Advance Directives in Hospitalized Patients: A Retrospective Cohort Study

The purpose of this study was to examine processes for advance directives (ADs) in hospitalized patients to inform improvements in practice and policy. This was a retrospective study examining electronic records of 5,330 inpatients admitted over a 3-month period. During admission, 63.5% of patients were queried, with 37.2% of patients having ADs and only 14.4% available in the record. Older age and Medicare insurance were associated with having ADs. Opportunities exist for nurse practitioners to change structure and processes related to ADs improving completion and availability.     

Test-retest reliability of EEG spectra during a working memory task

The inter-individual variation of EEG spectra is large even for the same cognitive task. We asked whether task-induced EEG spectra remain stable over more than a year.We recorded EEG in 41 healthy adults who performed a modified Sternberg task. In 20 subjects EEG was recorded in a second session with retest intervals 12–40 months. For electrodes AFz, Cz and Pz peak frequency and peak height were determined. We compared the curve shape of power spectra by regressing spectra pairwise onto each other and calculated a t-value. The t-value and pairwise differences in peak frequency and peak height between all sessions were entered into a generalized linear model (GLM) where binary output represents the recognition probability. The results were cross-validated by out-of-sample testing.Of the 40 sessions, 35 were correctly matched. The shape of power spectra contributed most to recognition. Out of all 2400 pairwise comparisons 99.3% were correct, with sensitivity 87.5% and specificity 99.5%.The intra-individual stability is high compared to the inter-individual variation. Thus, interleaved EEG-fMRI measurements are valid. Furthermore, longitudinal effects on cognitive EEG can be judged against the intra-individual variability in subjects.     

Longitudinal Analysis of Peritoneal Fluid Transport and Its Determinants in a Cohort of Incident Peritoneal Dialysis Patients

♦ Background and Objectives: There is a paucity of large longitudinal studies on the time course of peritoneal fluid transport. The aim of the present study was to longitudinally analyze changes in fluid transport and relevant solute transport parameters in patients treated with a conventional peritoneal dialysis (PD) fluid and, to mimic clinical reality, not selected for the presence or absence of ultrafiltration (UF) failure.♦ Methods: This prospective single-center cohort study followed 138 consecutive incident PD patients from July 1994 until censoring in August 2004. The design was longitudinal, with repeated measures over time in each patient. Patients had undergone at least 1 and a maximum of 5 annual standard peritoneal permeability analyses (SPAs) using 3.86% glucose dialysate. A linear mixed model was used to analyze the longitudinal data.♦ Results: No differences in patient characteristics were present at baseline in relation to the number of available SPAs. There were also no differences in patient withdrawal during the years of follow-up. A gradual decline in fluid transport, expressed as free water transport (FWT), small-pore fluid transport (SPFT), and transcapillary UF (TCUF), was observed with duration of PD. The decline was mainly attributable to patients who developed UF failure. The time courses for the determinants of fluid transport, such as the reflection coefficient (σ) and the UF coefficient (LpA), were not different. However, they were associated with an increase in the mass transfer area coefficient of creatinine, reflecting the peritoneal vascular surface area.♦ Conclusions: Fluid profiles for FWT and SPFT during a dwell can be explained by current knowledge of the three-pore model. Fluid transport declines with the duration of PD because of an increase in the vascular surface area, leading to a rapid dissipation of glucose as the osmotic agent. The absence of a trend in the time course of osmotic conductance and its constituents—that is, LpA and σ—suggests that, in an unselected population, these parameters are affected only late in the time course of PD.     

Thromboembolic Risk in Hospitalized and Nonhospitalized COVID-19 Patients: A Self-Controlled Case Series Analysis of a Nationwide Cohort

ObjectiveTo assess the associations between coronavirus disease 2019 (COVID-19) infection and thromboembolism including myocardial infarction (MI), ischemic stroke, deep vein thrombosis (DVT), and pulmonary embolism (PE).Patients and MethodsA self-controlled case-series study was conducted covering the whole of Scotland’s general population. The study population comprised individuals with confirmed (positive test) COVID-19 and at least one thromboembolic event between March 2018 and October 2020. Their incidence rates during the risk interval (5 days before to 56 days after the positive test) and the control interval (the remaining periods) were compared intrapersonally.ResultsAcross Scotland, 1449 individuals tested positive for COVID-19 and experienced a thromboembolic event. The risk of thromboembolism was significantly elevated over the whole risk period but highest in the 7 days following the positive test (incidence rate ratio, 12.01; 95% CI, 9.91 to 14.56) in all included individuals. The association was also present in individuals not originally hospitalized for COVID-19 (incidence rate ratio, 4.07; 95% CI, 2.83 to 5.85). Risk of MI, stroke, PE, and DVT were all significantly higher in the week following a positive test. The risk of PE and DVT was particularly high and remained significantly elevated even 56 days following the test.ConclusionConfirmed COVID-19 infection was associated with early elevations in risk with MI, ischemic stroke, and substantially stronger and prolonged elevations with DVT and PE both in hospital and community settings. Clinicians should consider thromboembolism, especially PE, among people with COVID-19 in the community.     

