Initial functional recovery as a measure for rehabilitation outcome in post-acute hip fractured patients

BackgroundThe assessment of immediate functional change after hip fracture surgery may assist in predicting rehabilitation outcome and improve program efficiency.ObjectiveTo evaluate the potential of the initial functional recovery measure in predicting rehabilitation outcome of hip fractured patients.DesignRetrospective cohort study.SettingPost-acute geriatric rehabilitation center.ParticipantsA total of 630 hip fractured patients admitted from 1/2016-6/2019.MethodsThe initial functional recovery, a measure of functional change from the time of surgery to rehabilitation was calculated for each patient. The association between initial functional recovery and clinical and demographic variables was assessed by the Mann-Whitney and chi-square tests. A multiple linear regression model evaluated the association between initial functional recovery and the discharge functional independence measure score. Regression analysis estimated the association between initial functional recovery and the achievement of a favorable outcome measure.ResultsA good correlations were found between initial functional recovery and rehabilitation outcomes but not length of stay (p < 0.001). Multiple linear regression analysis showed that after adjustment for potential confounding variables, the higher the initial functional recovery, the better the discharge functional independence measure score (r² = 0.783; p < 0.001). Logistic regression revealed that a high initial functional recovery was significantly associated with a higher probability of achieving a favorable functional gain (OR = 1.093; 95% CI = 1.04-1.15, P < 0.001).ConclusionInitial functional recovery is a good predictor of rehabilitation outcomes in hip fractured patients, and may be utilized in decision-making regarding the rehabilitation program in addition to coordinating expectations with patients and their caregivers.     

肺结核并发糖尿病患者临床特征及淋巴细胞亚群检测结果分析

目的 探讨肺结核并发糖尿病(pulmonary tuberculosis complicated with diabetes mellitus, PTB-DM)患者临床特征及淋巴细胞亚群特点。方法 回顾性收集2018年4月1日至2019年5月31日在解放军总医院第八医学中心结核二科住院的符合纳入标准的肺结核患者。根据是否并发糖尿病将其分为两组:PTB-DM组85例,单纯肺结核组(PTB组)96例。对两组患者临床特征包括性别、年龄、治疗史和胸部CT检查结果进行比较分析;对两组患者淋巴细胞亚群和结核分枝杆菌特异性反应T细胞检测结果分别进行比较分析。结果 PTB-DM组男性和女性分别占76.4%(65/85)和23.6%(20/85),PTB组分别占57.3%(55/96)和42.7%(41/96),差异有统计学意义(χ²=7.42,P=0.006)。PTB-DM组<25岁、25~60岁和>60岁的患者分别占2.4%(2/85)、68.2%(58/85)和29.4%(25/85); PTB组则分别占25.0%(24/96)、63.5%(61/96)和11.5%(11/96),差异有统计学意义(χ²=23.55,P=0.000)。PTB-DM组初治和复治患者分别占74.1%(63/85)和25.9%(22/85),PTB组分别占84.4%(81/96)和15.6%(15/96),差异无统计学意义(χ²=2.92,P=0.088)。PTB-DM组胸部CT扫描显示无空洞、有空洞、病变范围<3个肺叶和≥3个肺叶者分别占23.5%(20/85)、76.5%(65/85)、31.8%(27/85)和68.2%(58/85);PTB组分别为53.1%(51/96)、46.9%(45/96)、54.2%(52/96)和45.8%(44/96);PTB-DM组胸部CT有空洞和病变范围≥3个肺叶的患者明显多于PTB组,差异有统计学意义(χ²=16.56,P=0.000和χ²=9.20,P=0.002)。PTB-DM组结核分枝杆菌特异性反应T细胞阳性率为81.3%(65/80),PTB组阳性率为74.2%(66/89),差异无统计学意义(χ²=1.22,P=0.270)。PTB-DM组总T淋巴细胞绝对计数、CD4⁺T淋巴细胞绝对计数、CD8⁺T淋巴细胞绝对计数、自然杀伤细胞(NK细胞)绝对计数、NK样T淋巴细胞绝对计数和总B淋巴细胞绝对计数的中位数(四分位数)值分别为1069.00(753.50,2372.50)、548.00(381.00,787.50)、380.00(270.50,574.50)、184.00(111.00,294.50)、60.00(36.00,120.50)和162.00(80.50,244.00)个/μl,PTB组则分别为1161.50(858.50,1601.00)、628.00(472.75,860.50)、457.50(286.00,614.75)、191.50(115.75,315.75)、65.50(34.50,119.50)和184.50(112.25,301.00)个/μl,两组间6项指标差异无统计学意义(Z=-1.80,P=0.073;Z=-1.47,P=0.142;Z=-1.46,P=0.144;Z=-0.57,P=0.568;Z=-0.09,P=0.931;Z=-1.93,P=0.053)。结论 PTB-DM中老年男性较多,病灶范围广泛、严重; PTB是否并发DM对淋巴细胞亚群6项指标检测结果无明显影响。     

