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1.
ObjectiveTo investigate whether a tailored intersectoral discharge program (TIDP) impacts on multidimensional frailty, rehospitalization days, and patient-related outcome measures in older in-patients undergoing acute care and usual rehabilitative care.DesignRandomized controlled trial of TIDP vs usual rehabilitative care with a 6-month follow-up, 2019–2020, and historical control with a 6-month follow-up, 2016–2019.Setting and ParticipantsGeriatric co-managed internal medicine ward of a metropolitan university hospital. One hundred-twelve multimorbid patients older than age 60 years were consecutively assessed for eligibility and inclusion (age ≥60 years, multimorbidity, admitted for treatment of acute disease, at least 2 geriatric syndromes requiring usual rehabilitative care, and able to consent) and signed informed consent, with 110 recruited and randomized to either TIDP or usual rehabilitative care. At discharge, 104 patients were alive in the intention-to-treat group, the 6-month follow-up was completed for 91 patients. A historical control group of 468 patients was included for comparison.InterventionTIDP as intervention included contact with treating general practitioner to discuss the further treatment plan, a structured medical and lifestyle counseling to patients and caregivers at admission as well as a discharge program with internist, geriatrician, and general practitioner in shared decision making with patients.MethodsFifty-four patients underwent TIDP, 53 patients underwent usual rehabilitative care only. Rehospitalization days at follow-up as primary endpoint; multidimensional frailty and prognosis (Multidimensional Prognostic Index, Geriatric Depression Scale, Rosenberg Self-Esteem Scale, quality of life, falls, mortality, home care service need, and need of long-term care at 1-, 3- and 6-month follow-up as secondary endpoints.ResultsTIDP (median age 76.0 years, 56% female) showed significantly improved Multidimensional Prognostic Index scores at discharge compared with usual rehabilitative care (median age 78.5 years, 58% female) (0.43 vs 0.49, P = .011). Compared with usual rehabilitative care, TIDP improved self-confidence (Rosenberg Self-Esteem Scale 13.9 vs 12.4, P = .009) and mood (Geriatric Depression Scale 4 vs 5, P = .027) at follow-up. Compared with historical control (median age 77.0 years, 39 % female), usual rehabilitative care patients showed significantly lower rehospitalization rates (53% vs 70%, P = .002) and lower mortality rates (13% vs 32%, P < .001).Conclusions and ImplicationsA feasible TIDP improves frailty and mood in advanced age. In older patients undergoing potentially disabling acute treatments, usual rehabilitative care significantly reduces rehospitalization rates. Therefore, implementing geriatric treatment in general is useful to improve outcomes in older in-patients and a tailored discharge program can further increase the benefit for this frail population.  相似文献   
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目的通过有限元分析,初步评估股骨头部分置换术后股骨与内植物模型的应力分布和位移。 方法选择一名成年健康志愿者,获取股骨全长CT扫描数据,利用Mimics 20.0软件、Geomagic软件及UG NX 12.0软件建立股骨头缺血坏死模型,骨隧道切除股骨头坏死区域后装配设计开发的股骨头假体,模拟单腿站立环境进行有限元仿真模拟,获取股骨与内植物模型的应力分布和位移数据。 结果股骨应力分布主要集中在股骨颈下方和股骨干皮质骨两侧,最大应力为48.25 Mpa,最大位移为10.98 mm。内植物模型的应力主要分布在金属内植物主体结构下方,最大应力为147.2 Mpa,最大位移为9.58 mm。 结论股骨头部分置换后,假体头与股骨头曲率一致,应力传导模式与正常侧髋关节一致,但在假体头与茎部连接处发生应力集中,应重点考虑选择更大强度的材料。  相似文献   
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目的 调查肝硬化患者出院准备度现状,并分析其影响因素。方法 采用便利抽样方法,选取2019年10月-2020年4月消化内科住院的102例肝硬化患者作为调查对象,使用一般资料调查表、出院准备度量表和出院指导质量量表评估患者出院准备度与出院指导质量,分析出院指导质量与出院准备度间的相关性,采用多元线性回归分析肝硬化患者出院准备度的影响因素。结果 肝硬化患者的出院准备度的总分为(178.98±15.00)分,出院指导质量总分为(150.86±14.36)分,处于中等偏上水平。多元线性回归分析结果显示,文化程度、婚姻状况、家庭人均月收入及家庭照顾者为肝硬化患者出院准备度的独立影响因素(F=16.427,P<0.001)。Pearson相关分析显示,出院指导质量与肝硬化患者出院准备度呈正相关(r=0.354,P<0.001)。结论 肝硬化患者出院准备度呈中等偏上水平,医护人员应针对出院准备度的影响因素制定干预措施,并提升出院指导质量,以提高此类患者的出院准备度水平,提高患者及家属对疾病的应对能力,降低再住院率及病死率。  相似文献   
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Background: A new VMAT method called “Augmented Arc” (or simply Aug Arc) is proposed. The aim of this study is to demonstrate the validity of the proposed method in different clinical cases. Basically, Aug Arc refers to the portion(s) of the VMAT arc that is augmented with an additional arc to improve the plan quality. The Aug Arc portions in the Arc is determined using an objective function-based scoring method called “ψ – score”. Methods: To validate our approach, we have applied it in four clinical cases: Lung, Abdomen, Gynecologic (Gyn) and Pancreas. Basically, for Lung and Pancreas cases, four sets of plans were created, which are: (1) Single arc plan (S Arc), (2) Double arc plan (D Arc), (3) Partial Arc plan without Aug Arc (P Arc) and (4) Partial plan with Aug Arc (P+Aug Arc). For Abdomen and Gyn cases, three sets of plans were created, which are: (1) Single arc plan (S Arc), (2) Double arc plan (D Arc) and (3) Single Arc with Aug Arc (S+Aug Arc). To compute the “ψ – score”, an initial optimization was performed by using full Arc with 4-degree gantry spacing. Subsequently, Aug Arc portions were identified using the ψ – score plot in the single arc and partial arc scenarios. Results: The study finds that the proposed method is useful to improve the plan quality and plan deliverability for both centrically and non-centrically located tumors in terms of reducing the OAR dose, monitor units, beam on time and low dose volume without compromising the target coverage. Conclusion: The results indicate that the proposed approach could strike a balance between full double arc and single arc or partial arc in such a way that the planner can find a sweet spot of delivery parameters that result in optimal plan quality.  相似文献   
6.