Connectedness of Pregnant Adolescents Who Smoke

PURPOSE: To examine the relationship of the constructs from the family and school environments and protective individual characteristics to health risk behaviors among pregnant adolescents who smoke. METHODS: Inner-city adolescents (N = 53), aged 14-19 years, who were participating in a smoking cessation intervention program, completed self-report demographic, social, and behavioral questionnaires. FINDINGS: Independent variables included family connectedness, school connectedness, and individual characteristics of religiosity, self-esteem, and grade-point average. Three areas of health risk behavior were dependent variables: delinquent behavior, substance, and precocious sexual behavior. CONCLUSIONS: Positive self-esteem served as a protectivefactorfor alcohol use. In contrast to past studies, school connectedness was a risk, not a protective, factor for substance abuse. Neither school nor family connectedness were protective against delinquent or precocious sexual behavior.     

住院老年患者卧床不起的心理社会因素分析

目的探讨住院老年患者卧床不起的心理社会因素，以预防或减少住院老年患者患病后的卧床不起。方法随机选择60例卧床不起（观察组）和60例非卧床不起（对照组）的老年患者，采用对照研究分析方法，对选择对象采用老年抑郁量表、焦虑量表、社会支持评定量表和生活满意度指数A进行评定。结果观察组的平均抑郁评分、焦虑评分明显高于对照组，有统计学意义（13．3vs8．5，47．0vs40．1，P〈0．01），生活满意度评分、社会支持总分、主观支持评分和支持利用度评分明显低于对照组，有统计学意义（12．8vs15．3，36．4vs40．7，19．7vs22．2，7．2vs8．0，P〈0．01），而客观支持评分两组比较，差异无统计学意义（10．1vs11．1，P〉0．05）。结论住院老年患者卧床不起的主要心理因素是抑郁和焦虑；主要社会因素是社会支持水平低下。     

住院老年患者卧床不起的心理社会因素分析

目的 探讨住院老年患者卧床不起的心理社会因素,以预防或减少住院老年患者患病后的卧床不起.方法 随机选择60例卧床不起(观察组)和60例非卧床不起(对照组)的老年患者,采用对照研究分析方法,对选择对象采用老年抑郁量表、焦虑量表、社会支持评定量表和生活满意度指数A进行评定.结果 观察组的平均抑郁评分、焦虑评分明显高于对照组,有统计学意义(13.3 vs 8.5,47.0 vs 40.1,P＜0.01),生活满意度评分、社会支持总分、主观支持评分和支持利用度评分明显低于对照组,有统计学意义(12.8 vs 15.3,36.4 vs 40.7,19.7 vs 22.2,7.2 vs 8.0,P＜0.01),而客观支持评分两组比较,差异无统计学意义(10.1 vs 11.1,P＞0.05).结论 住院老年患者卧床不起的主要心理因素是抑郁和焦虑;主要社会因素是社会支持水平低下.     

住院老年患者卧床不起的心理社会因素分析

目的探讨住院老年患者卧床不起的心理社会因素,以预防或减少住院老年患者患病后的卧床不起。方法随机选择60例卧床不起(观察组)和60例非卧床不起(对照组)的老年患者,采用对照研究分析方法,对选择对象采用老年抑郁量表、焦虑量表、社会支持评定量表和生活满意度指数A进行评定。结果观察组的平均抑郁评分、焦虑评分明显高于对照组,有统计学意义(13.3 vs 8.5,47.0 vs 40.1,P<0.01),生活满意度评分、社会支持总分、主观支持评分和支持利用度评分明显低于对照组,有统计学意义(12.8 vs 15.3,36.4 vs 40.7,19.7 vs 22.2,7.2 vs 8.0,P<0.01),而客观支持评分两组比较,差异无统计学意义(10.1 vs 11.1,P>0.05)。结论住院老年患者卧床不起的主要心理因素是抑郁和焦虑;主要社会因素是社会支持水平低下。     

