Utilidad y seguridad de los ingresos directos a una unidad hospitalaria de agudos de un servicio de geriatría valorados por atención geriátrica en residencias

Background and objectiveMore than half of institutionalized older people need a emergency department visit annually, with high resources consumption and higher risk of adverse events, due to high complexity. Direct admission to Acute Geriatric Unit (AGU), after geriatric consultant and nursing home medical team assessment, could be a safety and effective alternative to emergency department (ED) admission.MethodsRetrospective observational study of AGU patients admitted by Nursing Home Geriatric Team between January, 1st and December, 31st, 2021. Planned admissions and SARS-CoV-2 positive patients were excluded. Medical (sociodemographic, clinical, functional and cognitive) records and outcomes data (inpatient mortality, hospital and ED lenght of stay, transfer to ED and delirium within 48 h after admission, hospital discharge location) were collected.ResultsTwo hundred and six patients directly admitted, 101 through ED (N 307). 62.5% with Barthel index <40, 65% with dementia, 56.4% with Charlson index ≥3. Inpatient mortality was 14.6% in direct admission, 20.8% in ED referral group, p = 0.14. Hospital lenght of stay was 9.61 ± 6.01 days in direct admission, 11.22 ± 5.36 days in ED group, p = 0.02. 27.7% of patients with delirium in direct admission and 36.6% in ED group; only one patient was transferred to ED, within 48 h after admission.ConclusionsDirect admission is a safety and effective alternative to ED referral in institutionalized older people after geriatric assessment, due to no increased mortality, shorter length of stay and hospital cost reduction.     

首都医科大学宣武医院神经内科高级研修培训模式的探讨分析

医学进修是提高医务人员综合素质的重要途径.宣武医院神经内科依托于首都医科大学神经病学系开展了”神经内科高级研修培训班”,选取高素质的医师进行个体化培训.已培训学员112名,其中16人成为医院或当地神经内科系统学科带头人,35人成为学术骨干;建立专科专病门诊(中心)38个,建立疑难病会诊中心21个;申请省市级课题36项,国家级课题18项.极大的提高了当地的临床、科研和学术水平,取得了显著的成效,值得推广和借鉴.     

Elevated serum lactate in emergency department patients predicts hospital admission unrelated to diagnosis – but not more

Purpose: The value of lactate as a screening biomarker in the emergency department is debated. We analysed all unselected patients in the emergency department with serum lactate measured with regard to different outcome parameters.

Material and Methods: In a retrospective single centre study, we analysed all digitalized patient data of a two-week period of all patients ≥18 where a serum lactate was measured. The lactate levels as well as demographic and other laboratory data were correlated in a logistic regression analysis, univariable as well as multivariable, with the outcome parameters.

Results: A total of 1157 patients contacted the emergency department of which 587 were included. The average lactate level was 2,08?mmol/l (SD ±1.51, median 1.73). A total of 313 patients were admitted to hospital, 274 treated as outpatients. Their median lactate levels were 2.0?mmol/l (min/max 0.6–18?mmol/l) and 1.5?mmol/l (min/max 0.5–7.4?mmol/l), respectively. Univariable regression analysis for hospital admission showed an odds ratio of 1756 (p?p?=?0.004). There was no correlation with admission to ICU, length of stay or a relation to a certain diagnostic group.

Conclusions: Screening lactate levels in unselected emergency department patients do not have a clinical relevance yet.     

综合性医院临床科室目标管理效益效率分析

目的 通过对临床科室综合目标管理效益效率考核实施情况进行分析,评价考核方法及考核成效,为医院改进相关考核工作提供参考。方法 科学确立考核指标,并应用横向比较法实证分析安徽医科大学第二附属医院2012年各临床科室综合目标管理效益效率考核实施情况。结果 确立以门诊人次、出院人次、手术台次、净收益、每医生实际占用总床日等为核心指标的测算方案,对12个内科科室、10个外科科室进行测算并获得排名,结果基本客观公正地反映了科室效益效率情况。结论 采用横向比较方法对上述指标进行评价能有效反映效益效率考核要求,一定程度上克服科室之间不能直接比较的困难。该评价方法及测算过程简单实用,易于操作,在医院综合目标管理体系效益效率考核中有着一定的应用价值。

     

Impact of High Deductible Health Plans on Diabetes Care Quality and Outcomes: Systematic Review

