Diabetes--inpatient utilisation, costs and data validity. Dunedin 1985-9.

AIM: to describe the impact of diabetes on the public hospital inpatient services in one New Zealand region over the period 1985-9, from one 450 bedded university teaching hospital in a major urban centre in New Zealand serving a population of approximately 125,000 people. METHODS: by the analysis of routinely collected hospital discharge data and the application thereto of the resource utilisation system (RUS). Data validation was performed by means of a survey of clinical notes. RESULTS: admission, bed utilisation rates and associated costs for diabetes rose over the period by factors of 3.2, 3.8 and 2.8 respectively; due primarily to the management of macrovascular disease in the elderly. The rise was most marked in those 75 years and over; admission rates, bed utilisation rates and costs in this age group being respectively 1.9, 4.3 and 2.9 times greater than the 60 to 74 year age group. For admissions with diabetes as principal diagnosis, admissions for glycaemic control showed a significant decrease in lengths of stay over the period. Admissions with diabetic peripheral vascular disease were cumulatively, and per case, the most costly, the mean cost, at $16,000 per case, being 5.1 times greater than the mean cost of all admissions with diabetes as principal diagnosis. In 1989 diabetes accounted for 5% of the cost of all inpatient care provided by the hospital. These results are an underestimate, as 45% of admissions of people where diabetes should have been cited as a subsidiary diagnosis were omitted from the discharge data. CONCLUSION: diabetes is a major consumer of hospital resources in this region. As the majority of diabetes associated resource use is in the elderly, a population projected to increase significantly, consideration needs to be given to the options for the provision of care. More work also needs to be done on the reasons underlying these changes. If routinely collected data is to be used for these purposes then audit of the data must be performed or use should be restricted to certain defined groups, eg, diabetes as principal diagnosis only.     

A two year retrospective review of reasons for pediatric admission to Chiro Hospital, Eastern Ethiopia

BACKGROUND: The health and well being of children is of a major importance. Even though much activity and effort is directed towards promoting children's health there is scarcity of information on child health morbidity in this country. The objective of this study was to review pediatric admission and discharge records of Chiro Hospital, East Ethiopia. METHOD: A two-year retrospective record analysis of pediatric ward admission and discharge of Chiro hospital during September 2000 - August 2002 was conducted A record book of pediatric ward of the Hospital was reviewed using pre-tested format. The main diagnosis, cause of admission and death, personal characteristics and length of stay was included in the analysis. Data were analyzed by SPSS version 11. computer statistical software. RESULT: Nine hundred and sixty three pediatric patients were admitted to the hospital within the two years Period. Most common diagnosis leading to pediatric admission were diseases of respiratory system 215 (22.9%) and infective and parasitic diseases (22.9%). The three most common infections: pneumonia 368 (39.2%), malaria 140 (14.9%) and tuberculosis 103 (10.9) were more common among male than female children, but no statistical difference was observed between the ten common infectious diseases and sex of the children (P>0.5). More death was observed in males 50 (5.3%) than females 32 (3.4%). Twenty-eight (34.2%) of the deaths occurred within 48 hours and (39.0%) died after 72 hours of admission. CONCLUSION: The review showed that communicable diseases were the most common causes of admissions (61.3%) and the patterns of morbidity and mortality reflects those of developing countries that call for extensive preventive measures. In view of the limited duration of the study, further review taking five or ten year duration is recommended for planning and strengthen maternal and child health services.     

慢性心力衰竭NT-ProBNP、hs-CRP变化及其预后价值

目的探讨B型钠尿肽前体(NT-ProBNP)和高敏C反应蛋白(hs-CRP)联合检测对心力衰竭诊断、病情评估和预后判断的价值。方法测定该院2010年1月—2012年11月103例明确诊断为充血性心力衰竭(CHF)的患者,测定入院时、出院时血浆NT-ProBNP和血清hs-CRP水平,进行治疗前后对比观察,并随机抽取该院35名健康体检者作对照组比较,随访6月观察患者心脏事件再发生的情况。结果血浆NT-ProBNP和血清hs-CRP和水平在心衰不同心功能分级组和健康对照组之间差异有统计学意义,心功能越差,其浓度越高(P0.05);治疗前后比较,差异均也有统计学意义(P0.05);出院后发生心脏事件组血浆NT-ProBNP和血清hs-CRP水平浓度明显高于未发生心脏事件组(P0.05)。结论心衰患者中NT-ProBNP、hs-CRP明显升高,二者联合检测对心衰诊断、病情评估和预后判断有应用意义。     

