OBJECTIVE:Admission hyperglycemia in acute myocardial infarction (MI) is related with increased in-hospital and long term mortality and major cardiac adverse events。 We aimed to investigate how admission hyperglycemi...OBJECTIVE:Admission hyperglycemia in acute myocardial infarction (MI) is related with increased in-hospital and long term mortality and major cardiac adverse events。 We aimed to investigate how admission hyperglycemia affects the short and long term outcomes in elderly patients >65 years) after primary percutaneous coronary intervention for ST elevation myocardial infarction。 METHODS:We retrospectively analyzed 677 consecutive elderly patients (mean age 72.2 ±5.4)。 Patients were divided into two groups according to admission blood glucose levels。 Group : low glucose group (LLG), glucose < 168 mg/dL; and Group 2: high glucose group (HGG), glucose >168 mg/dL。 RESULTS:In-hospital, long term mortality and in-hospital major adverse cardiac events were higher in the high admission blood glucose group (P <0.001)。 Multivariate regression analysis showed: Killip > 1, post-thrombolysis in MI <3 and admission blood glucose levels were independent predictors of in-hospital adverse cardiac events (P <0.001)。 CONCLUSIONS:Admission hyperglycemia in elderly patients presented with ST elevation myocardial infarction is an independent predictor of in-hospital major adverse cardiac events and is associated with in-hospital and long term mortality。展开更多
The main objective of this study was always to know the profile of the institutionalized people in our environment, to know their reality： age, age of admission, level of dependency and evolution during their stay, y...The main objective of this study was always to know the profile of the institutionalized people in our environment, to know their reality： age, age of admission, level of dependency and evolution during their stay, years of stay, number of children, reason for admission. We use data from more than 600 patients from different residences of different backgrounds： public and private, lay and religious, rural and urban. We performed a descriptive study expressing the results in percentages with standard deviation and later evaluated the statistical significance of the differences using the student＇s t-test for the quantitative and Chi-square variables to compare qualitative variables. The results of the study are numerous and of diverse nature, because of their extension, from the general profile of the resident, to the important gender differences, attributed in principle to the different roles of each gender in the studied generations. There are also differences depending on the funding, the reason for admission or the environment. This is at the end only the beginning of a large comparative study with non-institutionalized population, in order to compare this population.展开更多
Objective:To compare the characteristics of patients between adverse event(AE)group and non-AE group,and to assess the causes,preventability,and severity of AE.Methods:A retrospective triple-phase medical record study...Objective:To compare the characteristics of patients between adverse event(AE)group and non-AE group,and to assess the causes,preventability,and severity of AE.Methods:A retrospective triple-phase medical record study was conducted at a Spanish tertiary hospital.Data was collected over a 6-month period,including all patients with an unplanned intensive care admission.Demographic characteristics,APACHEⅡ,length of ICU stay,mortality were compare between AE and non-AE group causes,preventability and severity were analyzed in AE cases.Results:597 Patients were included in the study.The overall incidence of AEs was 17.3%(n=103),of which 83.5%were considered preventable.Mortality within the AE group was higher than in the non-AE group(23.3%vs.13.6%),making it 1.7 times more frequent in the AE group(95%CI:1.143-2.071).The primary cause of AE was associated with surgical procedures(43.7%).Of the AEs,18.4%were classified as mild,58.3%as moderate,and 23.3%as severe.Conclusions:The incidence of unplanned intensive care admissions due to AE is high and potentially preventable.This is concerning given the high mortality observed in patients admitted to the intensive care unit because of an AE,although direct causality cannot always be established.The findings emphasize the importance of patient safety and underscore the need for improved quality and management of care resources.They also indicate where efforts should be directed to enhance care risk management.展开更多
AIM To construct and assess the psychometric properties of an instrument to measure patients' attitudes towards involuntary hospitalization. METHODS This is a two phase study. In the first phase, based on comprehe...AIM To construct and assess the psychometric properties of an instrument to measure patients' attitudes towards involuntary hospitalization. METHODS This is a two phase study. In the first phase, based on comprehensive literature review, a twenty one item scale to measure patients' attitudes to involuntary admission was constructed. Forensic and inpatient Psychiatrists, patients' advocates and legal experts(n = 15) were invited to participate in the validation process of the written instrument, by formally rating each item of the instrument for its relevancy in measuring patients' attitudes to involuntary admission. In the second phase of the project, the instrument was administered to a sample of eighty consecutive patients, who were admitted involuntarily to an acute psychiatric unit of a teaching hospital. All patients completed the constructed attitudes towards involuntary admission scale, and the client satisfaction questionnaire. RESULTS Responses from psychiatry and advocacy experts provided evidence for face and content validity for the constructed instrument. The internal consistency reliability of the instrument is 0.84(Chronbach' alpha), factor analysis resulted in three correlated, and theoretically meaningful factors. There was evidence for content, convergent, and concurrent validity.CONCLUSION A reliable twenty one item instrument scale to measure patients' attitudes to involuntary admission was developed. The developed instrument has high reliability, there is strong evidence for validity, and it takes ten minutes to complete.展开更多
