Selection and validation of quality indicators for the Shorter Stays in Emergency Departments National Research Project

Objective: Despite the spread of time targets for ED lengths of stay around the world, there have been few studies exploring the effects of such policies on quality of ED care. The Shorter Stays in Emergency Departments (SSED) National Research Project seeks to address this. The purpose of this paper was to describe how the indicators for the SSED study in New Zealand were selected and validated. Methods: A literature review was used to identify potential indicators. A reference group of 25 key stakeholders from across the health system was convened, with the aims of validating the suggested indicators and to ensure that other candidate indicators were not overlooked. A thematic analysis using a general inductive approach was used to analyse focus group discussions. Results: The major themes were communication, access, timeliness, appropriateness and satisfaction. The 12 indicators selected after literature review were confirmed and two further indicators added after the thematic analysis. The indicators are: hospital and ED length of stay; re‐presentation within 48 h; mortality; times to reperfusion, antibiotics, asthma treatment, analgesia, CT for head injury and to theatre (appendicitis and fractured neck of femur); triage time compliance; proportion who left without being seen; quality of discharge information; and ED overcrowding/access block. Conclusion: Through literature review and consultation with stakeholders, an evidence‐based and clinically relevant set of indicators was compiled with which to measure the effect of the SSED target. This indicator set is consistent with recent international recommendations for measuring quality of care in EDs.     

中国烧伤休克液体复苏70年进展

建国70年以来,中国烧伤休克液体复苏从最初的引用美国补液公式逐步发展到创立国内通用烧伤液体复苏公式、现代烧伤液体复苏公式与烧伤延迟复苏补液公式等液体复苏公式,并经历了"机械遵循补液公式""个性化补液"与"目标复苏"三个阶段,显著提高了烧伤休克液体复苏的成功率。然而,随着研究的不断深入,部分研究学者发现了烧伤休克液体复苏的发展规律不明确、复苏监测指标不完善等新的问题,遂笔者于本研究中对建国70年来国内烧伤休克液体复苏公式与治疗方案的发展、晶胶体液与水分的应用以及烧伤休克复苏监测指标的变迁等进行了综述,旨在为烧伤休克液体复苏新问题、新方法与新指标的进一步深入研究提供思路与帮助,从而有效提高烧伤休克的防治效果。     

医院突发公共卫生事件应对能力评价体系测评分析

目的对医院突发公共卫生事件应对能力（医院应急能力）评价指标体系进行分析和验证。方法在文献复习、典型案例分析的基础上,通过Delphi专家咨询构建医院应急能力评价指标体系。并以广东省急救系统的医院为研究对象,采用目标抽样方法,抽取广州市和深圳市120急救网络医院以及广东省其余19个地级市的市、县区级医院,共227家医院进行问卷调查。采用Spearson相关分析检验综合评价指标与内部指标间联系,采用因子分析检验评价指标体系的信度与效度。结果医院应急能力评价指标与内部指标具有正相关;评价指标体系中10个维度得分之间的复测信度系数在0．712—0．834之间,整体评价问卷的复测信度系数为0．806,均具有统计学意义（P〈0．05）;对评价指标体系的10个维度分别进行内部一致性信度检验,其取值在0．622～0．922之间,整体评价问卷的内部一致性信度为0．949;指标体系表面效度、内容效度经专家咨询,其协调系数W达到0．820,经χ^2检验具有统计学意义（P〈0．05）;因子分析提取出意识、制度、资源、技术4个公共因子,构成了医院应急能力评价指标体系的4个内在的稳定结构。结论医院应急能力评价指标体系具有合理性、科学性和较好的信度与效度。     

Extravascular lung water volume measurement by a novel lithium-thermal indicator dilution method: comparison of three techniques to post-mortem gravimetry

