目的评价STAF评分(score for the targeting of atrial fibrillation,STAF)筛查缺血性卒中患者心房颤动(atrial fibrillation,AF)的诊断价值。方法为单中心、回顾性研究,连续收集年龄≥18岁、发病7 d内、经头颅MR/CT证实的缺血性卒中患...目的评价STAF评分(score for the targeting of atrial fibrillation,STAF)筛查缺血性卒中患者心房颤动(atrial fibrillation,AF)的诊断价值。方法为单中心、回顾性研究,连续收集年龄≥18岁、发病7 d内、经头颅MR/CT证实的缺血性卒中患者,收集其基本临床特征、入院首次美国国立卒中卫生院卒中评分量表(the Na tional Institute of Health stroke scale,NIHSS)评分、心脏彩超结果、经典TOAST(Trial of Org 10172 in Acute Stroke Treatment)分型、既往史、12导联心电图(electrocardiogram,ECG)、24小时动态心电图(24h-Holter)、心电监护结果并进行STAF评分。绘制受试者工作特征(receiver operator characteristic,ROC)曲线确定STAF诊断房颤的界值,分析其诊断价值。结果共收集患者219例,STAF评分诊断房颠的ROC曲线下面积(area under the curve,AUC)为0.901。以STAF≥5分作为界值,STAF评分的灵敏度为97.37%,特异度为70.72%。结论初步发现STAF评分对缺血性卒中患者具有较好的诊断价值,仍需进一步研究验证。展开更多
目的本研究旨在分析并比较心肌肌钙蛋白I(cardiac troponin I,cTnI)升高及STAF评分(Score for the Targeting of Atrial Fibrillation)对心源性脑梗死诊断的预测价值。方法本研究纳入223例急性缺血性脑卒中患者,心源性脑梗死38例,非心...目的本研究旨在分析并比较心肌肌钙蛋白I(cardiac troponin I,cTnI)升高及STAF评分(Score for the Targeting of Atrial Fibrillation)对心源性脑梗死诊断的预测价值。方法本研究纳入223例急性缺血性脑卒中患者,心源性脑梗死38例,非心源性脑梗死185例。收集患者详细的临床资料后,检测血清cTnI的浓度,计算STAF评分。比较两组临床基线资料,采用ROC曲线确定cTnI和STAF评分对心源性脑梗死诊断的界值,并对比分析其预测价值。结果心源性脑梗死组患者相比于非心源性脑梗死组,年龄更大,心房颤动、缺血性心脏病史更多,NIHSS评分、cTnI 值以及STAF评分明显更高(P<0.05)。STAF的ROC曲线下面积为0.954,其95%CI为0.924~0.985。cTnI值的ROC曲线下面积为0.852,其95%CI为0.788~0.916。STAF评分截点为4分,此时灵敏度为92.1%,特异度为89.2%。cTnI值截点为0.0085 ng/mL,此时灵敏度为73.7%,特异度为84.9%。结论本研究中STAF评分和cTnI 值均对心源性脑梗死有良好的预测价值,且STAF评分对心源性脑梗死诊断的预测价值高于cTnI。血清cTnI 值和STAF评分对急性缺血性脑卒中患者的病因分型具有一定的临床运用价值。展开更多
Intensive care is slowly being recognized as a separate medical specialization. Physicians, called intensivists, are being specially trained to manage intensive care units(ICUs) and provide focused, high quality care ...Intensive care is slowly being recognized as a separate medical specialization. Physicians, called intensivists, are being specially trained to manage intensive care units(ICUs) and provide focused, high quality care to critically ill patients. However, these ICUs were traditionally managed by primary physicians who used to admit patients in ICUs under their own care. The presence of specially trained intensivists in these ICUs has started a "turf" war. In spite of the availability of overwhelming evidence that intensivists-based ICUs can provide better patient care leading to improved outcome, there is hesitancy among hospital administrators and other policy makers towards adopting such a model. Major critical care societies and workgroups have recommended intensivists-based ICU models to care for critically ill patients, but even in developed countries, on-site intensivist coverage is lacking in a great majority of hospitals. Lack of funds and unavailability of skilled intensivists are commonly cited as the main reasons for not implementing intensivist-led ICU care in most of the ICUs. To provide optimal, comprehensive and skilled care to this severely ill patient population, it is imperative that a multi-disciplinary team approach must be adopted with intensivists as in-charge. Even though ICU organization and staffingmay be determined by hospital policies and other local factors, all efforts must be made to attain the goal of having round-the-clock onsite intensivist coverage to ensure continuity of specialized care for all critically ill patients.展开更多
Background: Academic anesthesia departments are under increasing financial pressure. Many struggle to integrate the priorities of their academic and clinical missions. Previous studies have documented increasing need ...Background: Academic anesthesia departments are under increasing financial pressure. Many struggle to integrate the priorities of their academic and clinical missions. Previous studies have documented increasing need for monetary institutional support of academic anesthesia departments. In view of current economic and legislative circumstances, it is arguable that the need for support will grow. This survey demonstrates that staffing issues, which are most likely engendered by financial circumstances, have impacted academic anesthesia departments in the United States to the point of having deleterious effects upon clinical safety and resident education.Methods: After IRB approval, we electronically solicited the anonymous response to a 23 question survey from all 133 chairpersons of academic anesthesia departments in the United States. Results: Sixty-two responded electronically, for an overall response rate of 46.6%. Conclusion: The results of this survey suggest that academic anesthesia departments are being financially stressed to the point that education and patient care are affected.展开更多