BACKGROUND Sacubitril-valsartan has been shown to reduce hospitalizations and mortality in patients with heart failure(HF)and reduced ejection fraction.The PIONEER-HF trial demonstrated that initiation of the drug dur...BACKGROUND Sacubitril-valsartan has been shown to reduce hospitalizations and mortality in patients with heart failure(HF)and reduced ejection fraction.The PIONEER-HF trial demonstrated that initiation of the drug during acute HF hospitalization reduced NT-proBNP levels and a post-hoc analysis of the trial found a reduction in HF hospitalizations and deaths.Real-life studies in the elderly population are scarce.The aim of our study was to assess the effectiveness of sacubitril-valsartan versus angiotensin converting enzyme inhibitors(ACEI)in elderly patients who initiate this treatment during hospitalization for acute HF.METHODS We conducted a retrospective cohort study using the Spanish acute heart failure registry(RICA)comparing rehospitalizations and deaths at 3 months and 1 year among patients aged 70 years or older who had initiated treatment with sacubitrilvalsartan during hospitalization for acute HF versus those treated with ACEI.RESULTS One hundred and ninety-nine patients hospitalized between October 2016 and November 2020 were included,with a median age of 82 years and high rate of comorbidity.Of these,107 were treated with sacubitril-valsartan and 92 with ACEI.The adjusted OR for readmission for HF at 3 months was 0.906(95%CI:0.241-3.404)and for the combined variable readmission for HF or death at 3 months was 0.696(95%CI:0.224-2.167).The adjusted OR for HF readmission at one year was 0.696(95%CI:0.224-2.167).and for the combined variable HF readmission or death at one year 0.724(95%CI:0.325-1.612).CONCLUSION Treatment with sacubitril-valsartan initiated early in hospitalization for HF in elderly patients with high comorbidity was associated with a trend towards a reduction in readmissions and death due to HF compared to treatment with ACEI,which did not reach statistical significance either at 3 months or 1 year of follow-up.展开更多
To the Editor:Compared with non-readmission chronic obstructive pulmonary disease(COPD)patients,the mortality rate of readmission patients is significantly higher(2.3%vs.13.4%),[1]which undoubtedly causes socio-econom...To the Editor:Compared with non-readmission chronic obstructive pulmonary disease(COPD)patients,the mortality rate of readmission patients is significantly higher(2.3%vs.13.4%),[1]which undoubtedly causes socio-economic pressures on rehabilitation care and medical resources.The potential factors affecting the risk of readmission are required to be identified.The incidence of malnutrition,occurring frequently in elderly COPD patients,varies from 20%to 45%depending on the screening tools used.As a practical,economical and effective scoring system,the Mini Nutrition Assessment(MNA)is of great value to assessing nutritional status in the elderly.Malnutrition is a state of vulnerability in elder populations and is associated with a poor long-term prognosis.This study aimed to research the impact of nutritional status related risk factors on readmission and assess the value of MNA scoring system and updated sarcopenia diagnostic criteria in predicting readmission risk for elderly COPD patients.展开更多
文摘OBJECTIVE:Admission hyperglycemia in acute myocardial infarction (MI) is related with increased in-hospital and long term mortality and major cardiac adverse events。 We aimed to investigate how admission hyperglycemia affects the short and long term outcomes in elderly patients >65 years) after primary percutaneous coronary intervention for ST elevation myocardial infarction。 METHODS:We retrospectively analyzed 677 consecutive elderly patients (mean age 72.2 ±5.4)。 Patients were divided into two groups according to admission blood glucose levels。 Group : low glucose group (LLG), glucose < 168 mg/dL; and Group 2: high glucose group (HGG), glucose >168 mg/dL。 RESULTS:In-hospital, long term mortality and in-hospital major adverse cardiac events were higher in the high admission blood glucose group (P <0.001)。 Multivariate regression analysis showed: Killip > 1, post-thrombolysis in MI <3 and admission blood glucose levels were independent predictors of in-hospital adverse cardiac events (P <0.001)。 CONCLUSIONS:Admission hyperglycemia in elderly patients presented with ST elevation myocardial infarction is an independent predictor of in-hospital major adverse cardiac events and is associated with in-hospital and long term mortality。
文摘The main objective of this study was always to know the profile of the institutionalized people in our environment, to know their reality： age, age of admission, level of dependency and evolution during their stay, years of stay, number of children, reason for admission. We use data from more than 600 patients from different residences of different backgrounds： public and private, lay and religious, rural and urban. We performed a descriptive study expressing the results in percentages with standard deviation and later evaluated the statistical significance of the differences using the student＇s t-test for the quantitative and Chi-square variables to compare qualitative variables. The results of the study are numerous and of diverse nature, because of their extension, from the general profile of the resident, to the important gender differences, attributed in principle to the different roles of each gender in the studied generations. There are also differences depending on the funding, the reason for admission or the environment. This is at the end only the beginning of a large comparative study with non-institutionalized population, in order to compare this population.
