ObjectiveTo evaluate the reasonableness of anticoagulation management strategy in patients after mechanical heart valve replacement. MethodsAll patients were followed and registered continually at outpatient clinic from July 2011 to February 2013, with a minimum of 6 months after surgery. Targeted international normalized rate (INR) 1.60 to 2.20 and warfarin weekly dosage adjustment were used as the strategy of anticoagulation management. Except bleeding, thrombogenesis and thromboembolism, time in therapeutic range (TTR) and fraction of TTR (FTTR) were adopted to evaluate the quality of anticoagulation management. ResultsA total 1 442 patients and 6 461 INR values were included for data analysis. The patients had a mean age of 48.2±10.6 years (14-80 years) and the following up time were 6 to 180 months (39.2±37.4 months) after surgery. Of these patients, 1 043 (72.3%) was female and 399 (27.7%) was male. INR values varied from 0.90-8.39 (1.85±0.49) and required weekly doses of warfarin were 2.50-61.25 (20.89±6.93 mg). TTR of target INR and acceptable INR were 51.1% (156 640.5 days/306 415.0 days), 64.9% (198 856.0 days/306 415.0 days), respectively. FTTR of target INR and acceptable INR were 49.4% (3 193 times/6 461 times), 62.6% (4 047 times/6 461 times). There were 8 major bleeding events, 7 mild bleeding events, 2 thromboembolism events, and 2 thrombogenesis in the left atrium. ConclusionIt is reasonable to use target INR 1.60-2.20 and warfarin weekly dosage adjustment for patients after mechanical heart valve replacement.
ObjectiveTo investigate the etiologic feature and prognosis of adult patients with severe community-acquired pneumonia (SCAP). MethodsAccording to the guideline on the diagnosis and treatment of community-acquired pneumonia in 2006, 105 patients with SCAP were included in the study. The proportion of pathogens (including multiple resistant bacteria) and mortality rate were recorded. Appropriate statistical methods were selected and all data were analyzed by using SPSS Version 18.0 computerized program. ResultsThe predominant pathogen with SCAP was Pseudomonas aeruginosa, followed by Klebsiella pneumoniae, Staphylococcus aureus, and Legionella pneumophila. In death cases, Klebsiella pneumoniae was the most common pathogen, followed by Staphylococcus aureus. It was showed in the drug sensitivity test that most pathogens were drug-sensitive strains. The patients with tumor had higher risks to get infected with Gram-negative bacillus. ConclusionsThe etiology of patients with SCAP in our emergency department is given priority to Gram-negative bacillus and sensitive strains, of which Pseudomonas aeruginosa and Klebsiella pneumoniae are predominant. As for the Gram-positive cocci, Staphylococcus aureus is the most common pathogen. Legionella pneumophila is the most common pathogen in atypical pathogens, which only account for a small proportion of the aetiology of SCAP. Patients with Klebsiella pneumoniae and Staphylococcus aureus infections are associated with poor prognosis.
ObjectiveTo compare the predictive value of the BAP-65 score, the DECAF score, the CURB-65 score, and the Pneumonia Severity Index (PSI) on short-term mortality and adverse outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with community-acquired pneumonia (CAP). MethodsThis study enrolled patients hospitalized for AECOPD and CAP from ten hospitals in China from September 2017 to July 2021. All-cause mortality within 30 days was investigated. Patients were divided into the death and the survival groups according to their survival status. The differences in basic conditions, complications, symptoms, signs and auxiliary examination results between the two groups were compared, and the independent risk factors of all-cause mortality were analyzed. The included patients were scored and graded according to the 4 scales, respectively, and the validity of the four scales in predicting short-term mortality and adverse outcomes was compared based on the receiver operating charateristic (ROC) curve analysis. ResultsA total of 3375 patients including 2545 males and 830 females with a mean age of (73.66 ±10.73) years were enrolled in this study. Within 30 days, 129 (3.82%) patients died and 614 (18.19%) patients had an adverse outcome (including all-cause death, invasive mechanical ventilation and admission into intensive care unit). Altered state of consciousness, diabetes mellitus, atrial fibrillation, chronic pulmonary heart disease, age, pulse rate, serum albumin, diastolic blood pressure, and pH value were independent risk factors for 30-day mortality in AECOPD patients with CAP. The area under the ROC curve (AUC) of the CURB-65 score, BAP-65 score, DECAF score, and PSI score for predicting all-cause mortality were 0.780, 0.782, 0.614, and 0.816, and these AUCs for predicting adverse outcomes were 0.694, 0.687, 0.564 and 0.705, respectively. PSI score had the best predictive efficacy for all-cause mortality and adverse outcomes, and the DECAF score had the worst predictive efficacy. ConclusionsAECOPD patients with CAP have a relatively high incidence of all-cause mortality and adverse outcomes within 30 days. Altered state of consciousness, diabetes mellitus, atrial fibrillation, chronic pulmonary heart disease, age, pulse rate, serum albumin, diastolic blood pressure, and pH value are independent risk factors for 30-day mortality. PSI score has the best performance in predicting all-cause mortality and adverse outcomes, while the DECAF score has the worst performance.