《Clinical breast cancer》2022,22(6):619-627
BackgroundIncreasingly, breast surgery is same day or 23-hour day-case surgery. Discharge criteria need to ensure patient safety outside hospital. We explore some of the evolving day-case factors in oncoplastic breast surgery (OBS).Materials and MethodsAvailable data of BMI and drain usage of an OBS practice (Nov 2014-Oct 2019) were reviewed. These were correlated with length of stay (LoS) and complications. Statistical analysis was performed using R programming language; Pearson's correlation, χ2 test, and Welch's 2 sample t test.ResultsOf 188 patients in the study, drain usage was highest following mastectomy (62%) followed by partial reconstruction and mammaplasty. Drain was associated with increased seroma rates in all three operations. Its use in the partial reconstruction group was associated with significantly longer mean LoS with drain vs. those without drain (0.93 vs. 0.45 day, P = .009). Drain was associated with nonsignificantly longer LoS in both mammaplasty (1.57 vs. 1.00 day, P = .0708) and mastectomy (1.08 vs. 0.927 day, P = .685) groups. The mean BMI across all patients was 27.5, lowest in partial reconstruction (25.31), highest in mammaplasty (31.79), and 27.1 in mastectomy.ConclusionDrain use did not correlate directly with occurrence of seroma. However, overall, it was associated increased LoS, being significant in the partial reconstruction group. The temporal trend over the dataset shows numerically less drain usage in the latter half of series across all procedures with decreasing LoS. Minimal drain use may allow more day-case OBS.  相似文献   
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目的:分析在预防重症脑卒中患者发生肺部感染的过程中振动排痰机的临床应用效果。方法:本次实验研究的76例对象随机选取于2019年10月~2020年10月本院收治的重症脑卒中患者,根据掷硬币法实现患者的分组,其中将振动排痰机作为预防肺部感染方法的38例患者作为Ⅰ组,运用传统排痰方式预防肺部感染的38例患者作为Ⅱ组。结果:比较后可知Ⅰ组患者排痰效果与排痰满意度均明显高于Ⅱ组患者,P<0.05;统计学分析后可知,与Ⅱ组患者相比,Ⅰ组患者肺部感染发生率明显较低,P<0.05。结论:在预防重症脑卒中患者出现肺部感染的过程中振动排痰机的运用不仅可以提高排痰的效果与排痰满意度,同时也有效地降低了肺部感染的发生概率,为患者的高效治疗、更好恢复奠定了基础。  相似文献   
8.
《Saudi Dental Journal》2021,33(7):656-660
PurposeKnowledge about the most prevalent types of Kennedy classifications is of great value and will enlighten dental students, dental technicians, and practitioners regarding the treatment needs of their patients, ultimately leading to better treatment outcomes. The aim was to determine the prevalence of various Kennedy classifications among patients attending clinics at the College of Dentistry at King Saud bin Abdulaziz University for Health Sciences and King Abdulaziz Dental Center, National Guard Health Affairs, who were seeking treatment for partial edentulism.MethodsAn observational cross-sectional study was conducted by visualizing cast models for partially edentulous patients. Kennedy classification, age, gender, and treatment design were recorded from the lab request sheets that were attached to the casts in the labs at both the College of Dentistry at King Saud bin Abdulaziz University for Health Sciences and King Abdulaziz Dental Center, National Guard Health Affairs. The statistical analyses were performed with SPSS version 20.0 utilizing frequency and Pearson’s and Spearman’s correlation tests.ResultsKennedy Class I (45.0%) was the most prevalent pattern in both dental arches, followed by Class III (26.2%). Next was Class II (23.3%), while Class IV was the least prevalent (5.4%).ConclusionKennedy Class I was the most noted classification in our patient population. As age increases, there is an increased tendency toward Class I and II.  相似文献   
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目的 探讨老年择期手术患者护理依赖类别及与出院准备度的关系,为制订针对性的出院干预计划提供参考.方法 选取江苏省6所综合性三级医院的362例老年择期手术出院患者,采用一般资料调查表、出院准备度量表、护理依赖量表进行调查.结果 老年择期手术患者出院准备度得分为(159.39±30.79)分,护理依赖得分为(53.54±11.49)分.患者护理依赖可分为3个类别:社交依赖型(43.6%)、全面依赖型(23.8%)、学习依赖型(32.6%).多分类Logistic回归分析显示,患者年龄、人均月收入、居住方式及是否合并慢性病是护理依赖的影响因素(P<0.05,P<0.01).结论 老年择期手术患者护理依赖性较高,且与出院准备度关系密切.医务人员应针对不同类别制订针对性的干预措施,降低其护理依赖,提高出院准备度.  相似文献   
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