Swallowing and Voice Outcomes in Patients Hospitalized With COVID-19: An Observational Cohort Study

ObjectiveTo evaluate the presentations and outcomes of inpatients with coronavirus disease 2019 (COVID-19) presenting with dysphonia and dysphagia to investigate trends and inform potential pathways for ongoing care.DesignObservational cohort study.SettingAn inner-city National Health Service Hospital Trust in London, United Kingdom.ParticipantsAll adult inpatients hospitalized with COVID-19 (N=164) who were referred to Speech and Language Therapy (SLT) for voice and/or swallowing assessment for 2 months starting in April 2020.InterventionsSLT assessment, advice, and therapy for dysphonia and dysphagia.Main Outcome MeasuresEvidence of delirium, neurologic presentation, intubation, tracheostomy, and proning history were collected, along with type of SLT provided and discharge outcomes. Therapy outcome measures were recorded for swallowing and tracheostomy pre- and post-SLT intervention and Grade Roughness Breathiness Asthenia Strain Scale for voice.ResultsPatients (N=164; 104 men) aged 56.8±16.7 years were included. Half (52.4%) had a tracheostomy, 78.7% had been intubated (mean, 15±6.6d), 13.4% had new neurologic impairment, and 69.5% were delirious. Individualized compensatory strategies were trialed in all and direct exercises with 11%. Baseline assessments showed marked impairments in dysphagia and voice, but there was significant improvement in all during the study (P<.0001). On average, patients started some oral intake 2 days after initial SLT assessment (interquartile range [IQR], 0-8) and were eating and drinking normally on discharge, but 29.3% (n=29) of those with dysphagia and 56.1% (n=37) of those with dysphonia remained impaired at hospital discharge. A total of 70.9% tracheostomized patients were decannulated, and the median time to decannulation was 19 days (IQR, 16-27). Among the 164 patients, 37.3% completed SLT input while inpatients, 23.5% were transferred to another hospital, 17.1% had voice, and 7.8% required community follow-up for dysphagia.ConclusionsInpatients with COVID-19 present with significant impairments of voice and swallowing, justifying responsive SLT. Prolonged intubations and tracheostomies were the norm, and a minority had new neurologic presentations. Patients typically improved with assessment that enabled treatment with individualized compensatory strategies. Services preparing for COVID-19 should target resources for tracheostomy weaning and to enable responsive management of dysphagia and dysphonia with robust referral pathways.     

住院患者肝功异常病因分析

目的 探讨住院患者肝功异常病因及影像学诊断意义。方法 对2008年1月—12月住院的223例18～83岁肝功异常患者进行相关实验室检查,以及B超、CT和MRI检查。结果 肝脏本身疾病引起135例,占6054%,肝外疾病引起83例,占37.22%,原因不明5例,占2.24%。B超作为无创性检查,价格低亷,准确率高,可作为常规检查。结论 住院患者肝功损害病因复杂,以药物性肝炎、胆道系统疾病及脂肪肝较多见。     

98例恶性淋巴瘤患者医院感染分析及护理对策

目的：调查分析恶性淋巴瘤患者医院感染情况及相关因素,探讨行之有效的护理对策,指导临床工作,提高恶性淋巴瘤患者的生活质量。方法：对１９９７ 年１ 月～１９９８ 年３ 月住淋巴血液病房患者的出院病历进行统计学分析。结果：９８ 例中４１ 例发生医院感染,发生率为４１８４ ％ 。发生部位以呼吸道最多,占６０ ．７９ ％ ;其次为皮肤和消化道。随着住院时间延长,感染发生率逐渐增加;医院感染患者死亡率是非感染者３ 倍;４１ 例感染患者在病程中送检标本共３４ 次。结论：护理人员应明确预防感染的重要性,加强恶性淋巴瘤患者预防感染措施。     

Activation detection in diffuse optical imaging by means of the general linear model

Due to its non-invasive nature and low cost, diffuse optical imaging (DOI) is becoming a commonly used technique to assess functional activation in the brain. When imaging with DOI, two major issues arise in the data analysis: (i) the separation of noise of physiological origin and the recovery of the functional response; (ii) the tomographic image reconstruction problem. This paper focuses on the first issue. Although the general linear model (GLM) has been extensively used in functional magnetic resonance imaging (fMRI), DOI has mostly relied on filtering and averaging of raw data to recover brain functional activation. This is mainly due to the high temporal resolution of DOI which implies a new design of the drift basis modelling physiology. In this paper, we provide (i) a filtering method based on cosine functions that is more adapted than standard averaging techniques for DOI specifically; (ii) a new mode-locking technique to recover small signals and locate them temporally with high precision (shift method). Results on real data show the capability of the shift method to retrieve HbR and HbO(2) peak locations.     

