Compliance to Advisory Committee on Immunization Practices recommendations for pneumococcal vaccination

We evaluated compliance to the ACIP pneumococcal vaccination recommendations issued in 2014 for adults aged ≥ 65 years and in 2012 for adults with high-risk (HR) conditions. The MarketScan® Commercial and Medicare Supplemental databases (January 2007-June 2019) were used to identify the cohorts of interest. Analyses for adults aged ≥ 65 years were adjusted to account for missing vaccination history. Two HR cohorts were identified. The HR1 cohort included patients with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implant. The HR2 cohort included patients with chronic heart, lung, or liver disease; diabetes mellitus; alcoholism; cirrhosis; or cigarette smoking. Full compliance for those aged ≥ 65 years or in the HR1 cohort was defined as receipt of PCV13 and PPSV23, and partial compliance was defined as receipt of PCV13 or PPSV23. For those in the HR2 cohort, full compliance was defined as receipt of PPSV23. Annual compliance rates were estimated using the Kaplan–Meier method.Among those aged ≥ 65 years, partial compliance at 4 years post index was 53% and full compliance was 17% in adjusted analyses. In subjects ≥ 65 years receiving the first vaccination, 42% received the second vaccination by year 4. For the HR1 cohort, partial compliance was 19% and full compliance was 5% at 6 years post index date. For the HR2 cohort, full compliance was 20% at 6 years, with the highest rate in patients with diabetes (27%) and the lowest rate in patients with alcoholism (8%).Additional efforts are needed to maximize compliance to the ACIP pneumococcal vaccine recommendations among adults ≥ 65 years of age and adults with HR conditions including streamlined recommendations and single-dose vaccines. These efforts may subsequently reduce the incidence and burden of pneumococcal disease.     

社区动脉粥样硬化风险研究的进展和展望

社区动脉粥样硬化风险（ARIC）研究是1987年由美国心、肺和血液研究所资助的关注非洲裔美国人心血管健康的最大研究。旨在调查心脏病的危险因素以及心血管疾病与认知之间的联系。ARIC研究的许多发现加深了对动脉粥样硬化性心血管病病因的了解,在心血管病预防领域做出了重大贡献,证明了以人群为基础的研究对改善健康和预防疾病的重要性。主要概述ARIC研究的起源、目的、研究设计、对心血管医学的贡献以及未来的发展方向。     

Characterizing hospital pathways for the care of acquired hemophilia in France using comprehensive national health data

PurposeAcquired hemophilia (AH) is a rare, serious bleeding disorder most often associated with older age and life-threatening complications. The patient care pathway for AH is complex because of the different types of bleeding, the presence of comorbidities, and the heterogeneity of medical specialists who care for these patients.MethodsThis observational study used the French national PMSI (Programme de médicalisation des systèmes d’information) database to characterize patients with AH in real-life practice and analyze their hospital pathway. In total, 180 patients with AH were identified over a 5-year study period (January 2010 to December 2014), based on three criteria: bypassing agent use, International Classification of Diseases, 10th revision code allocation, and aged over 65 years. Comparison of the incidence rate of AH versus registry data validated the PMSI as an epidemiological database.ResultsRituximab was prescribed more often (60/180; 33.3%) than expected following guidelines and was associated in half of cases to early infections (32/60; 53.3%), surgery procedures were frequently performed during the year before AH onset (29/159; 18.2%), which may suggest a triggering effect, extended hospital stays (median: 20 days) and mortality remaining high (66/180; 36.7%) that occurred mainly during the first month after AH diagnosis. Median costs and number of injections were comparable between recombinant activated factor VII and plasma-derived activated prothrombin complex concentrate.ConclusionThese findings could inform future medico-economic approaches in this AH population (duration of stays, bypassing agents, rituximab use, comorbidities, hospitalizations with infections).     

基于记忆-遗忘规律的健康教育在改善冠心病患者自我管理中的应用研究

目的 探讨基于记忆-遗忘规律的健康教育在改善冠心病患者健康促进生活方式和自我健康管理行为中的影响。方法 选择住院治疗的冠心病患者160例,采用随机数字表法分为观察组(80例)和对照组(80例)。对照组接受常规住院健康教育,观察组接受基于记忆-遗忘曲线规律制定的针对性的健康教育干预。在干预前、干预后使用健康促进生活方式评定量表和冠心病自我管理行为量表,测量两组患者的健康促进生活方式和自我管理行为水平。结果 干预前,两组患者健康促进生活方式和自我健康管理行为水平比较,差异无统计学意义(t=-1.72, 1.88,P值均>0.05)。干预后,观察组健康促进生活方式总分为(83.58±9.54),高于干预前的(63.08±7.11),(t=11.11, P<0.001)。干预前,2组自我管理行为得分比较,差异无统计学意义(t=1.88, P>0.05);干预后,观察组自我管理行为总得分为(118.44±8.42),高于对照组的(99.86±6.49),(t=-15.63, P<0.001)。结论 基于记忆-遗忘规律的健康教育,对冠心病患者健康促进生活方式和自我管理行为有明显改善和提高。     

