Integrating remote follow-up into electronic health records workflow

BackgroundThe Colorado Health Medical Group, Cardiology (formerly Heart Center of the Rockies) is a paperless clinic which follows about 4000 cardiac rhythm management device patients and relies heavily on advanced remote follow-up and remote monitoring features.MethodsWorking with a device manufacturer and our own information technology team, we were able to redesign our workflow procedures so that data downloaded from devices could be imported directly into our electronic health records with no need to manually populate any templates. We were able to import device data as discrete information, making records more readily searchable.ResultsWith this revised workflow, we were able to transition from about 19 min per patient to about 3.5 min with no compromise in patient care. The new workflow allows device nurses to spend more time engaging with patients and reviewing clinical data and less time managing clerical tasks. Although not captured in this study, our improved workflow also helped us schedule all reimbursable remote and in-clinic follow-ups without fail.ConclusionsWith technical support from the institution and the device company, device clinics can develop systems to import remote follow-up data directly into electronic medical records allowing for more efficient workflows and time savings.     

众生丸治疗急性咽炎（风热证）临床研究

目的：评价众生丸治疗急性咽炎（风热证）的临床疗效和安全性。方法采用分层区组随机、盲法、阳性药平行对照、非劣效的、多中心临床试验方法,共观察病例336例。治疗组252例,服用众生丸和喉疾灵模拟剂。对照组84例,服用喉疾灵片和众生丸模拟剂。众生丸为1次6丸,1日3次;喉疾灵片为1次3片,1日3次。5天为1个疗程。结果治疗组总有效率为97.21％（244／251）、对照组为97.59％（81／83）,组间疗效差异无统计学意义（ P＞0.05）。治疗期间未见有与试验药物相关的实验室指标异常的变化,未见有严重不良事件及不良反应发生。结论众生丸能明显改善风热证引起的咽痛、吞咽痛以及咽部红肿等症状体征,治疗风热引起的急性咽炎安全有效。     

Efficacy comparison of optimal treatments for hepatocellular carcinoma patients with portal vein tumor thrombus

Introduction and objectivesOptimal treatment of hepatocellular carcinoma (HCC) involving portal vein tumor thrombus (PVTT) remains controversial.Materials and methodsA total of 627 HCC patients with PVTT after initial treatment with one of the following at Affiliated Tumor Hospital of Guangxi Medical University: liver resection (LR, n = 225), transarterial chemoembolization (TACE, n = 298) or sorafenib (n = 104) were recruited and randomly divided into the training cohort (n = 314) and internal validation cohort (n = 313). Survival analysis were repeated after stratifying patients by Cheng PVTT type.ResultsResection led to significantly higher OS than the other two treatments among patients with type I or II PVTT. TACE worked significantly better than the other two treatments for patients with type III. All three treatments were associated with similar OS among patients with type IV. These findings were supported by the internal validation cohort.ConclusionsOur results suggest that the optimal treatment for HCC involving PVTT depends on the type of PVTT. LR may be more appropriate for type I or II PVTT; TACE, for type III Sorafenib may be more appropriate than invasive treatments for patients with type IV PVTT.     

Change in the Recurrence Pattern and Predictors over Time after Complete Cure of Hepatocellular Carcinoma

