Can binary early warning scores perform as well as standard early warning scores for discriminating a patient's risk of cardiac arrest,death or unanticipated intensive care unit admission?

IntroductionAlthough the weightings to be summed in an early warning score (EWS) calculation are small, calculation and other errors occur frequently, potentially impacting on hospital efficiency and patient care. Use of a simpler EWS has the potential to reduce errors.MethodsWe truncated 36 published ‘standard’ EWSs so that, for each component, only two scores were possible: 0 when the standard EWS scored 0 and 1 when the standard EWS scored greater than 0. Using 1564,153 vital signs observation sets from 68,576 patient care episodes, we compared the discrimination (measured using the area under the receiver operator characteristic curve—AUROC) of each standard EWS and its truncated ‘binary’ equivalent.ResultsThe binary EWSs had lower AUROCs than the standard EWSs in most cases, although for some the difference was not significant. One system, the binary form of the National Early Warning System (NEWS), had significantly better discrimination than all standard EWSs, except for NEWS. Overall, Binary NEWS at a trigger value of 3 would detect as many adverse outcomes as are detected by NEWS using a trigger of 5, but would require a 15% higher triggering rate.ConclusionsThe performance of Binary NEWS is only exceeded by that of standard NEWS. It may be that Binary NEWS, as a simplified system, can be used with fewer errors. However, its introduction could lead to significant increases in workload for ward and rapid response team staff. The balance between fewer errors and a potentially greater workload needs further investigation.     

拜阿司匹林对老年糖尿病患者血小板活性及眼底血流动力学指标的影响观察

目的:观察拜阿司匹林对老年糖尿病患者血小板活性及眼底血流动力学指标的影响程度。方法:选取2012年12月至2014年1月本院收治的74例老年糖尿病患者为研究对象,将其随机分为对照组(常规糖尿病治疗组)37例和观察组(常规糖尿病治疗加拜阿司匹林组)37例,然后将两组患者治疗前和治疗后4周、8周的血小板活性及眼底血流动力学指标进行检测及比较。结果:观察组治疗后4周及8周时的血小板活性指标均低于对照组,眼底血流动力学指标也均好于对照组,P均<0.05,两组治疗后4周与8周时的比较指标间均有显著性差异。结论:拜阿司匹林对老年糖尿病患者血小板活性及眼底血流动力学指标的影响较大,其有效地改善了此类患者的微血供。     

Use of alarm features in referral of febrile children to the emergency department: an observational study

Background

The diagnostic value of alarm features of serious infections in low prevalence settings is unclear.

Aim

To explore to what extent alarm features play a role in referral to the emergency department (ED) by GPs who face a febrile child during out-of-hours care.

Design and setting

Observational study using semi-structured, routine clinical practice data of febrile children (<16 years) presenting to GP out-of-hours care.

Method

Logistic regression analyses were performed to assess the association between alarm features of serious infections (selected from two guidelines and one systematic review) and referral to the ED. Adherence to the guideline was explored by a 2×2 contingency table.

Results

In total 794 (8.1%) of 9794 eligible patients were referred to the ED. Alarm signs most strongly associated with referral were ‘age <1 month’, ‘decreased consciousness’, ‘meningeal irritation’, and ‘signs of dehydration’. Nineteen percent of 3424 children with a positive referral indication according to the guideline were referred to the ED. The majority of those not referred had only one or two alarm features present. A negative referral indication was adhered to for the majority of children. Still, in 20% of referred children, alarm features were absent.

Conclusion

In contrast to guidance, GPs working in primary out-of-hours care seem more conservative in referring febrile children to the ED, especially if only one or two alarm features of serious infection are present. In addition, in 20% of referred children, alarm features were absent, which suggests that other factors may be important in decisions about referral of febrile children to the hospital ED.     

西部某医院484例重型手足口病临床特点分析

目的探讨重型手足口病的临床特点,以总结救治经验。方法回顾性分析我院2011年1月—2012年12月收治的484例手足口病的临床表现和治疗情况。结果本组患儿男女比为1.5∶1,年龄(2.17±0.60)岁,病程(2.74±1.19)d,住院天数(6.14±1.78)d。临床症状和体征主要有手和(或)足部皮疹(100%)、精神差(98.1%)、发热(95.7%)、惊跳(95.7%)、激惹(94.4%)、心率加快(81.8%)、呕吐(40.1%)、血压升高(36.6%)和肢体抖动(33.9%)。实验室检查异常指标主要有白细胞计数升高(60.1%)、心肌损伤(38.0%)、血糖升高(32.9%)、血乳酸升高(31.0%)。脑脊液检查为病毒性脑炎改变,脑部CT/MRI检查均未见异常。病原学检查以EV71感染为主(65.1%)。经抗病毒和对症治疗,应用静脉免疫球蛋白(intravenous immunoglobulin,IVIG)、米力农(甲氰吡酮)、甘露醇和地塞米松等治疗后,所有患儿均痊愈出院,无一例转为危重型。结论重型手足口病早期临床表现较隐匿,精神差、惊跳、激惹为神经系统最主要表现。早期诊断并及时应用甘露醇和地塞米松,血压升高时及时应用米力农,血糖和白细胞明显升高时酌情应用IVIG,则预后良好。     