基于标准化患者法评价四川农村基层医生两种慢性病诊断准确性及其影响因素

目的 运用标准化患者法评估四川农村地区基层医生不稳定型心绞痛和2型糖尿病两种慢性病诊断准确性现状,探讨基层医生两种慢性病诊断准确性的主要影响因素,为提升基层医生两种慢性病诊断准确性提供科学依据。方法 采用多阶段随机整群抽样方法,抽取四川省自贡市5个区/县50个乡镇100个村为研究现场,以调查当日在岗的全科及内科医生作为研究对象。共进行两轮数据采集,第1轮采集样本乡镇卫生院和村卫生室医生的基本信息;第1轮调查完成1个月后,运用标准化患者法开展第2轮调查,收集农村基层医生对不稳定型心绞痛和2型糖尿病诊断结果信息。运用Logistic回归分析农村基层医生不稳定型心绞痛和2型糖尿病诊断准确性的影响因素。结果 共纳入172名农村基层医生,完成186次标准化患者访问,正确诊断率为48.39%。其中不稳定型心绞痛的正确诊断率为18.68%(17/91),2型糖尿病的正确诊断率为76.84%(73/95)。Logistic回归分析显示,具有执业医师资质的农村基层医生更有可能做出正确诊断(OR=4.857,95%CI=1.076~21.933,P=0.040)。农村基层医生在诊断过程中涉及的必要问诊和检查条目越多,做出正确诊断的概率越高(OR=1.627,95%CI=1.065~2.485,P=0.024)。与不稳定型心绞痛相比,农村基层医生对2型糖尿病做出正确诊断的可能性更高(OR=6.306,95%CI=3.611~11.013,P<0.001)。结论 四川农村基层医生不稳定型心绞痛和2型糖尿病诊断准确性整体较差,建议以基层医生慢性病诊断过程质量改善为突破口,提升基层医生执业水平,进而提高慢性病诊断准确性。     

Patient and Procedure-related Characteristics Correlated With Severity of Hemoptysis Following Percutaneous Transthoracic Needle Biopsy: Results of a 10-year Retrospective Review

PurposeA risk of percutaneous transthoracic needle biopsy (PTNB) is hemoptysis, which can range from mild to life-threatening. The reported occurrence of hemoptysis is 1.7% to 14.5%, and the demographic, patient, and procedure characteristics have not been extensively described. The purpose of this study was to assess the associations of demographic, patient, and procedure characteristics with the severity of hemoptysis.Materials and MethodsA single institution, single group, retrospective, electronic medical record (EMR) review was performed on all hemoptysis events occurring between 2008 and 2018. Demographic, clinical, and procedure variables were extracted from EMRs. Outcome of hemoptysis events was graded using Common Terminology Criteria for Adverse Events (CTCAE). Mild-moderate and severe hemoptysis were defined as CTCAE classifications of 1-2 and 3-5, respectively. Associations were generated using logistic regressions and Likelihood Ratio Chi-Square tests.ResultsIn 10 years, 14,665 PTNB resulted in 231 hemoptysis events occurring in 229 patients; 12.7% (n = 29) of those were severe. The strongest and statistically significant variables associated with an increased likelihood of a severe event, if an event occurred, were cigarette pack years (OR = 1.02, 95% C.I. = 1.01-1.04, p = .020); history of chronic obstructive pulmonary disease (COPD) (OR = 3.68, 95% C.I. = 1.53-8.82, p = .003); core biopsy technique (OR = 8.13, 95% CI = 1.07, 61.40, p = .042), and larger diameter needle (20 g vs. 18 g: OR = 2.60, 95% CI 1.09, 6.17, p = .031).ConclusionsPTNB-associated hemoptysis was an uncommon event that was rarely life-threatening. The extent of the patient’s smoking history, the diagnosis of COPD, and core biopsy technique were associated with an increased likelihood of severe hemoptysis.     

Postoperative mortality and morbidity after D2 lymphadenectomy for gastric cancer:A retrospective cohort study

BACKGROUND Surgery for gastric cancer is a complex procedure and lymphadenectomy is often mandatory.Postoperative mortality and morbidity after curative gastric cancer surgery is not insignificant.AIM To evaluate the factors determining mortality and morbidity in a population of patients undergoing R0 resection and D2 lymphadenectomy for gastric cancer.METHODS A retrospective analysis of clinical data and pathological characteristics(age,sex,primary site of the tumor,Lauren histotype,number of positive lymph nodes resected,number of negative lymph nodes resected,and depth of invasion as defined by the standard nomenclature)was conducted in patients with gastric cancer.For each patient we calculated the Kattan’s score.We arbitrarily divided the study population of patients into two groups based on the nomogram score(<100 points or≥100 points).Prespecified subgroups in these analyses were defined according to age(≤65 years or>65 years),and number of lymph nodes retrieved(≤35 lymph nodes or>35 lymph nodes).Uni-and multivariate analysis of clinical and pathological findings were performed to identify the factors affecting postoperative mortality and morbidity.RESULTS One-hundred and eighty-six patients underwent a curative R0 resection with D2 lymphadenectomy.Perioperative mortality rate was 3.8%(7 patients);a higher mortality rate was observed in patients aged>65 years(P=0.002)and in N+patients(P=0.04).Following univariate analysis,mortality was related to a Kattan’s score≥100 points(P=0.04)and the presence of advanced gastric cancer(P=0.03).Morbidity rate was 21.0%(40 patients).Surgical complications were observed in 17 patients(9.1%).A higher incidence of morbidity was observed in patients where more than 35 lymph nodes were harvested(P=0.0005).CONCLUSION Mortality and morbidity rate are higher in N+and advanced gastric cancer patients.The removal of more than 35 lymph nodes does not lead to an increase in mortality.