Comprehensive geriatric assessment in the emergency department for the prediction of readmission among older patients: A 3-month follow-up study

BackgroundOlder people present to the emergency department (ED) with distinct patterns and emergency care needs. This study aimed to use comprehensive geriatric assessment (CGA) surveying the patterns of ED visits among older patients and determine frailty associated with the risk of revisits/readmission.MethodsThis prospective study screened 2270 patients aged ≥75 years in the ED from August 2018 to February 2019. All patients underwent CGA. A 3-months follow-up was conducted to observe the hospital courses of admission and revisit/readmission.ResultsA total of 270 older patients were enrolled. The independent predictors of admission at initial ED visit were the risk of nutritional deficit and instrumental activities of daily living (IADL). In the admission group, the independent predictors of revisit/readmission were a fall in the past year and mobility difficulties. In the discharge group, the independent predictors of revisit/readmission were frailty and insomnia. Regardless if older patients were either admitted or discharged at the initial ED visit, the independent predictor of revisit/readmission for older patients was frailty.ConclusionOur study showed that frailty was the only independent predictor for revisit/readmission after ED discharge during the 3-month follow up. For ED physicians, malnutrition and IADL were independent predictors in recognizing whether the older patient should be admitted to the hospital. For discharged older ED patients, frailty was the independent predictor for the integration of community services for older patients to decrease the rate of revisit/readmission in 3 months.     

健康教育对精神分裂症患者临床疗效的影响

目的观察健康教育对精神分裂症患者疗效的影响。方法将160例精神分裂症患者随机分为药物治疗并健康教育组（研究组）80例和单纯药物治疗组（对照组）80例。研究组接受药物治疗、健康教育指导，对照组仅接受药物治疗。出院时和随访2年末，采用简明精神病量表（BPRS）、自制调查表评定精神症状、疗效、住院天数、治疗依从性和复发率。结果出院时：研究组平均住院天数明显短于对照组，分别为57±6天和78±19天，显效率和有效率明显高于对照组．分别为72．2％与43．5％；91．7％与75．4％；BPRS量表评分明显低于对照组24．3±4．1与29．6±5．2；治疗依从性研究组分别为：完全依从为75．0％，部分依从为19．4％，不依从为5．6％；对照组分别为52．2％、34．8％和13．0％，差异有显著性（P〈0．01）。随访2年末：研究组显效率和有效率明显高于对照组63．9％与30．4％；77．8％与44．9％；研究组BPRS量表评分明显低于对照组27．2±5．1与34．7±7．8；治疗依从性研究组分别是：完全依从为62．5％，部分依从为26．4％。不依从为11．1％，对照组分别为36．2％．26．1％和37．7％，差异有显著性（P〈0．01）；复发率明显低于对照组13．9％与30．4％，差异有显著性（P〈0．01）；两组脱落率无显著性差异（P〉0．05）。结论健康教育有利于精神分裂症患者精神症状的改善，能缩短住院时间，提高治疗依从性和减少复发率。     

加强病人随访管理促进医院营销发展

探讨加强病人随访管理必须明确和理解的若干重要的营销理念，即顾客含义的认识的市场概念的形成和营销观念的演进，认识到通过病人随访管理，可以向顾客让渡价值，提高患者满意度；继而提出建立病人随访服务的长效营销机制的方式，以促进医院更好发展。     

重温《内经》诊察疾病方法的基本内容与学术特点

文章从诊法的定义、《内经》诊法的基本内容、《内经》诊法的主要特点、《内经》有关诊断的内容、《内经》诊法的要点五个方面,重温了《内经》诊察疾病方法,以飨读者。     

肝癌介入术后随访的影像学比较

经导管肝动脉化疗栓塞术（TACE）治疗肝细胞癌（HCC）已有30年历史,1979年开始用碘化油栓塞治疗肝癌并逐渐应用于临床,现已成为HCC非手术治疗的有效和首选方法。其基本原理：肝细胞癌的血供主要来自肝动脉,尤其是有包膜的肝细胞癌,经导管自肝动脉注入化疗药物的杀伤作用与药物的浓度及与癌细胞的接触时间成正比,肝动脉灌注化疗可明显提高抗癌药物的杀伤作用,减少副反应。将提供肿瘤营养的肝动脉支栓塞,使肿瘤缺血坏死。灌注化疗与碘油栓塞并用可增加化疗药物与癌肿的接触时间,最终达到肿瘤缩小,控制肿瘤生长的目的。     

A simplified scoring model for predicting bacteremia in the unscheduled emergency department revisits: The SADFUL score

BackgroundBacteremia is a severe complication of infectious disease. Patients with a high bacteremia risk in the emergency department (ED) but misidentified would lead to the unscheduled revisits. This study aimed to develop a simplified scoring model to predict bacteremia in patients with unscheduled ED revisits.MethodsAdult patients with unscheduled ED revisits within 72 h with a final diagnosis of infectious disease were retrospectively included. The development cohort included patients visiting the ED from January 1, 2019 to December 31, 2021. Internal validation was performed in patients visiting the ED from January 1, 2022 to March 31, 2022. Variables including demographics, pre-comorbidities, triage levels, vital signs, chief complaints, and laboratory data in the index visit were analyzed. Bacteremia was the primary outcome determined by blood culture in either index visits or revisits.ResultsThe SADFUL score for predicting bacteremia comprised the following predictors: “S”egmented neutrophil percentage (+3 points), “A”ge > 55 years (+1 point), “D”iabetes mellitus (+1 point), “F”ever (+2 points), “U”pper respiratory tract symptoms (−2 points), and “L”eukopenia (2 points). The area under receiver operating characteristic curve with 95% confidence interval in the development (1802 patients, 190 [11%] with bacteremia) and the validation cohort (134 patients, 17 [13%] with bacteremia) were 0.78 (0.74–0.81) and 0.79 (0.71–0.88), respectively.ConclusionsThe SADFUL score is a simplified useful tool for predicting bacteremia in patients with unscheduled ED revisits. The scoring model could help ED physicians decrease misidentification of patients at a high risk for bacteremia and potential complications.