Gender as a Moderator Between Having an Anxiety Disorder Diagnosis and Coronary Artery Bypass Grafting Surgery (CABG) Outcomes in Rural Patients

Purpose: This paper examines gender as a moderating variable between having an anxiety disorder diagnosis and coronary artery bypass grafting surgery (CABG) outcomes in rural patients. Methods: Using the 2008 Nationwide Inpatient Sample (NIS) database, 17,885 discharge records of patients who underwent a primary CABG surgery were identified. Independent variables included age, gender, race, median household income based on patient's ZIP code, primary expected payer, the Deyo, Cherkin, and Ciol Comorbidity Index, and an anxiety comorbidity diagnosis. Outcome variables included in‐hospital length of stay and patient disposition (routine and nonroutine discharge). A 2 × 2 analysis of variance and logistic regression analyses were used to assess the interaction between gender and an anxiety disorder diagnosis on in‐hospital length of stay and patient disposition. Findings: Twenty‐seven percent of rural patients undergoing a CABG operation had a comorbid anxiety diagnosis. Rural patients who had nonroutine discharge were more likely to have comorbid anxiety diagnosis compared to rural patients who had a routine discharge. There was a significant interaction effect between having an anxiety diagnosis and gender on length of hospital stay but not for patient disposition. Conclusions: Three findings were noteworthy. First, anxiety disorder is prevalent in rural patients who are undergoing a CABG operation. Second, anxiety was a significant independent predictor of both length of hospital stay and nonroutine discharge for patients receiving CABG surgery. Last, having an anxiety disorder diagnosis increased hospital stay for both males and females; however, females seemed to be impacted more than males.     

冠状动脉旁路移植手术与经皮冠状动脉介入治疗多支血管病变合并糖尿病患者的预后比较

目的比较冠状动脉旁路移植手术(CABG)与经皮冠状动脉介入(PCI)治疗多支血管病变(MVD)合并糖尿病(DM)患者的预后结果。方法连续收集2010年1月至2012年12月于咸阳市中心医院住院接受CABG和PCI的MVD合并DM患者入组。收集并获取患者基线资料,包括性别、年龄、既往病史、左心室射血分数、血生化指标、住院天数、住院费用、出院诊断等信息,并进行术后定期随访。结果本研究共收集MVD合并DM患者625例,其中接受CABG的共205例,接受PCI的共420例。与PCI组相比,CABG患者冠状动脉狭窄程度及左主干狭窄程度更严重(P<0.001),患者遭受的并发症更多(P<0.001);CABG组的主动脉内球囊反搏使用率高,住院总花费也显著偏高(P<0.001);CABG组患者的住院死亡率(1.5%)略高于PCI组患者(0.5%),但差异不显著(P>0.05);CABG组的五年生存率(98.0%)显著高于PCI组(74.5%);CABG组患者的预后显著优于PCI组,五年内发生心梗和心脑血管不良事件的概率也更低(P<0.05)。结论对于MVD合并DM患者,CABG手术的长期预后结局优于PCI手术。     

连续性护理对心脏外科冠脉搭桥术后患者的影响分析

目的 对心脏外科冠脉搭桥患者术后实施连续性护理的效果进行观察.方法 选取2017年8月—2019年8月期间106例行心脏外科冠脉搭桥术患者,根据随机数字表法分为对照组(n=53,常规护理)与观察组(n=53,连续性护理),对比两组护理效果.结果 在疾病知识、治疗知识、康复知识及日常生活知识等健康知识知晓率方面,观察组均...     

手术机器人应用于冠状动脉旁路移植术的安全性和有效性评估

目的 评价Da Vinci手术机器人辅助CABG术的安全性和有效性,为我国手术机器人的临床使用和配置提供循证信息和政策建议.方法 通过文献检索收集国内外Da Vinci手术机器人辅助CABG术的原始研究,提取手术安全性和有效性的相关信息并进行分析.结果 在获得的13项相关研究中,2项属Ⅲ级证据,11项属于Ⅳ级证据.各研究中,机器人具体应用的环节有差异,尚无足够证据证实手术机器人辅助CABG术的安全性和有效性优于现有的微创CABG术和经典开胸CABG术,且机器人应用于CABG术存在明显的学习曲线.结论 在条件成熟的地区,有必要适度发展手术机器人技术,但卫生行政部门应加以严格监管.     

