BACKGROUND Understanding a virus shedding patterns in body fluids/secretions is importantto determine the samples to be used for diagnosis and to formulate infectioncontrol measures.AIM To investigate the severe acute...BACKGROUND Understanding a virus shedding patterns in body fluids/secretions is importantto determine the samples to be used for diagnosis and to formulate infectioncontrol measures.AIM To investigate the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)shedding patterns and its risk factors.METHODS All laboratory-confirmed coronavirus disease 2019 patients with completemedical records admitted to the Shenzhen Third People’s Hospital from January28, 2020 to March 8, 2020 were included. Among 145 patients (54.5% males;median age, 46.1 years), three (2.1%) died. The bronco-alveolar lavage fluid(BALF) had the highest virus load compared with the other samples. The viralload peaked at admission (3.3 × 108 copies) and sharply decreased 10 d afteradmission.RESULTS The viral load was associated with prolonged intensive care unit (ICU) duration.Patients in the ICU had significantly longer shedding time compared to those inthe wards (P < 0.0001). Age > 60 years [hazard ratio (HR) = 0.6;95% confidenceinterval (CI): 0.4-0.9] was an independent risk factor for SARS-CoV-2 shedding,while chloroquine (HR = 22.8;95%CI: 2.3-224.6) was a protective factor.CONCLUSION BALF had the highest SARS-CoV-2 load. Elderly patients had higher virus loads,which was associated with a prolonged ICU stay. Chloroquine was associatedwith shorter shedding duration and increased the chance of viral negativity.展开更多
Purpose:This paper reports an analysis of the concept of patient outcomes.Methods:The Walker and Avant concept analysis approach was applied.Results:The attributes of patient outcomes include(1)patient functional stat...Purpose:This paper reports an analysis of the concept of patient outcomes.Methods:The Walker and Avant concept analysis approach was applied.Results:The attributes of patient outcomes include(1)patient functional status(maintained or improved),(2)patient safety(protected or unharmed),and(3)patient satisfaction(patient reporting of comfort and contentment).These attributes are influenced by the antecedents of individual patient characteristics and health problems,the structure of healthcare organizations and received health interventions.Additionally,patient outcomes do significantly impact the quality of nursing care,the cost of effective care and healthcare policy making formulation.Conclusion:Providing good nursing care to all patients is a central goal of nursing.Patient outcomes in nursing are primarily about the results for the patient receiving nursing care.This analysis provides nurses with a new perspective by helping them to understand all the components within the concept of patient outcomes.展开更多
The primary goal of the study was to develop a PRP （patient reminder program）. The PRP is an innovation developed by using the integration of two technologies--web-based database and SMS （short message service）. R...The primary goal of the study was to develop a PRP （patient reminder program）. The PRP is an innovation developed by using the integration of two technologies--web-based database and SMS （short message service）. Reminder massages were delivered to users through a mobile phone. The program development composed of three phases. In initial phase, the PRP was designed and developed. In second phase, the PRP was tested for its efficacy by sending trial massages to users for seven consecutive days. PRP then was modified and copyright. In last phase, PRP was fully implemented. Data were collected from 30 elderly who came for their visit at one hospital located in Nakhon Ratchasima province. Participants＇ preferences reminder messages--medications to be taken and appointments--were delivered to elderly for four weeks. Measured outcomes included （1） number of forgetfulness, （2） number of missed appointments, and （3） participants＇ overall satisfaction. Data were analyzed using descriptive statistics. The findings showed that participants reported decreasing in number of forgetfulness after using a reminder service （mean = 0.62 times/week）. No missed appointment was reported, In addition, they were very satisfied with PRP （mean = 4.35, S.D. = 0.67）. In conclusion, PRP is an effective program to use in improving patient outcome. Health care providers can expand the use of PRP to improve the quality of care, hence improve patient outcome.展开更多
Digital technology has fundamentally transformed healthcare delivery, exerting profound influence on patient outcomes. This paper delves into the roles played by telemedicine, electronic health records (EHRs), and mob...Digital technology has fundamentally transformed healthcare delivery, exerting profound influence on patient outcomes. This paper delves into the roles played by telemedicine, electronic health records (EHRs), and mobile health applications in augmenting healthcare services. The objective is to scrutinize the ways in which these digital innovations enhance healthcare delivery and patient outcomes, while also identifying the attendant challenges in their adoption. To achieve this, a rigorous literature review encompassing peer-reviewed articles, reports, and case studies that examine the impact of digital technology in healthcare settings was conducted. The findings underscore that digital technology significantly bolsters patient care by enhancing access, operational efficiency, and diagnostic accuracy. Nonetheless, persistent challenges such as safeguarding data privacy, ensuring interoperability across systems, and managing implementation costs continue to pose significant hurdles.展开更多
Introduction:With the aging population,more females will suffer from pelvic organ prolapse.Both urologists and gynecologists perform sacrocolpopexy,but there is no comparative study analyzing differences in provision ...Introduction:With the aging population,more females will suffer from pelvic organ prolapse.Both urologists and gynecologists perform sacrocolpopexy,but there is no comparative study analyzing differences in provision of care,outcomes,or patient population.We aimed to elucidate potential differences in demographics,outcomes,and minimally invasive surgery utilization for SCP performed by urology and gynecology.Methods:In our retrospective analysis,sacrocolpopexies were identified using the American College of Surgeons National Surgical Quality Improvement Project database from 2006–2020.Pearson’s chi-square test was performed to test trends in the utilization of MIS in five-year blocks.Frailty was calculated using the NSQIP modified frailty index and the revised surgical Risk Analysis Index.Univariate analysis was performed using Student’s t-test and Pearson’s chi-square to compare operative parameters,frailty,demographics,and outcomes.Results:We identified 8944 sacrocolpopexies.Gynecology performed 81%of cases while urology performed the remaining 19%(p<0.001).Between the specialties,there were no significant differences in outcomes,minor or major complications,or 30-day reoperations/hospital readmissions/mortality.However,urologists tended to care for patients who were older(65 vs.61 years,p<0.001)and frailer by both frailty indices(p<0.001).Conclusion:Case distributions have remained stable,with gynecologists four-fold more sacrocolpopexies,in keeping with the larger number of practicing gynecologists vs.urologists.There was no difference in 30-day outcomes between both specialties.However,urologists operated on older,more frail patients.展开更多
This manuscript provides a commentary on the article by Zhang et al.Patients with heart and pulmonary failure who do not respond to standard treatment may benefit from extracorporeal membrane oxygenation(ECMO)support....This manuscript provides a commentary on the article by Zhang et al.Patients with heart and pulmonary failure who do not respond to standard treatment may benefit from extracorporeal membrane oxygenation(ECMO)support.Advanced heart failure and transplant cardiology(AHFTC)teams play an essential role in managing patients in cardiogenic shock.To determine whether ECMO patient management outcomes differ based on whether AHFTC physicians assume a direct or consultative role,a retrospective cohort study of 51 patients placed on veno-venous and veno-arterial(VA)ECMO between January 2015 and February 2023 was conducted.Results demonstrated a significantly higher 30-day postdischarge survival rate in the AHFTC direct involvement cohort compared to the consultative group(67%vs 30%)for all ECMO patients.This survival benefit was primarily attributable to VA ECMO patients(64%vs 20%).Direct involvement of AHFTC teams in patient selection and management may enhance survival in patients requiring VA ECMO for cardiogenic shock;however,further research is necessary to confirm these findings.展开更多