某院2005～2009年内科糖尿病住院病人统计分析

目的了解某院内科住院患者中糖尿病患病情况,探索糖尿病发生的特点和规律,为预防和治疗提供一定的统计参考资料。方法调取2005年~2009年期间在内科住院患者有关资料,以出院主要诊断为依据进行整理分析。按照患者的年龄,性别和入院时间不同归类统计糖尿病的发病情况。结果（1）住院患者中糖尿病构成比逐年增加。（2）不同年龄组之间糖尿病构成比存在差异（P〈0.05）。（3）住院患者中女性糖尿病患者构成高于男性。结论本院住院患者中糖尿病构成比逐年递增,不同年龄组人群之间糖尿病构成比存在差异,女性高于男性。     

健康教育对哮喘患者吸入治疗的依从性分析

目的探讨健康教育对哮喘患者依从性的影响。方法对81例哮喘患者在入院前、住院中以及出院后进行比较,研究组45例,对照组36例。结果出院时研究组的哮喘知识和住院时间与照组比较,差异具有统计学意义(P<0.05);出院后研究组哮喘知识和住院天数与对照组比较,差异具有统计学意义(P<0.05)。结论健康教育方式对于提高哮喘患者的依从性很有帮助,有利于哮喘患者的治疗和康复。     

糖化血红蛋白检测在糖尿病诊断中的价值

目的探讨检测糖化血红蛋白在糖尿病诊断中的应用。方法回顾性分析2006年1月至2010年1月来我院接受糖尿病筛查的440例受检者的临床资料。结果 HbA1C诊断糖尿病的相关切点为6.1%,敏感性82.6%,特异性95.7%,曲线下面积90.7%;OGTT诊断糖尿病的FPG相关切点为6.3mmol/L,敏感性73.4%,特异性81.3%,曲线下面积83.7%。HbA1C诊断效率高于OGTT,但两种诊断方法未达统计学意义,P〉0.05。结论糖化血红蛋白筛查与诊断糖尿病不仅具有合理性,其准确性、敏感性与特异性也较为满意,但对于IGT（糖耐量受损）的诊断价值有待商榷。若与2hPG（餐后2h血糖）联合使用,对糖尿病诊断的敏感性进一步提高,也更有利于临床实践。     

Assessing the accuracy of hospital admission and discharge diagnosis of traumatic brain injury in a New Zealand hospital

AIMS: To investigate the accuracy of admission and discharge coding of traumatic brain injury (TBI) in a New Zealand hospital. METHOD: Prospective study of all patients over fifteen years of age admitted to Hutt Hospital over a six-month period with an actual or potential diagnosis suggesting TBI. RESULTS: During the six month period of study, 65 patients with the diagnosis of TBI were admitted to Hutt Hospital. Of these, 21 (32.3%) met the criteria for diagnosis of TBI ('Definite TBI'). A further eighteen patients, not admitted with a diagnosis of TBI, met the TBI criteria. Only 14/39 (35.9%) of 'Definite TBI' cases were identified at both admission and discharge. Discharge diagnosis of TBI identified correctly 26/39 (66.7%) of definite cases, with 34/60 (56.7%) cases with a discharge diagnosis of TBI not meeting our criteria for the diagnosis of TBI. Six out of 39 'Definite TBI' cases (15.4%) were not identified by either admission or discharge diagnosis. Thirty of the 65 patients (46.2%) admitted to hospital with the diagnosis of TBI showed clinical evidence of having taken alcohol, although only 12 had blood alcohol concentration measured. CONCLUSIONS: The admission and discharge diagnoses of TBI were not accurate when compared to a standard definition of TBI. For hospital discharge data to have any value, agreement on an operational diagnosis of TBI needs to be made, which should include measurement of the blood alcohol concentration. A suggestion for a diagnostic strategy is presented, along with ICD-10-AM codes that could be used to improve the current situation.     

个案管理师在鼻咽癌患者全病程个案管理中的临床实践效果

目的:探讨个案管理师在鼻咽癌患者全病程个案管理中的临床实践效果。方法:选择佛山市第一人民医院2018年1月至2019年12月初次病理确诊的鼻咽癌患者1 019例,男661例,女358例,年龄（48.22±12.1）岁,随机数字表法分为试验组510例和对照组509例。试验组予常规整体护理模式,同时结合个案管理模式,在患者...     

