PCI compared with medical therapy in elderly patients with chronic symptomatic coronary artery disease

Objective The aim of this study was to assess quality of results of elderly patients with coronary disease after medical or revascularisation therapy. Methods In this study, we enrolled 103 patients aged 75 years or older with chronic angina in which 47 patients were assigned coronary angiography and revascularisation and 56 patients with optimised medical therapy. The primary endpoint was quality of life after 6 months, as assessed by questionnaire and the presence of major adverse cardiac events (death, non fatal myocardial infarction, or hospital admission for acute coronary syndrome with or without the need for revascularisation). Results After 6 months follow up, angina severity decreased and measures of quality of life increased in both treatment groups( P <0.05 ); however, these improvements were significantly greater after revascularisation( P <0.01 ). Major adverse cardiac events occurred in 30 ( 53.6% ) of patients in the medical group and 9 ( 19.1% ) in the invasive group ( P <0.01 ).Conclusions Patients aged 75 years or older with angina benefit more from revascularisation than from optimised medical therapy in terms of symptom relief and quality of life. Therefore, these patients should be offered invasive assessment despite their high risk profile followed by revascularisation if feasible.

Analysis on Nutritional Risk Screening and Influencing Factors of Hospitalized Patients in Central Urban Area

Rational nutritional support shall be based on nutritional screening and nutritional assessment. This study is aimed to explore nutritional risk screening and its influencing factors of hospitalized patients in central urban area. It is helpful for the early detection of problems in nutritional supports, nutrition management and the implementation of intervention measures, which will contribute a lot to improving the patient＇s poor clinical outcome. A total of three tertiary medical institutions were enrolled in this study. From October 2015 to June 2016, 1202 hospitalized patients aged ≥18 years were enrolled in Nutrition Risk Screening 2002（NRS2002） for nutritional risk screening, including 8 cases who refused to participate, 5 cases of same-day surgery and 5 cases of coma. A single-factor chi-square test was performed on 312 patients with nutritional risk and 872 hospitalized patients without nutritional risk. Logistic regression analysis was performed with univariate analysis（P〈0.05）, to investigate the incidence of nutritional risk and influencing factors. The incidence of nutritional risk was 26.35% in the inpatients, 25.90% in male and 26.84% in female, respectively. The single-factor analysis showed that the age ≥60, sleeping disorder, fasting, intraoperative bleeding, the surgery in recent month, digestive diseases, metabolic diseases and endocrine system diseases had significant effects on nutritional risk（P〈0.05）. Having considered the above-mentioned factors as independent variables and nutritional risk（Y=1, N=0） as dependent variable, logistic regression analysis revealed that the age ≥60, fasting, sleeping disorders, the surgery in recent month and digestive diseases are hazardous factors for nutritional risk. Nutritional risk exists in hospitalized patients in central urban areas. Nutritional risk screening should be conducted for inpatients. Nutritional intervention programs should be formulated in consideration of those influencing factors, which enable to reduce the nutritional risk and to promote the rehabilitation of inpatients.

Human Respiration Rate Estimation Using Ultra-wideband Distributed Cognitive Radar System

It has been shown that remote monitoring of pulmonary activity can be achieved using ultra-wideband (UWB) systems, which shows promise in home healthcare,rescue,and security applications.In this paper,we first present a multi-ray propagation model for UWB signal,which is traveling through the human thorax and is reflected on the air/dry-skin/fat/muscle interfaces,A geometry-based statistical channel model is then developed for simulating the reception of UWB signals in the indoor propagation environment.This model enables replication of time-varying multipath profiles due to the displacement of a human chest.Subsequently, a UWB distributed cognitive radar system (UWB-DCRS) is developed for the robust detection of chest cavity motion and the accurate estimation of respiration rate.The analytical framework can serve as a basis in the planning and evaluation of future rheasurement programs.We also provide a case study on how the antenna beamwidth affects the estimation of respiration rate based on the proposed propagation models and system architecture.

Can Opening ‘Ethics Files’ on Medical Staff Improve Patients’ Care?

Healthcare workers in Shanghai are walking the line after recent news that regulations issued by local health authorities will soon enforce the opening of an “ethics file” for each of the city’s 140,000 medical workers. According to the regulations,

Should Patients Carry the Burden of Proof When Medical Disputes Arise?

Rigorous debates have followed the formulation of a new law that changes the way Chinese courts handle medical disputes.The draft Tort Liability Law,which is being deliberated by the National People’s Congress(NPC),China’s top legislature,deals with when a person/organization can be sued

Acupuncture combined with medication for blood-stasis in unstable angina patients with different thrombolysis in myocardial infarction risk stratification

Objective To observe the intervention effects of acupuncture combined with standardized treatment of western medicine on blood-stasis syndrome in unstable angina(UA)patients with different thrombolysis in myocardial infarction(TIMI)risk stratification.Methods According to TIMI risk score,a total of 72 UA patients were included,24 cases in low-risk(0 to 2 points)group,24

The Accountable Care Organization results:Population health management and quality improvement programs associated with increased quality of care and decreased utilization and cost of care

Objective:The Accountable Care Organization(ACO)model of health care delivery is based on new payment models for general practice to reward improved quality and decreased cost of care.Methods:Banner Health Network(BHN)is one of the original CMS Pioneer ACO programs and implemented a comprehensive disease management program based on the collaborative care model.Key performance indicators for CMS reflected quality and cost of care.Results:BHN has demonstrated both improved quality and cost savings in the first two years of the pilot program.The disease management program based on the collaborative care model appears to have improved patient health outcomes based on quality improvement measures.In addition the program has reduced emergency department and hospital utilization,resulting in cost savings.Conclusions:The BHN quality improvement program is the platform for analyzing and improving on the BHN ACO model.This model appears to have excellent application to the China health care system that is also focused on prevention and improvement of chronic disease and cost-effectiveness.