Objective To assess the clinical efficacy of acupuncture and moxibustion on depression based on the outcome indexes of the patient subjective reports. Methods One hundred and sixty-three cases of depression conformed ...Objective To assess the clinical efficacy of acupuncture and moxibustion on depression based on the outcome indexes of the patient subjective reports. Methods One hundred and sixty-three cases of depression conformed to the inclusive standards were randomized into a soothing liver and regulating mind group （group A）, an acupoint shallow puncturing group （group B） and a non- acupoint shallow puncturing group （group C）. In group A, the conventional acupuncture was applied to the four gate points [Hegu （合谷 LI 4） and Taichong （太冲 LR 3）], Baihui （百会 GV 20） and Yintang （印堂 GV 29）, direct moxibustion with moxa cone was applied to the four flower points [Geshu （膈俞 BL 17）, Danshu （胆俞 BL 19）]. Finally, intradermal needling was used at Xinshu （心俞 BL 15） and Ganshu （肝俞 BL 18）. In group 13, the acupoints selected were same as those in the soothing liver and regulating mind group, with a shallower needling depth and a shorter duration of moxibustion. In group C, the spots selected were located at 10 mm lateral to the acupoints selected in group A, with same manipulation method as that in group 13. In all the three groups, the treatment was given twice a week, for 12 weeks. Before treatment, 1 month and 3 months after treatment, the scores of symptoms were respectively assessed with the symptom checklist 90 （SCL 90）, and the corresponding short- term, mid-term and long-term efficacies of the acupuncture and moxibustion program for soothing the liver and regulating mind were investigated. Results At each time point after treatment, the scores of somatization, compulsion, depression, anxiety, hostility, extremeness, psychotic behavior and other 8 dimensionalit-ies were significantly different between group A and group C （all P〈0.05）. In the scores of depression, anxiety and hostility there were significant differences between the group A and the group C （all P〈0.05）. Conclusion Acupuncture and moxibustion can improve the scores of SCL 90 for the patients with depression, and the outcome indexes of the patient subjective reports can accurately assess the clinical efficacy.展开更多
This study investigates the evidence supporting the impact of the built environment on the health outcomes for patients within the hospital setting.Improving the hospital environment may potentially impact the lives o...This study investigates the evidence supporting the impact of the built environment on the health outcomes for patients within the hospital setting.Improving the hospital environment may potentially impact the lives of millions of patients,patients’family,and staff.Prior research has suggested that the built environment can contribute to positive health outcomes.Reporting the most recent evidence may assist designers in making informed decisions.In this study,a literature review was conducted using the PICO framework within scientific databases and additional hand-searched documents.A total number of 15 articles were included.Effects of each environmental factor on patients’health outcomes were discussed in detail.Environmental factors that affect patient outcomes are(1)form,(2)unit layout,(3)floor material,(4)room features,(5)medical equipment visibility,(6)nature,(7)lighting,and(8)music.Although several studies have provided a high level of evidence,other studies have lacked a robust research design.Thus,evidence regarding several environmental factors is not conclusive.Additional studies using experimental/quasi-experimental research design have been suggested.In some studies,several environmental factors were introduced simultaneously which obscured the separate effects of each environmental factor.展开更多
BACKGROUND Acute non-variceal bleeding accounts for approximately 20%of all-cause bleeding episodes in patients with liver cirrhosis.It is associated with high morbidity and mortality therefore prompt diagnosis and en...BACKGROUND Acute non-variceal bleeding accounts for approximately 20%of all-cause bleeding episodes in patients with liver cirrhosis.It is associated with high morbidity and mortality therefore prompt diagnosis and endoscopic management are crucial.AIM To evaluate available data on the efficacy of endoscopic treatment modalities used to control acute non-variceal gastrointestinal bleeding(GIB)in cirrhotic patients as well as to assess treatment outcomes.METHODS Employing PRISMA methodology,the MEDLINE was searched through PubMed using appropriate MeSH terms.Data are reported in a summative manner and separately for each major non-variceal cause of bleeding.RESULTS Overall,23 studies were identified with a total of 1288 cirrhotic patients of whom 958/1288 underwent endoscopic therapy for acute non-variceal GIB.Peptic ulcer bleeding was the most common cause of acute non-variceal bleeding,followed by portal hypertensive gastropathy,gastric antral vascular ectasia,Mallory-Weiss syndrome,Dieaulafoy lesions,portal hypertensive colopathy,and hemorrhoids.Failure to control bleeding from all-causes of non-variceal GIB accounted for less than 3.5%of cirrhotic patients.Rebleeding(range 2%-25%)and mortality(range 3%-40%)rates varied,presumably due to study heterogeneity.Rebleeding was usually managed endoscopically and salvage therapy using arterial embolisation or surgery was undertaken in very few cases.Mortality was usually associated with liver function deterioration and other organ failure or infections rather than uncontrolled bleeding.Endoscopic treatment-related complications were extremely rare.Lower acute non-variceal bleeding was examined in two studies(197/1288 patients)achieving initial hemostasis in all patients using argon plasma coagulation for portal hypertensive colopathy and endoscopic band ligation or sclerotherapy for bleeding hemorrhoids(rebleeding range 10%-13%).Data on the efficacy of endoscopic therapy of cirrhotic patients vs non-cirrhotic controls with acute GIB are very scarce.CONCLUSION Endotherapy seems to be efficient as a means to control non-variceal hemorrhage in cirrhosis,although published data are very limited,particularly those comparing cirrhotics with noncirrhotics and those regarding acute bleeding from the lower gastrointestinal tract.Rebleeding and mortality rates appear to be relatively high,although firm conclusions may not be drawn due to study heterogeneity.Hopefully this review may stimulate further research on this subject and help clinicians administer optimal endoscopic therapy for cirrhotic patients.展开更多
BACKGROUND Indications to refer patients with cirrhosis for liver transplant evaluation(LTE)include hepatic decompensation or a model for end stage liver disease(MELDNa)score≥15.Few studies have evaluated how delayin...BACKGROUND Indications to refer patients with cirrhosis for liver transplant evaluation(LTE)include hepatic decompensation or a model for end stage liver disease(MELDNa)score≥15.Few studies have evaluated how delaying referral beyond these criteria affects patient outcomes.AIM To evaluate clinical characteristics of patients undergoing inpatient LTE and to assess the effects of delayed LTE on patient outcomes(death,transplantation).METHODS This is a single center retrospective cohort study assessing all patients undergoing inpatient LTE(n=159)at a large quaternary care and liver transplant center between 10/23/2017-7/31/2021.Delayed referral was defined as having prior indication(decompensation,MELD-Na≥15)for LTE without referral.Early referral was defined as referrals made within 3 mo of having an indication based on practice guidelines.Logistic regression and Cox Hazard Regression were used to evaluate the relationship between delayed referral and patient outcomes.RESULTS Many patients who require expedited inpatient LTE had delayed referrals.Misconceptions regarding transplant candidacy were a leading cause of delayed referral.Ultimately,delayed referrals negatively affected overall patient outcome and an independent predictor of both death and not receiving a transplant.Delayed referral was associated with a 2.5 hazard risk of death.CONCLUSION Beyond initial access to an liver transplant(LT)center,delaying LTE increases risk of death and reduces risk of LT in patients with chronic liver disease.There is substantial opportunity to increase the percentage of patients undergoing LTE when first clinically indicated.It is crucial for providers to remain informed about the latest guidelines on liver transplant candidacy and the transplant referral process.展开更多
