1401例超长住院日患者分布与影响因素分析

目的分析超长住院患者分布及影响因素,探讨减少超长住院日的措施。方法从江苏省某三甲医院病案管理系统中调取2020年1月1日-2020年12月31日134016例出院患者的住院病案首页资料,对住院时间≥30天的1401例超长住院患者的分布特征进行统计描述,采用Logistic回归模型分析超长住院日的影响因素。结果2020年全院平均住院日为7.13天,其中超长住院患者平均住院日为41.85天。超长住院患者以60岁以上年龄组最多(39.61%);出院科室主要分布在血液科(42.18%)、普通外科(11.85%)、骨科(7.49%)等;疾病类别主要为肿瘤(47.32%)、影响健康状态和与保健机构接触的因素(10.56%)、循环系统疾病(7.07%)等;多因素Logistic回归结果显示,男性(OR=1.188)、离院方式为非医嘱离院或其他(OR=2.046)和死亡病例(OR=3.362)是超长住院的危险因素。结论控制超长住院日对平均住院日影响显著,医院应加强重点人群、重点科室和重点病种管理提高诊疗管理水平,缩短平均住院日。     

Análisis de supervivencia en investigación cardiovascular (I): lo esencial

This review provides a practical guide to the essentials of survival analysis and their reporting in cardiovascular studies, although most of its key content can be extrapolated to other medical fields. This is the first in a series of 2 educational articles laying the groundwork to address the most relevant statistical issues in survival analyses, which will smoothly drive the reader from the most basic analyses to the most complex situations. The focus will be on the type and shape of survival data, and the most common statistical methods, such as nonparametric, parametric and semiparametric models. Their adequacy, interpretation, advantages and disadvantages are illustrated by examples from the field of cardiovascular research. This article ends with a set of recommendations to guide the strategy of survival analyses for a randomized clinical trial and observational studies. Other topics, such as competing risks, multistate models and recurrent-event methods will be addressed in the second article.     

435例原发性高血压患者脉图参数与心血管危险分层的相关性分析

目的 本研究旨在探讨原发性高血压患者脉图参数与心血管危险分层的相关性，为原发性高血压患者心血管风险事件预警提供中医特色的依据。方法 采集435例原发性高血压患者的症状体征、脉象信息、生化指标等，分为低中危组、高危组、很高危组，采用单因素方差分析、秩和检验、有序logistic回归分析等方法，探讨原发性高血压患者脉图参数与心血管危险分层的相关性。结果 ①高血压低中危组→高危组→很高危组患者病程逐渐延长，两两组间比较有统计学差异；②高血压低中危组→高危组→很高危组患者的脉图参数H3/H1、H4/H1逐渐上升；高血压患者很高危组H5/H1、T1/T低于低中危组；③有序logistic回归分析结果显示，脉图参数T1、T4、T5、T为影响因素。结论 病程、血脂、肾功能是高血压患者心血管危险分层的影响因素之一。心血管危险分层等级的升高与脉图参数H3/H1、H4/H1、T5、T的升高及H5/H1、T4、T1的降低相关，说明脉图能一定程度上反映原发性高血压患者血管壁增厚、血管内壁受损、血管硬化及左心室收缩功能的减退程度。     

A new analytical cut-off point for determining 18 years of age using MRI on medial clavicular epiphysis

Evaluation of the ossification of the medial clavicular epiphysis plays a key role in forensic age estimation. The purpose of the present study was to assess a new numerical cut-off at the age of 18 years, taking into consideration Magnetic Resonance (MR) images of the medial clavicular epiphysis. We analyzed 163 MR scans of Italian subjects aged between 14 and 25 years. Using the data obtained we calculated two ratios: REM-1 (ratio between the length of the whole epiphysis and the length of the metaphysis) and REM-2 (ratio between the length of epiphyseal-metaphyseal fusion and the length of the metaphysis). In 68 out of 163 cases it was not possible to measure REM-2. The reproducibility was demonstrated using the Intraclass Correlation Coefficient (ICC) (Cronbach’s alpha > 0.80). REM-1 and REM-2 were compared in each category of age (adult and minor) by the Wilcoxon signed-rank test. The cut-off points for measurements of REM-1 and REM-2 were determined by logistic regression. For REM-1, the cut-off scores were 0.83 for all individuals (accuracy = 94.77%) and males (accuracy = 96.05%), and 0.86 for females (accuracy = 92.30%). For REM-2, the cut-off values were 0.40 for all individuals and males (accuracy = 100.00%), and 0.41 for females (accuracy = 100.00%). Finally, receiver operating characteristic (ROC) curves for age classification based on REM-1 and REM-2 were constructed, showing that REM-2 had the highest discriminative power. Thus, a new cut-off model for predicting the age of majority has been introduced, conducting a quantitative analysis thanks to the use of a high-resolution imaging tool.     

