Clinical and non-clinical factors that predict discharge disposition after a fall

BackgroundFalls can result in injuries that require rehabilitation and long-term care after hospital discharge. Identifying factors that contribute to prediction of discharge disposition is crucial for efficient resource utilization and reducing cost. Several factors may influence discharge location after hospitalization for a fall. The aim of this study was to examine clinical and non-clinical factors that may predict discharge disposition after a fall. We hypothesized that age, injury type, insurance type, and functional status would affect discharge location.MethodsThis two-year retrospective study was performed at an urban, adult level-1 trauma center. Fall patients who were discharged home or to a facility after hospital admission were included in the study. Data was obtained from the trauma registry and electronic medical records. Logistic regression modeling was used to assess independent predictors.ResultsA total of 1,121 fallers were included in the study. 621 (55.4%) were discharged home and 500 (44.6%) to inpatient rehabilitation (IRF)/skilled nursing facility (SNF). The median age was 64 years (IQR: 49–79) and 48.4% (543) were male. The median length of hospital stay was 5 days (IQR: 2.5–8). Increasing age (p < 0.001), length of stay in the ICU (p < 0.001), injury severity (p < 0.001), number of comorbidities (p = 0.038), having Medicare insurance (p = 0.025), having a fracture at any body region (p < 0.001), and ambulation status (p = 0.025) significantly increased the odds of being discharged to IRF/SNF compared to home. The removal of injury severity score and ICU length of stay from the “late/regular discharge” model, to create an “early discharge” model, decreased the accuracy of the prediction rate from 78.5% to 74.9% (p < 0.001).ConclusionA combination of demographic, clinical, social, economic, and functional factors can together predict discharge disposition after a fall. The majority of these factors can be assessed early in the hospital stay, which may facilitate a timely discharge plan and shorter stays in the hospital.     

Evaluating the “cushion effect” among children in frontal motor vehicle crashes

Background

The “Cushion Effect,” the phenomenon in which obesity protects against abdominal injury in adults in motor vehicle accidents, has not been evaluated among pediatric patients. This work evaluates the association between subcutaneous fat cross-sectional area, quantified using analytic morphomic techniques and abdominal injury.

不同陪护类型对脊髓损伤患者功能恢复及心理状态的影响

目的了解不同陪护类型对脊髓损伤患者躯体功能恢复及心理的影响。方法2001年12月～2006年10月对不同陪护类型（家属、请专人陪护、护工陪护、无陪护）的87例脊髓损伤伴有躯体功能障碍患者在入院3d内、住院后1个月采用Zung忧郁自评量表（SDS）评估患者的心理状态,用功能独立性评价量表（Functional independent measures,FIM）评估患者躯体功能恢复情况。同时住院期间对患者及陪护者进行脊髓损伤相关知识及康复知识培训。结果入院时4组陪护的患者SDS、FIM得分比较,差异无统计学意义;入院后1个月由家属陪护的患者SDS得分下降,FIM得分提高,与其他陪护类型患者比较,差异有统计学意义（P〈0.05）;专人陪护、护工陪护、无陪护3种陪护类型患者SDS得分下降不明显,3组比较,差异无统计学意义（P〉0.05）;专人陪护、护工陪护、无陪护3种陪护类型患者FIM得分有提高,但3组比较,差异无统计学意义（P〉0.05）,有家属陪护的患者FIM得分较前3种陪护类型患者得分明显提高（P〈0.05）。结论不同陪护类型对脊髓损伤患者功能恢复及心理状态有直接影响,家属陪护对患者更有安全感,在治疗中更能帮助、鼓励患者积极配合治疗,改善患者的心理状态,促进患者康复。     

Initial development and validation of a fecal incontinence-specific quality of life measure

Background/Purpose

Fecal incontinence is a prevalent pediatric condition with psychosocial impacts on both children and their caregivers. We sought to develop and validate the Cincinnati Fecal Incontinence Scale (CINCY-FIS) as a psychometrically valid measure to assess the quality of life and caregiver impacts of pediatric fecal incontinence.

