Admission rates for peptic ulcer in the Trent Region, UK, 1972–2000: Changing pattern, a changing disease?

BACKGROUND AND AIM: Peptic ulcer disease is believed to be less common and less severe as a result of modern medical treatment. We therefore examined changes in the admission rates for patients with duodenal ulcer and gastric ulcer, both emergency (for haemorrhage, perforation or severe pain) and for elective surgery, before and since the introduction of the new advances in therapy. These admission indices reflect disease prevalence and severity. PATIENTS AND METHODS: We identified admission rates during 1972--2000 within the Trent Regional Health Authority, UK (population 4.7 million), from computerised patient information using diagnostic search codes ICD8-10 and expressed as rates per million resident population. Drug expenditure details were obtained from the Department of Health. RESULTS: Emergency admission rates as a whole changed little, a decline in the young being offset by an increase in the elderly. Haemorrhage was the most common reason (approximately 115 per million for duodenal ulcer and 87 for gastric ulcer) throughout [compared with perforation (80 and 21) and pain (90 and 68)]. In contrast, elective surgery has almost disappeared; this reduction began before the introduction of modern treatment. CONCLUSION: Emergency admission rates for duodenal and gastric ulcer for complications or severe pain have fluctuated over the last three decades but with little overall change. In contrast, elective surgery has declined dramatically, as a result of advances in treatment but also from changes in the natural history.     

First incident hospitalisation for Australian women aged 70 and beyond: A 10 year examination using competing risks

There are increasing concerns regarding high hospital use among older adults and the capacity to manage the economic impact of the ageing population trend on healthcare systems. First hospitalisation in old age may act as a catalyst for ongoing intensification of health problems and acute care use. This study examined factors associated with first incident hospitalisation in women aged over 70, accounting for the health inequalities associated with geographic location. Survey data from 3780 women from the 1921 to 1926 cohort of the Australian Longitudinal Study on Women’s Health were matched with the Admitted Patients Data Collection and National Death Index. Days to first event (hospitalisation or death) were modelled using competing risks methods. A total of 3065 (80.3%) women had at least one hospital admission. More than half of the top 15 reasons for first hospitalisation were related to cardiovascular disease, with atrial fibrillation the most common. Proportional subdistribution hazards models showed that first hospital admission was driven by enabling and need factors including asthma/bronchitis diagnosis (HR = 1.16; p = 0.047), private health insurance (HR = 1.16; p = 0.004) more than two prescribed medications in previous month (HR = 1.31; p = 0.001), more than four general practitioner visits in previous year (HR = 1.50; p = 0.034), lower physical functioning (HR = 0.99; p < 0.001) and living in an inner regional area (HR = 1.17; p = 0.003). First overnight hospitalisation was primarily related with potentially preventable and treatable chronic diseases. Primary and secondary strategies aimed at chronic disease generally, and better chronic disease management particularly for cardiovascular and respiratory diseases, may play a vital role in disease prevention or delay in readmissions among this population.     

入院视频宣教的应用效果评价

目的探讨视频辅助入院宣教在腹腔镜病房新病人入院宣教中的应用效果。方法采用便利取样方法,选取腹腔镜病房2013年11月新入院患者100例作为研究对象,并按入院先后顺序随机分为观察组与对照组各50例。对照组采用传统口述讲解进行一对一宣教;观察组采用一对一视频辅助入院宣教形式,患者及家属观看入院宣教视频,观看结束后护士针对不清楚的问题进行解答。统计分析两组在宣教时间、护士病员及对入院宣教满意度的差异。结果实验组患者宣教时间低于对照组(P<0.05),实验组病员及护士对入院宣教满意度均高于对照组(P<0.05)。结论采用视频入院宣教的形式充分应用了多媒体的功能,能增加患者的视听效果及兴趣,有助于患者尽快熟悉和适应环境,消除陌生感,减轻焦虑,建立良好的护患关系,提高患者对护理的满意度;节约了宣教时间,降低了护士工作强度,减轻了护士工作量,提高了工作效率,提高了护士对工作的满意度,具有重要的临床应用推广价值。     

Reflux-related symptoms reflect poor asthma control and the presence of airway neuronal dysfunction

BackgroundGastroesophageal reflux may be associated with the worsening of asthma by increasing cough reflex sensitivity. Hull Airway Reflux Questionnaire (HARQ) consists of 14 prevalent reflux-related symptoms. It may be useful in predicting the presence of cough reflex hypersensitivity in asthma.MethodsFrom August 2018 to July 2020, 266 asthmatic patients completed the HARQ. They underwent blood analysis, spirometry, fraction of exhaled nitric oxide (FeNO) measurement, and the capsaicin cough challenge test. Patients were considered to have reflux-related symptoms if their HARQ scores were 13 points or higher. We evaluated the association between reflux-related symptoms and clinical asthma outcomes. Finally, we performed a multivariate analysis to determine the clinical significance of the HARQ for asthma. This study was registered in the University Hospital Medical Information Network (UMIN000040732).ResultsThe mean HARQ scores were 13.1 (standard deviation 12.0). Patients in the high HARQ scores group (HARQ ≥13, n = 105) showed a lower prevalence of atopic predisposition, lower levels of FeNO, heightened capsaicin cough reflex sensitivity, poorer asthma control, and more frequent admissions due to asthma than those in the low HARQ groups (all p values < 0.05). The HARQ was useful in selecting patients with poor controlled asthma and those with severe cough when the cut-off value was set at 13. Multivariate analysis revealed that heightened capsaicin cough reflex sensitivity affected reflux-related symptoms, as well as lower levels of FeNO and younger age.ConclusionsHigher HARQ scores (≥13) may be useful in predicting not only poor asthma condition but also the presence of airway neuronal dysfunction in patients with asthma to some extent.     

