Characteristics of hospitalizations due to acute stroke in the Silesian Province,Poland, between 2009 and 2015

Introduction

The available data on acute stroke (AS) in Poland come mainly from non-representative cohorts or are outdated. Therefore, the current study was done to access the most recent data on AS in the industrial region that covers 12% (4.6 mln) of the country's population.

Thumper心肺复苏机在院内心脏骤停心肺复苏中的应用

目的探讨Thumper-1007型心肺复苏机在抢救院内心脏骤停患者的应用价值。方法回顾性分析73例应用Thumper-1007型心肺复苏机（Thumper组）和58例应用标准CPR（SCPR组）抢救的院内心脏骤停患者的临床资料,比较2组患者的恢复自主循环（ROSC）、ROSC所需时间以及生存出院率。结果Thumper组ROSC显著高于SCPR组（P〈0．05）,复苏时间〈30min时,Thumper组ROSC比例显著高于SCPR组（P〈0．05）,ROSC所需时间Thumper组优于SCPR组（P〈0．05）。2组生存出院率无显著性差异。结论对于院内心脏骤停患者,Thumper心肺复苏机复苏效率优于标准CPR。     

取消医院药品加成后医院药学工作的经济价值体现

目的:探讨取消医院药品加成后医院药学工作如何体现出自身的经济价值。方法:借鉴发达国家经验,分析寻找国内医疗机构通过开展药学服务创造经济价值的途径。结果与结论:取消医院药品加成有利于医院药师地位的提高;通过积极开展相应的药学技术服务,医疗机构可以从多个方面获得经济回报。     

多次标准加入分光光度法同时测定复方药物中各组分含量的研究

分光光度法同时测定多组分体系的研究及应用进展很快。其中,计算数学同分光光度法联用则尤为人们所重视。本文提出的方法是根据多波长处多次标准加入分光光度测定所得的数据,通过矩阵运算求出复方药物中各组分的含量。作者以双组分药物——复方甲基异(口恶)唑为例,应用线性方程组求解过程的误差传递与矩阵条件数的关系,对测定所需条件的优化     

Risk Prediction Scores for Postoperative Mortality After Esophagectomy: Validation of Different Models

Background  Different prediction models for operative mortality after esophagectomy have been developed. The aim of this study is to independently validate prediction models from Philadelphia, Rotterdam, Munich, and the ASA. Methods  The scores were validated using logistic regression models in two cohorts of patients undergoing esophagectomy for cancer from Switzerland (n = 170) and Australia (n = 176). Results  All scores except ASA were significantly higher in the Australian cohort. There was no significant difference in 30-day mortality or in-hospital death between groups. The Philadelphia and Rotterdam scores had a significant predictive value for 30-day mortality (p = 0.001) and in-hospital death (p = 0.003) in the pooled cohort, but only the Philadelphia score had a significant prediction value for 30-day mortality in both cohorts. Neither score showed any predictive value for in-hospital death in Australians but were highly significant in the Swiss cohort. ASA showed only a significant predictive value for 30-day mortality in the Swiss. For in-hospital death, ASA was a significant predictor in the pooled and Swiss cohorts. The Munich score did not have any significant predictive value whatsoever. Conclusion  None of the scores can be applied generally. A better overall predictive score or specific prediction scores for each country should be developed. No score generally applicable     

驻景丸、加减驻景丸、驻景丸加减方的溯源及其在眼科的应用

通过驻景丸、加减驻景丸、驻景丸加减方的溯源及其在眼科的应用,认为加减驻景丸和驻景丸加减方在驻景丸治疗肝肾俱虚的基础上有所发展,临床上只有掌握各方的用药特点,才能取得更好的疗效。     

Impact of prior statin use on clinical outcomes in COVID-19 patients: data from tertiary referral hospitals during COVID-19 pandemic in Italy