慢性肾脏病3~4期患者自我管理量表的构建

目的研制慢性肾脏病3~4期患者自我管理量表,为临床干预提供依据。方法通过文献查阅和历史回顾制定量表初稿,量表每个指标采用4分计分法,以分层次量化患者的自我管理能力。邀请45名慢性肾脏病领域专家进行2轮德尔菲专家咨询,完善该量表指标。对30例门诊随访的慢性肾脏病3~4期患者进行预实验,检验量表的信度和效度。结果 2轮德尔菲专家咨询确立的量表包含了4个一级指标、43个二级指标。2轮专家咨询的问卷回收率分别为100.00%、86.67%,专家权威系数分别为(0.86±0.10)、(0.88±0.07),指标变异系数分别在6.43%~20.78%、0.00%~21.79%,一级指标的协调系数分别为0.564、0.560,二级指标的协调系数分别为0.590、0.595,经卡方检验P<0.01,有统计学意义。通过预实验,量表的信度Cronbach’sα为0.819,效度KMO值为0.790。结论慢性肾脏病3~4期患者自我管理量表研制过程科学、可靠,量表内容符合临床患者实际需求,适合临床使用。     

重复经颅磁刺激联合文拉法辛及劳拉西泮治疗广泛性焦虑

背景：焦虑障碍是精神科最常见的疾病之一,但是25%的患者对药物,心理及认知行为治疗等无反应。重复经颅磁刺激目前已广泛用于精神分裂症,抑郁症,焦虑症,强迫症等精神障碍的治疗,并取得了满意的疗效。
　　目标：探讨文拉法辛联合重复经颅磁刺激治疗广泛性焦虑症的疗效和安全性。
　　方法：70例广泛性焦虑症患者随机分为两组,研究组口服文拉法辛及劳拉西泮联合重复经颅磁刺激治疗,对照组单用文拉法辛劳拉西泮治疗,连续观察6周。与治疗前后采用汉密尔顿焦虑量表及临床疗效总评量表-病情严重程度分量表评定临床疗效,副反应量表评定不良反应。
　　结果：治疗后两组均能改善广泛性焦虑患者的临床症状,但是药物联合rTMS治疗组疗效要优于单纯药物治疗组。
　　结论：重复经颅磁刺激治联合文拉法辛治疗对广泛性焦虑有显著的疗效。     

歧视与病耻感量表(DISC)中文版在精神障碍患者中的信度和效度研究

目的:评估歧视与病耻感量表(DISC)在中国精神障碍患者中的信度和效度。方法:引进Thornicroft团队研发的DISC,按初译、回译等步骤形成DISC中文版,以242例精神障碍患者作为受访对象,验证量表的信度和效度。结果:DISC的Cronbach'α系数为0.70,分半信度为0.85,总分重测信度为0.83;DISC分量表1总分与精神疾病内在病耻感调查表(ISMI)歧视经历因子分呈正相关(r=0.417,P0.01),分量表2总分与ISMI社会退缩因子分呈正相关(r=0.332,P0.01);分量表2总分与自尊量表(SES)总分呈正相关(r=0.250,P0.01),分量表3总分与SES总分呈负相关(r=-0.187,P0.01);分量表4总分与社会支持评定量表(SSRS)客观支持分以及对支持的利用度分均呈正相关(r=0.177,0.170,P均0.01)。结论:DISC中文版具有较好的信度和效度,可作为评估精神障碍患者歧视与病耻感的临床工具。     

188例重症肌无力患者生活质量研究

目的分析重症肌无力(MG)患者的生活质量。方法纳入2013-03-2014-06在唐都医院神经内科就诊的MG患者188例,应用重症肌无力量化评分(QMGs)评估患者病情严重程度,采用36项简明健康状况调查表(SF-36)评估患者生活质量,采用汉密尔顿抑郁量表(HDRS)和汉密尔顿焦虑量表(HARS)评估抑郁和焦虑症状。比较不同教育水平、职业、眼肌型重症肌无力(ocular MG,OMG)症状、胸腺情况等患者间SF-36评分的差异,并对QMG评分、年龄、HARS和HDRS得分与SF-36两项复合得分进行多元线性回归分析。结果高级教育组在躯体疼痛项得分高于初级教育组(P0.05),学生组在生理机能项(P0.05)和生理角色功能项(P0.05)得分均高于脑力劳动组,学生组在生理角色功能项得分亦高于体力劳动组(P0.05);学生组在生理复合得分(PCS)项得分高于按照职业分组的其他3组(均P0.05);OMG组在精神复合得分(MCS)项得分高于全身型重症肌无力(generalized MG,GMG)组(P0.05)。较高的QMGs、HARS得分和高龄可以预测较低的PCS得分,较高的QMGs和HARS得分可预测较低的MCS得分。结论影响MG患者生活质量的因素包括年龄、教育水平、职业、胸腺情况、MG的类型和GMG的类型、疾病的严重程度和心理障碍。较高的QMGs和HARS得分可以预测较低的PCS和MCS得分,年龄大可预测较低的PCS得分。