目的上消化道出血是急诊科常见的消化道疾病,识别适合门诊治疗的低危患者,是临床和研究的重点。我们的目的是建立一个简单的预测模型来识别可以避免住院的上消化道出血患者,从而为急诊医生的分诊提供一个可行的依据。方法回顾性分析2015...目的上消化道出血是急诊科常见的消化道疾病,识别适合门诊治疗的低危患者,是临床和研究的重点。我们的目的是建立一个简单的预测模型来识别可以避免住院的上消化道出血患者,从而为急诊医生的分诊提供一个可行的依据。方法回顾性分析2015年1月至2020年12月在东南大学附属中大医院治疗的上消化道出血患者。记录患者的一般资料和首次就诊时的临床参数,采用多因素logistic回归模型确定安全出院的预测因素。结果612/1334例(45.9%)患者非安全出院。安全出院组和非安全出院组在年龄、察尔逊氏共病指数、收缩压、脉率、血红蛋白、白蛋白、血尿素氮、肌酐、国际标准化比值等方面差异有统计学意义(P<0.05)。应用多因素logistic回归分析,7个变量被纳入上消化道出血危险分层的临床预测模型:察尔逊氏共病指数>2、收缩压<90 mmHg、血红蛋白<10 g/dL、尿素氮≥6.5mmol/L、白蛋白<30 g/L、脉搏≥100次/min和国际标准化比值≥1.5。其最佳cutoff值≥1预测非安全出院的敏感性为98.37%,特异度为24.10%,阳性预测值为52.3%,阴性预测值为94.6%;受试者工作特征曲线下面积AUCROC(the area under the receiver operating characteristic curve)为0.822,显著高于Glasgow Blatchford score(GBS)0.786(95%CI 0.752~0.820,P<0.01)和AIMS650.676(95%CI 0.638~0.714,P<0.01)。结论预测评估模型具有可靠的预测价值,可为急诊医务人员分诊治疗上消化道出血患者提供参考依据,从而减少医疗开支,具有一定的社会经济效益。展开更多
This paper reviews programs and projects that are elements of the strategy to boost crop production in general and grain legumes in particular in Nigeria. The objective is to bring to fore the neglect of grain legumes...This paper reviews programs and projects that are elements of the strategy to boost crop production in general and grain legumes in particular in Nigeria. The objective is to bring to fore the neglect of grain legumes production in such strategies and for improved understanding of the need to implement grain legumes specific programs for enhanced food security in the country. The paper reiterates that grain legumes were neglected in most of the strategies for increased crop production which presented enormous challenges and reflects largely the inbalance in the policies for the attainment of food self-sufficiency and food security in the country The paper gives an overview of the programs and projects, and reviews the output of grain legumes during the period （1970-2007）. It submits that the activities of some research institutes and the presidential initiative on vegetable oil development program had positive impact on the output of legumes which is an added impetus for the need to establish grain legumes specific research institutes and programs for further productivity increases. Constraints identified by the paper include： poverty, storage systems, among others. It itemizes prospects and current challenges for grain legume crop sub-sector in Nigeria.展开更多
文摘目的上消化道出血是急诊科常见的消化道疾病,识别适合门诊治疗的低危患者,是临床和研究的重点。我们的目的是建立一个简单的预测模型来识别可以避免住院的上消化道出血患者,从而为急诊医生的分诊提供一个可行的依据。方法回顾性分析2015年1月至2020年12月在东南大学附属中大医院治疗的上消化道出血患者。记录患者的一般资料和首次就诊时的临床参数,采用多因素logistic回归模型确定安全出院的预测因素。结果612/1334例(45.9%)患者非安全出院。安全出院组和非安全出院组在年龄、察尔逊氏共病指数、收缩压、脉率、血红蛋白、白蛋白、血尿素氮、肌酐、国际标准化比值等方面差异有统计学意义(P<0.05)。应用多因素logistic回归分析,7个变量被纳入上消化道出血危险分层的临床预测模型:察尔逊氏共病指数>2、收缩压<90 mmHg、血红蛋白<10 g/dL、尿素氮≥6.5mmol/L、白蛋白<30 g/L、脉搏≥100次/min和国际标准化比值≥1.5。其最佳cutoff值≥1预测非安全出院的敏感性为98.37%,特异度为24.10%,阳性预测值为52.3%,阴性预测值为94.6%;受试者工作特征曲线下面积AUCROC(the area under the receiver operating characteristic curve)为0.822,显著高于Glasgow Blatchford score(GBS)0.786(95%CI 0.752~0.820,P<0.01)和AIMS650.676(95%CI 0.638~0.714,P<0.01)。结论预测评估模型具有可靠的预测价值,可为急诊医务人员分诊治疗上消化道出血患者提供参考依据,从而减少医疗开支,具有一定的社会经济效益。
文摘This paper reviews programs and projects that are elements of the strategy to boost crop production in general and grain legumes in particular in Nigeria. The objective is to bring to fore the neglect of grain legumes production in such strategies and for improved understanding of the need to implement grain legumes specific programs for enhanced food security in the country. The paper reiterates that grain legumes were neglected in most of the strategies for increased crop production which presented enormous challenges and reflects largely the inbalance in the policies for the attainment of food self-sufficiency and food security in the country The paper gives an overview of the programs and projects, and reviews the output of grain legumes during the period （1970-2007）. It submits that the activities of some research institutes and the presidential initiative on vegetable oil development program had positive impact on the output of legumes which is an added impetus for the need to establish grain legumes specific research institutes and programs for further productivity increases. Constraints identified by the paper include： poverty, storage systems, among others. It itemizes prospects and current challenges for grain legume crop sub-sector in Nigeria.