BackgroundEpidemiological evidence suggests that anti-inflammatory and immunomodulatory properties of statins may reduce the risk of infections and infection-related complications.ObjectiveWe aimed to assess the impact of prior statin use on coronavirus disease (COVID-19) severity and mortality.MethodsIn this observational multicenter study, consecutive patients hospitalized for COVID-19 were enrolled. In-hospital mortality and severity of COVID-19 assessed with National Early Warning Score (NEWS) were deemed primary and secondary outcomes, respectively. Propensity score (PS) matching was used to obtain balanced cohorts.ResultsAmong 842 patients enrolled, 179 (21%) were treated with statins before admission. Statin patients showed more comorbidities and more severe COVID-19 (NEWS 4 [IQR 2–6] vs 3 [IQR 2–5], p < 0.001). Despite having similar rates of intensive care unit admission, noninvasive ventilation, and mechanical ventilation, statin users appeared to show higher mortality rates. After balancing pre-existing relevant clinical conditions that could affect COVID-19 prognosis with PS matching, statin therapy confirmed its association with a more severe disease (NEWS ≥5 61% vs. 48%, p = 0.025) but not with in-hospital mortality (26% vs. 28%, p = 0.185). At univariate logistic regression analysis, statin use was confirmed not to be associated with mortality (OR 0.901; 95% CI: 0.537 to 1.51; p = 0.692) and to be associated with a more severe disease (NEWS≥5 OR 1.7; 95% CI 1.067–2.71; p = 0.026).ConclusionsOur results did not confirm the supposed favorable effects of statin therapy on COVID-19 outcomes. Conversely, they suggest that statin use should be considered as a proxy of underlying comorbidities, which indeed expose to increased risks of more severe COVID-19.     

Epidemiology and outcomes of in-hospital cardiac arrest in critically ill children across hospitals of varied center volume: A multi-center analysis

Objective

To describe epidemiology and outcomes associated with cardiac arrest among critically ill children across hospitals of varying center volumes.

Methods

Patients <18 years of age in the Virtual PICU Systems (VPS, LLC) Database (2009–2013) were included. Patients with both cardiac and non-cardiac diagnoses were included. Data on demographics, patient diagnosis, cardiac arrest, severity of illness and outcomes were collected. Hierarchical cluster analysis was performed to categorize all the participating centers into low, low-medium, high-medium, and high volume groups using the center volume characteristics (annual hospital discharges per center, annual extracorporeal membrane oxygenation per center, and annual mechanical ventilators per center). Multivariable models were used to evaluate association of center volume with incidence of cardiac arrest, and mortality after cardiac arrest, adjusting for patient and center characteristics.

Results

Of 329,982 patients (108 centers), 2.2% (n = 7390) patients had cardiac arrest with an associated mortality of 35% (n = 2586). In multivariable models controlling for patient and center characteristics, center volume was not associated with either the incidence of cardiac arrest (OR: 1.00; 95% CI: 0.95–1.06; p = 0.98), or mortality in those with cardiac arrest (OR: 0.93; 95% CI: 0.82–1.06; p = 0.27). These associations were similar across cardiac and non-cardiac disease categories. Furthermore, we demonstrated that there was no correlation between incidence of cardiac arrest and mortality in those with cardiac arrest across different study hospitals in adjusted models.

Conclusions

Both incidence of cardiac arrest, and mortality in those with cardiac arrest vary substantially across hospitals. However, center volume is not associated with either of these outcomes, after adjusting for patient and center characteristics.     

The effect of adherence to ACLS protocols on survival of event in the setting of in-hospital cardiac arrest

Aim

Advanced Cardiac Life Support (ACLS) algorithms are the default standard of care for in-hospital cardiac arrest (IHCA) management. However, adherence to published guidelines is relatively poor. The records of 149 patients who experienced IHCA were examined to begin to understand the association between overall adherence to ACLS protocols and successful return of spontaneous circulation (ROSC).

Methods

A retrospective chart review of medical records and code team worksheets was conducted for 75 patients who had ROSC after an IHCA event (SE group) and 74 who did not survive an IHCA event (DNS group). Protocol adherence was assessed using a detailed checklist based on the 2005 ACLS Update protocols. Several additional patient characteristics and circumstances were also examined as potential predictors of ROSC.

Results

In unadjusted analyses, the percentage of correct steps performed was positively correlated with ROSC from an IHCA (p < 0.01), and the number of errors of commission and omission were both negatively correlated with ROSC from an IHCA (p < 0.01). In multivariable models, the percentage of correct steps performed and the number of errors of commission and omission remained significantly predictive of ROSC (p < 0.01 and p < 0.0001, respectively) even after accounting for confounders such as the difference in age and location of the IHCAs.

Conclusions

Our results show that adherence to ACLS protocols throughout an event is correlated with increased ROSC in the setting of cardiac arrest. Furthermore, the results suggest that, in addition to correct actions, both wrong actions and omissions of indicated actions lead to decreased ROSC after IHCA.