Depression and remoteness from health services in South Australia

OBJECTIVE: To determine whether the prevalence of depression, its associated quality of life, treatment and mental health literacy about depression varied according to accessibility to health services. DESIGN: Face-to-face interviews with a random and representative sample of the South Australian population (aged >or= 15 years) were conducted between March and June 2004, with the respondents stratified using the Accessibility and Remoteness Index of Australia into categories of 'highly accessible', 'accessible', and 'moderately accessible and remote'. RESULTS: From 4700 households selected, 3015 participants were interviewed (65.9% response rate). The prevalence of major depression and other depressions was not significantly different between each of the categories, although there was a trend for those from moderately accessible and remote areas to be less depressed overall. A significantly lower proportion of respondents from moderately accessible and remote locations reported that they had family or close friends who had suffered from symptoms consistent with depression, or that they had ever had treatment for those symptoms. However, there was no significant difference between the groups in those who had ever had or who were currently taking antidepressant medication. For those who were depressed, a significantly higher proportion from the accessible, and moderately accessible and remote regions had seen a community or district health service, social worker or other counsellor as compared with those from the highly accessible area. CONCLUSIONS: These findings indicate that depression is no more prevalent in less accessible regions of South Australia, and that when it is present, its treatment, in terms of antidepressants, which can be considered as a proxy marker for the overall management of depression, is similar to treatment in more accessible areas.     

Acute Myocardial Infarction and Coronary Artery Bypass Grafting Outcomes in Specialty and General Hospitals: Analysis of State Inpatient Data

Objective. Compare characteristics and outcomes of patients hospitalized in specialty cardiac and general hospitals for acute myocardial infarction (AMI) and coronary artery bypass grafting (CABG).
Data. 2000–2005 all-payor administrative data from Arizona, California, Texas, and Wisconsin.
Study Design. We identified patients admitted to specialty and competing general hospitals with AMI or CABG and compared patient demographics, comorbidity, and risk-standardized mortality in specialty and general hospitals.
Principal Findings. Specialty hospitals admitted a lower proportion of women and blacks and treated patients with less comorbid illness than general hospitals. Unadjusted in-hospital AMI mortality for Medicare enrollees in specialty and general hospitals was 6.1 and 10.1 percent ( p <.0001) and for non-Medicare enrollees was 2.8 and 4.0 percent ( p <.04). Unadjusted in-hospital CABG mortality for Medicare enrollees in specialty and general hospitals was 3.2 and 4.7 percent ( p <.01) and for non-Medicare enrollees was 1.1 and 1.8 percent ( p =.02). After adjusting for patient characteristics and hospital volume, risk-standardized in-hospital mortality for all AMI patients was 2.7 percent for specialty hospitals and 4.1 percent for general hospitals ( p <.001) and for CABG was 1.5 percent for specialty hospitals and 2.0 percent for general hospitals ( p =.07).
Conclusions. In-hospital mortality in specialty hospitals was lower than in general hospitals for AMI but similar for CABG. Our results suggest that specialty hospitals may offer significantly better outcomes for AMI but not CABG.     

影响冠状动脉旁路移植术手术死亡的危险因素分析

目的：观察分析影响冠状动脉旁路移植术手术死亡的危险因素,对预防检查和治疗方案提供针对性的帮助和改善。方法：回顾性分析本院心血管科2010年1月-2013年12月收治住院并接受冠状动脉旁路移植术的137例冠心病患者的临床资料,选择可能导致患者死亡的危险因素为研究对象并调查收集资料,进行单因素与多因素分析,选出影响冠状动脉旁路移植术手术死亡的危险因素。结果：137例接受冠状动脉旁路移植术的患者手术中有5例患者死亡,占总数的3.65%。单因素与多因素分析显示影响术后死亡的危险因素包括：年龄、围手术期心肌梗死、心功能不全、室壁瘤、心力衰竭、左主干病变大于50%、心律失常、肺动脉瓣反流、二尖瓣反流、心源性休克、左心室射血分数、术前血红蛋白值、术前肌酐值和合并主动脉瘤手术。手术前后针对带有以上单个或多个危险因素的患者进行重点监测,以减少患者死亡率。结论：影响冠状动脉旁路移植术手术死亡的危险因素较多,需及时干预。     