Background:Limited data are available for sirolimus-eluting stent(SES,Cypher)implantation in patients with coronary artery disease in small vessels.The clinical longtermoutcomes of SES in patients with coronary artery...Background:Limited data are available for sirolimus-eluting stent(SES,Cypher)implantation in patients with coronary artery disease in small vessels.The clinical longtermoutcomes of SES in patients with coronary artery disease after intracoronary stenting in small vessels has not been yet evaluated.展开更多
It is increasingly recognised that collecting patient reported outcome measures(PROMs)data is an important part of healthcare and should be considered alongside traditional clinical assessments.As part of a more holis...It is increasingly recognised that collecting patient reported outcome measures(PROMs)data is an important part of healthcare and should be considered alongside traditional clinical assessments.As part of a more holistic view of healthcare provision,there has been an increased drive to implement PROM collection as part of routine clinical care in hepatology.This drive has resulted in an increase in the number of PROMs currently developed to be used in various liver conditions.However,the development and validation of a new PROM is time-consuming and costly.Therefore,before deciding to develop a new PROM,researchers should consider identifying existing PROMs to assess their appropriateness and,if necessary,make adaptations to existing PROMs to ensure their rigour when used with the target population.Little is written in the literature on how to identify and adapt the existing PROMs in hepatology.This article aims to provide a summary of the current literature and guidance regarding identifying and adapting existing PROMs in clinical practice.展开更多
BACKGROUND Two-stage revision arthroplasty with an antibiotic-loaded spacer is the treatment of choice in chronically infected total hip arthroplasties.Interval spacers can be functional articulating or prefabricated....BACKGROUND Two-stage revision arthroplasty with an antibiotic-loaded spacer is the treatment of choice in chronically infected total hip arthroplasties.Interval spacers can be functional articulating or prefabricated.Functional results of these spacers have scarcely been reported.AIM To compare retrospectively the patient reported outcome and infection eradication rate after two-stage revision arthroplasty of the hip with the use of a functional articulating or prefabricated spacer.METHODS All patients with two-stage revision of a hip prosthesis at our hospital between 2003 and 2016 were included in this retrospective cohort study.Patients were divided into two groups;patients treated with a functional articulating spacer or with a prefabricated spacer.Patients completed the Hip Osteoarthritis Outcome Score and the EQ-5D-3L(EQ-5D)and the EQ-5D quality of life thermometer(EQVAS)scores.Primary outcomes were patient reported outcome and infection eradication after two-stage revision.The results of both groups were compared to the patient acceptable symptom state for primary arthroplasty of the hip.Secondary outcomes were complications during spacer treatment and at final follow-up.Descriptive statistics,mean and range are used to represent the demographics of the patients.For numerical variables,students’t-tests were used to assess the level of significance for differences between the groups,with 95%confidence intervals;for binary outcome,we used Fisher’s exact test.RESULTS We consecutively treated 55 patients with a prefabricated spacer and 15 patients with a functional articulating spacer of the hip.The infection eradication rates for functional articulating and prefabricated spacers were 93%and 78%,respectively(P>0.05).With respect to the functional outcome,the Hip Osteoarthritis Outcome Score(HOOS)and its subscores(all P<0.01),the EQ-5D(P<0.01)and the EQVAS scores(P<0.05)were all significantly better for patients successfully treated with a functional articulating spacer.More patients in the functional articulating spacer group reached the patient acceptable symptom state for the HOOS pain,HOOS quality of life and EQ-VAS.The number of patients with a spacer dislocation was not significantly different for the functional articulating or prefabricated spacer group(P>0.05).However,the number of dislocations per patient experiencing a dislocation was significantly higher for patients with a prefabricated spacer(P<0.01).CONCLUSION Functional articulating spacers lead to improved patient reported functional outcome and less perioperative complications after two-stage revision arthroplasty of an infected total hip prosthesis,while maintaining a similar infection eradication rate compared to prefabricated spacers.展开更多
OBJECTIVE Obstructive sleep apnea(OSA)is a potential cardiovascular risk.We aimed to investigate the association of OSA with heart rhythm disorders and prognosis in elderly patients with new-onset acute myocardial inf...OBJECTIVE Obstructive sleep apnea(OSA)is a potential cardiovascular risk.We aimed to investigate the association of OSA with heart rhythm disorders and prognosis in elderly patients with new-onset acute myocardial infarction(AMI).METHODS We prospectively enrolled 252 AMI elderly patients(mean age,68.5±6.9 years)who were undergoing revascularization and completed a sleep study during their hospitalization.All subjects were categorized into non-OSA(apnea–hypopnea index(AHI)<15,n=130)and OSA(AHI≥15,n=122)groups based on the AHI.The changes in the autonomic nervous system,incidence of arrhythmia during nocturnal sleep,and major adverse cardiovascular and cerebrovascular events(MACCEs)were compared between the groups.RESULTS The mean AHI value in all AMI patients was 22.8±10.9.OSA patients showed higher levels of body mass index and peak high-sensitivity C-reactive protein and lower levels of minimum nocturnal oxygen saturation(Min Sa O2),as well as greater proportion of multivessel coronary artery disease(all P<0.05).The OSA group also showed significant increases in heart rate variability and heart rate turbulence onset(both P<0.05)and higher incidence of arrhythmia(including sinus,atrial,and ventricular in origin).At a median follow-up of 6 months(mean 0.8–1.6 years),OSA(AHI≥15)combined with hypoxia(Min Sa O2≤80%)was independently associated with the incidence of MACCEs(hazard ratio[HR]:4.536;95%confidence interval[CI]:1.461-14.084,P=0.009)after adjusting for traditional risk factors.CONCLUSIONS OSA and OSA-induced hypoxia may correlate with the severity of myocardial infarction,increase the occurrence of heart rhythm disorders in elderly subacute MI patients,and worsen their short-term poor outcomes.展开更多
BACKGROUND The variability of metabolic biomarkers has been determined to provide incremental prognosis information,but the implications of electrolyte variability remained unclear.METHODS We investigate the relations...BACKGROUND The variability of metabolic biomarkers has been determined to provide incremental prognosis information,but the implications of electrolyte variability remained unclear.METHODS We investigate the relationships between electrolyte fluctuation and outcomes in survivors of acute myocardial infarction(n=4386).Ion variability was calculated as the coefficient of variation,standard deviation,variability independent of the mean(VIM)and range.Hazard ratios(HR)were estimated using the multivariable-adjusted Cox proportional regression method.RESULTS During a median follow-up of 12 months,161(3.7%)patients died,and heart failure occurred in 550(12.5%)participants after discharge,respectively.Compared with the bottom quartile,the highest quartile potassium VIM was associated with increased risks of all-cause mortality(HR=2.35,95%CI:1.36–4.06)and heart failure(HR=1.32,95%CI:1.01–1.72)independent of cardiac troponin I(c Tn I),N terminal pro B type natriuretic peptide(NT-pro BNP),infarction site,mean potassium and other traditional factors,while those associations across sodium VIM quartiles were insignificant.Similar trend remains across the strata of variability by other three indices.These associations were consistent after excluding patients with any extreme electrolyte value and diuretic use.CONCLUSIONS Higher potassium variability but not sodium variability was associated with adverse outcomes post-infarction.Our findings highlight that potassium variability remains a robust risk factor for mortality regardless of clinical dysnatraemia and dyskalaemia.展开更多