Non-invasive methods for measuring data quality in general practice

AIM: To develop non-invasive methods of measuring the quality of data recorded in general practice. METHODS: Laboratory and pharmaceutical claims data from fourteen practices (44 doctors) from the FirstHealth network of general practices were examined to determine the extent to which valid minimum bounds on expected rates of diagnosis coding could be established. These were compared with recorded rates in patient notes to measure completeness of diagnosis recording. Data completeness was measured for demographic data and a marker for the accuracy of gender coding was developed from diagnosis data. RESULTS: Minimum rates of diagnosis could be established for asthma, diabetes (NIDDM and IDDM), ischaemic heart disease, hypothyroidism, bipolar affective disorder and Parkinson's disease. Minimum bounds for the number of patients requiring monitoring of warfarin and digoxin levels were also established. These expected minimum rates were combined with measures of completeness of age, gender, ethnicity and smoking data, and a gender coding accuracy measure, to produce a set of fourteen data quality indicators. Pass/fail thresholds on each indicator were set and each of the fourteen practices was scored on the number of passes they achieved. The scores ranged from three to nine out of fourteen passses. CONCLUSIONS: Non-invasive data quality measures may be useful in providing feedback to general practitioners as part of a data quality improvement cycle. The sensitivity of this method will decline as data quality improves.     

Mortality after hip fracture: regional variations in New Zealand.

AIM: To determine the 35-day and one-year mortality rates following a hospital admission for hip fracture, among individuals aged 60 years or older in New Zealand. METHODS: New Zealand Health Information Service mortality data for the years 1988 to 1992 were examined to determine the case fatality rate among individuals aged 60 years or older admitted to hospital for fractures of the neck of femur (ICD-9 N-code 820). Case fatality rates assessed at 35 days and one year after admission to hospital were examined by age, gender, year of admission, place of residence, area health board region and cause of death. RESULTS: Between 1988 and 1992, the case fatality rate was 8% within 35 days of admission to hospital and 24% within one year of admission. Case fatality rates were found to be twice as high in men compared to women and four to five times higher in individuals aged 85 years and older, compared to people aged between 60 and 64 years. The only regional difference in hip fracture mortality was found in the Canterbury area health board region, which had a 30% higher rate of hip fracture mortality compared to all regions combined. The two main cited underlying causes of death after hip fracture were accidental falls (ICD E880-E888) and ischaemic heart disease (ICD 410-414). CONCLUSION: Over three-quarters of individuals aged 60 years or older who are hospitalised with a hip fracture in New Zealand survive for at least one year after admission. However, significant variations in mortality exist with age and gender. These data highlight the importance of preventive strategies for hip fracture in older people and the need to identify ways of improving post-admission care.     

“健康教育和随访机制”系统干预冠心病危险因素效益评估

目的探讨健康教育和随访在冠状动脉粥样硬化性心脏病(简称冠心病,CHD)危险因素干预中的作用。方法观察参加健康教育和随访的600例冠心病患者或冠心病危险因素高危者主观和客观指标的改变。结果 (1)主观指标:患者对健康的认识程度由20%增加到87%,锻炼身体时间达标率由34%增加到76%,认识到吸烟的危害性并已经戒烟者由15%增加到56%,坚持按照医嘱服药者由16%增加到88%,展开随访后患者对健康教育的认知度明显较随访前提高,差异均有统计学意义(P<0.05);(2)客观指标:随访期间急性冠状动脉事件发生率由20%减至8%,差异有统计学意义(P<0.01);因急性冠状动脉事件住院次数大于2次的患者由40%降至15%,差异有统计学意义(P<0.01);血压、血脂达标率由12%增加到75%,差异有统计学意义(P<0.05)。结论通过健康教育和随访干预冠心病危险因素,可以很大程度地提高患者的生活质量,防止并发症发生。     

Accuracy of hospital discharge data: five alcohol-related diseases

Accuracy of hospital discharge register data was studied by comparing 954 randomly selected abstracts to the respective medical records. The average percentages of agreement were: date of birth 98, date of admission 96, date of discharge 94, area of residence 93, principal diagnosis 91, disposition on discharge 89, marital status 84, third diagnosis 83, second diagnosis 76, social group 74, occupation 60, and source of admission 49. Accuracy of items was not related to alcohol etiology. An analysis of variance indicated that the number of items in agreement varied by both diagnosis and type of hospital.     

