中国10省(市)流感成年人住院病例的临床特征及重症危险因素分析

目的 了解中国10省(市)严重急性呼吸道感染(SARI)住院病例哨点监测纳入的流感成年人住院病例的临床特征及重症危险因素。方法 对2009年12月至2014年6月中国10省(市)SARI哨点监测医院纳入的符合SARI定义的≥15岁病例进行流行病学和临床信息调查,采集呼吸道标本进行流感病毒核酸检测。按检测结果将病例分为流感住院组和非流感住院组,分析两组人口统计学信息、临床和流行病学特征,并分析重症危险因素。结果 10家哨点医院共纳入3 071例SARI成年人病例,其中实验室确诊240例(7.8%),以A(H1N1)pdm2009和A(H3N2)亚型流感病毒为主。病例年龄M为63岁,≥65岁老年人占47.1%。144例(60.0%)患有至少1种慢性基础性疾病,流感病例肺气肿比例(7.9%)高于非流感病例(3.8%),差异有统计学意义(χ²=3.963,P=0.047)。19.4%的流感育龄妇女为孕妇,240例流感病例中仅有1.1%在过去一年接种过流感疫苗。流感住院病例中咽痛、呼吸困难所占比例高于非流感住院病例。17.5%的流感病例收入重症监护室治疗,与非流感住院病例间的差异无统计学意义(P=0.160)。23.1%的流感病例在发病后使用了抗病毒药物治疗,高于非流感住院组(4.8%),差异有统计学意义(P<0.001)。流感住院病例中41.5%出现并发症,病毒性肺炎比例明显高于非流感组(P<0.001)。危险因素分析显示,发病入院时间>7 d(RR=1.673,95%CI:1.071～2.614)、患有哮喘(RR=15.200,95%CI:1.157～199.633)、免疫抑制疾病(RR=5.250,95%CI:1.255～21.960)、怀孕(RR=21.000,95%CI:1.734～254.275)是流感重症的危险因素。结论 成年人流感住院病例主要集中在≥65岁组,流感疫苗接种率极低、抗病毒药物使用不足,应推荐孕妇、老年人、慢性病病例等高危人群每年进行流感疫苗预防接种,流感住院病例应及早应用抗病毒药物。     

Effect of Race on the Incidence of Aortic Stenosis and Outcomes of Aortic Valve Replacement in the United States

Objective

To assess the effect of race on the incidence of aortic stenosis (AS) and utilization and outcomes of aortic valve replacement (AVR).

Functional Status Is Associated With 30-Day Potentially Preventable Hospital Readmissions After Inpatient Rehabilitation Among Aged Medicare Fee-for-Service Beneficiaries

ObjectivesTo determine the association between patients' functional status at discharge from inpatient rehabilitation and 30-day potentially preventable hospital readmissions. A secondary objective was to examine the conditions resulting in these potentially preventable readmissions.DesignRetrospective cohort study.SettingInpatient rehabilitation facilities submitting claims to Medicare.ParticipantsNational cohort (N=371,846) of inpatient rehabilitation discharges among aged Medicare fee-for-service beneficiaries in 2013 to 2014. The average age was 79.1±7.6 years. Most were women (59.7%) and white (84.5%).InterventionsNot applicable.Main Outcome Measures(1) Observed rates and adjusted odds of 30-day potentially preventable hospital readmissions after inpatient rehabilitation and (2) primary diagnoses for readmissions.ResultsThe overall rate of any 30-day hospital readmission after inpatient rehabilitation was 12.4% (n=46,265), and the overall rate of potentially preventable readmissions was 5.0% (n=18,477). Functional independence was associated with lower observed rates and adjusted odds ratios for potentially preventable readmissions. Observed rates for the highest versus lowest quartiles within each functional domain were as follows: self-care: 3.4% (95% confidence interval [CI], 3.3–3.5) versus 6.9% (95% CI, 6.7–7.1), mobility: 3.3% (95% CI, 3.2–3.4) versus 7.2% (95% CI, 7.0–7.4), and cognition: 3.5% (95% CI, 3.4–3.6) versus 6.2% (95% CI, 6.0–6.4), respectively. Similarly, adjusted odds ratios were as follows: self-care: .70 (95% CI, .67–.74), mobility: .64 (95% CI, .61–.68), and cognition: .84 (95% CI, .80–.89). Infection-related conditions (44.1%) were the most common readmission diagnoses followed by inadequate management of chronic conditions (31.2%) and inadequate management of other unplanned events (24.7%).ConclusionsFunctional status at discharge from inpatient rehabilitation was associated with 30-day potentially preventable readmissions in our sample of aged Medicare beneficiaries. This information may help identify at-risk patients. Future research is needed to determine whether follow-up programs focused on improving functional independence will reduce readmission rates.     