OBJECTIVE In patients undergoing cardiac surgery,reduced preoperative ejection fraction(EF)and senior age are associated with a worse outcome.As most outcome data available for these patients are mainly from Western s...OBJECTIVE In patients undergoing cardiac surgery,reduced preoperative ejection fraction(EF)and senior age are associated with a worse outcome.As most outcome data available for these patients are mainly from Western surgical populations involving specific surgery types,our aim is to evaluate the real-world characteristics and perioperative outcomes of surgery in senior-aged heart failure patients with reduced EF across a broad range cardiac surgeries.METHODS Data were obtained from the China Heart Failure Surgery Registry(China-HFSR)database,a nationwide multicenter registry study in China's Mainland.Multiple variable regression analysis was performed in patients over 75 years old to identify risk factors associated with mortality.RESULTS From 2012 to 2017,578 senior-aged(>75 years)patients were enrolled in China HFSR,21.1%of whom were female.Isolated coronary bypass grafting(CABG)were performed in 71.6%of patients,10.1%of patients underwent isolated valve surgery and 8.7%received CABG combined with valve surgery.In-hospital mortality was 10.6%,and the major complication rate was 17.3%.Multivariate analysis identified diabetes mellitus(odds ratio(OR)=1.985),increased creatinine(OR=1.007),New York Heart Association(NYHA)Class III(OR=1.408),NYHA class IV(OR=1.955),cardiogenic shock(OR,6.271),and preoperative intra-aortic balloon pump insertion(OR=3.426)as independent predictors of in-hospital mortality.CONCLUSIONS In senior-aged patients,preoperative evaluation should be carefully performed,and strict management of reversible factors needs more attention.Senior-aged patients commonly have a more severe disease status combined with more frequent comorbidities,which may lead to a high risk in mortality.展开更多
BACKGROUND Numerous anterior cruciate ligament(ACL) clinical outcome measures exist.However,the result of one score does not equate to the findings of another even when evaluating the same patient group.AIM To investi...BACKGROUND Numerous anterior cruciate ligament(ACL) clinical outcome measures exist.However,the result of one score does not equate to the findings of another even when evaluating the same patient group.AIM To investigate if statistically derived formulae can be used to predict the outcome of one knee scoring system when the result of another is known in patients with ACL rupture before and after reconstruction.METHODS Fifty patients with ACL rupture were evaluated using nine clinical outcome measures.These included Tegner Activity Score,Lysholm Knee Score,Cincinnati Knee Score,International Knee Documentation Committee(IKDC) Objective Knee Score,Tapper and Hoover Meniscal Grading Score,IKDC Subjective Knee Score,Knee Outcome Survey-Activities of Daily Living Scale(KOS-ADLS),Short Form-12 Item Health Survey and Knee Injury and Osteoarthritis Outcome Score.Thirtyfour patients underwent an ACL reconstruction and were reassessed post-operatively.RESULTS The mean total of each of the nine outcome scores appreciably differed from each other.Significant correlations and regressions were found between most of the outcome scores and were stronger post-operatively.The strongest correlation was found between Cincinnati and KOS-ADLS (r=0.91,P<0.001).The strongest regression formula was also found between Cincinnati and KOS-ADLS (R~2=0.84,P<0.001).CONCLUSION The formulae produced from this study can be used to predict the outcome of one knee score when the results of the other are known.These formulae could facilitate the conduct of systematic reviews and meta-analysis in studies relating to ACL injuries by allowing the pooling of substantially more data.展开更多
BACKGROUND Inflammatory bowel disease(IBD)patients’expectations of treatment outcomes may differ by ethnicity.AIM To investigate treatment preferences of Jewish and Arabs patients.METHODS This prospective survey rank...BACKGROUND Inflammatory bowel disease(IBD)patients’expectations of treatment outcomes may differ by ethnicity.AIM To investigate treatment preferences of Jewish and Arabs patients.METHODS This prospective survey ranked outcomes treatment preferences among Arab IBD patients,based on the 10 IBD-disk items compared to historical data of Jews.An anonymous questionnaire in either Arabic or Hebrew was distributed among IBD patients.Patients were required to rank 10 statements describing different aspects of IBD according to their importance to the patients as treatment goals.Answers were compared to the answers of a historical group of Jewish patients.RESULTS IBD-disk items of 121 Arabs were compared to 240 Jewish patients.The Jewish patients included more females,[151(62.9%)vs 52(43.3%);P<0.001],higher education level(P=0.02),more urban residence[188(78.3%)vs 54(45.4%);P<0.001],less unemployment[52(21.7%)vs 41(33.9%);P=0.012],higher income level(P<0.001),and more in a partnership[162(67.8%)vs 55(45.4%);P<0.001].Expectations regarding disease symptoms:abdominal pain,energy,and regular defecation ranked highest for both groups.Arabs gave significantly lower rankings(range 4.29-6.69)than Jewish patients(range 6.25-9.03)regarding all items,except for body image.Compared to Arab women,Jewish women attached higher priority to abdominal pain,energy,education/work,sleep,and joint pain.Multivariable regression analysis revealed that higher patient preferences were associated with Jewish ethnicity(OR 4.77;95%CI 2.36-9.61,P<0.001)and disease activity.The more active the disease,the greater the odds ratio for higher ranking of the questionnaire items(1-2 attacks per year:OR 2.13;95%CI 1.02-4.45,P=0.043;and primarily active disease:OR 5.29;95%CI 2.30-12.18,P<0.001).Factors inversely associated with higher patient preference were male gender(OR 0.5;95%CI 0.271-0.935,P=0.030),UC(OR 0.444;95%CI 0.241-0.819,P=0.009),and above average income level(OR 0.267;95%CI:0.124-0.577,P=0.001).CONCLUSION The highest priority for treatment outcomes was symptom relief.,Patients preferences were impacted by ethnicity,gender,and socio-economic disparity.Understanding patients'priorities may improve communication and enable a personalized approach.展开更多
Patient-reported outcomes measures form the backbone of outcomes evaluation in orthopaedics,with most of the literature now relying on these scoring tools to measure change in patient health status.This patient-report...Patient-reported outcomes measures form the backbone of outcomes evaluation in orthopaedics,with most of the literature now relying on these scoring tools to measure change in patient health status.This patient-reported information is increasingly collected routinely by orthopaedic providers but use of the data is typically restricted to academic research.Developments in electronic data capture and the outcome tools themselves now allow use of this data as part of the clinical consultation.This review evaluates the role of patient reported outcomes data as a tool to enhance daily orthopaedic clinical practice,and documents how developments in electronic outcome measures,computer-adaptive questionnaire design and instant graphical display of questionnaire can facilitate enhanced patientclinician shared decision making.展开更多
Conventional dentistry or periodontal research often ignores the human component in favor of clinical outcomes and biological causes.Clinical research is driven by the statistical significance of outcome parameters ra...Conventional dentistry or periodontal research often ignores the human component in favor of clinical outcomes and biological causes.Clinical research is driven by the statistical significance of outcome parameters rather than the satisfaction level of the patient.In this context,patient-centric periodontal research(PCPR)is an approach that considers the patient´s feedback concerning their functional status,experience,clinical outcomes,and accessibility to their treatments.It is argued that data self-reported by the patient might have low reliability owing to the confounding effect of their personal belief,cultural background,and social and economic factors.However,literature has shown that the incorporation of“patient-centric outcome”components considerably enhances the validity and applicability of research findings.Variations in the results of different studies might be due to the use of different and non-standardized assessment tools.To overcome this problem,this editorial enlists various reliable tools available in the literature.In conclusion,we advocate that the focus of researchers should shift from mere periodontal research to PCPR so that the results can be effectively applied in clinical settings and the therapeutic strategy can also change from mere periodontal therapy to patient-centric periodontal therapy.展开更多
基金Supported by Startup Fund forYouth Faculty of ShenzhenUniversity, No. 2018009.