风湿性疾病并发肺结核患者的三种免疫学指标检测结果分析

目的 探讨风湿性疾病并发肺结核患者的免疫学指标特点。方法 搜集2017年7月至2019年7月解放军总医院第八医学中心全军结核病研究所明确诊断为风湿性疾病并发肺结核患者117例(观察组),采用系统抽样方法随机选取同时期诊断为单纯肺结核患者117例(对照组)进行研究。比较两组患者结核抗体检测阳性率、γ-干扰素释放试验阳性率和T淋巴细胞亚群计数的差异。结果 结核抗体38kD+16kD(1kD=相对分子质量1000)和结核抗体38kD的检测中观察组患者阳性率[分别为6.84%(8/117)、21.37%(25/117)]均低于对照组患者的阳性率[分别为33.33%(39/117)、71.79%(84/117)],差异均有统计学意义(χ²值分别为25.59、59.78,P值均为0.000)。观察组患者γ-干扰素释放试验阳性率为57.26%(67/117)与对照组患者阳性率[55.56%(65/117)]比较,差异无统计学意义(χ²=0.70,P=0.792)。淋巴细胞亚群检测中观察组患者外周血CD4⁺细胞计数的中位数(四分位数)[M(Q₁,Q₃)]为513.00(339.75,844.50)个/μl,CD4⁺/CD8⁺值的M(Q₁,Q₃)为0.96(0.74,1.53),均高于对照组患者外周血CD4⁺细胞绝对计数[M(Q₁,Q₃)为380.00(320.00,503.00)个/μl]和CD4⁺/CD8⁺值[M(Q₁,Q₃)为0.91(0.74,0.96)],两组间比较差异均有统计学意义(Z=2.11,P=0.035;Z=4.90,P=0.000)。而观察组外周血CD8⁺细胞计数[M(Q₁,Q₃)为377.50(193.00,528.50)个/μl]低于对照组[M(Q₁,Q₃)为475.00(410.00,524.00)个/μl],两组间比较差异有统计学意义(Z=2.27,P=0.023)。结论 风湿性疾病并发肺结核患者结核抗体检测阳性率及外周血CD8⁺细胞计数低于单纯肺结核患者,外周血CD4⁺细胞计数高于单纯肺结核患者,γ-干扰素释放试验阳性率与单纯肺结核患者比较差异无统计学意义。     

Impact of serum uric acid levels on cardiovascular events and quality of life in patients with chronic coronary syndromes: Insights from a contemporary,prospective, nationwide registry

Background and aimsHyperuricemia is a metabolic disorder that has been associated with adverse cardiovascular (CV) events. Using the data from a nationwide, prospective registry on patients with chronic coronary syndromes (CCS), we assessed the impact of serum uric acid (SUA) levels on quality of life (QoL) and major adverse CV events (MACE), a composite of CV death and hospitalization for myocardial infarction, heart failure (HF), angina or revascularization at 1-year.Methods and resultsAmong the 5070 consecutive CCS patients enrolled in the registry, levels of SUA were available for 2394 (47.2%). Patients with SUA levels available at baseline were grouped as low tertile (n = 860; 4.3 [3.7–4.7] mg/dL), middle tertile (n = 739; 5.6 [5.3–5.9] mg/dL) and high tertile (n = 795; 7.1 [6.7–7.9] mg/dL). At 1 year, the incidence of MACE was 3.7%, 4.1% and 6.8% for low, middle and high tertiles, respectively (p = 0.005 for low vs high tertile). Patients in the high tertile of SUA had a significantly higher rate of CV mortality (1.4% vs 0.4%; p = 0.05) and hospital admission for HF (2.8% vs 1.6%; p = 0.03) compared to the low tertile. However, hyperuricemia did not result as an independent predictor of MACE at multivariable analysis [hazard ratio: 1.27; 95% confidence intervals: 0.81–2.00; p = 0.3].ConclusionsIn this contemporary, large cohort of CCS, those in the high tertile of SUA had a greater burden of CV disease and worse QoL. However, SUA did not significantly influence the higher rate of CV mortality, hospitalization for HF and MACE observed in these patients during 1-year follow-up.     

