Recurrent stroke admissions with vs without COVID-19 and associated in-hospital mortality: A United States nationwide analysis, 2020

BACKGROUND Coronavirus disease 2019(COVID-19)has been shown to increase the risk of stroke.However,the prevalence and risk of recurrent stroke in COVID-19 patients with prior stroke/transient ischemic attack(TIA),as well as its impact on mor-tality,are not established.AIM To evaluate the impact of COVID-19 on in-hospital mortality,length of stay,and healthcare costs in patients with recurrent strokes.METHODS We identified admissions of recurrent stroke(current acute ischemic stroke admissions with at least one prior TIA or stroke)in patients with and without COVID-19 using ICD-10-CM codes using the National Inpatient Sample(2020).We analyzed the impact of COVID-19 on mortality following recurrent stroke admissions by subgroups.RESULTS Of 97455 admissions with recurrent stroke,2140(2.2%)belonged to the COVID-19-positive group.The COVID-19-positive group had a higher prevalence of diabetes and chronic kidney disease vs the COVID-19 negative group(P<0.001).Among the subgroups,patients aged>65 years,patients aged 45–64 years,Asians,Hispanics,whites,and blacks in the COVID-19 positive group had higher rates of all-cause mortality than the COVID-19 negative group(P<0.01).Higher odds of in-hospital mortality were seen in the group aged 45-64(OR:8.40,95%CI:4.18-16.91)vs the group aged>65(OR:7.04,95%CI:5.24-9.44),males(OR:7.82,95%CI:5.38-11.35)compared to females(OR:6.15,95%CI:4.12-9.18),and in Hispanics(OR:15.47,95%CI:7.61-31.44)and Asians/Pacific Islanders(OR:14.93,95%CI:7.22-30.87)compared to blacks(OR:5.73,95%CI:3.08-10.68),and whites(OR:5.54,95%CI:3.79-8.09).CONCLUSION The study highlights the increased risk of all-cause in-hospital mortality in recurrent stroke patients with COVID-19,with a more pronounced increase in middle-aged patients,males,Hispanics,or Asians.

Adherence to Physical Measures during the SARS-COV2 Pandemic by Haemodialysis Patients in a Burkina Faso Tertiary Hospital: A Cross-Sectional Survey

Context: COVID-19 can spread rapidly in haemodialysis centres, leading to fatal outcomes. Implementing physical measures is crucial in limiting the spread of infection. Aims: To assess adherence to physical measures against SARS-Cov2 in haemodialysis patients. Methods and Material: From 13 to 19 July 2021, we administered the questionnaire to haemodialysis patients during or immediately after the dialysis session. The dependent variables were adherence to wearing masks, hand washing outside the dialysis centre, social distancing of at least 1.5 meters, and cough and sneeze hygiene. Statistical Analysis Used: Data were analyzed using Epi info software;descriptive statistics were presented as mean, headcount, and percentage;related factors were determined by multi-logistic regression. The significance level was 5%. The Health Research Ethics Committee approved the research protocol. Results: 142 patients were included (mean age: 42.5 ± 14 years). Wearing masks, hand-washing, social distancing, and coughing and sneezing hygiene were observed by 88%, 75%, 47%, and 60% of patients, respectively. Conclusion: Wearing masks was the most respected physical measure, while social distancing was the least respected.

Bowel preparation protocol for hospitalized patients ages 50 years or older:A randomized controlled trial