Objective  To compare the lithium-thermal double indicator dilution (Li-thermal), indocyanine green-thermal double indicator dilution (ICG-thermal), single thermal indicator dilution (single-thermal) and gravimetric techniques of extravascular lung water volume (EVLW) measurement in porcine models of acute lung injury. Design  Two animal models designed to invoke a systemic inflammatory response. Setting  Laboratory study. Subjects  A total of 12 immature Deutsches Landschwein pigs. Interventions  Extravascular lung water volume was measured at four time points using Li-thermal, ICG-thermal and single-thermal techniques. Measurements were performed using existing technology according to manufacturer’s instructions. Post-mortem gravimetric EVLW measurements were performed by measuring wet and dry mass of lung tissue. Measurements were compared using the Bland–Altman method. Data are presented as mean (SD). Measurements and main results  Data were collected in 12 animals and comparison between all 4 techniques was possible in 10 animals. EVLW measured by gravimetry was 9.2 (±3.0)ml kg⁻¹. When compared to gravimetry, both Li-thermal and ICG-thermal techniques showed minimal bias but wide limits of agreement (LOA) [Li-thermal: bias −1.8 ml kg⁻¹ (LOA ± 13.1); ICG-thermal bias −1.0 ml kg⁻¹ (LOA ± 6.6)]. Comparison between the single-thermal and gravimetric methods identified both considerable bias and wide LOA [+8.5 ml kg⁻¹ (LOA ± 14.5)]. Conclusion  Clinically significant differences between EVLW measurements obtained with the gravimetric method and three in vivo indicator dilution techniques were identified. While none of the techniques could be considered ideal, the ICG-thermal method appeared more reliable than either the Li-thermal or single thermal techniques. Further research is required to determine whether the accuracy of the prototype Li-thermal technique can be improved. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Identifying Communities at Risk for COVID-19–Related Burden Across 500 US Cities and Within New York City: Unsupervised Learning of the Coprevalence of Health Indicators

BackgroundAlthough it is well-known that older individuals with certain comorbidities are at the highest risk for complications related to COVID-19 including hospitalization and death, we lack tools to identify communities at the highest risk with fine-grained spatial resolution. Information collected at a county level obscures local risk and complex interactions between clinical comorbidities, the built environment, population factors, and other social determinants of health.ObjectiveThis study aims to develop a COVID-19 community risk score that summarizes complex disease prevalence together with age and sex, and compares the score to different social determinants of health indicators and built environment measures derived from satellite images using deep learning.MethodsWe developed a robust COVID-19 community risk score (COVID-19 risk score) that summarizes the complex disease co-occurrences (using data for 2019) for individual census tracts with unsupervised learning, selected on the basis of their association with risk for COVID-19 complications such as death. We mapped the COVID-19 risk score to corresponding zip codes in New York City and associated the score with COVID-19–related death. We further modeled the variance of the COVID-19 risk score using satellite imagery and social determinants of health.ResultsUsing 2019 chronic disease data, the COVID-19 risk score described 85% of the variation in the co-occurrence of 15 diseases and health behaviors that are risk factors for COVID-19 complications among ~28,000 census tract neighborhoods (median population size of tracts 4091). The COVID-19 risk score was associated with a 40% greater risk for COVID-19–related death across New York City (April and September 2020) for a 1 SD change in the score (risk ratio for 1 SD change in COVID-19 risk score 1.4; P<.001) at the zip code level. Satellite imagery coupled with social determinants of health explain nearly 90% of the variance in the COVID-19 risk score in the United States in census tracts (r²=0.87).ConclusionsThe COVID-19 risk score localizes risk at the census tract level and was able to predict COVID-19–related mortality in New York City. The built environment explained significant variations in the score, suggesting risk models could be enhanced with satellite imagery.     

重症登革热的研究进展

登革热是流行于全球尤其是热带亚热带地区的急性传染病,其中有重症表现的登革热是引起登革热患者死亡的主要原因,但是由于目前WHO关于登革热分类的缺陷,使得重症登革热发生率被低估,已经有越来越多的中外学者对WHO定义的登革热分类提出质疑,提出了重症登革热的概念并得到认可。文章主要对重症登革热的临床表现、流行情况、危险人群、危险指标等最新研究进展进行综述,以提高人们对重症登革热的认识,为制定新的登革热诊断标准和治疗方案提供理论基础。     

Localized olfactory representation in mushroom bodies of Drosophila larvae

Odor discrimination in higher brain centers is essential for behavioral responses to odors. One such center is the mushroom body (MB) of insects, which is required for odor discrimination learning. The calyx of the MB receives olfactory input from projection neurons (PNs) that are targets of olfactory sensory neurons (OSNs) in the antennal lobe (AL). In the calyx, olfactory information is transformed from broadly-tuned representations in PNs to sparse representations in MB neurons (Kenyon cells). However, the extent of stereotypy in olfactory representations in the calyx is unknown. Using the anatomically-simple larval olfactory system of Drosophila in which odor ligands for the entire set of 21 OSNs are known, we asked how odor identity is represented in the MB calyx. We first mapped the projections of all larval OSNs in the glomeruli of the AL, and then followed the connections of individual PNs from the AL to different calyx glomeruli. We thus established a comprehensive olfactory map from OSNs to a higher olfactory association center, at a single-cell level. Stimulation of single OSNs evoked strong neuronal activity in 1 to 3 calyx glomeruli, showing that broadening of the strongest PN responses is limited to a few calyx glomeruli. Stereotypic representation of single OSN input in calyx glomeruli provides a mechanism for MB neurons to detect and discriminate olfactory cues.