文摘BACKGROUND Understanding a virus shedding patterns in body fluids/secretions is importantto determine the samples to be used for diagnosis and to formulate infectioncontrol measures.AIM To investigate the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)shedding patterns and its risk factors.METHODS All laboratory-confirmed coronavirus disease 2019 patients with completemedical records admitted to the Shenzhen Third People’s Hospital from January28, 2020 to March 8, 2020 were included. Among 145 patients (54.5% males;median age, 46.1 years), three (2.1%) died. The bronco-alveolar lavage fluid(BALF) had the highest virus load compared with the other samples. The viralload peaked at admission (3.3 × 108 copies) and sharply decreased 10 d afteradmission.RESULTS The viral load was associated with prolonged intensive care unit (ICU) duration.Patients in the ICU had significantly longer shedding time compared to those inthe wards (P < 0.0001). Age > 60 years [hazard ratio (HR) = 0.6;95% confidenceinterval (CI): 0.4-0.9] was an independent risk factor for SARS-CoV-2 shedding,while chloroquine (HR = 22.8;95%CI: 2.3-224.6) was a protective factor.CONCLUSION BALF had the highest SARS-CoV-2 load. Elderly patients had higher virus loads,which was associated with a prolonged ICU stay. Chloroquine was associatedwith shorter shedding duration and increased the chance of viral negativity.
文摘Purpose:This paper reports an analysis of the concept of patient outcomes.Methods:The Walker and Avant concept analysis approach was applied.Results:The attributes of patient outcomes include(1)patient functional status(maintained or improved),(2)patient safety(protected or unharmed),and(3)patient satisfaction(patient reporting of comfort and contentment).These attributes are influenced by the antecedents of individual patient characteristics and health problems,the structure of healthcare organizations and received health interventions.Additionally,patient outcomes do significantly impact the quality of nursing care,the cost of effective care and healthcare policy making formulation.Conclusion:Providing good nursing care to all patients is a central goal of nursing.Patient outcomes in nursing are primarily about the results for the patient receiving nursing care.This analysis provides nurses with a new perspective by helping them to understand all the components within the concept of patient outcomes.
文摘The primary goal of the study was to develop a PRP （patient reminder program）. The PRP is an innovation developed by using the integration of two technologies--web-based database and SMS （short message service）. Reminder massages were delivered to users through a mobile phone. The program development composed of three phases. In initial phase, the PRP was designed and developed. In second phase, the PRP was tested for its efficacy by sending trial massages to users for seven consecutive days. PRP then was modified and copyright. In last phase, PRP was fully implemented. Data were collected from 30 elderly who came for their visit at one hospital located in Nakhon Ratchasima province. Participants＇ preferences reminder messages--medications to be taken and appointments--were delivered to elderly for four weeks. Measured outcomes included （1） number of forgetfulness, （2） number of missed appointments, and （3） participants＇ overall satisfaction. Data were analyzed using descriptive statistics. The findings showed that participants reported decreasing in number of forgetfulness after using a reminder service （mean = 0.62 times/week）. No missed appointment was reported, In addition, they were very satisfied with PRP （mean = 4.35, S.D. = 0.67）. In conclusion, PRP is an effective program to use in improving patient outcome. Health care providers can expand the use of PRP to improve the quality of care, hence improve patient outcome.
文摘Digital technology has fundamentally transformed healthcare delivery, exerting profound influence on patient outcomes. This paper delves into the roles played by telemedicine, electronic health records (EHRs), and mobile health applications in augmenting healthcare services. The objective is to scrutinize the ways in which these digital innovations enhance healthcare delivery and patient outcomes, while also identifying the attendant challenges in their adoption. To achieve this, a rigorous literature review encompassing peer-reviewed articles, reports, and case studies that examine the impact of digital technology in healthcare settings was conducted. The findings underscore that digital technology significantly bolsters patient care by enhancing access, operational efficiency, and diagnostic accuracy. Nonetheless, persistent challenges such as safeguarding data privacy, ensuring interoperability across systems, and managing implementation costs continue to pose significant hurdles.
文摘Introduction:With the aging population,more females will suffer from pelvic organ prolapse.Both urologists and gynecologists perform sacrocolpopexy,but there is no comparative study analyzing differences in provision of care,outcomes,or patient population.We aimed to elucidate potential differences in demographics,outcomes,and minimally invasive surgery utilization for SCP performed by urology and gynecology.Methods:In our retrospective analysis,sacrocolpopexies were identified using the American College of Surgeons National Surgical Quality Improvement Project database from 2006–2020.Pearson’s chi-square test was performed to test trends in the utilization of MIS in five-year blocks.Frailty was calculated using the NSQIP modified frailty index and the revised surgical Risk Analysis Index.Univariate analysis was performed using Student’s t-test and Pearson’s chi-square to compare operative parameters,frailty,demographics,and outcomes.Results:We identified 8944 sacrocolpopexies.Gynecology performed 81%of cases while urology performed the remaining 19%(p<0.001).Between the specialties,there were no significant differences in outcomes,minor or major complications,or 30-day reoperations/hospital readmissions/mortality.However,urologists tended to care for patients who were older(65 vs.61 years,p<0.001)and frailer by both frailty indices(p<0.001).Conclusion:Case distributions have remained stable,with gynecologists four-fold more sacrocolpopexies,in keeping with the larger number of practicing gynecologists vs.urologists.There was no difference in 30-day outcomes between both specialties.However,urologists operated on older,more frail patients.
