Safety of elective percutaneous peripheral revascularization in outpatients: A 10-year single-center experience

PurposeTo evaluate the safety and feasibility of peripheral percutaneous endovascular procedures in a large group of outpatients with peripheral arterial disease (PAD).Materials and methodsWe retrospectively evaluated all consecutive patients who underwent peripheral transluminal angioplasty (PTA) for PAD of the lower extremities as “Out-Patient Admission Protocol” (OPAP) from January 2005 until December 2015. A total of 498 consecutive patients (305 men and 193 women) with mean age of 66 ± 10 (SD) years (range: 37–90 years) were evaluated. By protocol, patients were expected to be discharged 6 hours after the procedure. Clinical profile, procedure details and technical success were reviewed. Complications, conversion rate, readmission rate and long-term follow-up were evaluated.ResultsNinety one percent of patients (454/498) suffered from claudication. Unilateral femoral access was performed in 75.4% (493/654) of procedures with a 6-French sheath in 80.7% (528/654) of procedures. Balloon PTA alone was performed in 17.3% (148/857) and stent placement in 82.7% (709/857) of treated segments. Technical success of lesion treatment was 98.2% (857/873). Closure devices were used in 55.4% (362/654) of procedures. Conversion and readmission rates were 1.8% (12/654) and 0.6% (4/654), respectively. Long-term follow-up was obtained in 386 target lesions, 5-year restenosis of lesion was 20.5% (79/386).ConclusionAs designed, the OPAP was feasible, safe and effective with very low conversion and complications rates. These results strongly support a larger use of such approaches as routine practice.     

门诊患者健康素养对就医体验的影响及机制

目的: 探究中国门诊患者的健康素养与就医体验之间的关联,分析其具体的影响机制。方法: 以安德森医疗卫生服务利用行为模型和健康素养技能模型为理论依据,构建患者层面的就医体验影响因素理论框架。采用滚雪球抽样法,通过线上电子问卷调查,利用自行设计的患者健康素养量表和北京协和医学院开发的中国门诊患者体验量表,评估门诊患者的健康素养和就医体验,构建结构方程模型探究两者之间的关系。结果: 最终纳入门诊患者2 773名,健康素养总得分的平均值为(90.72±12.90)分,就医体验综合评价的平均分为(3.71±0.74)分。结构方程模型分析结果表明,门诊患者的健康素养对其就医体验的综合评价产生积极影响,健康素养每提升一个标准差,就医体验增加0.275个单位。在就医体验的不同维度上,健康素养对就医体验总效应的标准化路径系数从高到低依次是:信息引导体验0.337,人文关怀体验0.319,诊疗行为体验0.294,流程效率体验0.240,环境设施体验 0.173。结论: 提升个体的健康素养水平,对于门诊患者的就医体验有显著促进作用,其中信息引导体验和人文关怀体验受健康素养影响最大。     

肾病患者医疗花费趋势研究——基于北京市某三甲医院的分析

目的: 探究肾病患者医疗费用变化趋势及原因,为医疗改革决策提供参考依据。方法: 使用北京市某三甲医院成年肾病患者2012—2017年门诊及住院数据,利用描述性统计的方法分析患者次均花费和人均花费的时间趋势,并探究医疗花费变化的原因。结果: 肾病患者年均花费在2012—2017年间出现较快上涨。门诊和住院的花费上涨由不同原因导致,其中门诊年均花费的上升来源于患者年均就诊次数的增加,而住院年均花费的上升来源于患者次均花费的增加。住院花费上涨贡献最大的类别为药品和耗材,其中药品类费用上涨贡献最大,2017年次均12 524元,占当年平均次均总花费的32.4%;耗材类次均9 215元,占比23.9%。结论: 门诊年均花费的上升主要来源于肾病患者年均就诊次数的增加,药物类和耗材类费用的增长是导致住院医疗总费用上升的主要因素。治疗类费用以及医疗服务费在总花费中所占比例仍然较低,可能需要适当调整。     

门诊糖尿病患者饮食控制现状的调查研究

目的了解门诊糖尿病患者饮食控制现状。方法方便取样调查60例门诊糖尿病患者3d的饮食热量控制、膳食结构和饮食行为。结果40例患者填写的问卷有效,日均饮食总热量理想9例(22.5%),不足16例(40.0%),过多15例(37.5%)。总热量与年龄、病程、睡前加餐热比呈正相关。超重者总热量控制不如体重正常和肥胖者(P<0.05)。碳水化合物、脂肪、蛋白质占总热量的比例分别为47.0%±9.0%、35.3%±8.5%、17.6%±3.4%。碳水化合物比例与在外就餐频率有关,脂肪比例与每天食用油量呈正相关,与每天蔬菜食用量呈负相关。结论门诊糖尿病患者饮食总热量不足和过多同时存在,三大营养素比例不合理问题突出。肥胖者饮食控制较好,超重者的饮食控制问题较为突出。     