Long-Term Clinical Outcomes of Care Management for Chronically Depressed Primary Care Patients: A Report From the Depression in Primary Care Project

PURPOSE Recent studies examining depression disease management report improvements in short-term outcomes, but less is known about whether improvements are sustainable over time. This study evaluated the sustained clinical effectiveness of low-intensity depression disease management in chronically depressed patients.METHODS The Depression in Primary Care (DPC) intervention was introduced in 5 primary care practices in the University of Michigan Health System, with 5 matched practices selected as control sites. Clinicians were free to refer none, some, or all of their depressed patients at their discretion. Core clinical outcomes of remission and serial change in Patient Health Questionnaire (PHQ-8) scores for 728 DPC enrollees observed for up to 18 months after enrollment were compared with those for 78 patients receiving usual care who completed mailed questionnaires at baseline, 6, 12, and 18 months.RESULTS DPC enrollees had sustained improvement in remission rates and reduced-function days over the full 18 months. Mean change in the PHQ-8 score over each 6-month interval was more favorable for DPC enrollees than for usual care patients, and the proportion of DPC enrollees in remission was higher at 6 months (43.4% vs 33.3%; P = .11), 12 months (52.0% vs 33.9%; P=.012), and 18 months (49.2% vs 27.3%; P = .004). Multivariate analysis controlling for age, sex, ethnicity, baseline severity, and comorbid medical illness confirmed that DPC enrollees had significantly more reduction in depressive symptom burden over 18 months.CONCLUSIONS The DPC intervention produced sustained improvement in clinical outcomes over 18 months in a cohort of chronically depressed patients with persistent symptoms despite active treatment.     

兰州市城乡居民精神卫生知识知晓率调查与分析

目的：调查兰州市城乡居民对精神卫生知识的掌握程度,进一步提高大众对精神卫生知识的知晓率,更好地预防和控制精神疾患的发生,降低精神患者肇事肇祸的风险。方法采用分层整群随机抽样法,抽取兰州市18岁及以上的常住人口城市居民785人和农村居民741人,调查内容为卫生部办公厅2010年关于精神卫生工作指标调查评估方案的问卷之一,实际调查城市居民688名,农村居民674名。比较城市居民与农村居民对精神卫生知识的知晓程度并进行相关分析。结果本次调查中,兰州市城乡居民精神卫生知识平均知晓率为59．0％,其中城市居民为63．4％,农村居民为54．6％。城市居民精神卫生知识知晓率高于农村居民。回答正确率较低的条目主要集中在精神疾病的病因、预防、长期服药以及重大精神卫生纪念日方面。结论兰州市城乡居民精神卫生知识知晓率较低,未达到国家精神卫生工作纲要的要求,今后需继续加强精神卫生知识的宣传和教育。     

单病种协作模式在统筹城乡卫生资源中的作用

改善城乡卫生资源分布不均的现状是我国医疗卫生改革的主要方向,有效整合城乡医疗卫生资源将有利于解决农民"看病难、看病贵"的问题,直接关系到农民群众的身心健康。通过分析我国城乡卫生资源分布的现状及存在的问题,结合单病种协作防治体系的建立和运行,探讨单病种协作模式在统筹城乡卫生资源中的促进作用,为有效解决农民"看病难、看病贵"的问题提供理论依据。     

Quality of Life and Coping Following Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) Surgery