急性老年晕厥患者临床特征和预后危险因素分析

目的 探讨老年急性晕厥患者临床特征和预后危险因素.方法 选取邓州市人民医院2020年2月至2021年2月收治的130例老年急性晕厥患者作为研究对象.检测患者血脂、血糖、血压等指标,收集患者病史、个人基本信息、生活习惯等资料,对患者展开为期4个月的院后随访并统计患者终点事件(心源性休克、死亡、二次入院、不良心血管事件、血...     

Multicenter hospital study on prescribing patterns for prophylaxis and treatment of complications of cirrhosis

OBJECTIVE: To describe the prescribing patterns for liver disease management. METHODS: A multicenter cross-sectional prospective observational study was carried out in 25 Spanish hospitals. Inpatients, admitted to gastrointestinal and liver units with a diagnosis of liver cirrhosis, were included in five centrally assigned index days between February and June 1999. Information was collected about demographic variables and pharmacological treatments used on admission and recommended at discharge. RESULTS: Five hundred and sixty-eight patients (70% men, mean age 61 years) were studied. Alcoholic cirrhosis of the liver accounted for 44% of the sample, ascites being the most prevalent complication. The most frequent diuretic schedule on admission was the combination of spironolactone and furosemide at a ratio of 1 (100 mg/40 mg). Hospitalization resulted in an increase in the percentage of patients that received the combination at a ratio higher than 1. Diuretics were a major cause of adverse drug events on admission (7.5%). Ulcer-healing drugs showed a notable increase at discharge (35%; range 10-59%) compared with 24% (6-37%) on admission. Utilization rates at discharge were 65% (59-74%) for diuretics, 51% (38-76%) for laxatives, 31% (0-75%) for vitamin K, 24% (4-53%) for beta-adrenergic blocking agents, and 13% (0-47%) for nitrates, which were significantly higher than on admission. CONCLUSION: These results provide the first quantitative data of drug utilization in liver disease and highlight the wide variability in prescribing practices across centers and the higher than expected use of non-evidence-based treatments, especially vitamin K and antiulcer drugs.     

Adverse events regional feasibility study: indicative findings.

AIMS: To identify substantive findings of potential clinical and managerial significance from a regional feasibility study of adverse events (AEs). METHODS: A standardised protocol using structured implicit review was applied to 142 AEs generated in an audit study of three public hospitals in the Auckland region for admissions in 1995. Areas of potential significance addressed were: timing, location and impact of AEs; preventability; and clinical context and predictability. RESULTS: 142 cases were identified as AEs (10.7% of 1,326 screened records). In 102 cases, 7.7% of all screened records, it was considered to be more likely than not that health care management contributed to the AE. About half the reported AEs occurred before the index admission, the majority outside hospital. Over half of all events resulted in disability that was resolved within a month. An average 6.7 extra days stay in hospital were attributable to AEs. For 60% of AEs the evidence for preventability was either low or nonexistent. Areas of potential prevention were predominantly educational. Over half of all AEs occurred in a surgical context. Medical AEs were more likely to have occurred outside hospital, to be drug-related, to be associated with an acute admission, to be classified as highly preventable, and to have a greater impact on hospital stay. CONCLUSIONS: Although the data generated by a feasibility study must be treated with caution, the pattern of results is consistent with comparable Australian findings and is of potential clinical and managerial significance.     

老年糖尿病患者健康教育需求程度调查

目的:了解老年糖尿病患者对健康教育需求情况,为实施个性化健康教育服务提供依据。方法:参考相关资料,设计老年糖尿病患者健康教育需求程度调查问卷。分一般糖尿病知识需求情况、营养、运动、健康教育、自我监测、并发症、药物及出院指导8个维度。每个维度设计相应的条目,每一条目采用单项选择法分为非常需要、需要、无所谓、不是很需要及不需要5个等级。统计分析老年糖尿病患者对各个维度的需求情况。结果:老年糖尿病患者对一般糖尿病知识、健康教育、营养、并发症等知识的需求最高;其次为药物、运动方面;对出院指导、自我监测了解的需求较低。文化程度越高对健康教育的需求越高。结论:对老年糖尿病患者健康教育应重视其内容的实用性,老年;满足不同患者的需求。