Objective To explore whether hospitalized elderly patients with severe communityacquired pneumonia ( SCAP) have better outcomes if they are treated with dual-therapy consisting of a β-lactam/macrolide or fluoroquinolone.Methods A prospective study was conducted in patients with SCAP aged 65 years or older between January 2007 and January 2012. These patients were assigned to a combination therapy group or a β-lactam monotherapy group by the attending physicians. Time to clinical stability( TCS) and total mortality were calculated. Prognostic factors for death were analyzed. Results Among the 232 patients, 153 patients were given β-lactam/macrolide or β-lactam/ fluoroquinolone ( macrolide in 67 patients and fluoroquinolone in 86) , while 79 were treated with β-lactam monotherapy. Compared with the monotherapy group, the combination therapy group was associated with significant decreased TCS ( median TCS, 10 days vs. 13 days) , and lower overall in-hospital mortality( 24.2% vs. 43.0%, P lt;0. 01) . Compared with fluoroquinolone, macrolide use was associated with lower ICU mortality ( 14.9% vs. 31.4% , P lt;0. 01) . Simplified acute physiology score Ⅱ, pneumonia severity index, mutilobar infiltration, and β-lactam monotherapy were confirmed as independent predictors of death. Conclusion β-lactam/macrolide or β-lactam/ fluoroquinolone combination therapy, especially with macrolide, has superiority over β-lactam monotherapy in elderly patients with SCAP, and should be recommended.
Objective To explor the influence of the hospital-community-family mental rehabilitation mode on the quality of life of patients with schizophrenia. Methods We selected 101 patients diagnosed as schizophrenia according to ICD-10, who were hospitalized in mental health center of the West China Hospital and took part in rehabilitation voluntarily after discharge. Those patients were randomly assigned to two groups. Hospital-community-family mental rehabilitation mode intervention was applied to the patients based on inpatient rehabilitation in the trial group (n=52), while inpatient rehabilitation alone was applied in the control group (n=49). The total score of quality of life, psycho-social dimension, motivation and energy dimension, score of mental disability and social function, and family social care index were recorded. Then, statistical analysis was performed using SPSS 17.0 software. Results After 3 months and 6 months, the trial group had lower scores of the total score of quality of life, psycho-social domain, and motive and energy dimension than those of the control group (Plt;0.05). After 6 months, the trial group had lower scores of mental disability and social function (Plt;0.05) but a higher score of family social care index (Plt;0.05). The scores of WHO-DSA II and SQLS were positively correlated, while the scores of APGAR and SQLS were negatively correlated. Conclusion The integral mode of hospital-community-family mental rehabilitation effectively improves the quality of life of patients with schizophrenia, which also positively improves patients’ rehabilitation.
Objective To investigate the clinical characteristics and risk factors associated with death in critically ill patients with severe community-acquired pneumonia( CAP) .Methods A retrospective analysis was carried out in 125 hospitalized patients with severe CAP admitted from July 2008 to February 2012. Earlier clinical features were compared between 109 survival patients and 16 dead patients, and logistic regression analysis was conducted. Results The death group had more underlying diseases than the survival group( P lt;0. 05) . The heart rate at admission in the death group was significantly higher than that in the survival group( P lt;0.05) . The ratio and number of complication, the highest temperature before admission, the platelet count, the arterial blood pH, PaO2 and PaO2 /FiO2 in the death group were significantly lower than those in the survival group( P lt; 0. 05) . Logistic regression analysis showed that the number of underlying diseases, heart rate and PaO2 were predictors of death in the patients with severe pneumonia. Conclusion The number of underlying diseases, heart rate and PaO2 has highly predictive value of death for severe CAP.