The nursing shortage is a global issue that because there is a growing consensus that identifying flaws and opportunities for improving the working environment in hospital is vital to maintain positive patient outcome...The nursing shortage is a global issue that because there is a growing consensus that identifying flaws and opportunities for improving the working environment in hospital is vital to maintain positive patient outcomes, adequate staffing, high-quality care, nurses’ job satisfaction and hence their retention. The aim of this study was to explore the staffing and resource adequacy in NPE and the association with POs (adverse events). A descriptive correlational study was conducted and participated 395 staff nurses (94.3%) from three university hospitals in Malaysia over two months, from January to February 2011. In this paper, the results showed that 344 (87.1%) staff nurses rated that was unfavorable (展开更多
An assessment of staffing and training needs for effective delivery of extension services in mainstreaming sustainable land management (SLM) practices in Kilimanjaro Region was conducted in June/July 2013. Data collec...An assessment of staffing and training needs for effective delivery of extension services in mainstreaming sustainable land management (SLM) practices in Kilimanjaro Region was conducted in June/July 2013. Data collection methods included discussions with key informants at the regional and district levels, consultations with village level stakeholders and potential collaborators, review of human resources data both at regional, district and ward levels and collection of individual staff bio-data including capacity deficiencies. The staffing situation at the regional and district levels was considered to be adequate for effective mainstreaming of SLM interventions in the region. Staffing at ward and village levels was very poor and largely inadequate for sustainable execution of extension services. It is optimistically estimated that on average the staffing at ward level needs to be increased by at least 50%. In some districts the deficiency of extension staff at ward level was as high as 80%. Training needs exist at all levels from the region down to community level. At the regional and district levels both long and short term training programs were required. At the community level required training is more practical and purely focused in mainstreaming SLM interventions at individual households and community lands. Potential collaborators with local government were identified in four main categories namely, NGOs/CBOs, private sector, government departments and faith-based organizations. The study recommends a capacity building program on specific knowledge gaps identified at regional, district, ward and village levels. The study further recommends that immediate measures need to be taken by the district authorities to address the staffing problem at ward level including recruitment of volunteers and developing collaboration framework with identified potential partners.展开更多
文摘目的评价STAF评分(score for the targeting of atrial fibrillation,STAF)筛查缺血性卒中患者心房颤动(atrial fibrillation,AF)的诊断价值。方法为单中心、回顾性研究,连续收集年龄≥18岁、发病7 d内、经头颅MR/CT证实的缺血性卒中患者,收集其基本临床特征、入院首次美国国立卒中卫生院卒中评分量表(the Na tional Institute of Health stroke scale,NIHSS)评分、心脏彩超结果、经典TOAST(Trial of Org 10172 in Acute Stroke Treatment)分型、既往史、12导联心电图(electrocardiogram,ECG)、24小时动态心电图(24h-Holter)、心电监护结果并进行STAF评分。绘制受试者工作特征(receiver operator characteristic,ROC)曲线确定STAF诊断房颤的界值,分析其诊断价值。结果共收集患者219例,STAF评分诊断房颠的ROC曲线下面积(area under the curve,AUC)为0.901。以STAF≥5分作为界值,STAF评分的灵敏度为97.37%,特异度为70.72%。结论初步发现STAF评分对缺血性卒中患者具有较好的诊断价值,仍需进一步研究验证。
文摘目的本研究旨在分析并比较心肌肌钙蛋白I(cardiac troponin I,cTnI)升高及STAF评分(Score for the Targeting of Atrial Fibrillation)对心源性脑梗死诊断的预测价值。方法本研究纳入223例急性缺血性脑卒中患者,心源性脑梗死38例,非心源性脑梗死185例。收集患者详细的临床资料后,检测血清cTnI的浓度,计算STAF评分。比较两组临床基线资料,采用ROC曲线确定cTnI和STAF评分对心源性脑梗死诊断的界值,并对比分析其预测价值。结果心源性脑梗死组患者相比于非心源性脑梗死组,年龄更大,心房颤动、缺血性心脏病史更多,NIHSS评分、cTnI 值以及STAF评分明显更高(P<0.05)。STAF的ROC曲线下面积为0.954,其95%CI为0.924~0.985。cTnI值的ROC曲线下面积为0.852,其95%CI为0.788~0.916。STAF评分截点为4分,此时灵敏度为92.1%,特异度为89.2%。cTnI值截点为0.0085 ng/mL,此时灵敏度为73.7%,特异度为84.9%。结论本研究中STAF评分和cTnI 值均对心源性脑梗死有良好的预测价值,且STAF评分对心源性脑梗死诊断的预测价值高于cTnI。血清cTnI 值和STAF评分对急性缺血性脑卒中患者的病因分型具有一定的临床运用价值。
