A Tailored Discharge Program Improves Frailty and Mood in Patients Undergoing Usual Rehabilitative Care: A Randomized Controlled Trial

ObjectiveTo investigate whether a tailored intersectoral discharge program (TIDP) impacts on multidimensional frailty, rehospitalization days, and patient-related outcome measures in older in-patients undergoing acute care and usual rehabilitative care.DesignRandomized controlled trial of TIDP vs usual rehabilitative care with a 6-month follow-up, 2019–2020, and historical control with a 6-month follow-up, 2016–2019.Setting and ParticipantsGeriatric co-managed internal medicine ward of a metropolitan university hospital. One hundred-twelve multimorbid patients older than age 60 years were consecutively assessed for eligibility and inclusion (age ≥60 years, multimorbidity, admitted for treatment of acute disease, at least 2 geriatric syndromes requiring usual rehabilitative care, and able to consent) and signed informed consent, with 110 recruited and randomized to either TIDP or usual rehabilitative care. At discharge, 104 patients were alive in the intention-to-treat group, the 6-month follow-up was completed for 91 patients. A historical control group of 468 patients was included for comparison.InterventionTIDP as intervention included contact with treating general practitioner to discuss the further treatment plan, a structured medical and lifestyle counseling to patients and caregivers at admission as well as a discharge program with internist, geriatrician, and general practitioner in shared decision making with patients.MethodsFifty-four patients underwent TIDP, 53 patients underwent usual rehabilitative care only. Rehospitalization days at follow-up as primary endpoint; multidimensional frailty and prognosis (Multidimensional Prognostic Index, Geriatric Depression Scale, Rosenberg Self-Esteem Scale, quality of life, falls, mortality, home care service need, and need of long-term care at 1-, 3- and 6-month follow-up as secondary endpoints.ResultsTIDP (median age 76.0 years, 56% female) showed significantly improved Multidimensional Prognostic Index scores at discharge compared with usual rehabilitative care (median age 78.5 years, 58% female) (0.43 vs 0.49, P = .011). Compared with usual rehabilitative care, TIDP improved self-confidence (Rosenberg Self-Esteem Scale 13.9 vs 12.4, P = .009) and mood (Geriatric Depression Scale 4 vs 5, P = .027) at follow-up. Compared with historical control (median age 77.0 years, 39 % female), usual rehabilitative care patients showed significantly lower rehospitalization rates (53% vs 70%, P = .002) and lower mortality rates (13% vs 32%, P < .001).Conclusions and ImplicationsA feasible TIDP improves frailty and mood in advanced age. In older patients undergoing potentially disabling acute treatments, usual rehabilitative care significantly reduces rehospitalization rates. Therefore, implementing geriatric treatment in general is useful to improve outcomes in older in-patients and a tailored discharge program can further increase the benefit for this frail population.     

城镇污水综合排放消毒效果实验研究

用实验的方法观察城镇污水综合排放消毒前后效果。消毒前,菌落总数为48000(cuf/ml),总大肠菌和粪大肠菌群>16000(个/L)。消毒后,菌落总数灭活率90分钟达85.93％,总大肠菌群和粪大肠菌群30分钟灭活率达98％,经统计学处理,有极显著差异。结论 加入有效氯30mg/L,消毒30分钟能达到较好效果,提示城镇污水应有效地消毒后排放。     

Predictive Factors of Extended Length of Hospital Stay Following Total Joint Arthroplasty in a Veterans Affairs Hospital Population

BackgroundImproved perioperative care for total joint arthroplasty (TJA) procedures has resulted in decreased hospital length of stay (LOS), including effective discharge on postoperative day (POD) 1 in many patients. It remains unclear what contributes to discharge delay in patients that are not discharged on POD 1. This study investigated factors associated with delayed discharge in patients whose original planned discharge was on POD 1.MethodsA retrospective cohort of 451 patients who underwent a hip or knee TJA procedure from April 2015 to March 2018 with planned discharge on POD 1 was analyzed. Patient characteristics included demographics, lab values, course of treatment, procedure, Charlson Comorbidity Index (CCI), complications, and other factors. Statistical regression was used to identify factors associated with delayed discharge; odds ratios (OR) were calculated for significant factors (α = 0.05).ResultsOf those studied, 70/451 (15.5%) experienced a delay from the planned POD 1 discharge. An increased likelihood of delayed discharge was associated with a nonhome discharge (P < .001, OR = 8.72 [95% CI: 4.22-18.06]) and higher CCI (P = .034, OR = 1.16 [95% CI: 1.01-1.32]). Inpatient physical therapy on the day of surgery was found to significantly correlate with successful discharge on POD 1 (P = .004, OR = 0.44 [95% CI: 0.25-0.77]).ConclusionMost patients can be discharged on POD 1 after TJA. Physical therapy on the day of surgery increased the likelihood of patients being discharged on POD 1. Those with a higher CCI and a nonhome discharge were more likely to have a discharge delay. This information can help surgeons counsel patients and prepare for postoperative care.     

