恶性肿瘤患者低相位角与营养风险和住院时间相关性研究

目的探讨恶性肿瘤患者相位角与营养风险和住院时间相关性。方法利用生物电阻抗分析对2017年10月至2018年9月在河北医科大学第一医院接受治疗的259例恶性肿瘤患者进行人体成分检测、应用营养风险筛查2002和患者主观整体营养评估进行营养风险筛查和评估、同时收集患者血清ALB指标和住院时间。结果正常相位角组患者的BMI、ICW、FFM、SMM、BCM、蛋白质等均高于低相位角组（P<0.05）；正常相位角组与低相位角组男性患者ICW、FFM、SMM、BCM、蛋白质等均高于女性患者（P<0.05）；相位角与营养风险筛查2002评分（r=－0.346，P<0.05）、患者主观整体营养评估（r=－0.393，P＜0.05）呈负相关，与血清ALB值呈正相关（r=0.363，P<0.05）；与正常相位角组患者相比，低相位角组营养风险更高，计算相关风险比发现，按营养风险筛查2002评价营养不良分组，发现存在营养风险（OR=3.7，95%CI=1.8～7.7），按PG-SGA评估分组，结果显示中度风险（OR=4.5，95％CI=2.1～9.4），重度风险（OR=12.6，95％CI=5.1～31.3），按血清ALB值分组，ALB<40g/L（OR=3.7，95％CI=2.1～6.4）（P<0.05）；与正常相位角组患者相比，低相位角组住院时间较长，住院时间≥14d（OR=1.9，95％CI=1.0～3.3）（P<0.05）。 结论低相位角与营养风险和住院时间密切相关。与正常相位角患者相比，低相位角患者存在营养风险高，住院时间延长。因此对肿瘤患者进行相位角测量有助于快速判断其是否存在营养风险，为及时进行营养干预的实施提供了客观依据，利于患者疾病控制与好转。     

Trends in advanced imaging and hospitalization for emergency department syncope care before and after ACEP clinical policy

ObjectivesTo describe recent trends in advanced imaging and hospitalization of emergency department (ED) syncope patients, both considered “low-value”, and examine trend changes before and after the publication of American College Emergency Physician (ACEP) syncope guidelines in 2007, compared to conditions that had no changes in guideline recommendations.MethodsWe analyzed 2002–2015 National Hospital Ambulatory Medical Care Survey data using an interrupted-time series with comparison series design. The primary outcomes were advanced imaging among ED visits with principal diagnosis of syncope and headache and hospitalization for ED visits with principal diagnosis of syncope, chest pain, dysrhythmia, and pneumonia. We adjusted annual imaging and hospitalization rates using survey-weighted multivariable logistic regression, controlling for demographic and visit characteristics. Using adjusted outcomes as datapoints, we compared linear trends and trend changes of annual imaging and hospitalization rates before and after 2007 with aggregate-level multivariable linear regression.ResultsFrom 2002 to 2007, advanced imaging rates for syncope increased from 27.2% to 42.1% but had no significant trend after 2007 (trend change: ?3.1%; 95%CI ?4.7, ?1.6). Hospitalization rates remained at approximately 37% from 2002 to 2007 but declined to 25.7% by 2015 (trend change: ?2.2%; 95%CI ?3.0, ?1.4). Similar trend changes occurred among control conditions versus syncope, including advanced imaging for headache (difference in trend change: ?0.6%; 95%CI ?2.8, 1.6) and hospitalizations for chest pain, dysrhythmia, and pneumonia (differences in trend changes: 0.1% [95%CI ?1.9, 2.0]; ?0.9% [95%CI ?3.1, 1.3]; and ?1.2% [95%CI ?5.3, 2.9], respectively).ConclusionsBefore and after the release of 2007 ACEP syncope guidelines, trends in advanced imaging and hospitalization for ED syncope visits had similar changes compared to control conditions. Changes in syncope care may, therefore, reflect broader practice shifts rather than a direct association with the 2007 ACEP guideline. Moreover, utilization of advanced imaging remains prevalent. To reduce low-value care, policymakers should augment society guidelines with additional policy changes such as reportable quality measures.     

