Estimation of Causal Effects using Propensity Score Weighting: An Application to Data on Right Heart Catheterization

We consider methods for estimating causal effects of treatments when treatment assignment is unconfounded with outcomes conditional on a possibly large set of covariates. Robins and Rotnitzky (1995) suggested combining regression adjustment with weighting based on the propensity score (Rosenbaum and Rubin, 1983). We adopt this approach, allowing for a flexible specification of both the propensity score and the regression function. We apply these methods to data on the effects of right heart catheterization (RHC) studied in Connors et al (1996), and we find that our estimator gives stable estimates over a wide range of values for the two parameters governing the selection of variables.     

北京市某三级甲等综合性教学医院急性心肌梗死诊疗流程现状研究:概述

目的与方法本研究旨在采用定性与定量研究相结合的方法,通过描述急性心肌梗死诊疗流程,深刻理解急性心肌梗死诊疗流程的现状、存在的问题和"共同原因",为急性心肌梗死诊疗流程的重组研究奠定基础.结果绘制了急性心肌梗死诊疗流程图:较深入地了解了该医院急性心肌梗死诊疗流程的现状、存在的问题和"共同原因".结论该医院急性心肌梗死诊疗流程在医疗服务质量和效率方面已达到国内领先水平,但仍有较大的重组空间.     

急性心肌梗死合并心律失常应用心电监护仪的效果观察

目的:观察并分析心电监护仪在急性心肌梗死合并心律失常患者中的应用效果。方法:将本院自2017年11月~2019年3月收治的114例急性心肌梗死患者作为临床观察对象,采取随机数字表法将所有患者随机分为两组。观察组(57例)采用心电监护仪进行监测,对照组(57例)采取常规监测,对两组患者不同时间段内的心率失常发生情况、室早、室速或室颤、Ⅱ或Ⅲ度房室传导阻滞、窦性停搏等发生率进行观察和统计。结果:观察组患者室早、室速或室颤、Ⅱ或Ⅲ度房室传导阻滞、窦性停搏等发生率与对照组患者比较明显更低,P<0.05;观察组患者不同时间段内的心律失常发生率与对照组患者比较均更低,且总心律失常发生率明显更低,P<0.05。结论:将心电监护仪应用于急性心肌梗死患者监测中,不仅可以有效减少心律失常发生的情况,还可以降低室早、室速或室颤、Ⅱ或Ⅲ度房室传导阻滞、窦性停搏等发生率。     

全程优质护理在急性心肌梗死患者中的应用效果

目的：探讨全程优质护理在急性心肌梗死患者中的应用效果。方法：选取本院2012年2月-2013年1月收治的60例急性心肌梗死的作为研究对象,按照随机数字表法将其分为对照组和观察组各30例。对照组采用常规性护理措施,观察组采用全程优质护理措施。观察比较两组患者的护理效果。结果：通过全程优质护理,观察组的住院时间明显短于对照组,平均住院费用明显少于对照组,治疗满意度明显高于对照组,差异均有统计学意义（P〈0.05）。结论：急性心肌梗死患者采用全程优质护理的临床护理效果明显优于常规性护理,能够提高患者满意度,降低患者住院时间及住院费用,值得在临床护理中应用。     

循证护理应用于急性心肌梗死后心律失常病人中的效果评价

目的 分析并评价将循证护理应用于急性心肌梗死后心律失常病人的效果.方法 将我院自2011年12月至2013年4月期间收治的124例住院急性心肌梗死后心律失常病人随机分成观察组（循证护理组）与对照组（常规护理组）,各为62例.对照组给予常规护理措施;观察组在常规护理的前提下,实施循证护理.对比分析两组病人各心功能指标、住院时间、卧床时间、医疗费用、对健康知识的达标率以及病人满意度.结果 对照组心率失常发生率（66.13％）显著高于观察组（11.29％）,两组相比存在统计学意义（P ＜0.01）;对照组健康知识达标率（70.97％）显著低于观察组（95.16％）,两组相比差异存在统计学意义（P＜0.05）.两组病人心功能分级相比差异存在统计学意义（P＜0.05）.观察组病人的平均住院时间、平均卧床时间、平均住院费用均优于对照组,差异存在统计学意义（P＜0.05）.观察组病人的满意度显著高于对照组,两组相比差异存在统计学意义（P＜0.05）.结论 循证护理应用于急性心肌梗死后心律失常病人能够提高病人满意度,有利于病人的尽快康复.     

Management and Outcomes of ST-Elevation Myocardial Infarction in Nursing Home Versus Community-Dwelling Older Patients: A Propensity Matched Study

ObjectivesThe influence of admission source (nursing home [NH] versus community-dwelling) on treatment strategies and outcomes among elderly patients with ST-elevation myocardial infarction (STEMI) has not been investigated.ParticipantsNationwide Inpatient Sample databases from 2003 to 2010 were used to identify 270,117 community-dwelling and 4082 NH patients 75 years of age or older with STEMI.DesignRetrospective observational study.MeasurementsPropensity scores for admission source were used to assemble a matched cohort of 3081 community-dwelling and 3132 NH patients, who were balanced on baseline demographic and clinical characteristics. Bivariate logistic regression models were then used to determine the associations of NH with in-hospital outcomes among matched patients.ResultsIn-hospital mortality was significantly higher in patients with STEMI presenting from a NH as compared with community-dwelling patients (30.5% versus 27.6%; odds ratio [OR] 1.15, 95% confidence interval [CI] 1.03–1.29; P = .012). Overall, NH patients were less likely to receive reperfusion (thrombolysis, percutaneous coronary intervention, or coronary artery bypass grafting) (11.5% versus 13.4%; OR 0.84, 95% CI 0.72–0.98; P = .022). However, rates of percutaneous coronary intervention alone were similar in both groups (9.9% in NH versus 9.1% in community-dwelling; OR 1.10, 95% CI 0.93–1.30; P = .276). Mean length of stay was also similar in both groups (5.68 ± 5.40 days in NH versus 5.69 ± 4.98 days in community-dwelling, P = .974).ConclusionCompared with their community-dwelling counterparts, older NH patients are less likely to receive reperfusion therapy for STEMI and have higher in-hospital mortality.