BACKGROUND The incidence and mortality rate of colorectal cancer progressively increase with age and become particularly prominent after the age of 50 years.Therefore,the population that is≥50 years in age requires long-term and regular colonoscopies.Uncomfortable bowel preparation is the main reason preventing patients from undergoing regular colonoscopies.The standard bowel preparation regimen of 4-L polyethylene glycol(PEG)is effective but poorly tolerated.AIM To investigate an effective and comfortable bowel preparation regimen for hospitalized patients≥50 years in age.METHODS Patients were randomly assigned to group 1(2-L PEG+30-mL lactulose+a lowresidue diet)or group 2(4-L PEG).Adequate bowel preparation was defined as a Boston bowel preparation scale(BBPS)score of≥6,with a score of≥2 for each segment.Non-inferiority was prespecified with a margin of 10%.Additionally,the degree of comfort was assessed based on the comfort questionnaire.RESULTS The proportion of patients with a BBPS score of≥6 in group 1 was not significantly different from that in group 2,as demonstrated by intention-to-treat(91.2%vs 91.0%,P=0.953)and per-protocol(91.8%vs 91.0%,P=0.802)analyses.Furthermore,in patients≥75 years in age,the proportion of BBPS scores of≥6 in group 1 was not significantly different from that in group 2(90.9%vs 97.0%,P=0.716).Group 1 had higher comfort scores(8.85±1.162 vs 7.59±1.735,P<0.001),longer sleep duration(6.86±1.204 h vs 5.80±1.730 h,P<0.001),and fewer awakenings(1.42±1.183 vs 2.04±1.835,P=0.026)than group 2.CONCLUSION For hospitalized patients≥50 years in age,the bowel preparation regimen comprising 2-L PEG+30-mL lactulose+a low-residue diet produced a cleanse that was as effective as the 4-L PEG regimen and even provided better comfort.

Comparison of Oral Manifestations in Hospitalized COVID-19 Positive Patients and COVID-19 Negative Dental Outpatients. A Case Series Study and Literature Review

Background: The Coronavirus disease 2019 (COVID-19) is a respiratory infectious disease, also named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which can cause various systemic manifestations that pose a threat to human life. Oral lesions in patients with COVID-19 may appear during or after the illness and may or may not be a consequence of the viral infection. Objective: In this case series we compare the oral manifestations in hospitalized COVID-19 positive patients and COVID-19 negative dental outpatients. Methods: 60 hospitalized COVID-19 patients and 41 control patients, were examined for oral signs and symptoms. The controls were dental patients who visited the hospital for dental care without complaining of any problems related to the oral cavity itself. Results: We have observed a strong association between certain clinical findings and COVID-19, including alterations in taste (ageusia, dysgeusia, and hypogeusia), anosmia, hairy tongue, tongue imprints, red tongue, erythematous candidiasis, pseudomembranous candidiasis, and exfoliative cheilitis. A trend but not statistically significant association at the level of 5% was also noted for colored tongue, linea alba, and pale mucosa. On the contrary, fissured tongue and oral mucosa pigmentation were more frequent in the controls, statistically significant at the level of 5%. Conclusion: COVID-19 has been found to impact the oral cavity, resulting in various oral lesions that can be attributed to either the direct action of the virus or the patient’s immune response.

Temporal and Spatial Distribution of SARS-CoV-2 Aerosols in a Large-Scale Fangcang Shelter Hospital in Shanghai,China

The coronavirus disease 2019(COVID-19)pandemic caused by frequently mutating severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has had a worldwide impact.However,detailed data on the potential aerosol transmission of SARS-CoV-2 in real-world and controlled laboratory settings remain sparse.During the COVID-19 pandemic in Shanghai,China in 2022,samples were collected in a Fangcang shelter hospital,a large-scale temporary hospital rapidly built by converting the existing National Exhibition and Convention Center(Shanghai)into a health care facility.Aerosol samples at different sites and intervals around patients and in public areas,surface samples,and pharyngeal swab samples from corresponding patients were included.Samples were tested for SARS-CoV-2 using real-time quantitative polymerase chain reaction(RT-qPCR)assays,followed by sequencing if the cycle threshold(Ct)value was<30.The positivity rate for SARS-CoV-2 in aerosol samples was high in contaminated zones(37.5%,104/277),especially around the bed(41.2%,68/165)and near ventilation inlets(45.2%,14/31).The prevalence of SARS-CoV-2 around the bed,public areas,and air inlets of exhaust vents fluctuated and was closely related to the positivity rate among patients at corresponding sampling sites.Some surface samples of different personal protective equipment from medical staff had high positivity rates.Sixty sequences of joined ORF1ab and spike genes obtained from sixty samples represented two main clusters of Omicron SARS-CoV-2.There was consistency in virus sequences from the same patient and their environment,and the detected virus sequences matched those of virus strains in circulation during the collection periods,which indicated a high likelihood of cross-contamination in the Fangcang shelter hospital.In summary,the results provide a quantitative and real landscape of the aerosol transmission of SARS-CoV-2 and a patient-centered view of contamination in large and enclosed spaces and offer a useful guide for taking targeted measures to avoid nosocomial infections during the management of SARS-CoV-2 or other respiratory virus diseases in a Fangcang shelter hospital.