文摘This manuscript provides a commentary on the article by Zhang et al.Patients with heart and pulmonary failure who do not respond to standard treatment may benefit from extracorporeal membrane oxygenation(ECMO)support.Advanced heart failure and transplant cardiology(AHFTC)teams play an essential role in managing patients in cardiogenic shock.To determine whether ECMO patient management outcomes differ based on whether AHFTC physicians assume a direct or consultative role,a retrospective cohort study of 51 patients placed on veno-venous and veno-arterial(VA)ECMO between January 2015 and February 2023 was conducted.Results demonstrated a significantly higher 30-day postdischarge survival rate in the AHFTC direct involvement cohort compared to the consultative group(67%vs 30%)for all ECMO patients.This survival benefit was primarily attributable to VA ECMO patients(64%vs 20%).Direct involvement of AHFTC teams in patient selection and management may enhance survival in patients requiring VA ECMO for cardiogenic shock;however,further research is necessary to confirm these findings.
基金Supported by National natural science fund (No: 81173348)Class general financial grant of the China postdoctoral science foundation (No: 2012M511784)+2 种基金Science foundation of the outstanding young innova ve personnel of department of education Guangdong Province (No.2012LYM_0043)Special research foundation of the new teacher category for the doctoral program of higher school by National ministry of education (No.20124425120005)Science founda on of the postdoctoral researchers in Guangzhou University of Chinese Medicine from Guangdong Provincial Department of human resources and social security fund(No.BBK429122K19)
文摘Objective To assess the clinical efficacy of acupuncture and moxibustion on depression based on the outcome indexes of the patient subjective reports. Methods One hundred and sixty-three cases of depression conformed to the inclusive standards were randomized into a soothing liver and regulating mind group （group A）, an acupoint shallow puncturing group （group B） and a non- acupoint shallow puncturing group （group C）. In group A, the conventional acupuncture was applied to the four gate points [Hegu （合谷 LI 4） and Taichong （太冲 LR 3）], Baihui （百会 GV 20） and Yintang （印堂 GV 29）, direct moxibustion with moxa cone was applied to the four flower points [Geshu （膈俞 BL 17）, Danshu （胆俞 BL 19）]. Finally, intradermal needling was used at Xinshu （心俞 BL 15） and Ganshu （肝俞 BL 18）. In group 13, the acupoints selected were same as those in the soothing liver and regulating mind group, with a shallower needling depth and a shorter duration of moxibustion. In group C, the spots selected were located at 10 mm lateral to the acupoints selected in group A, with same manipulation method as that in group 13. In all the three groups, the treatment was given twice a week, for 12 weeks. Before treatment, 1 month and 3 months after treatment, the scores of symptoms were respectively assessed with the symptom checklist 90 （SCL 90）, and the corresponding short- term, mid-term and long-term efficacies of the acupuncture and moxibustion program for soothing the liver and regulating mind were investigated. Results At each time point after treatment, the scores of somatization, compulsion, depression, anxiety, hostility, extremeness, psychotic behavior and other 8 dimensionalit-ies were significantly different between group A and group C （all P〈0.05）. In the scores of depression, anxiety and hostility there were significant differences between the group A and the group C （all P〈0.05）. Conclusion Acupuncture and moxibustion can improve the scores of SCL 90 for the patients with depression, and the outcome indexes of the patient subjective reports can accurately assess the clinical efficacy.
文摘This study investigates the evidence supporting the impact of the built environment on the health outcomes for patients within the hospital setting.Improving the hospital environment may potentially impact the lives of millions of patients,patients’family,and staff.Prior research has suggested that the built environment can contribute to positive health outcomes.Reporting the most recent evidence may assist designers in making informed decisions.In this study,a literature review was conducted using the PICO framework within scientific databases and additional hand-searched documents.A total number of 15 articles were included.Effects of each environmental factor on patients’health outcomes were discussed in detail.Environmental factors that affect patient outcomes are(1)form,(2)unit layout,(3)floor material,(4)room features,(5)medical equipment visibility,(6)nature,(7)lighting,and(8)music.Although several studies have provided a high level of evidence,other studies have lacked a robust research design.Thus,evidence regarding several environmental factors is not conclusive.Additional studies using experimental/quasi-experimental research design have been suggested.In some studies,several environmental factors were introduced simultaneously which obscured the separate effects of each environmental factor.
文摘BACKGROUND Acute non-variceal bleeding accounts for approximately 20%of all-cause bleeding episodes in patients with liver cirrhosis.It is associated with high morbidity and mortality therefore prompt diagnosis and endoscopic management are crucial.AIM To evaluate available data on the efficacy of endoscopic treatment modalities used to control acute non-variceal gastrointestinal bleeding(GIB)in cirrhotic patients as well as to assess treatment outcomes.METHODS Employing PRISMA methodology,the MEDLINE was searched through PubMed using appropriate MeSH terms.Data are reported in a summative manner and separately for each major non-variceal cause of bleeding.RESULTS Overall,23 studies were identified with a total of 1288 cirrhotic patients of whom 958/1288 underwent endoscopic therapy for acute non-variceal GIB.Peptic ulcer bleeding was the most common cause of acute non-variceal bleeding,followed by portal hypertensive gastropathy,gastric antral vascular ectasia,Mallory-Weiss syndrome,Dieaulafoy lesions,portal hypertensive colopathy,and hemorrhoids.Failure to control bleeding from all-causes of non-variceal GIB accounted for less than 3.5%of cirrhotic patients.Rebleeding(range 2%-25%)and mortality(range 3%-40%)rates varied,presumably due to study heterogeneity.Rebleeding was usually managed endoscopically and salvage therapy using arterial embolisation or surgery was undertaken in very few cases.Mortality was usually associated with liver function deterioration and other organ failure or infections rather than uncontrolled bleeding.Endoscopic treatment-related complications were extremely rare.Lower acute non-variceal bleeding was examined in two studies(197/1288 patients)achieving initial hemostasis in all patients using argon plasma coagulation for portal hypertensive colopathy and endoscopic band ligation or sclerotherapy for bleeding hemorrhoids(rebleeding range 10%-13%).Data on the efficacy of endoscopic therapy of cirrhotic patients vs non-cirrhotic controls with acute GIB are very scarce.CONCLUSION Endotherapy seems to be efficient as a means to control non-variceal hemorrhage in cirrhosis,although published data are very limited,particularly those comparing cirrhotics with noncirrhotics and those regarding acute bleeding from the lower gastrointestinal tract.Rebleeding and mortality rates appear to be relatively high,although firm conclusions may not be drawn due to study heterogeneity.Hopefully this review may stimulate further research on this subject and help clinicians administer optimal endoscopic therapy for cirrhotic patients.
文摘BACKGROUND Indications to refer patients with cirrhosis for liver transplant evaluation(LTE)include hepatic decompensation or a model for end stage liver disease(MELDNa)score≥15.Few studies have evaluated how delaying referral beyond these criteria affects patient outcomes.AIM To evaluate clinical characteristics of patients undergoing inpatient LTE and to assess the effects of delayed LTE on patient outcomes(death,transplantation).METHODS This is a single center retrospective cohort study assessing all patients undergoing inpatient LTE(n=159)at a large quaternary care and liver transplant center between 10/23/2017-7/31/2021.Delayed referral was defined as having prior indication(decompensation,MELD-Na≥15)for LTE without referral.Early referral was defined as referrals made within 3 mo of having an indication based on practice guidelines.Logistic regression and Cox Hazard Regression were used to evaluate the relationship between delayed referral and patient outcomes.RESULTS Many patients who require expedited inpatient LTE had delayed referrals.Misconceptions regarding transplant candidacy were a leading cause of delayed referral.Ultimately,delayed referrals negatively affected overall patient outcome and an independent predictor of both death and not receiving a transplant.Delayed referral was associated with a 2.5 hazard risk of death.CONCLUSION Beyond initial access to an liver transplant(LT)center,delaying LTE increases risk of death and reduces risk of LT in patients with chronic liver disease.There is substantial opportunity to increase the percentage of patients undergoing LTE when first clinically indicated.It is crucial for providers to remain informed about the latest guidelines on liver transplant candidacy and the transplant referral process.