Background/AimsWe investigated changes in recurrence rates and significant recurrence predictors over time after complete cure of hepatocellular carcinoma (HCC).MethodsA total of 1,491 patients with first-time diagnosis of Barcelona Clinic Liver Cancer stage A HCC, completely cured by treatment between 2007 and 2016, were recruited from two Korean tertiary institutes.ResultsThe mean age of the population (1,144 men and 347 women) was 58.6 years. Of the total population, 914 patients (61.3%) had liver cirrhosis. Nine-hundred and forty-one (63.1%) and 550 (36.9%) patients were treated with surgical resection and radiofrequency ablation (RFA), respectively. One-year cumulative incidences of HCC recurrence were 14.3%, 9.9%, and 5.1% from the time of treatment, 3 years after treatment, and 5 years after treatment, respectively. Upon multivariate analysis, multiple tumors, maximal tumor size ≥3 cm, and high Model for End-Stage Liver Disease scores were independently associated with increased HCC recurrence risk from the time of treatment and 1 and 2 years after curative treatment (all p<0.05, except for maximal tumor size ≥3 cm for recurrence 2 years after treatment). Meanwhile, liver cirrhosis and RFA were independently associated with the increased HCC recurrence risk for almost all time points (liver cirrhosis all p<0.05; RFA all p<0.005 except for recurrence from 5 years after treatment).ConclusionsThe recurrence rate of HCC after curative treatment gradually decreased over time. Two years after treatment, when tumor-related factors lose their prognostic implications, may be used as a cutoff to define the boundary between early and late recurrence of HCC. (Gut Liver 2021;15-429)     

颅痛安颗粒治疗血管性头痛的临床及实验研究

目的：观察颅痛安颗粒对血管性头痛的疗效及其对血液流变学指标的影响；方法：①临床研究：同期内用同一纳入标准将确诊为本病的病人随机分为两组进行对照试验，治疗组口服颅痛安颗粒l袋(10g)，每日3次；对照组口服正天丸l袋(6g)，每日3次。连续服用28d后按同一疗效标准判定，同时采用全自动血流变快测仪(FASCO——9700型)观测两组血液流变学指标治疗前后的变化，并将结果进行统计学检验。②实验研究：采用全自动血流变快测仪(FAS—CO-3030型)观测不同剂量颅痛安颗粒对肾上腺素所致血瘀家兔模型的血液流变学指标的影响，同时设置空白对照组、模型组、正天丸对照组进行对比，并将结果进行统计学检验。结果：两组临床总有效率分别是：颅痛安颗粒组95%，正天丸组85％。实验研究中，颅痛安颗粒组和血瘀模型家兔在治疗全血黏度、血浆黏度、红细胞比容、血沉、红细胞聚集指数、红细胞电泳时间、卡松屈服应力，两组比较有统计学意义。结论：颅痛安颗粒治疗血管性头痛疗效确切，并能明显改善其血液流变学指标。     

Diurnal variations of cardiac rhythm,arterial pressure,and urinary catecholamines in borderline and established essential hypertension

Ambulatory continuous ECG and arterial pressure (BP) were recorded simultaneously (Delmar Avionics Pressurometer II) for 24 hours in 13 age-matched normotensive subjects, 11 patients with borderline hypertension (HBP), and in 10 patients with uncomplicated established essential HBP. Urinary concentrations of epinephrine, norepinephrine, and dopamine were simultaneously collected over four successive 4-hour periods and one 8-hour period. Prevalence and total number of ventricular and supraventricular ectopic beats was low and not affected by arterial BP. Twenty-four-hour heart rate (HR) and 4-hourly excretion of epinephrine, norepinephrine, and dopamine were comparable between normotensive and HBP persons and no correlation between urinary catecholamines and arterial BP (systolic, diastolic, or mean), HR, or prevalence of ectopic beats was found in any of the three groups or in the total study population. We conclude that HBP patients without ECG evidence of left ventricular hypertrophy do not have a higher prevalence of supraventricular or ventricular ectopic beats. Urinary catecholamines are not related to circadian fluctuations or variability in arterial BP, HR, or prevalence of ectopic beats.     

Long-term endocardial atrial pacing in children with postoperative bradycardia-tachycardia syndrome and limited ventricular access

Permanent pacing in children, including those with postoperative bradycardia-tachycardia syndrome, has been compromised by the availability of pulse generators, electrode leads and implantation techniques designed for the adult patient. Recent technologic improvements and simplified implantation techniques have reduced many of these barriers and have made endocardial as well as epicardial ventricular pacing more feasible. However, in some children, ventricular pacing may be impeded by anatomic abnormalities due to congenital anomalies or prior cardiac operations. In these instances, endocardial atrial pacing may provide an alternative therapeutic approach in selected patients. This report describes the use of endocardial atrial demand pacing in four children with postoperative bradycardia-tachycardia syndrome and restricted ventricular access. This approach controls symptomatic bradycardia, helps prevent and convert paroxysmal intraatrial tachycardia and overcomes the problem of limited ventricular access.     