Prevalence and associated factors of hospitalization for dysglycemia among elderly type 2 diabetes patients: A nationwide study

BACKGROUND The prevalence of older individuals with type 2 diabetes mellitus (T2DM) is increasing due to the aging population and improved medical care. These patients are very susceptible to disease and treatment-related hospitalizations, resulting in higher health care costs, morbidity, and decreased quality of life. However, data of treatment-related complications, especially dysglycemiarelated hospitalizations, are lacking. AIM To assess the prevalence and associated factors for dysglycemia-related hospitalizations among elderly diabetic patients in Thailand using nationwide patient sample. METHODS T2DM patients aged ≥ 65 years who received medical care at public hospitals in Thailand in the year 2014 were included. The prevalence of hospitalization due to dysglycemia within one year was examined. Multivariable logistic regression was performed to assess the independent factors associated with hospitalization due to hypoglycemia and hyperglycemia RESULTS A total of 11404 elderly T2DM patients were enrolled in this study. The mean age was 72.9 ± 5.5 years. The prevalence of hospital admissions due to diabetic ketoacidosis, hyperosmolar hyperglycemic state, hyperglycemic dehydration syndrome, and hypoglycemia among elderly T2DM patients in the year 2014 was 0.1%, 0.1%, 1.7% and 3.1%, respectively. Increased hospitalization due to hypoglycemia was associated with older age, female sex, had hypertension, dementia, lower body mass index, elevated hemoglobin A1C (HbA1C), decreased kidney function, insulin use. Increased hospitalization due to hyperglycemia was associated with dementia, depression, lower body mass index, elevated HbA1C, and insulin use. CONCLUSION The prevalence of dysglycemia-related hospitalization in elderly T2DM patients in Thailand was 4.9%. Close monitoring of blood glucose should be provided in high-risk patients for prevention and early detection for these complications.

Knowledge and attitude toward COVID-19 among healthcare workers at District 2 Hospital, Ho Chi Minh City

Objective:To assess the knowledge and attitude toward coronavirus disease-2019(COVID-19)among healthcare workers at District 2 Hospital in Ho Chi Minh City(HCMC).Methods:A cross-sectional study was performed between January 2020 and February 2020 at District 2 Hospital.A systematic random sampling strategy was carried out and the data was collected through a self-administered questionnaire of the knowledge and attitude of healthcare workers regarding COVID-19.Descriptive analysis was reported to describe the demographic,mean knowledge and attitude score of healthcare workers.Inferential statistics including t-test,ANOVA and Spearman’s correlation were used to evaluate the relationship between study variables.Results:A total of 327 eligible healthcare workers had a mean score of knowledge and attitude of 8.17±1.3(range 4-10)and 1.86±0.43(range 1-5),respectively.They showed good knowledge and a positive attitude.However,approximately two thirds of the participants knew the mode of transmission,the isolation period and treatment(67.0%,65.8%,and 58.4%,respectively),and 82.3%and 79.8%,respectively,held positive attitude regarding the risk of personal and family members getting illness.There was a negative correlation between knowledge scores and attitude scores(r=-0.21,P<0.001).Additionally,healthcare workerspredominately used social media to inform themselves about COVID-19(91.1%).Conclusions:The majority of healthcare workers had good knowledge and positive attitude toward COVID-19.However,the level of some knowledge and attitude lower than that expected for their position level towards the virus.Additional education interventions and campaigns are required for healthcare workers.