文摘Intensive care is slowly being recognized as a separate medical specialization. Physicians, called intensivists, are being specially trained to manage intensive care units(ICUs) and provide focused, high quality care to critically ill patients. However, these ICUs were traditionally managed by primary physicians who used to admit patients in ICUs under their own care. The presence of specially trained intensivists in these ICUs has started a "turf" war. In spite of the availability of overwhelming evidence that intensivists-based ICUs can provide better patient care leading to improved outcome, there is hesitancy among hospital administrators and other policy makers towards adopting such a model. Major critical care societies and workgroups have recommended intensivists-based ICU models to care for critically ill patients, but even in developed countries, on-site intensivist coverage is lacking in a great majority of hospitals. Lack of funds and unavailability of skilled intensivists are commonly cited as the main reasons for not implementing intensivist-led ICU care in most of the ICUs. To provide optimal, comprehensive and skilled care to this severely ill patient population, it is imperative that a multi-disciplinary team approach must be adopted with intensivists as in-charge. Even though ICU organization and staffingmay be determined by hospital policies and other local factors, all efforts must be made to attain the goal of having round-the-clock onsite intensivist coverage to ensure continuity of specialized care for all critically ill patients.
文摘Background: Academic anesthesia departments are under increasing financial pressure. Many struggle to integrate the priorities of their academic and clinical missions. Previous studies have documented increasing need for monetary institutional support of academic anesthesia departments. In view of current economic and legislative circumstances, it is arguable that the need for support will grow. This survey demonstrates that staffing issues, which are most likely engendered by financial circumstances, have impacted academic anesthesia departments in the United States to the point of having deleterious effects upon clinical safety and resident education.Methods: After IRB approval, we electronically solicited the anonymous response to a 23 question survey from all 133 chairpersons of academic anesthesia departments in the United States. Results: Sixty-two responded electronically, for an overall response rate of 46.6%. Conclusion: The results of this survey suggest that academic anesthesia departments are being financially stressed to the point that education and patient care are affected.
文摘The nursing shortage is a global issue that because there is a growing consensus that identifying flaws and opportunities for improving the working environment in hospital is vital to maintain positive patient outcomes, adequate staffing, high-quality care, nurses’ job satisfaction and hence their retention. The aim of this study was to explore the staffing and resource adequacy in NPE and the association with POs (adverse events). A descriptive correlational study was conducted and participated 395 staff nurses (94.3%) from three university hospitals in Malaysia over two months, from January to February 2011. In this paper, the results showed that 344 (87.1%) staff nurses rated that was unfavorable (
文摘An assessment of staffing and training needs for effective delivery of extension services in mainstreaming sustainable land management (SLM) practices in Kilimanjaro Region was conducted in June/July 2013. Data collection methods included discussions with key informants at the regional and district levels, consultations with village level stakeholders and potential collaborators, review of human resources data both at regional, district and ward levels and collection of individual staff bio-data including capacity deficiencies. The staffing situation at the regional and district levels was considered to be adequate for effective mainstreaming of SLM interventions in the region. Staffing at ward and village levels was very poor and largely inadequate for sustainable execution of extension services. It is optimistically estimated that on average the staffing at ward level needs to be increased by at least 50%. In some districts the deficiency of extension staff at ward level was as high as 80%. Training needs exist at all levels from the region down to community level. At the regional and district levels both long and short term training programs were required. At the community level required training is more practical and purely focused in mainstreaming SLM interventions at individual households and community lands. Potential collaborators with local government were identified in four main categories namely, NGOs/CBOs, private sector, government departments and faith-based organizations. The study recommends a capacity building program on specific knowledge gaps identified at regional, district, ward and village levels. The study further recommends that immediate measures need to be taken by the district authorities to address the staffing problem at ward level including recruitment of volunteers and developing collaboration framework with identified potential partners.
