Ambulante indirekte Blutdrucklangzeitmessung bei primärer und sekundärer Hypertonie

Summary Ambulatory 24 hour blood pressure measurements were performed in 21 patients with various forms of secondary hypertension and were compared with the blood pressure profile of a matched group of patients with primary hypertension. Patients with renovascular (n=8) and renoparechymal hypertension (n=8), and with primary hyperaldosteronism (n=4) showed no significant fall in systolic blood pressure during the sleeping period (00-03 a.m.) and in systolic and diastolic blood pressure in the early morning (06 a.m.) as compared with essential hypertensives. However, in a single case of hypertension due to coarctation of the aorta the 24 hour blood pressure profile is not different from essential hypertension.Thus, ambulatory 24 hour blood pressure recording is a good method for screening secondary forms of hypertension.

     

Laboratory and Ambulatory Monitoring of Menopausal Hot Flashes

A large increase in skin conductance activity recorded from the sternum was found during menopausal hot flashes and corresponded well with patient self-reports. The magnitude and time course of this skin conductance change was similar during spontaneous hot flashes recorded in the laboratory, during heat-induced hot flashes, and during those recorded by ambulatory monitoring techniques. This pattern of sternal skin conductance change did not occur in premenopausal women during body heating or ambulatory monitoring. These methods should be useful in research on the etiology and treatment of menopausal hot flashes.     

Determinants of private clinics' productivity: a comparison of city and county clinics in Korea

This study was designed to assess determinants of private clinics' productivity, and to compare city and county clinics in South Korea. We analyzed the revenue and patient data from all 9,212 private clinics in South Korea. This data was obtained from the Korean National Health Insurance Corporation, during the period between 1996 and 1999. We used a mixed model for repeatedly measured data. The following listed variables were used in our analysis: sex and age of physician, number of beds of clinics, competitiveness of medical institution, inhabitants'incomes, the proportion of elderly in the administrative unit, and time effects. Age, sex, number of beds, and specialty were found to be the most relevant determinants for the productivity of private clinics in both urban and rural settings, and number of clinics and beds per 100,000 and income of the administrative unit were found to be significant determinants, but only in city environments.     

Prevalence and prognostic significance of cardiac arrhythmias detected by ambulatory electrocardiography in subjects 85 years of age

24 hour ambulatory electrocardiography was performed in a representativegroup of people born in 1897. Out of 73 people included in thestudy, 22 were without known heart disease, 15 had definiteischaemic heart disease (IHD) and 36 symptoms of possible cardiacorigin. An R-R interval in excess of 2000 ms was seen in only3 subjects and Wenckebach A-V block in only one. One subjectwithout a history of syncope had a nocturnal episode of completeA-V block with an escape interval of 8000 ms. The most strikingdifference between healthy subjects and patients with IHD wasthe higher number of patients with more than 1000 ventricularpremature beats (VPBs) per 24 hour and ventricular coupletscompared with the number of healthy subjects with such findings.At follow-up two years later 11% had died, with the highestmortality in patients with IHD (33%), and out of 8 patientswith IHD who had more than 1000 VPBs per 24 hour, 4 (50%) haddied compared with only one (14%) of those with less than 1000VPBs. Our results seem to indicate that more than 1000 VPBsper 24 hour is a very unusual finding in healthy 85 year oldindividuals. When it occurs in very old people, it is usuallyin connection with IHD, and in this setting it signifies a poorprognosis.     

老年患者日间手术全程质量管理模式研究

目的探索老年患者日间手术全程质量管理模式。方法通过医院病历系统采集2015年-2020年应用老年患者日间手术全程质量管理模式前后患者信息,进行对比分析。结果老年患者应用日间手术全程质量管理模式后,≥65岁老年患者日间手术人数逐年上升,占比从13.52%上升至18.62%,差异有统计学意义（χ2=6.450,P=0.011）;日间手术住院时间＞5 d的比例从0.72%下降至0.50%,差异有统计学意义（χ2=338.088,P<0.001）;不良事件发生率从3.77‰下降至1.56‰,差异有统计学意义（χ2=5.156,P=0.023）,其中严重不良事件发生率从2.08‰下降至0.35‰,差异有统计学意义（χ2=7.019,P=0.008）。结论应用日间手术全程质量管理模式能够有效提高老年患者日间手术的安全性,值得借鉴与推广。     

Estimating the financial savings from maintaining the level of acute services with fewer hospital beds

All district health authorities are obliged to use resources most efficiently. One approach to increasing efficiency is to identify measures which allow service levels, in terms of patients treated and standards of care, to be maintained at a lower cost. This could be achieved by maintaining service levels with fewer hospital beds. Reducing lengths of stay by removing organizational delays and expansions of day-case care, are policies which can increase patient caseload per bed. This paper puts forward an approach for estimating the resources released by such policies and assesses the savings achieved by realizing efficiency gains identified in a previous study by Beech et al. (1987). That study identified significant potential for maintaining services with fewer beds, with the expansion of day-case care being a key mechanism. However this paper concludes that when services are maintained with fewer beds, the vast majority of hospital costs remain fixed. It also reaches the alarming conclusion that as a vehicle for reducing costs, day-case care is much less effective than previous studies have implied. However, increasing hospital throughput per bed does release capacity to treat more patients. The proposed reforms of the NHS (Secretaries of State, 1989) envisage an internal market for health care, allowing hospitals to enter into contracts with purchasers of health care. The approach to costing described in this paper is applicable to assessing the increased costs associated with such developments. These extra costs can then be compared with expected income.     