文摘Objective:To compare the characteristics of patients between adverse event(AE)group and non-AE group,and to assess the causes,preventability,and severity of AE.Methods:A retrospective triple-phase medical record study was conducted at a Spanish tertiary hospital.Data was collected over a 6-month period,including all patients with an unplanned intensive care admission.Demographic characteristics,APACHEⅡ,length of ICU stay,mortality were compare between AE and non-AE group causes,preventability and severity were analyzed in AE cases.Results:597 Patients were included in the study.The overall incidence of AEs was 17.3%(n=103),of which 83.5%were considered preventable.Mortality within the AE group was higher than in the non-AE group(23.3%vs.13.6%),making it 1.7 times more frequent in the AE group(95%CI:1.143-2.071).The primary cause of AE was associated with surgical procedures(43.7%).Of the AEs,18.4%were classified as mild,58.3%as moderate,and 23.3%as severe.Conclusions:The incidence of unplanned intensive care admissions due to AE is high and potentially preventable.This is concerning given the high mortality observed in patients admitted to the intensive care unit because of an AE,although direct causality cannot always be established.The findings emphasize the importance of patient safety and underscore the need for improved quality and management of care resources.They also indicate where efforts should be directed to enhance care risk management.
文摘AIM To construct and assess the psychometric properties of an instrument to measure patients' attitudes towards involuntary hospitalization. METHODS This is a two phase study. In the first phase, based on comprehensive literature review, a twenty one item scale to measure patients' attitudes to involuntary admission was constructed. Forensic and inpatient Psychiatrists, patients' advocates and legal experts(n = 15) were invited to participate in the validation process of the written instrument, by formally rating each item of the instrument for its relevancy in measuring patients' attitudes to involuntary admission. In the second phase of the project, the instrument was administered to a sample of eighty consecutive patients, who were admitted involuntarily to an acute psychiatric unit of a teaching hospital. All patients completed the constructed attitudes towards involuntary admission scale, and the client satisfaction questionnaire. RESULTS Responses from psychiatry and advocacy experts provided evidence for face and content validity for the constructed instrument. The internal consistency reliability of the instrument is 0.84(Chronbach' alpha), factor analysis resulted in three correlated, and theoretically meaningful factors. There was evidence for content, convergent, and concurrent validity.CONCLUSION A reliable twenty one item instrument scale to measure patients' attitudes to involuntary admission was developed. The developed instrument has high reliability, there is strong evidence for validity, and it takes ten minutes to complete.
文摘BACKGROUND Sacubitril-valsartan has been shown to reduce hospitalizations and mortality in patients with heart failure(HF)and reduced ejection fraction.The PIONEER-HF trial demonstrated that initiation of the drug during acute HF hospitalization reduced NT-proBNP levels and a post-hoc analysis of the trial found a reduction in HF hospitalizations and deaths.Real-life studies in the elderly population are scarce.The aim of our study was to assess the effectiveness of sacubitril-valsartan versus angiotensin converting enzyme inhibitors(ACEI)in elderly patients who initiate this treatment during hospitalization for acute HF.METHODS We conducted a retrospective cohort study using the Spanish acute heart failure registry(RICA)comparing rehospitalizations and deaths at 3 months and 1 year among patients aged 70 years or older who had initiated treatment with sacubitrilvalsartan during hospitalization for acute HF versus those treated with ACEI.RESULTS One hundred and ninety-nine patients hospitalized between October 2016 and November 2020 were included,with a median age of 82 years and high rate of comorbidity.Of these,107 were treated with sacubitril-valsartan and 92 with ACEI.The adjusted OR for readmission for HF at 3 months was 0.906(95%CI:0.241-3.404)and for the combined variable readmission for HF or death at 3 months was 0.696(95%CI:0.224-2.167).The adjusted OR for HF readmission at one year was 0.696(95%CI:0.224-2.167).and for the combined variable HF readmission or death at one year 0.724(95%CI:0.325-1.612).CONCLUSION Treatment with sacubitril-valsartan initiated early in hospitalization for HF in elderly patients with high comorbidity was associated with a trend towards a reduction in readmissions and death due to HF compared to treatment with ACEI,which did not reach statistical significance either at 3 months or 1 year of follow-up.
基金supported by grants from the National Natural Science Foundation of China(Nos.81900072 and 82170092).
文摘To the Editor:Compared with non-readmission chronic obstructive pulmonary disease(COPD)patients,the mortality rate of readmission patients is significantly higher(2.3%vs.13.4%),[1]which undoubtedly causes socio-economic pressures on rehabilitation care and medical resources.The potential factors affecting the risk of readmission are required to be identified.The incidence of malnutrition,occurring frequently in elderly COPD patients,varies from 20%to 45%depending on the screening tools used.As a practical,economical and effective scoring system,the Mini Nutrition Assessment(MNA)is of great value to assessing nutritional status in the elderly.Malnutrition is a state of vulnerability in elder populations and is associated with a poor long-term prognosis.This study aimed to research the impact of nutritional status related risk factors on readmission and assess the value of MNA scoring system and updated sarcopenia diagnostic criteria in predicting readmission risk for elderly COPD patients.