Surgical repair of uncomplicated atrial septal defect without "routine" preoperative cardiac catheterization

Whether all patients with atrial septal defect should undergo cardiac catheterization before surgical correction is controversial. Of 152 patients of all ages with surgically documented isolated atrial septal defect (ostium secundum, ostium primum and sinus venosus types) who underwent preoperative two-dimensional echocardiography between January 1978 and December 1983, there were 55 (36%) (group 1) who did not have preoperative cardiac catheterization. These 55 patients are compared with the 97 patients (64%) who did have preoperative catheterization studies (group 2). Group 1 patients were younger (mean age 22 versus 36 years) and did not have clinical evidence of other associated cardiac disorders. Forty-four (80%) of the group 1 patients had typical findings for atrial septal defect on cardiac examination, chest radiograph and electrocardiogram compared with 16 (16%) of group 2 patients (p less than 0.001). The most frequent reasons for cardiac catheterization in group 2 patients were documentation of diagnosis, usually because of atypical clinical findings, and exclusion of associated cardiac abnormalities. Contrast echocardiography, radionuclide shunt studies and Doppler echocardiography were used as additional confirmatory tests in 36 patients (65%). In 19 patients (35%), two-dimensional echocardiography was the only confirmatory test. There were no false positive two-dimensional echocardiographic studies. There were no operative deaths or significant perioperative complications in any of the patients. At a mean follow-up of 28 months (range 6 to 64), there was one late death (3 1/2 years postoperatively) in a 61 year old man with chronic congestive heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)     

Beneficial hemorheologic therapy of chronic peripheral arterial disorders with pentoxifylline: Results of double-blind study versus vasodilator-nylidrin

Pentoxifylline (Trental 400 mg coated tablets) and nylidrin HCl 3 mg were compared for clinical efficacy and safety in an 8-week randomized double-blind trial. The study was conducted in patients with peripheral arterial disease (Fontaine stage II or III), with 30 patients receiving pentoxifylline (23 returned for follow-up), and 30 patients receiving nylidrin HCl (24 returned for follow-up). Efficacy was assessed objectively in terms of walking performance (absolute walking time and walking distance on a treadmill ergometer) and by acral plethysmography. The clear improvement shown for both variables was greater and statistically significant (p ≤ 0.05) after treatment with pentoxifylline. Laboratory data provided no evidence to suggest any adverse effect of either treatment. Subjective side effects were reported by six patients in the pentoxifylline group and by three patients in the nylidrin HCl group.     

系统变异管理对临床路径的影响

目的 研究临床路径实施过程中出现的系统变异及变异原因,探索干预措施,旨在降低可控变异的发生率.方法 选择妇科、神经内科两个试点科室共11个病种为受试对象,将2011年1月～6月进入临床路径的受试对象1682例设为对照组,将2012年7月～12月进入临床路径的受试对象5 639例设为研究组,比较两组的变异差异情况.结果 对照组病例数1 683例,变异例数489,变异率29.1％;研究组病例数5 639,变异数962,变异率17.06％.两组比较,因主管医生检查滞后、检查结果滞后、费用滞后、不配合检查、自动出院,路径设计缺陷原因引起的变异有显著差异,P＜0.05;因设备故障,共病情况原因引起的变异无显著差异,P＞0.05.主管医生检查滞后、检查结果滞后和路径设计缺陷能够单独引起系统变异,P＜0.05.而设备故障不能单独引起系统变异,P＞0.05.结论 通过全面优化医疗服务流程,完善信息化建设、加强医院硬软件建设等措施,能够明显降低由于系统管理缺陷导致的临床路径系统变异,明显减少临床路径负变异,增加正变异.