上海市某方舱医院2897例新型冠状病毒Omicron变异株轻型/无症状感染者住院时间影响因素分析

目的探讨上海市某方舱医院新型冠状病毒奥密克戎(Omicron)变异株轻型/无症状感染者住院时间的影响因素。方法回顾性收集上海宝山泾灿路(罗泾京东)方舱医院收治的2897例Omicron变异株轻型/无症状感染者的病历资料,分析其一般资料、住院时间等基本情况,探究不同特征的新冠病毒Omicron变异株感染者住院时间差异,采用多重线性回归方法分析住院时间的影响因素。根据单因素分析结果,采用二元logistic回归分析住院时间≥14 d可能的影响因素。结果2897例Omicron变异株轻型/无症状感染者的平均住院时间为(9.1±4.6)d,不同年龄段、入舱前核酸阳性时间以及伴有咳嗽、咳痰、咽痛、发热、流涕、鼻塞、口干咽燥、头痛、乏力、肌痛、腹泻、恶寒、恶心呕吐、头晕症状的感染者住院时间不同,差异具有统计学意义(P<0.05)。多重线性回归结果显示,年龄增加、患有糖尿病史以及咽痛、发热、流涕、肌痛症状会增加住院天数,而入舱前核酸阳性时间长则会减少住院天数。住院时间≥14 d者,高龄、糖尿病史以及出现咽痛、发热、口干咽燥、肌痛、恶心呕吐症状的占比更高,入舱前核酸阳性时间相对更短,接种2针及以上疫苗占比更低,差异具有统计学意义(P<0.05)。二元Logistic回归结果显示,高龄、入舱前核酸阳性时间短、糖尿病史以及发热和口干咽燥症状可能是导致住院时间超过14 d的危险因素,接种2针及以上疫苗可能是保护因素。结论Omicron变异株轻型/无症状感染者平均住院时间约为9 d,高龄、疫苗接种2针及以上、患有糖尿病史、入舱前核酸阳性时间短以及咽痛、发热、流涕、口干咽燥、肌痛等正气虚衰、病邪入里、化热伤阴表现对于住院时间可能产生重要影响。通过尽早识别核酸转阴慢、住院时间长的高危患者,以期为缩短核酸转阴时间、指导重点人群精准防控提供指导方向。

Financial Sustainability of the Japanese Medical Payment System: Analysis of the Japanese Medical Expenditure for Educational Hospitalization of Patients with Type 2 Diabetes

Japanese medical expenditures have increased rapidly in recent years and are predicted to continue rising. Indeed, it remains uncertain whether the current Japanese medical system can be sustained. In this paper, we analyzed the medical expenditures for educational hospitalization of patients with type 2 diabetes. A dataset of 6173 patients from 36 hospitals was used in the analysis. The sample period was from July 2008 to March 2012. We analyzed the medical expenditures in two ways. First, we analyzed the length of hospital stay (LOS). Next, we analyzed the daily expenditure per patient. The Box-Cox transformation model was used in the first analysis and the ordinary least squares method in the second. Comorbidities and complications prolonged LOS and increased daily expenditures. The LOS was significantly different among hospitals. On the other hand, the differences in daily expenditures among hospitals were relatively small, such that LOS was the main determinant of medical expenditures. Previous studies suggested that LOS could be shortened without degradation of medical quality. Moreover, LOS could be controlled by introducing proper critical paths and improving and standardizing educational programs. Hence, it would be possible to control the medical expenditures for this disease.

Comparison of the Length of Stay and Medical Expenditures among Japanese Hospitals for Type 2 Diabetes Treatments: The Box-Cox Transformation Model under Heteroscedasticity