动态血压检测临床意义的探讨

目的 :探讨动态血压检测在临床应用的意义。方法 :采用动态血压检测 (ABPM) ,被检查者分二组 :无高血压病史 ,常规测血压高于正常值 (140 / 90 mm Hg)为 A组 4 0例 ,有高血压病史者为 B组 10 4例。结果 :A组常规测血压平均值为 16 3± 7.3/ 115± 4 .5mm Hg,ABPM平均值为 12 8± 8.2 / 85± 5.0 mm Hg;血压高于 140 / 90 mm Hg超过 50 %占 10 % (4 / 4 0 ) ;杓形曲线占 90 % (36 / 4 0 )。 B组 :常规测血压平均值为 158.5± 10 .6 / 95± 5.5mm Hg,ABPM平均值为 135± 6 .5/ 88± 4 .5mm Hg,血压高于140 / 90 mm Hg,超过 50 %占 19.2 % (2 0 / 10 4 )非杓形曲线占 16 .3% (17/ 10 4 )。结论 :ABPM能更真实地反应被检查者的血压 ,也可以作为评价高血压病人降压疗效的一种方法。     

充血性心力衰竭患者动态血压的变化及意义

目的 探讨慢性充血性心力衰竭（ＣＨＦ）患者２４ｈ动态血压的变化及意义。方法 将５７例ＣＨＦ患者按心功能的受损程度（ＮＹＨＡ分组）分为Ａ组（１７例,心功能Ⅱ组）、Ｂ组（１９例、心功能Ⅲ级）和Ｃ组（２１例,心功能Ⅳ级）;根据病因的不同,分为Ｄ组（１６例,扩张型心肌病）和Ｅ组（４１例,非扩张型心肌病）;全部患者行２４ｈ动态血压（２４ｈ ＡＢＰ）检查,比较Ａ,Ｂ,Ｃ三组及Ｄ、Ｃ两组之间平均收缩压、夜间平均收缩压下降率（ｎｓＢＰＲ）及２４ｈ平均收缩压变异率（２４ｈ ｓＢＰＶ）的差异。结果 Ｃ组的平均收缩压较Ａ组和Ｂ组略低,但三组之间差异无显著性（Ｐ〉０．０５）;Ｄ组的平均收缩压显著低于Ｅ组（Ｐ〈０．０５）。Ａ,Ｂ,Ｃ３组的ｎｓＢＰＲ减弱或消失,分别占５８．８％,８８．３％和９５．２％,Ａ组与Ｂ,Ｃ,组的平均收缩压显著低于     

动态血压正常高限者的左室肥厚

目的：观察动态血压为正常高限者的左室肥厚情况,为该患者群靶器官损害的防治策略提供依据。方法：根据２４小时动态血压监测结果将病人分为３组：Ｎ组（正常血压组）、ＮＨ组（血压正常高限组）和Ｈ组（高血压组）。以超声心动图检测左室舒张末期内径,舒张末期室间隔和左室后壁厚度等,计算左室重量指数（ＬＶＭＩ）。结果：Ｈ组（１２９±４１）和ＮＨ组（１１５±３２）的ＬＶＭＩ明显高于Ｎ组（９７±２３,Ｐ＝０．００００１和０．００５）,Ｈ组和ＮＨ组间无统计学差异。结论：动态血压正常高限者左室肥厚程度明显重于血压完全正常者。对该人群亦应积极采取措施预防和治疗靶器官损害     

"三线防控"模式在新冠肺炎疫情期间妇产科患者门诊就诊管理实践探讨

目的探讨新冠肺炎疫情期间"三线防控"模式在广州医科大学附属第三医院妇产科门诊的实践成效。 方法自新冠肺炎疫情以来，我院妇产科门诊自主制定了"三线防控"模式并常态化实施，采用回顾性研究方法分析2021年3月至8月广州市荔湾区疫情前后我院妇产科普通门诊、急诊及发热门诊的患者就诊情况，重点分析5~6月普通门诊中发现健康码异常或流行病学史的漏诊率、普通门诊的实际就诊率及候诊时间、患者满意度、发热门诊会诊率、妇科门诊手术情况、产科患者收住院情况等，同比2020年及2019年5~6月我院妇产科患者就诊情况变化。 结果在2021年广州市荔湾区疫情期间的5~6月，我院妇产科门诊累计预检分诊33 782例，其中黄码患者73例，健康码正常但流行病学史疑似患者108例，最终确诊新冠肺炎患者0例。2021年5月患者就诊同比2020年上升了6.09%，但较疫情前的2019年下降11.6%；6月患者就诊同比2019年及2020年分别明显下降了40.73%及41.51%。2021年5月21日至7月2日妇产科普通门诊患者的实际就诊率平均为90.8%，呈逐渐增长的趋势。2021年5~6月妇产科门诊手术总数为2501例，总收住院人数为1286例，收住院患者中持有72 h有效新冠核酸阴性结果的占比100%，隔离病房的收治情况为0；患者的就诊满意度平均高达8.76分。 结论"三线防控"管理模式，建立有效的普通门诊应急反应体系，保障了不同状况、不同需求的患者得到及时诊治，为广大患者安全就医提供了坚实的保障，并获得较高的满意度。