Outcome of cardiopulmonary resuscitation in hospitalized patients

Background: Information on who is likely to benefit from cardiopulmonary resuscitation (CPR) is essential for decision-making regarding resuscitative efforts. The purpose of the present study was to evaluate the results of CPR in hospitalized patients and to investigate the influence of clinical variables and their value as prognostic tools. Methods: We analysed prospectively collected data of 253 consecutive hospitalized patients in whom CPR was performed. Main outcome measures were: success of CPR, 24-h survival, discharge from hospital, mental status at the time of hospital discharge, diagnosis, age, adequacy of basic life support, duration of CPR, time of CPR. Results: The mean age was 69.5 years, with a range of 27 to 97 years. Distribution of sex was 145 men and 108 women. Of 253 CPR efforts, 141 (56%) were successful, and in 110 (43%), patients were alive after 24 h. Fifty patients (20%) were discharged alive. The mechanism of arrest with the best outcome was ventricular tachycardia or fibrillation. Advanced age and adequacy of basic life support by first-responders did not affect survival to discharge. Prolonged duration of the resuscitative effort was associated with a poor outcome. Among patients whose arrest lasted longer than 30 min, 89% died. Conclusion: 20% of patients who underwent in-hospital resuscitation were discharged alive. Need for prolonged resuscitation as well as certain mechanisms of arrest, such as progression of a shock state, were associated with a poor outcome. Patients who are likely to benefit from CPR performed for >30 min are rare. Therefore, a decision for prolonged CPR should be made only in reasonable cases.     

克山病发病和转归的动态分析

1973～1990年,对陕西省黄陵县店头病区克山病发病和转归进行了观察,结果表明:(l)1974年起,店头病区各型克山病发病率呈下降趋势,急性(包括急型和亚急型)、慢型和潜在型年平均下降率分别为75.2％、32.4%和28.6％,1983年至今未见急发病例,但慢型和潜在型仍有新发;(2)1974年后潜在型病情恶化率平均下降26.2％,1980年后新发慢型2～7年生存率明显提高;(3)慢型克山病病死率高,其5、10和15年病死率分别为70.9%、89.1%和93.6%,治疗慢型和管理潜在型是降低病死率的关键。     

Long-term outcome in ICU patients: what about quality of life?

Objective Analysis of mortality and quality of life (QOL) after intensive care unit (ICU) discharge.Design Prospective, observational study.Setting Mixed, 31-bed, medico-surgical ICU.Patients Consecutive adult ICU admissions between June 25 and September 10, 2000, except admissions for uncomplicated elective postoperative surveillance.Interventions None.Measurements and results Age, past history, admission APACHE II, SOFA score (admission, maximum, discharge), ICU and hospital mortality were recorded. A telephone interview employing the EuroQol 5D system was conducted 18 months after discharge. Of 202 patients, 34 (16.8%) died in the ICU and 23 (11.4%) died in the hospital after ICU discharge. Of the 145 patients discharged alive from hospital, 22 could not be contacted and 27 (13.4%) had died after hospital discharge. Of the 96 patients (47.5%) who completed the questionnaire, 38% had a worse QOL than prior to ICU admission, but only 8.3% were severely incapacitated. Twenty-three patients (24%) had reduced mobility, 15 (15.6%) had limited autonomy, 24 (25%) had alteration in usual daily activities, 29 (30.2%) expressed more anxiety/depression, and 42 (44%) had more discomfort or pain. Twenty-eight (62.2% of those who worked previously) patients had returned to work 18 months after ICU discharge.Conclusions Comparing QOL after discharge with that before admission, patients more frequently report worse QOL for the domains of pain/discomfort and anxiety/depression than for physical domains. Factors commonly associated with a change in QOL were previous problems in the affected domains, prolonged hospital length of stay (LOS), greater disease severity at admission and degree of organ dysfunction during ICU stay.     

Validation of a model for evaluating outcome after traumatic brain injury

OBJECTIVE: To validate a model that examines the contribution of premorbid variables, injury severity, and functional and cognitive status to outcome 1 year after traumatic brain injury (TBI). DESIGN: Cross-validation study using a larger, national, prospective, longitudinal sample. SETTING: Acute inpatient rehabilitation hospitals at Traumatic Brain Injury Model Systems centers. PARTICIPANTS: Two sample populations followed through acute rehabilitation to 1 year after TBI. The original sample included 107 patients, and the cross-validation sample included 294 patients. Participants were predominantly young men who had experienced moderate to severe TBI in motor vehicle crashes. INTERVENTIONS: Acute medical and rehabilitation care. MAIN OUTCOME MEASURES: Disability Rating Scale, Community Integration Questionnaire, and return to employment. RESULTS: Structural equation modeling was used to compare the fit of the data to a path analysis developed through clinical use and previous research. Both samples provided adequate goodness of fit, supporting the model's validity. Injury severity affected cognitive and functional status, and cognitive and functional status significantly influenced 1-year outcome. Premorbid factors and injury severity did not directly influence outcome. CONCLUSIONS: Both samples supported the proposed model, which was cross-validated. Injury severity indirectly influences outcome through its effects on cognitive and functional status. Although treatment to decrease injury severity is obviously important, concentrated rehabilitation interventions aimed at improving patients' cognitive and functional status may have a more significant impact on 1-year outcome and should be the focus of future research.