Objective To discuss the running effect of the modified hospital-community integrated two-way-referral service mode in day surgery. Methods The hospital-community integrated two-way-referral service mode in day surgery was built in May 2014 by our center, and applied in the communities’ health service network in Chenghua District, Wuhou District, and Jinjiang District. From March 2017 some improvements of the mode were made, such as assigning specific person for the management of two-way-referral, conducting lectures in communities to train the community medical staff, and carrying out gratuitous treatment. The community acceptance rate and patients satisfaction were retrospectively analyzed between March of 2016 and March of 2017, and the number of upward referral (from community to hospital) was retrospectively analyzed between March to June of 2016 and March to June of 2017. Results The community acceptance rate was elevated from 81.3% to 99.1% and the patients satisfaction was improved from 95.4% to 100.0%, and the differences between the two periods were statistically significant (P<0.05). The number of upward referral increased from 0 to 23. Conclusions The modified hospital-community integrated service mode could optimize the course of surgery appointment, and make it convenient for patients. Furthermore, it also adjusts the reasonable allocation of medical resource effectively and promotes the implementation of national hierarchical medical system.
ObjectiveTo construct the general practice tutors’ ability system in community training bases under the background of hospital-community integrated teaching of general practice.Methods From January to April 2021, literature analysis, expert group consultation, in-depth interview and questionnaire survey were conducted to construct the grass-roots general practice tutors’ ability system, and exploratory factor analysis method was applied, using main component analysis to extract the competency elements. Results There were 4 first level indicators and 20 second level indicators in the system, among which the first level indicators were personal characteristics and professionalism, teaching and research ability, basic level clinical practice ability, and base organization management ability. Conclusion This research enriches the indicators and connotations of the general practice tutors in community training base of general practice, and provides empirical research basis for the selection, ability training and performance evaluation of tutors in community practice bases of general practice medicine.
Objective To understand the current rate of nosocomial infection and its changing trend in a grade A comprehensive hospital in 10 years, and to provide scientific basis for the monitoring, control and management of nosocomial infection. Methods Using the method of cross-sectional survey, the inpatients in Mianyang Central Hospital from 2011 to 2020 were selected for bedside survey, and the questionnaire was filled in after review of medical records. The data of cross-sectional survey of nosocomial infection were collected, and the infection-related data of nosocomial and community-acquired infection of patients in each department were statistically analyzed. Results A total of 19 595 cases were investigated. The prevalence rate of nosocomial infection was 3.79%, and the the case prevalence rate of nosocomial infection was 4.04%. The prevalence of community-acquired infection was 33.44%, and the case prevalence rate of community-acquired infection was 35.30%. The departments with higher prevalence rate in nosocomial infection were intensive care unit, neurosurgery, cardiothoracic surgery and hematology. The departments with high prevalence rate in the community-acquired infection were burn department, pediatrics department, neonatology department, respiratory medicine department and pediatric intensive care unit. The most common site of nosocomial infection was lower respiratory tract infection, followed by upper respiratory tract sensation, urinary tract, abdominal tissue and blood. The main pathogens of nosocomial infections were Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa. The utilization rate of antibacterial drugs was 42.93%. There was a downward trend in prophylactic drug use, mainly one drug combination, and the proportion of combination drug decreased.Conclusion Through the investigation, it can be seen that the key points of nosocomial infection management and prevention and control should be lower respiratory tract infection, postoperative surgical infection, multi-drug resistant bacteria management and rational use of antibiotics.
ObjectiveTo explore procalcitonin (PCT) dynamically in severe community-acquired pneumonia (SCAP) patients to evaluate the effects of different kinds of medical treatments and assess the clinical significance of the change of PCT. MethodsAll of the selected 60 SCAP patients treated from January 2009 to April 2011 met the standards of IDSA/ATS Guidelines for CAP. There were 38 males and 22 females, with an average age of 66.3 years. The sterile venous blood specimen samples were collected from the patients at day 0 to day 5. PCT and C-reactive protein (CRP) were measured by enzyme linked immunosorbent assay throughout the research. At day six, based on oxygenation index (PaO2/FiO2) ratio higher than 250, inflammation absorption on chest X ray after vasoactive agents were stopped, Glasgow scores higher than 10 and urine volume equal to or higher than 0.5 mL/(kg·d), we divided the patients into recovery group and deterioration group. Data were analyzed by SAS 9.0 software, and P<0.05 was considered to be statistically significant. ResultsThe analysis results showed that PCT and CRP bore a significantly positive relationship on day 0 (r=0.38, P=0.00). The research also indicated that PCT had a faster declining rate than CRP and white blood cells count throughout the clinical treatment. The average of PCT declined 29% in 48 hours. Following the criterion of PCT decrease by 30%, the research showed that PCT had a higher sensibility and specificity (66.87% and 85.50%, respectively) in 48 hours than 72 hours (70.05% and 100.00%), 96 hours (79.88% and 75.23%), and 120 hours (83.10% and 100.00%). ConclusionFollowing the criterion of PCT decrease by 30% after using antibiotics can be an clinical objective index to guide the use of antibiotics and provide the basis for clinical application and prognosis.