Soins psychiatriques sans consentement : une enquête auprès des juges des libertés et de la détention

The procedure of involuntary hospitalization in France has been recently modified by the law of 5 July 2011. Since that time, a liberty and custody judge has been appointed to guarantee the rights of psychiatric inpatients and to prevent abusive hospitalizations. Currently, for one involuntary hospitalization in ten a release is decided by the liberty and custody judge although psychiatrists consider that psychiatric care is necessary. In order to improve our understanding of the role of liberty and custody judges, and how they make their decisions, we conducted a qualitative survey of liberty and custody judges in the Tribunal de Grande Instance of Lille. Three judges were questioned, based on a semi-structured interview. Judges’ responses have highlighted the need for psychiatrists to strictly respect the legal procedures and to accurately describe the clinical signs and symptoms that justify the procedure of involuntary hospitalization in the medical certificates. The intervention of liberty and custody judges for patients with psychiatric disorders represents a breakthrough for patients’ rights in France, reflecting that they are considered as citizens, with the same rights as others. Nonetheless, this new mission needs a progressive learning, based on mutual exchanges with doctors and caregivers.     

Background rates of all-cause mortality,hospitalizations, and emergency department visits among nursing home residents in Ontario,Canada to inform COVID-19 vaccine safety assessments

BackgroundNursing home (NH) residents are prioritized for COVID-19 vaccination. We report monthly mortality, hospitalizations, and emergency department (ED) visit incidence rates (IRs) during 2010–2020 to provide context for COVID-19 vaccine safety assessments.MethodsWe observed outcomes among all NH residents in Ontario using administrative databases. IRs were calculated by month, sex, and age group. Comparisons between months were assessed using one-sample t-tests; comparisons by age and sex were assessed using chi-squared tests.ResultsFrom 2010 to 2019, there were 83,453 (SD: 652.4) NH residents per month, with an average of 2.3 (SD: 0.28) deaths, 3.1 (SD: 0.16) hospitalizations, and 3.6 (SD: 0.17) ED visits per 100 residents per month. From March to December 2020, mortality IRs were increased, but hospitalization and ED visit IRs were reduced (p < 0.05).ConclusionWe identified consistent monthly mortality, hospitalization, and ED visit IRs during 2010–2019. Marked differences in these rates were observed during 2020, coinciding with the COVID-19 pandemic.     

Le fil institutionnel en période Covid : utilisation de la plateforme Discord au CMPA

The COVID crisis led hospitals to reorganize care services and to develop innovative strategies to provide care at a distance. In our health care and education centre for adolescents, which provides both long-term psychiatric care and high school education, inpatients and outpatients were mostly confined at home. In order to ensure continuity of care as well as maintain institutional ties, different communication tools were used. Among them, we particularly relied upon Discord (social network initially designed for gamers) which allowed us to set up an entire virtual ward, maintain individual and group care programmes as well as team meetings. This innovation generated a number of preliminary questions and precautions which guided our decisions regarding the server settings. The outcome of this experiment is globally positive, both quantitatively and qualitatively, even if care at a distance showed its limits. Despite the involvement and creativity of health professionals, the confinement period disrupted and even led to the discontinuation of some care projects.     

美国药品成本管理策略对我国医疗机构药品费用控制启示

目的：为控制我国药品费用的不合理增长和促进医疗机构药学服务提供参考。方法：分析美国卫生系统药师协会制定的药品成本管理策略，对比我国医疗机构卫生现状，从而提出完善医疗机构药学工作，进行药品控费的建议。结果：美国药品成本管理策略建议医疗机构基于往年采购量（或金额）和使用量（或金额）开展药品预算管理；规范临床药师素质及临床药学服务质量的同时常态化开展交互治疗；成立药师参与临床治疗且获取医务人员支持的治疗小组；制定药品处方集并将成本较低、效果明显的药品纳入电子处方管理系统；建立药品使用替换制度，严格规范药品替换流程。结论：我国医疗机构可以开展药品预算研究来控制药品使用金额；通过提升临床药师技能来增强药师职业认知；加强药师医师沟通以明确两者职能分工；注重药师处方集制定并管控药品不合理使用；完善药品替换制度来规范药品使用管理。