品管圈在降低住院药房针剂内部调剂差错中的应用

目的:在住院药房开展降低针剂内部调配差错的品管圈活动,提升药事服务质量,提高药学专业人员的自我管理意识和解决问题的能力,保证临床用药安全有效. 方法:通过药师自发组成品管圈,找出针剂内部调配差错的主要原因,运用多种品管方法制定对策,依循"PDCA循环"开展各项活动. 结果:住院药房在开展品管圈活动之后,针剂内部调剂差错率由活动前的37.57%降到16.53%,工作环境与服务得到了改善.结论:住院药房开展品管圈活动能有效地降低住院药房针剂内部调配差错率,同时通过品管圈这种自下而上的管理方法,提高了圈员的自我管理能力以及病区对住院药房的满意度,最大限度地保障了患者的用药安全,和谐药护患关系.     

Inpatientvs. outpatient bowel preparation for elective colorectal surgery

BACKGROUND: Recent pressures to decrease the cost of medical care have mandated preoperative outpatient bowel preparation (OBP) for elective colorectal surgery without any data documenting equivalent quality of care. This study examined the safety and efficacy of OBP compared with inpatient bowel preparation (IBP). METHODS: Records of all patients who underwent OBP for elective colorectal resection since the inception of the OBP program from July 1993 to June 1994 were compared with records of all patients who received IBP for elective procedures from January to June 1993. RESULTS: The two groups, 90 patients who underwent OBP and 98 patient who had IBP, were well matched for age, sex, diagnosis, and operations performed. The OBP group had a shorter length of hospital stay (median, 7 vs. 9 days; P < 0.0001; chi-squared analysis), whereas the complication rate was similar (19 percent in the OBP group vs. 18 percent in the IBP group), including infectious complications (10 percent in the OBP group vs. 7 percent in the IBP group). Although operating time was similar (mean, 199 vs. 213 minutes) and estimated blood loss (mean, 528 vs. 536 ml), the OBP group had significantly higher perioperative fluid requirements: intraoperative fluids (median, 4300 vs. 3700 ml; P < 0.05; Student's t-test), intraoperative colloid administration (48 vs. 29 percent; P < 0.0002; chi-squared), 24-hour postoperative fluids (3224 vs. 2700 ml; P < 0.0001; Student's t-test), and postoperative fluid challenges (50 vs. 20 percent; P <0.0001; chi-squared analysis). CONCLUSION: Outpatient bowel preparation for elective colorectal surgery is safe and effective. It offers shorter hospital stay, and, therefore, potentially reduces medical care cost. Patients with multiple medical problems may not tolerate extensive fluid shifts; therefore, other preoperative arrangements, such as inpatient or outpatient intravenous fluid therapy, need to be considered to minimize complications that may outweigh potential cost savings.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Montreal, Quebec, Canada, May 7 to 12, 1995.     

Ischemic Stroke With Cerebral Protection System During Transcatheter Aortic Valve Replacement

ObjectivesThe objective of this study was to evaluate in-hospital outcomes with use of the Sentinel cerebral protection system (CPS) in transcatheter aortic valve replacement (TAVR).BackgroundThe role of the Sentinel CPS in preventing clinical ischemic stroke has been controversial.MethodsThe Nationwide Inpatient Sample database from the last three quarters of 2017, after the approval of the Sentinel CPS device, was queried to identify hospitalizations for TAVR. A 1:2 propensity score–matched analysis to compare in-hospital outcomes with versus without use of the CPS. The primary outcome was the occurrence of ischemic strokes.ResultsA total of 36,220 weighted discharges of patients who underwent TAVR (525 with the CPS and 35,695 without) were identified. The overall percentages of ischemic and hemorrhagic strokes were 2.4% and 0.2%, respectively. After propensity score matching (525 CPS, 1,050 no CPS), the risk for ischemic stroke was lower with use of the CPS (1 % vs. 3.8%, odd ratio [OR]: 0.243 (95% confidence interval: 0.095 to 0.619); p = 0.003). The cost of the index hospitalization was higher with use of the CPS ($47,783 vs. $44,578; p = 0.002). In multivariate regression analysis, use of the CPS was independently associated with a lower risk for ischemic stroke (OR: 0.380; 95% confidence interval: 0.157 to 0.992; p = 0.032).ConclusionsUse of the Sentinel CPS in patients undergoing TAVR is associated with a lower incidence of ischemic stroke and in-hospital mortality, without an increased risk for procedural complications but with an increased cost of the index hospitalization.     

住院药房药学服务满意度调查与分析

目的:为满足解放军总医院第五医学中心(以下简称“我院”)住院药房实际工作的需要,优化药学部药学服务质量,提高药学服务满意度。方法:采取随机抽样的方法,收集我院28个临床科室工作人员关于药学服务满意度的调查问卷。采用利克特量表,设置态度分值,通过Microsoft Excel软件对评分进行统计分析。结果:收集有效问卷226份,满意度平均得分>4.3分;病区对住院药房的药学服务基本满意,用药咨询评分最低,仅为(4.38±0.49)分,发药准确度[(4.44±0.89)分]和有效沟通[(4.84±0.39)分]方面有待提高。结论:我院各科室对住院药房的药学服务基本满意,问题主要体现在用药咨询和发药准确度等方面,整体药学服务质量还有一定的上升空间。