Should patients with complex febrile seizure be admitted for further management?

Background and aims

Children with first complex febrile seizure (CFS) are often admitted for observation. The goals of this study were 1) to assess the risk of seizure recurrence during admission, 2) to determine whether early EEG affects acute management.

A prospective investigation of depression and adverse outcomes in patients undergoing vascular surgical interventions: A retrospective cohort study using a large mental health database in South London

BackgroundPatients with depression are more susceptible to cardiovascular illness including vascular surgeries. However, health outcomes after vascular surgery among patients with depression is unknown. This study aimed to investigate associations of depression with post-operative health outcomes for vascular surgical patients.MethodsA retrospective observational study was conducted using data from a large mental healthcare provider and linked national hospitalization data for the same south London geographic catchment. OPCS-4 codes were used to identify vascular procedures. Health outcomes were compared between those with/without depression including length of hospital stay (LOS), inpatient mortality, and 30 day emergency hospital readmissions. Predictors of these health outcomes were also assessed.ResultsVascular surgery was received by 9,267 patients, including 446 diagnosed with depression. Patients with depression had a higher risk of emergency admission for vascular surgery (odds ratio [OR] 1.28; 1.03, 1.59), longer index LOS (IRR 1.38; 1.33–1.42), and a higher risk of 30-day emergency readmission (OR 1.82; 1.35–2.47). Patients with depression had higher inpatient mortality after adjustment for sociodemographic status (1.51; 1.03, 2.23) but not on full adjustment, and had longer emergency readmission LOS (1.13; 1.04, 1.22) after adjustment for sociodemographic factors and cardiovascular disease. Correlates of vascular surgery hospitalization among patients with depression included admission through emergency route for longer LOS, inpatient mortality, and 30-day hospital readmission.ConclusionPatients with depression undergoing vascular surgery have substantially poorer health outcomes. Screening for depression prior to surgery might be indicated to target preventative measures.     

中医护理准入管理制度在推广中医特色护理实践中的应用

目的探讨实施中医准入管理制度在西医专科医院推广中医特色护理实践中的应用成效。方法采用整群抽样法,选取中国科学院大学附属肿瘤医院42个护理单元的839名正式编制的护理人员作为研究对象。于2018年4月开始对其实施中医准入管理。比较实施前后患者对中医护理的满意度和科室的质控检查评分。结果实施中医护理准入管理后患者对中医护理的满意度评分较实施前均提高(P<0.05)。2018年4月—2020年3月,开展3项以上中医护理技术的科室由2018年的8个病区增加到2020年的33个病区。中医专科专项质控检查平均分逐年递增,2018年的质控检查评分为(92.80±2.02)分,2019年的质控检查评分为(96.17±3.04)分,2020年的质控检查评分为(98.27±3.11)分。结论实施中医准入管理制度,在全院开展中医特色护理并进行有效监管与质控,能够持续性地提高全院中医护理质量,也使中医特色护理在西医专科医院得到长久的发展。     

河北省急性心肌梗死患者使用急诊医疗服务系统现状分析及对治疗和预后影响

目的:调查河北省急性心肌梗死（acute myocardial infarction, AMI）患者使用急诊医疗服务系统（emergency medical service, EMS）现状及其对患者急性期治疗和近、远期预后的影响。方法:收集河北省主要三级及部分具有代表性的二级医院在2016年1至12月期间住院的AMI患者。根据其不同就诊方式分为EMS组和自行就诊组,对两组患者的一般情况、发病到就诊时间、治疗方法、院内病死率及3年病死率等指标进行分析总结。结果:共纳入2 961例患者,采用EMS方式就诊患者占33.13%,自行就诊患者占66.87%。既往有高血压病病史以及ST段抬高型心肌梗死（ST-segment elevation myocardial infarction, STEMI）患者更倾向于选择EMS方式就诊,差异有统计学意义。并且EMS组患者更倾向于前往三级医院就诊（88.58% vs 85.76%, P=0.033）。EMS组患者发病到就诊时间明显短于自行就诊组患者（160 min vs 185 min, P<0.01）,且EMS组从症状发作到就诊时间在<3 h及3~6 h时间段患者所占比例均高于自行就诊组（55.76% vs 49.14%,21.41% vs 19.09%, P<0.01）。相比自行就诊组,EMS组患者有更高的再灌注治疗率（67.48% vs 61.67%, P=0.002)。EMS组患者的急性期院内病死率较高（7.03% vs 4.44%, P=0.003）,但其3年病死率低于自行就诊组（17.31% vs 20.77%, P<0.05）。 结论:EMS能够缩短AMI患者发病到就诊时间,增加患者再灌注治疗率,并且能改善患者的远期预后。