青海地区获得性耐药结核病产生的危险因素及其预测模型的构建

目的探讨青海地区原发性与获得性耐药结核病的危险因素及临床发病风险预测模型构建。方法选取2018年7月-2019年7月青海地区132例耐药结核病患者为观察组,青海地区132例非耐药结核病患者为对照组,查阅患者的的临床资料,并自制调查问卷,以问卷调查的方式收集患者的相关信息,分析两组患者的临床指征,采用多因素Logistic回归分析完成风险模型建立,绘制ROC曲线分析风险模型的预测效能。结果单因素结果表明:青海地区原发性与获得性耐药结核病发生率与年龄、性别、与患者接触、3月底痰涂片结果无统计学意义(P>0.05);与居住地、婚姻状况、家庭收入、治疗末痰涂片结果、体重指数、抗结核药物性肝损害、结核病灶数、结核空洞、合并糖尿病及登记分类初治具有统计学意义(P<0.05);多因素logistic结果表明:青海地区原发性与获得性耐药结核病发生率与居住地、登记分类、体重指数、抗结核药物性肝损害、3月末肺结核病灶数及痰涂片结果,具有统计学意义(P<0.05);ROC曲线结果表明:构建获得性耐药结核病发病风险预测模型用于青海地区原发性与获得性耐药结核病患者中ACU值为0.847,预测敏感性为87.46%,特异性为90.29%。结论青海地区原发性与获得性耐药结核病危险因素较多,不同因素能相互作用、相互影响,构建获得性耐药结核病发病风险预测模型,能较好的预测临床发病,有助于指导临床诊疗。     

Stature estimation for Saudi men based on different combinations of upper limb part dimensions

Estimating stature based on body/limb parts can help define the characteristics of unidentified bodies. The most studied upper limb part is the hand, although few studies have examined whether stature can be estimated using fingers plus other hand dimensions. Moreover, there is paucity in anthropometric studies that determined whether bilateral whole limb parts (e.g., arms, forearms, and hands) are related to stature among the living subjects.This prospective cross-sectional study aimed to evaluate the relationship between different upper limb measurements and the stature of Saudi men. Furthermore, I assessed whether upper limb asymmetry was present, and developed regression models to estimate stature based on different available measurements. Stature and 13 upper limb parameters were measured for 100 right-handed Saudi men who were 18 to 24 years old.All measurements were positively correlated with stature (P < .001), and the best single predictor was the bilateral ulnar length. Asymmetry was more pronounced in the hand measurements. A multiparameter model provided reasonable predictive accuracy (±3.77–5.68 cm) and was more accurate than single-parameter models. Inclusion of the right-side fingers improved the model''s accuracy.This study developed potential models for estimating stature during the identification of bodies of Saudi men.     

Outcomes of coronary artery bypass grafting in patients with heart failure with a midrange ejection fraction

BackgroundCoronary artery bypass grafting (CABG) improves survival in patients with heart failure and severely reduced left ventricular systolic function (LVEF). Limited data exist regarding adverse cardiovascular event rates after CABG in patients with heart failure with midrange ejection fraction (HFmrEF; LVEF > 40% and < 55%).MethodsWe analyzed data on isolated CABG patients from the Veterans Affairs national database (2010-2019). We stratified patients into control (normal LVEF and no heart failure), HFmrEF, and heart failure with reduced LVEF (HFrEF) groups. We compared all-cause mortality and heart failure hospitalization rates between groups with a Cox model and recurrent events analysis, respectively.ResultsIn 6533 veterans, HFmrEF and HFrEF was present in 1715 (26.3%) and 566 (8.6%) respectively; the control group had 4252 (65.1%) patients. HFrEF patients were more likely to have diabetes mellitus (59%), insulin therapy (36%), and previous myocardial infarction (31%). Anemia was more prevalent in patients with HFrEF (49%) as was a lower serum albumin (mean, 3.6 mg/dL). Compared with the control group, a higher risk of death was observed in the HFmrEF (hazard ratio [HR], 1.3 [1.2-1.5)] and HFrEF (HR, 1.5 [1.2-1.7]) groups. HFmrEF patients had the higher risk of myocardial infarction (subdistribution HR, 1.2 [1-1.6]; P = .04). Risk of heart failure hospitalization was higher in patients with HFmrEF (HR, 4.1 [3.5-4.7]) and patients with HFrEF (HR, 7.2 [6.2-8.5]).ConclusionsHeart failure with midrange ejection fraction negatively affects survival after CABG. These patients also experience higher rates myocardial infarction and heart failure hospitalization.     

歧义病案产生的影响因素分析

目的分析歧义病案产生的影响因素,为医院开展相关DRGs管理提供决策依据。方法回顾性调查2019年1月1日-2019年12月31日广州市某三甲医院45856份手术病案,利用国家版DRGs分组器筛查出518份歧义病案。采用单因素卡方检验及多因素Logistic回归分析歧义病案产生的影响因素。结果45856份手术患者住院病案首页中共有歧义病案518份,占全部手术病案的1.13%。单因素分析显示,歧义病案的产生与患者性别、出院科别、是否转科、是否死亡和是否肿瘤有关(P<0.05),与患者的年龄、住院天数和病例分型无关(P>0.05)。多因素Logistic回归分析结果显示,男性、非手术科室出院、死亡患者、非转科患者和肿瘤患者都是歧义病案产生的危险因素(P<0.05)。结论性别、出院科别、是否死亡、是否转科和是否肿瘤与歧义病案的产生密切相关,应加强临床医师住院病案首页填写培训和开展病案编码质量评价,从而减少主观因素所造成的歧义病案。