老年择期手术患者护理依赖类别与出院准备度的关系

目的 探讨老年择期手术患者护理依赖类别及与出院准备度的关系,为制订针对性的出院干预计划提供参考.方法 选取江苏省6所综合性三级医院的362例老年择期手术出院患者,采用一般资料调查表、出院准备度量表、护理依赖量表进行调查.结果 老年择期手术患者出院准备度得分为(159.39±30.79)分,护理依赖得分为(53.54±11.49)分.患者护理依赖可分为3个类别:社交依赖型(43.6％)、全面依赖型(23.8％)、学习依赖型(32.6％).多分类Logistic回归分析显示,患者年龄、人均月收入、居住方式及是否合并慢性病是护理依赖的影响因素(P＜0.05,P＜0.01).结论 老年择期手术患者护理依赖性较高,且与出院准备度关系密切.医务人员应针对不同类别制订针对性的干预措施,降低其护理依赖,提高出院准备度.     

患者出院计划核心评价指标的构建

目的 构建出院计划核心评价指标,为出院计划实施效果评价提供参考.方法 运用文献分析法分析、整合出院计划评价指标,运用小组讨论法制定专家咨询问卷,通过德尔菲法对16名专家进行3轮咨询,完成指标筛选与修改,确定出院计划核心评价指标.结果 专家权威系数为0.945,每轮问卷有效回收率均为100％.第3轮专家咨询结束后,最终形成的出院计划核心评价指标集涵盖患者相关、照护者相关和医疗机构相关3大类共12项.各指标重要性赋值均数为8.88～9.63,变异系数为0.064～0.187;适用性赋值均数为8.75～9.63,变异系数为0.064～0.235.结论 构建的出院计划核心评价指标具有可靠性,可用于患者出院计划实施质量评价.     

阴道分泌物对尿常规临床检验结果的影响

目的探讨尿常规临床检验中阴道分泌物对检验结果的影响和预防对策。方法将2018年4月-2019年7月聊城市茌平区妇幼保健计划生育中心收治的临床诊断中需要进行尿常规检验的146例女性患者纳入研究,所有研究对象均采用常规尿液采集方法和阴道分泌物干预方法各采集1份尿液标本,并依次设为对照组和干预组,比较两组尿液标本的临床检验结果。结果干预组标本的pH值高于对照组,差异有统计学意义(P<0.05)。干预组尿比重、尿蛋白、尿糖、尿胆红素、酮体、尿胆原的检测结果均低于对照组,差异均有统计学意义(P<0.05)。干预组红细胞、白细胞、上皮细胞的检出率均低于对照组,差异均有统计学意义(P<0.05)。结论阴道分泌物可对尿常规临床检验结果产生较明显的影响,建议医疗领域完善和改进女性群体的尿液采集方法,以保证女性群体尿常规检验结果的准确性。     

含氢硅油表面接枝改性PET织物的拒水性能

通过接枝率、接触角、透水时间、拉伸应力应变、ＥＳＣＡ的测定以及不冲击实验研究了在ＤＣＰ和ＢＰ等存在下电晕放电引发含氢硅油接枝ＰＥＴ织物及其拒水性能,实验结果表明：电晕放电能有效引发含氢硅油在ＰＥＴ织物表面的接枝共聚反应,随电晕放电处理时间的延长,ＰＥＴ织物表面接枝率增大;接枝后ＰＥＴ织物拒水效果明显增强;电晕放电引发接枝改性后ＰＥＴ织物无损伤,力学性能基本保持不变。     

颈动脉体化学感受性在pH降低时的传递机制

目的　探讨胆碱能机制在 p H降低时颈动脉体 (CB)功能活动变化中的作用 .方法　在离体灌流条件下 ,记录颈动脉窦神经 (CSN)传入纤维的化学感受性单位放电 .结果　乙酰胆碱 (ACh)抑制单位放电 (n=16 ,P<0 .0 5 ) ,阿托品阻断 ACh的作用 ;尼古丁呈剂量依赖性增加单位放电 (n=10 ,r= 0 .94,P<0 .0 1) ;箭毒可阻断尼古丁的作用 ,对自发放电无显著影响 ;尼古丁并不增加化学感受性单位对 p H降低的放电反应 (n=19) ;p H降低时筒箭毒对化学感受性单位放电变化无显著影响 (n=17) ;硝苯吡啶 (5 mmol· L- 1 )对自发的基础单位放电 (n=8)和刺激诱导的电活动 (n=9)均无明显影响 .结论　胆碱能机制与 p H降低时 CB化学感受性功能活动的改变无直接关系