ObjectiveTo provide a review of the impact of high deductible health plans (HDHPs) on the utilizations of services required for optimal management of diabetes and subsequent health outcomes.MethodsSystematic literature review of studies published between January 1, 2000, and May 7, 2021, was conducted that examined the impact of HDHP on diabetes monitoring (eg, recommended laboratory and surveillance testing), routine care (eg, ambulatory appointments), medication management (eg, medication initiation, adherence), and acute health care utilization (eg, emergency department visits, hospitalizations, incident complications).ResultsOf the 303 reviewed articles, 8 were relevant. These studies demonstrated that HDHPs lower spending at the expense of reduced high-value diabetes monitoring, routine care, and medication adherence, potentially contributing to the observed increases in acute health care utilization. Additionally, patient out-of-pocket costs for recommended screenings doubled, and total health care expenditures increased by 49.4% for HDHP enrollees compared with enrollees in traditional health plans. Reductions in disease monitoring and routine care and increases in acute health care utilization were greatest in lower-income patients. None of the studies examined the impact of HDHPs on access to diabetes self-management education, technology use, or glycemic control.ConclusionAlthough HDHPs reduce some health care utilization and costs, they appear to do so at the expense of limiting high-value care and medication adherence. Policymakers, providers, and payers should be more cognizant of the potential for negative consequences of HDHPs on patients’ health.     

IMPROV-ED trial: eHealth programme for faster recovery and reduced healthcare utilisation after CABG

Netherlands Heart Journal - After coronary artery bypass grafting (CABG), healthcare utilisation is high and is partly unplanned. eHealth applications have been proposed to reduce healthcare...     

医院临床科室质量与安全管理架构的探讨

随着人们对健康的不断关注,促进临床医疗服务质量的持续改进,是现阶段医院质量与安全管理工作的重点。提出应强化科室质量与安全管理小组职责,构建临床科室质量与安全管理的九项工作架构,不断引领临床科室逐步落实医院各项管理要求,以达到质量持续改进的目标。     

L'âge du complexe récifal des côtes de meuse entre verdun et commercy et la stratigraphie de l'oxfordien dans l'est du bassin de Paris

The question of the age of «Hauts de Meuse coral rag is studied again using new faunas of brachiopods and ammonites collected above, below and inside the coral rag. Ammonites fauna of the well known «Calcaires de Creuë is revised. Results obtained agree closely.The «Hauts de Meuse coral rag grew up during Middle Oxfordian time; and extend part of the Plicatilis zone (Antecedens Subzone) and the whole Transversarium Zone up to the basis of the Bifurcatus Zone, for the first time identified in Lorraine. So it span a short depositional time, about 1 MY, with a high deposition rate, the thickness of the coral rag being more than 100 meters, reaching 150 meters in Saint-Mihiel area. Towards SE, on the other side of the Marne Gap, the sudden change into basinal facies go with a reducing of thickness and deposition rate.Upper Oxfordian deposits show a relative uniformity of facies and thickness. At the top of Middle Oxfordian limestones, the age of the discontinuity and the Sequanian renewal of deposition is basal Bifurcatus Zone. Erosional renewal and terrigeneous deposits are a wide spread event by the beginning of Upper Oxfordian.In the paleontological part, species upon which are based new ages and interpretations are only figured, except the species new or with new paleontological data, which are described. Type specimen of Perisphinctes mosensisBayle, from the «Calcaires de Creuë, is described and photographically figured for the first time.     

Overexpression of miRNA 4451 is Associated With a Poor Survival of Patients With Hypopharyngeal Cancer After Surgery With Postoperative Radiotherapy

Hypopharyngeal cancer (HC) is the most common subset of head and neck cancers. These tumors often have an aggressive clinical outcome characterized by local invasion and regional nodal metastasis. Upregulated miRNAs might be useful as biomarkers for prognosis and molecular targets for these tumors. We determined tumor expression of candidate miRNAs using microarray in 8 HC patients and validated in 372 HC patients. We also used paired tumorous and mucosal tissue to verify the miRNA expression. Log-rank test and Cox model were used to evaluate the survival; and Harrell's C-index was used to compare concordance of Cox models. Our results indicated 7 miRNAs aberrantly expressed in HC. Three of these candidate miRNAs (miRNA-4415, miRNA-200a, and miRNA-30b) were selected for further qRT-PCR validation and all of them were frequently found upregulated in HC tumors; with miR-4451 being the most differentially expressed. Moreover, high expression of miR-4451 was positively correlated with advanced tumor stage and increased mortality risk (HR: 1.6, 95% CI: 1.2–2.3; adjusted HR: 1.5, adjusted 95% CI: 1.1–2.1). Finally, significantly higher expression of miR-4451 in tumors compared to in fresh adjacent normal tissues indicates an oncogenic role of miR-4451 in this tumor. Upregulated miR-4451 in HC samples were frequently found and is significantly associated with advanced stage and poor survival of HC, which may indicate an association of this miRNA with the carcinogenesis process in this tumor site; and they could serve as a prognostic biomarker as well as help develop potential new targets for therapy.