老年稳定型冠心病患者B型利钠肽分层随访5年结果

目的：探讨稳定型冠心病（SCHD）患者静脉血浆B型利钠肽（BNP）水平与中远期住院事件的关系。方法：入选88例老年SCHD患者,均经冠脉造影（CAG）证实。按所测定的静脉BNP浓度分为BNP≥108pg／ml组（44例）和BNP〈108pg／ml组（44例）。随访两组5年的死亡、非致死性ACS、再次PCI等心血管原因和非心血管原因住院事件,并进行比较。结果：平均随访62．7月,高水平BNP组的全因住院事件率显著高于低水平BNP组E62．1％（141／227）比37．9％（86／227）,P=0．041],非心血管原因住院率非常显著高于低水平BNP组E39．2％（89／227）比16．3％（37／227）,P=0．010]。结论：老年稳定型冠心病中基线B型利钠肽水平较高者的远期住院事件率较高。     

品管圈活动在减少外科重症监护病房长期滞留患者中的作用

目的探讨品管圈活动对减少外科重症监护病房长期滞留患者的作用。方法成立品管圈小组,确定“减少SICU长期滞留患者,提高SICU利用率”为活动主题,按制订计划、现状把握、目标设定、解析、对策拟定、对策实施与检讨、标准化、检讨与改进,进行全面质量改进。结果经过品管圈小组6个月的实践,SICU长期滞留患者明显下降,由26例下降至10例;在床位数无变化情况下,收治总人数由954例提升到1102例,提高率15．5％。结论开展品管圈活动有效地减少SICU长期滞留患者数量,提高了SICU利用的合理性和有效性,保护患者的最大利益,并且提高了医护人员的主动性,参与科室管理,增进团结协作。     

老年入住院依赖性预测模型的研究

目的建立住院依赖性的预测模型,探讨住院依赖性发生的影响因素。方法收集167例老年科住院患者的资料,采用非条件Logistic回归分析,筛选产生住院依赖性的影响因素,建立预测模型,并对预测模型进行评价。结果构建的Logistic回归模型为Logit（P）=LnLP／（1-P）]=-11．131＋2．640X2＋1．853 X4＋2．152 X5＋1．866 X7-1．213 X10-1．748X16。该模型预测住院依赖性的灵敏度71．9％,特异度91．2％,准确度为83．8％。结论年龄、婚姻状况、同住者、合并症、生活自理能力和焦虑抑郁状态影响住院依赖性的发生,本研究得到的Logistic回归模型对临床工作有一定参考价值。     

Durée d’hospitalisation en pédopsychiatrie : étude rétrospective des facteurs prédictifs sur deux ans en unité d’adolescents

BackgroundIn a context of increasing needs for child and adolescent psychiatry, psychiatric inpatient units are more and more solicited. We aim here to determine the factors predicting the length of stay (LOS) in an adolescent psychiatric unit.MethodsWe conducted a monocentric retrospective chart-review study based on all medical charts of adolescents who had been hospitalized in two full-time hospitalization units for adolescents in a university-based child psychiatry service (n = 191).ResultsThe mean LOS in this sample was 96 days (SD = 101, min = 1, max = 600, median 67). In multivariate analyses, the variables statistically associated with LOS were: a diagnosis of schizophrenia, an eating disorder, presence of suicidal ideation, a low score on the Children's Global Assessment of Functioning (C-GAF) scale at admission, having an educational measure, and being addressed at discharge to a part-time ambulatory care center. This model predicted around 40% of the LOS variance.ConclusionThe association between clinical and functional factors and the LOS are independent. The contribution of other factors (e.g., social factors and due to the health care system) raises questions about the objectives of inpatient treatment (i.e., crisis interventions, or developing the outpatient health care project via collaborative works with other professions).     

Novel appearance of hyperglycemia/diabetes,associated with COVID-19

In a recent meta-analysis the prevalence of coronavirus disease 2019 (COVID-19)-associated hyperglycemia was 25%, and that of COVID-19-associated new-onset diabetes was 19%. An association between hyperglycemia or new-onset diabetes and COVID-19 has been suggested. In a recent relevant study of critically and non-critically ill patients with COVID-19, we found that indeed beta-cell function was compromised in critically ill patients with COVID-19 and that these patients showed a high glycemic gap. Nevertheless, one quarter of critically ill patients with no history of diabetes have stress hyperglycemia, a finding which could obscure the prevalence of hyperglycemia or new-onset diabetes that could be attributed to COVID-19 per se.     