文摘Background:Limited data are available for sirolimus-eluting stent(SES,Cypher)implantation in patients with coronary artery disease in small vessels.The clinical longtermoutcomes of SES in patients with coronary artery disease after intracoronary stenting in small vessels has not been yet evaluated.
文摘It is increasingly recognised that collecting patient reported outcome measures(PROMs)data is an important part of healthcare and should be considered alongside traditional clinical assessments.As part of a more holistic view of healthcare provision,there has been an increased drive to implement PROM collection as part of routine clinical care in hepatology.This drive has resulted in an increase in the number of PROMs currently developed to be used in various liver conditions.However,the development and validation of a new PROM is time-consuming and costly.Therefore,before deciding to develop a new PROM,researchers should consider identifying existing PROMs to assess their appropriateness and,if necessary,make adaptations to existing PROMs to ensure their rigour when used with the target population.Little is written in the literature on how to identify and adapt the existing PROMs in hepatology.This article aims to provide a summary of the current literature and guidance regarding identifying and adapting existing PROMs in clinical practice.
文摘BACKGROUND Two-stage revision arthroplasty with an antibiotic-loaded spacer is the treatment of choice in chronically infected total hip arthroplasties.Interval spacers can be functional articulating or prefabricated.Functional results of these spacers have scarcely been reported.AIM To compare retrospectively the patient reported outcome and infection eradication rate after two-stage revision arthroplasty of the hip with the use of a functional articulating or prefabricated spacer.METHODS All patients with two-stage revision of a hip prosthesis at our hospital between 2003 and 2016 were included in this retrospective cohort study.Patients were divided into two groups;patients treated with a functional articulating spacer or with a prefabricated spacer.Patients completed the Hip Osteoarthritis Outcome Score and the EQ-5D-3L(EQ-5D)and the EQ-5D quality of life thermometer(EQVAS)scores.Primary outcomes were patient reported outcome and infection eradication after two-stage revision.The results of both groups were compared to the patient acceptable symptom state for primary arthroplasty of the hip.Secondary outcomes were complications during spacer treatment and at final follow-up.Descriptive statistics,mean and range are used to represent the demographics of the patients.For numerical variables,students’t-tests were used to assess the level of significance for differences between the groups,with 95%confidence intervals;for binary outcome,we used Fisher’s exact test.RESULTS We consecutively treated 55 patients with a prefabricated spacer and 15 patients with a functional articulating spacer of the hip.The infection eradication rates for functional articulating and prefabricated spacers were 93%and 78%,respectively(P>0.05).With respect to the functional outcome,the Hip Osteoarthritis Outcome Score(HOOS)and its subscores(all P<0.01),the EQ-5D(P<0.01)and the EQVAS scores(P<0.05)were all significantly better for patients successfully treated with a functional articulating spacer.More patients in the functional articulating spacer group reached the patient acceptable symptom state for the HOOS pain,HOOS quality of life and EQ-VAS.The number of patients with a spacer dislocation was not significantly different for the functional articulating or prefabricated spacer group(P>0.05).However,the number of dislocations per patient experiencing a dislocation was significantly higher for patients with a prefabricated spacer(P<0.01).CONCLUSION Functional articulating spacers lead to improved patient reported functional outcome and less perioperative complications after two-stage revision arthroplasty of an infected total hip prosthesis,while maintaining a similar infection eradication rate compared to prefabricated spacers.
基金supported by National Natural Science Youth Fund of China(81100098)Shanghai Municipal Commission of Health and Family Planning for Key Discipline Establishment(2015ZB0503&201840083)Production,Teaching and Research Program for University Teachers in Shanghai(RC20190079)。
文摘OBJECTIVE Obstructive sleep apnea(OSA)is a potential cardiovascular risk.We aimed to investigate the association of OSA with heart rhythm disorders and prognosis in elderly patients with new-onset acute myocardial infarction(AMI).METHODS We prospectively enrolled 252 AMI elderly patients(mean age,68.5±6.9 years)who were undergoing revascularization and completed a sleep study during their hospitalization.All subjects were categorized into non-OSA(apnea–hypopnea index(AHI)<15,n=130)and OSA(AHI≥15,n=122)groups based on the AHI.The changes in the autonomic nervous system,incidence of arrhythmia during nocturnal sleep,and major adverse cardiovascular and cerebrovascular events(MACCEs)were compared between the groups.RESULTS The mean AHI value in all AMI patients was 22.8±10.9.OSA patients showed higher levels of body mass index and peak high-sensitivity C-reactive protein and lower levels of minimum nocturnal oxygen saturation(Min Sa O2),as well as greater proportion of multivessel coronary artery disease(all P<0.05).The OSA group also showed significant increases in heart rate variability and heart rate turbulence onset(both P<0.05)and higher incidence of arrhythmia(including sinus,atrial,and ventricular in origin).At a median follow-up of 6 months(mean 0.8–1.6 years),OSA(AHI≥15)combined with hypoxia(Min Sa O2≤80%)was independently associated with the incidence of MACCEs(hazard ratio[HR]:4.536;95%confidence interval[CI]:1.461-14.084,P=0.009)after adjusting for traditional risk factors.CONCLUSIONS OSA and OSA-induced hypoxia may correlate with the severity of myocardial infarction,increase the occurrence of heart rhythm disorders in elderly subacute MI patients,and worsen their short-term poor outcomes.
基金supported by the National Key R&D Program of China(No.2016YFC1301100)National Natural Science Foundation of China(No.81827806,81870353,31771241)Key Laboratory of Myocardial Ischemia,Ministry of Education(No.KF201903)。
文摘BACKGROUND The variability of metabolic biomarkers has been determined to provide incremental prognosis information,but the implications of electrolyte variability remained unclear.METHODS We investigate the relationships between electrolyte fluctuation and outcomes in survivors of acute myocardial infarction(n=4386).Ion variability was calculated as the coefficient of variation,standard deviation,variability independent of the mean(VIM)and range.Hazard ratios(HR)were estimated using the multivariable-adjusted Cox proportional regression method.RESULTS During a median follow-up of 12 months,161(3.7%)patients died,and heart failure occurred in 550(12.5%)participants after discharge,respectively.Compared with the bottom quartile,the highest quartile potassium VIM was associated with increased risks of all-cause mortality(HR=2.35,95%CI:1.36–4.06)and heart failure(HR=1.32,95%CI:1.01–1.72)independent of cardiac troponin I(c Tn I),N terminal pro B type natriuretic peptide(NT-pro BNP),infarction site,mean potassium and other traditional factors,while those associations across sodium VIM quartiles were insignificant.Similar trend remains across the strata of variability by other three indices.These associations were consistent after excluding patients with any extreme electrolyte value and diuretic use.CONCLUSIONS Higher potassium variability but not sodium variability was associated with adverse outcomes post-infarction.Our findings highlight that potassium variability remains a robust risk factor for mortality regardless of clinical dysnatraemia and dyskalaemia.