Minimally invasive direct coronary artery bypass (MIDCAB) surgery has been shown to be a promising technique for surgical treatment of single or double vessel disease. However, little is known about quality of life, mood state or coping in this group of patients. The records of 55 consecutive patients who underwent MIDCAB surgery at Harefield Hospital between April 1999 and May 2001 were reviewed. In order to assess quality of life, mood state and coping, patients were contacted by telephone to conduct a semi-structured interview and were subsequently sent four questionnaires. The measures used were the Hospital Anxiety and Depression Scale, the Short Form Health Survey, the WHOQoL-BREF and the COPE. Forty-eight patients were contacted by telephone, forty-four of whom returned the completed questionnaires. Overall ratings of quality of life were excellent for the majority of patients, and rates of anxiety and depression were lower than previously found following coronary artery bypass surgery. It is concluded that following MIDCAB surgery quality of life and mood state outcomes are encouraging. However, a prospective, longitudinal study is now required to further elucidate the relationship between quality of life, mood state and coping and to identify predictive factors for physical and psychological outcome following this new surgical technique.     

系统健康教育在冠脉搭桥术患者中的应用与评价

目的探讨系统健康教育对冠脉搭桥术患者康复的影响。方法将60例冠脉搭桥术患者按住院号奇偶数分为观察组和对照组,各30例。对照组采用常规健康教育,观察组采用系统健康教育,既遵循系统化、互动化、个体化原则分入院、围术期、出院前及出院后4个阶段连续性教育,根据患者反馈及时调整方式。教育方式包括健康教育手册、谈心式调查、多媒体集中讲解、个别指导、口试反馈及出院后电话随访等。结果与对照组比较,观察组遵医行为改善显著;并发症发生率显著降低;住院时间缩短;患者满意度提高。结论系统健康教育能提高患者对疾病的认知水平,改善患者的遵医行为;提高患者的自我保健意识和能力,降低并发症;密切护患关系,提高者的满意度。     

主动脉内球囊反搏术治疗高危冠状动脉疾病的监测及护理

目的探讨应用主动脉内球囊反搏（IABP）术治疗高危冠状动脉疾病的监测内容及综合护理措施。方法对我科12例高危冠状动脉疾病患者应用IABP治疗并精心护理,对护理要点进行总结。结果本组患者在治疗期间,经过细心观察和精心护理,患者的收缩压、舒张压、血氧饱和度明显提高、心功能明显改善,心率下降、尿量增加。结论对高危冠状动脉疾病患者早期应用IABP有较好的治疗作用,而精心、细致的护理能减少并发症的发生,降低死亡率,促进患者康复。     

Prolonged or Transition to Metabolically Unhealthy Status,Regardless of Obesity Status,Is Associated with Higher Risk of Cardiovascular Disease Incidence and Mortality in Koreans

The risk of chronic disease and mortality may differ by metabolic health and obesity status and its transition. We investigated the risk of cardiovascular disease (CVD) and cancer incidence and mortality according to metabolic health and obesity status and their transition using the nationally representative Korea National Health and Nutrition Examination Survey (KNHANES) and the Ansan-Ansung (ASAS) cohort of the Korean Genome and Epidemiology Study. Participants that agreed to mortality linkage (n = 28,468 in KNHANES and n = 7530 adults in ASAS) were analyzed (mean follow-up: 8.2 and 17.4 years, respectively). Adults with no metabolic risk factors and BMI <25 or ≥25 kg/m² were categorized as metabolically healthy non-obese (MHN) or metabolically healthy obese (MHO), respectively. Metabolically unhealthy non-obese (MUN) and metabolically unhealthy obese (MUO) adults had ≥1 metabolic risk factor and a BMI < or ≥25 kg/m², respectively. In KNHANES participants, MUN, and MUO had higher risks for cardiovascular mortality, but not cancer mortality, compared with MHN adults. MHO had 47% and 35% lower risks of cancer mortality and all-cause mortality, respectively, compared to MHN. Similar results were observed in the ASAS participants. Compared to those persistently MHN, the risk of CVD was greater when continuously MUN or MUO. Transitioning from a metabolically healthy state to MUO also increased the risk of CVD. Few associations were found for cancer incidence. Using a nationally representative cohort and an 18-year follow-up cohort, we observed that the risk of CVD incidence and mortality and all-cause mortality, but not cancer incidence or mortality, increases with a continuous or a transition to an unhealthy metabolic status in Koreans.