Developing a risk prediction model for 30-day unplanned hospitalization in patients receiving outpatient parenteral antimicrobial therapy

ObjectivesOutpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat a wide range of infections. However, there is risk of hospital readmissions. The study aim was to develop a prediction model for the risk of 30-day unplanned hospitalization in patients receiving OPAT.MethodsUsing a retrospective cohort design, we retrieved data on 1073 patients who received OPAT over 2 years (January 2015 to January 2017) at a large teaching hospital in Sheffield, UK. We developed a multivariable logistic regression model for 30-day unplanned hospitalization, assessed its discrimination and calibration abilities, and internally them validated using bootstrap resampling.ResultsThe 30-day unplanned hospitalization rate was 11% (123/1073). The main indication for hospitalization was worsening or nonresponse of infection (52/123, 42%). The final regression model consisted of age (adjusted odds ratio (aOR), 1.18 per decade; 95% confidence interval (CI), 1.04–1.34), Charlson comorbidity score (aOR, 1.11 per unit increase; 95% CI, 1.00–1.23), prior hospitalizations in past 12 months (aOR, 1.30 per admission; 95% CI, 1.17–1.45), concurrent intravenous antimicrobial therapy (aOR, 1.89; 95% CI, 1.03–3.47) and endovascular infection (aOR, 3.51; 95% CI, 1.49–8.28). Mode of OPAT treatment was retained in the model as a confounder. The model had adequate concordance (c-statistic 0.72; 95% CI 0.67–0.77) and calibration (Hosmer-Lemeshow p 0.546; calibration slope 0.99; 95% CI 0.78–1.21), and low degree of optimism (bootstrap optimism corrected c-statistic, 0.70).ConclusionsWe identified a set of six important predictors of unplanned hospitalization based on readily available data. The prediction model may help improve OPAT outcomes through better identification of high-risk patients and provision of tailored care.     

670例子宫肌瘤患者住院费用的影响因素分析

目的分析子宫肌瘤患者住院费用的影响因素,以控制住院费用的上涨。方法提取2010年1月至2011年3月期间出院的670例子宫肌瘤患者病案,用Logistic回归分析方法对可能的影响因素进行筛选。结果影响子宫肌瘤患者住院费用的因素依次为住院天数、年龄、治疗方式、其他诊断。结论控制住院费用要以缩短住院天数为突破口。     

81例眼眶海绵状血管瘤住院费用分析

目的进行住院费用分析有助于降低医疗成本,文中研究上海某医院2002年1月至2007年7月问眼眶海绵状血管瘤手术患者住院费用及其影响因素。方法从临床诊治及社会经济学角度出发,对6年间眼眶海绵状血管瘤手术患者住院费用的影响因素进行单因素分析和逐步回归的多因素分析。结果6年问平均住院费用7071．4元,住院费用中位数7038．7元,住院费用构成中所占比例居前3位的是手术材料费、西药费、化验费分别占54．3％、13．3％和8．1％。以住院费用为因变量,先进行单因素回归分析,在此基础上进行多元逐步回归分析。结果发现,婚姻状况、患者来源、并发症情况、前路开眶术、既往治疗情况、眼球移位情况、住院年份、术前天数8项因素对海绵状血管瘤手术患者住院费用的影响有统计学意义（P〈0．05）。结论影响眼眶海绵状血管瘤手术患者住院费用的因素众多,眼眶海绵状血管瘤手术患者住院费用的降低应采用综合性措施。     

Trends in deliveries in women with gestational diabetes in Spain, 2001-2008

We examined trends and characteristics of deliveries in women with gestational diabetes in Spain from 2001 to 2008. There were 101,643 deliveries with gestational diabetes among 2,782,369 delivery discharges (3.6%) with no increase over time. Rate of caesarean section increased (19-24.2%) and length of stay decreased.