文摘OBJECTIVE In patients undergoing cardiac surgery,reduced preoperative ejection fraction(EF)and senior age are associated with a worse outcome.As most outcome data available for these patients are mainly from Western surgical populations involving specific surgery types,our aim is to evaluate the real-world characteristics and perioperative outcomes of surgery in senior-aged heart failure patients with reduced EF across a broad range cardiac surgeries.METHODS Data were obtained from the China Heart Failure Surgery Registry(China-HFSR)database,a nationwide multicenter registry study in China's Mainland.Multiple variable regression analysis was performed in patients over 75 years old to identify risk factors associated with mortality.RESULTS From 2012 to 2017,578 senior-aged(>75 years)patients were enrolled in China HFSR,21.1%of whom were female.Isolated coronary bypass grafting(CABG)were performed in 71.6%of patients,10.1%of patients underwent isolated valve surgery and 8.7%received CABG combined with valve surgery.In-hospital mortality was 10.6%,and the major complication rate was 17.3%.Multivariate analysis identified diabetes mellitus(odds ratio(OR)=1.985),increased creatinine(OR=1.007),New York Heart Association(NYHA)Class III(OR=1.408),NYHA class IV(OR=1.955),cardiogenic shock(OR,6.271),and preoperative intra-aortic balloon pump insertion(OR=3.426)as independent predictors of in-hospital mortality.CONCLUSIONS In senior-aged patients,preoperative evaluation should be carefully performed,and strict management of reversible factors needs more attention.Senior-aged patients commonly have a more severe disease status combined with more frequent comorbidities,which may lead to a high risk in mortality.
文摘BACKGROUND Numerous anterior cruciate ligament(ACL) clinical outcome measures exist.However,the result of one score does not equate to the findings of another even when evaluating the same patient group.AIM To investigate if statistically derived formulae can be used to predict the outcome of one knee scoring system when the result of another is known in patients with ACL rupture before and after reconstruction.METHODS Fifty patients with ACL rupture were evaluated using nine clinical outcome measures.These included Tegner Activity Score,Lysholm Knee Score,Cincinnati Knee Score,International Knee Documentation Committee(IKDC) Objective Knee Score,Tapper and Hoover Meniscal Grading Score,IKDC Subjective Knee Score,Knee Outcome Survey-Activities of Daily Living Scale(KOS-ADLS),Short Form-12 Item Health Survey and Knee Injury and Osteoarthritis Outcome Score.Thirtyfour patients underwent an ACL reconstruction and were reassessed post-operatively.RESULTS The mean total of each of the nine outcome scores appreciably differed from each other.Significant correlations and regressions were found between most of the outcome scores and were stronger post-operatively.The strongest correlation was found between Cincinnati and KOS-ADLS (r=0.91,P<0.001).The strongest regression formula was also found between Cincinnati and KOS-ADLS (R~2=0.84,P<0.001).CONCLUSION The formulae produced from this study can be used to predict the outcome of one knee score when the results of the other are known.These formulae could facilitate the conduct of systematic reviews and meta-analysis in studies relating to ACL injuries by allowing the pooling of substantially more data.
文摘BACKGROUND Inflammatory bowel disease(IBD)patients’expectations of treatment outcomes may differ by ethnicity.AIM To investigate treatment preferences of Jewish and Arabs patients.METHODS This prospective survey ranked outcomes treatment preferences among Arab IBD patients,based on the 10 IBD-disk items compared to historical data of Jews.An anonymous questionnaire in either Arabic or Hebrew was distributed among IBD patients.Patients were required to rank 10 statements describing different aspects of IBD according to their importance to the patients as treatment goals.Answers were compared to the answers of a historical group of Jewish patients.RESULTS IBD-disk items of 121 Arabs were compared to 240 Jewish patients.The Jewish patients included more females,[151(62.9%)vs 52(43.3%);P<0.001],higher education level(P=0.02),more urban residence[188(78.3%)vs 54(45.4%);P<0.001],less unemployment[52(21.7%)vs 41(33.9%);P=0.012],higher income level(P<0.001),and more in a partnership[162(67.8%)vs 55(45.4%);P<0.001].Expectations regarding disease symptoms:abdominal pain,energy,and regular defecation ranked highest for both groups.Arabs gave significantly lower rankings(range 4.29-6.69)than Jewish patients(range 6.25-9.03)regarding all items,except for body image.Compared to Arab women,Jewish women attached higher priority to abdominal pain,energy,education/work,sleep,and joint pain.Multivariable regression analysis revealed that higher patient preferences were associated with Jewish ethnicity(OR 4.77;95%CI 2.36-9.61,P<0.001)and disease activity.The more active the disease,the greater the odds ratio for higher ranking of the questionnaire items(1-2 attacks per year:OR 2.13;95%CI 1.02-4.45,P=0.043;and primarily active disease:OR 5.29;95%CI 2.30-12.18,P<0.001).Factors inversely associated with higher patient preference were male gender(OR 0.5;95%CI 0.271-0.935,P=0.030),UC(OR 0.444;95%CI 0.241-0.819,P=0.009),and above average income level(OR 0.267;95%CI:0.124-0.577,P=0.001).CONCLUSION The highest priority for treatment outcomes was symptom relief.,Patients preferences were impacted by ethnicity,gender,and socio-economic disparity.Understanding patients'priorities may improve communication and enable a personalized approach.
文摘Patient-reported outcomes measures form the backbone of outcomes evaluation in orthopaedics,with most of the literature now relying on these scoring tools to measure change in patient health status.This patient-reported information is increasingly collected routinely by orthopaedic providers but use of the data is typically restricted to academic research.Developments in electronic data capture and the outcome tools themselves now allow use of this data as part of the clinical consultation.This review evaluates the role of patient reported outcomes data as a tool to enhance daily orthopaedic clinical practice,and documents how developments in electronic outcome measures,computer-adaptive questionnaire design and instant graphical display of questionnaire can facilitate enhanced patientclinician shared decision making.
文摘Conventional dentistry or periodontal research often ignores the human component in favor of clinical outcomes and biological causes.Clinical research is driven by the statistical significance of outcome parameters rather than the satisfaction level of the patient.In this context,patient-centric periodontal research(PCPR)is an approach that considers the patient´s feedback concerning their functional status,experience,clinical outcomes,and accessibility to their treatments.It is argued that data self-reported by the patient might have low reliability owing to the confounding effect of their personal belief,cultural background,and social and economic factors.However,literature has shown that the incorporation of“patient-centric outcome”components considerably enhances the validity and applicability of research findings.Variations in the results of different studies might be due to the use of different and non-standardized assessment tools.To overcome this problem,this editorial enlists various reliable tools available in the literature.In conclusion,we advocate that the focus of researchers should shift from mere periodontal research to PCPR so that the results can be effectively applied in clinical settings and the therapeutic strategy can also change from mere periodontal therapy to patient-centric periodontal therapy.