发热伴血小板减少综合征患者病死率 及临床特征的Meta 分析

目的 对文献报道的发热伴血小板减少综合征（SFTS）患者的病死率和临床特征进行Meta 分析。 方法 计算机检索PubMed、Embase、The Cochrane Library、CMB、CNKI 和VIP 数据库。选择报告SFTS 临 床特征的无对照观察性研究,摘录有关的信息,使用STATA 11 软件对所选定的数据进行合并。结果 中国地 区21 篇文献共4 320 例,韩国地区3 篇文献共262 例实验室确诊为SFTS 的患者被纳入Meta 分析。中国地区 SFTS 患者合并病死率为16.6%（95% CI ：0.155,0.177）;韩国地区SFTS 患者合并病死率为28.8%（95% CI ： 0.104,0.471）。中国地区SFTS 患者各临床表现的合并阳性率为发热81%（95% CI ：0.680,0.941）、乏力81.3% （95% CI ：0.754,0.872）、血小板减少82.9%（95% CI ：0.713,0.945）、白细胞减少84.9%（95% CI ：0.808, 0.891）、恶心54.2%（95% CI ：0.467,0.617）、厌食77.2%（95% CI ：0.690,0.854）及出血性表现 13.8%（95 CI ： 0.103,0.172）;韩国地区SFTS 患者各临床表现的合并阳性率为发热87.7%（95% CI ：0.810,0.945）、乏力 55.2%（95% CI ：0.180,0.923）、血小板减少88.5%（95% CI ：0.819,0.950）、白细胞减少90.1%（95% CI ： 0.840,0.963）、腹泻50.9%（95% CI：0.285,0.733）及出血性表现23.4%（95% CI：0.041,0.426）。结论 发热、 乏力、血小板减少及白细胞减少为所有SFTS 患者的共同临床表现,中国地区SFTS 患者的胃肠道症状以恶心 及厌食为主要表现,而韩国地区主要以腹泻为主。     

Hypoesthesia in generalised anxiety disorder and major depression disorder

Abstract

Objective: The determination of soft signs can be a conducive practice to understand the differential etiology between depression and anxiety. This study aims at examining malleolar hypoesthesia role in distinguishing between patients with generalised anxiety disorder (GAD) and major depression disorder (MDD).

Methods: This study examines the presence of malleolar hypoesthesia in patients with GAD (n?=?47) compared to patients with MDD (n?=?48) and healthy individuals (controls; n?=?99). The Wartenberg wheel, a medical device for neurological use, was employed to determine the presence of hypoesthesia on both sides of the ankles.

Results: The data revealed: i) MDD patients showed higher hypoesthesia than GAD patients (p?=?.008), ii) participants with hypoesthesia had higher anxiety and depression scores than participants without hypoesthesia (all p?<?.001) and iii) logistic regression model indicated that hypoesthesia can be a predictor of MDD relative to GAD diagnosis (Odds Ratio: 17.43 (1.40–217.09; p?=?.026)).

Conclusions: Malleolar hypoesthesia was higher in MDD than GAD. The detection of hypoesthesia may help to investigate the differential etiology between MDD and GAD diagnosis.     

Suicide among the elderly and associated factors in South Korea

With the population of the elderly increasing, suicides among elderly people present a serious problem for global societies. However, there are few studies on suicide among elderly subjects, especially in Asia. The study aimed to determine the relationship between physical health, mental health, social environmental condition, and the suicide behavior among elderly subjects in the city of Suwon, located southeast of Seoul. We analyzed 1548 Korean aged over 60 years from baseline data of a larger prospective study called the Suwon Project. The study protocol included sociodemographic variables, mental health factors, and physical health factors. In the interview, the subjects were asked about suicide ideation and history of suicide attempt. Of the total subjects, 7.42% reported suicide ideation and 1.42% reported a history of suicide attempt. A logistic regression analysis showed that physical illness, five stroke warning signs, anxiety and depression associated with suicide ideation, and depression strongly corresponded to the suicide ideation. Anxiety, depression, and stroke warning signs were associated with history of suicide attempt among the elderly. Additionally, stroke warning signs and depression are independently associated with history of suicide attempt. This study revealed that stroke warning signs have a high correlation with history of suicide attempt in the elderly, independent from the depression factors. This study suggests that there is an independent relationship between physical health status and suicide behavior in the case of elders.