痴呆患者院内走失事件原因分析

目的:分析痴呆患者住院期间发生走失的原因。方法:对在我科住院期间发生走失事件的痴呆患者20例的临床资料进行回顾性分析,对其病因、走失前因、时间、寻获地点及结局进行分析。结果:本组75%的患者为血管性痴呆或老年痴呆;75%的患者走失的前因为照料者不在现场或医生(护士)未宣教;70%的走失时间发生于12:00~18:00;所有走失患者均被寻获,75%的寻获地点位于院内;本组走失事件均导致不同程度伤害。结论:痴呆的病理生理特点、护士对痴呆认知程度的不足及医院管理方面的不足是住院痴呆患者发生走失事件的主要原因。     

Urban-Rural Differences in Service Utilization and Costs of Care for Racial-Ethnic Groups Hospitalized With Poststroke Aphasia

Objective

Although residence is a key contributor to cost and utilization in stroke patient care, its contribution to the care of persons with aphasia (PWA) is unknown. The objective of this study was to use discharge-level hospital inpatient data to examine the influence of patient residence (rural vs urban) and race-ethnicity on service utilization and cost of care among PWA.

综合性医院住院患者心理障碍及相关性分析

目的　了解综合性医院住院患者心理障碍程度并对相关因素进行分析讨论。方法　应用焦虑自评量表(SAS)和抑郁自评量表 (SDS)、汉密顿焦虑量表 (HAMA)和汉密顿抑郁量表 (HAMD)及自行设计的相关因素调查表 ,对 2 75例住院患者进行临床测评。结果　综合性医院患者SAS和SDS标准分均值均高于正常人群 ;抑郁反应发生率为 33.8% ,明显高于我国正常人群抑郁症状发生率 ;外科患者心理障碍较内科患者严重 (P <0 .0 1)。结论　提示应重视综合医院住院患者心理问题 ,尤其是手术前后患者 ,有的放矢地予以心理干预 ,以利于患者的康复     

Vitamin D Status Is Associated With In-Hospital Mortality and Mechanical Ventilation: A Cohort of COVID-19 Hospitalized Patients

ObjectiveTo explore the possible associations of serum 25-hydroxyvitamin D [25(OH)D] concentration with coronavirus disease 2019 (COVID-19) in-hospital mortality and need for invasive mechanical ventilation.Patients and MethodsA retrospective, observational, cohort study was conducted at 2 tertiary academic medical centers in Boston and New York. Eligible participants were hospitalized adult patients with laboratory-confirmed COVID-19 between February 1, 2020, and May 15, 2020. Demographic and clinical characteristics, comorbidities, medications, and disease-related outcomes were extracted from electronic medical records.ResultsThe final analysis included 144 patients with confirmed COVID-19 (median age, 66 years; 64 [44.4%] male). Overall mortality was 18%, whereas patients with 25(OH)D levels of 30 ng/mL (to convert to nmol/L, multiply by 2.496) and higher had lower rates of mortality compared with those with 25(OH)D levels below 30 ng/mL (9.2% vs 25.3%; P=.02). In the adjusted multivariable analyses, 25(OH)D as a continuous variable was independently significantly associated with lower in-hospital mortality (odds ratio, 0.94; 95% CI, 0.90 to 0.98; P=.007) and need for invasive mechanical ventilation (odds ratio, 0.96; 95% CI, 0.93 to 0.99; P=.01). Similar data were obtained when 25(OH)D was studied as a continuous variable after logarithm transformation and as a dichotomous (<30 ng/mL vs ≥30 ng/mL) or ordinal variable (quintiles) in the multivariable analyses.ConclusionAmong patients admitted with laboratory-confirmed COVID-19, 25(OH)D levels were inversely associated with in-hospital mortality and the need for invasive mechanical ventilation. Further observational studies are needed to confirm these findings, and randomized clinical trials must be conducted to assess the role of vitamin D administration in improving the morbidity and mortality of COVID-19.     

住院军队伤病员的护理管理

目的：探讨住院军队伤病员的管理方法,为实施有效管理提供科学依据。方法：从病区管理的角度入手,运用护理程序的模式,实施军队伤病员全程护理管理。结果：运行3年多来病区伤病员无违纪违规现象,伤病员满意率为98.9%。结论：运用护理程序实施住院军队伤病员管理是一条简单易行、行之有效的管理方法。