门诊静脉血栓栓塞症患者抗凝手册的建立及有效性分析

目的评估门诊静脉血栓栓塞症(venous thromboembolism,VTE)患者抗凝手册的建立及其临床可行性、安全性和有效性。方法前瞻性分析上海交通大学医学院附属第九人民医院2018年10月至2019年3月采用门诊VTE抗凝手册的门诊VTE患者随访资料,主要研究终点为规范性抗凝的依从性,次要研究终点包括出血并发症发生率和症状性血栓复发率和失访率。结果门诊VTE患者规范性抗凝依从性为89.4%,其中口服利伐沙班和皮下注射低分子量肝素患者的依从性分别为92.9%和100%,口服华法林患者的依从性为77.8%。出血并发症发生率为5.3%,均为轻微出血。症状性血栓复发率为2.1%,均发生于口服华法林患者。患者总失访率为4.3%。结论建立门诊VTE患者抗凝手册可以有效提高患者治疗依从性,降低失访率,且具有较低的并发症发生率和血栓复发率。     

医院门诊患者合理用药认知度及影响因素分析

目的：了解医院门诊患者合理用药认知现状,分析合理用药认知影响因素,为制定居民合理用药健康教育策略提供依据。方法采用分层随机抽样方法对安徽省3家三级医院、9家二级医院门诊患者进行合理用药认知度问卷调查,运用 SPSS 16.0进行描述性统计分析和多元线性回归分析。结果合理用药认知平均得分为（15.5±3.2）分,百分制为（70.5±14.3）分,其中认为中成药无副作用的占40.8%,认为注射剂更安全有效的占41.8%;70.3%未听说过基本药物,94.0%的患者会遵循医嘱服药;年龄、文化程度、职业、个人月收入、家人或朋友从医、学习意愿、与医生沟通是影响合理用药认知的因素。结论门诊患者合理用药认知度总体较高,用药依从性较好,但仍存在认知误区和不足问题,需要进一步加强合理用药健康教育。     

Identification of primary polydipsia in a severe and persistent mental illness outpatient population: A prospective observational study

Studies to date have only investigated primary polydipsia in hospitalized psychiatric patient populations, where rates range from 3% to 25%. The objective of the present study was to determine the occurrence of primary polydipsia in a psychiatric outpatient population, and to determine the perceptions of outpatients with self-induced water intoxication regarding reasons for drinking excess fluids, health risks, and insight into their behavior. All 115 psychiatric outpatients from a Community Outreach Program in Kingston, Ontario, were invited to participate in this study. Of these, 89 (77.4%) were enrolled. Data collection included chart reviews, structured interviews, weight measurements, and urine collection. The incidence of primary polydipsia was found to be 15.7%. One-half of the polydipsic people presenting with medical complications suggestive for water intoxication had cigarette smoking as a strong correlate. There were interesting answers to the self-induced water intoxication questionnaire. These showed a lack of knowledge related to the normal quantity of fluids necessary daily and about healthy behaviors. Excessive drinking occurs in psychiatric patient populations outside of institutional/hospital settings. Patients have limited awareness of the severity and possible complications from their problem. Given the prevalence of polydipsia, more effort should be put into identifying and treating this problem.     

Socio-demographic and clinical correlates of subjective quality of life among Nigerian outpatients with schizophrenia

This study aimed to measure the subjective quality of life (QOL) of Nigerian outpatients with schizophrenia and to examine its socio-demographic as well as clinical determinants. A total of 313 outpatients with schizophrenia participated in the study. Data were collected on socio-demographics, outpatient clinic attendance, perceived social support, perceived satisfaction with hospital care, medication adherence, illness severity and QOL. Multiple linear regression analysis was used to determine the amount of variance in the QOL domain scores explained by socio-demographic and clinical variables. Employment status, perceived social support, satisfaction with outpatient care, antipsychotic medication dose, Brief Psychiatric Rating Scale (BPRS) scores and medication adherence had significant relationships with all the QOL domains. Average monthly allowance and outpatient clinic default were significantly associated with all QOL domains except social relationship. Socio-demographic and clinical factors explained only a modest part (29.4%) of the variance in the QOL scores. It is likely that unmeasured ‘internalised’ determinants contribute in a much larger sense to the variation in subjective QOL.     

Is there an association between the level of grandiose narcissism severity of psychopathology?

Background: Narcissism is a personality trait associated with both psychological health and resilience as well as with aggression and interpersonal problems. Aim: This study compares levels of total narcissism and subscale scores in inpatients, outpatients and a community sample. Methods: Inpatients (N = 186) were recruited from consecutively admitted patients to two closed units, and the outpatient group (N = 144) consisted of patients attending a psychiatric outpatient clinic. The patients and a normative community sample (N = 437) all filled in the Narcissistic Personality Inventory questionnaire (NPI-29). Results: The NPI total and subscales scores showed considerable gender differences. Among men only the Uniqueness/Entitlement subscale showed significant group differences, with inpatients showing higher mean score than the two other groups. Among women three factors, Leadership/Power, Superiority/Arrogance, and Uniqueness/ Entitlement, showed significant differences between the different levels of psychopathology. The outpatient female group regularly had the lowest group mean scores. The NPI-29 scores of the normative group showed weak internal consistencies. Conclusion: Our hypothesis of a significant association between mean levels of total narcissism and subscale scores and severity of psychopathology was not supported.