影响

目的探讨复苏周期第5天(D5)单囊胚移植与双囊胚移植对年龄35岁、卵巢储备正常的不育症患者妊娠结局的影响。方法回顾性分析2013年1月至2015年4月我中心466例年龄35岁、卵巢储备正常的不育症患者复苏周期D5囊胚移植的妊娠结局,根据D5囊胚移植个数分为D5单囊胚移植组(207例)与D5双囊胚移植组(259例),对两组的妊娠结局进行比较。结果两组的生化妊娠率、临床妊娠率、活产率、异位妊娠率、流产率及单卵双胎率比较均无显著性差异(P0.05);双囊胚移植组的多胎妊娠率显著高于单囊胚移植组(52.6%vs.2.4%)(P0.001);单囊胚移植组的种植率显著高于双囊胚移植组(79.2%vs.57.5%)(P0.001);新生儿基本情况的统计显示,单囊胚移植组新生儿的胎龄及平均出生体重均显著大于双囊胚移植组[分别为(38.6±2.1)周vs.(37.4±2.4)周,(3 282.0±523.4)g vs.(2 937.9±645.5)g](P0.001)。结论对于年龄35岁、卵巢储备正常,新鲜周期未移植且为第一次复苏周期D5囊胚移植的患者,可以建议行D5单囊胚移植,其能获得与D5双囊胚移植相似的活产率,并能显著降低多胎率、延长孕周并改善新生儿出生体重。     

Current status of brachial plexus reconstruction: restoration of hand function

Although restoration of hand function in brachial plexus patients remains a formidable challenge, the past decade has brought significant improvement in our ability to restore hand function even in the most severe cases. Today, the following options are available to restore hand function: (1) direct nerve repair; (2) nerve grafting; (3) nerve transfers from intraplexal or extraplexal sources; (4) tendon transfers (and tenodesis); (5) free functioning muscle transfer; (6) arthrodesis; and (7) a combination of these techniques. Opportunity for future improvement exists, and the next decade will no doubt bring further innovation.     

智能任务分派分位点转运模式在急救患者院内转运中的应用

目的 探讨智能任务分派分位点转运模式在急救患者院内转运中的应用效果。 方法 采用类实验研究设计,选择2019年7~12月的急救患者60例为对照组,2020年7~12月的62例为干预组。对照组采用传统转运方式,干预组实施转运任务分派分位点院内转运模式。比较两组转运不良事件、转运时间。 结果 干预组转运总时间、急诊滞留时间、室外运送时间、科室交接时间显著短于对照组（均P＜0.05）。干预组任务延迟率显著低于对照组（P＜0.05）。 结论 智能任务分派分位点院内转运模式保证了转运患者信息传递的准确性,提升各环节的安全监控,降低运送延迟发生率。     

Transfer of the critically ill adult patient

Patient transfer has both resource ramifications and is an important public health issue. With increasing centralization of specialist services and the advent of regional trauma networks, the requirement for patient transfer is ever present. Every year in the UK over 11,000 intensive care patients are transferred and the majority of these transfers are facilitated by a team from the transferring hospital. Transferring a critically ill patient is a process involving inherent risk. It follows that prior preparation around planning for a safe transfer is essential, both in terms of anticipating potential problems, mitigating against them and ensuring clear and timely communication with the accepting hospital and respective specialties responsible for the patient. In the longer term, training of staff is essential in order to reduce instances of harm to patients. Medical transfers must be the subject of further research in order to consolidate best practice and improve our understanding of patient safety during transfer. This article provides an overview of the different types of patient transfer, the associated hazards, human factors around decision making, communication, equipment and organization.