In this paper, we analyzed length of stay (LOS) in hospitals and medical expenditures for type 2 diabetes patients. LOS was analyzed by the power Box-Cox transformation model when variances differed among hospitals. We proposed a new test and consistent estimator. We rejected the ho-moscedasticity of variances among hospitals, and then analyzed the LOS of 12,666 type 2 diabetes patients hospitalized for regular medical treatments collected from 60 general hospitals in Japan. The variables found to affect LOS were age, number of comorbidities and complications, introduced by another hospital, one-week hospitalization, 2010 revision, specific-hospitalization-period (SHP), and principal diseases E11.5, E11.6 and E11.7. There were surprisingly large differences in ALOS among hospitals even after eliminating the influence of characteristics and conditions of patients. We then analyzed daily medical expenditure (DME) by the ordinary least squares methods. The variables that affected DME were LOS, number of comorbidities and complications, acute hospitalization, hospital’s own outpatient, season, introduced by another hospital, one-week hospitalization, 2010 revision, SHP, time trend, and principal diseases E11.2, E11.4 and E117. The DME did not decrease after the SHP. After eliminating the influences of characteristics and conditions of patients, the differences among hospitals were relatively small, 12% of the overall average. LOS is the main determinant of medical expenditures, and new incentives to reduce LOS are needed to control Japanese medical expenditures. Since at least 99% of patients require medical care after leaving the hospital, systems that take proper care of patients for long periods of time after hospitalization are absolutely necessary for efficient treatment of diabetes.

Epidemiological characteristics of COVID-19 cases in a hotel Fangcang shelter hospital in Sanya

Objective:To analyze the epidemiological characteristics of COVID-19 cases(Omicron variant BA5.1.3)in a hotel Fangcang shelter hospital in Sanya,Hainan Province,and provide basis for optimizing epidemic prevention and control strategies.Methods:The epidemiological data of COVID-19 cases admitted to a hotel Fangcang shelter hospital in Sanya from August 10 to August 30 in 2022 were collected for descriptive epidemiological analysis.Results:By August 30,703 cases of COVID-19 had been treated in the hotel Fangcang shelter hospital.The epidemiological characteristics analysis showed that 328 cases were male,accounting for 46.7%,and 375 cases were female,accounting for 53.3%.The ratio of male to female was 0.87:1.The age range was 8 months to 85 years old,with a median of 37(20,49)years old.The majority of people aged 31-59 years old,accounting for 51.4%.Asymptomatic infection accounted for 39.8%,and mild infection accounted for 60.2%,the main clinical symptoms were cough 24.8%(105/423),fever 18.7%(79/423).8.8%of the infected people had a history of chronic basic diseases,and hypertension and diabetes were the most common.There were 416 infected patients discharged from hospital,and the median total hospital stay was 14(10,15)days.The proportion of people who did not receive COVID-19 vaccine was 10.1%,the proportion of people who completed one,two and three vaccination was 5.0%,36.3%and 48.6%respectively,and the proportion of people who completed two and three vaccinations among people ≥60 years old was only 10.1%and 8.8%.Conclusion:This strain was the novel coronavirus variant BA5.1.3,which was reported for the first time in China.It was more infectious and insidious,and generally susceptible to people of all ages.Therefore,it is necessary to strengthen personal prevention and control,and did a good job of external anti input and internal anti diffusion,and strengthen nucleic acid detection to realize timely detection and early treatment,and strengthen COVID-19 vaccination,to improve vaccination rate and reduce infection rate.

Did the Revision of the Japanese Medical Payment System Work Properly?—An Analysis of Averages and Variances of Length of Hospital Stay for Type 2 Diabetes Patients by Individual Hospital

We evaluated the effects of the 2010 revision of the medical payment system on the length of stay (LOS). In this analysis, we assessed not only the average length of stay (ALOS), but also variance of LOS at individual hospitals. We used a dataset of 18,641 type 2 diabetes patients collected from 51 general hospitals. The variables found to affect LOS were age, comorbidities, complications, acute hospitalization, introduced by other hospitals, winter, one-week hospitalization, specific hospitalization period, and principal diseases coded E11.5, E11.6 and E11.7. Although the effect was marginal, the 2010 revision did reduce ALOS, and the reduction was larger as ALOS became longer. On the other hand, we did not find that the variance of LOS within hospitals became smaller. The results of the study suggest that new incentives and assistance to hospitals to help them make efficient use of medical information are needed.

Investigation and analysis of lower extremity arterial disease in hospitalized elderly type 2 diabetic patients

Background:The risk of lower extremity arterial disease (LEAD) is increased in diabetic patients.LEAD in diabetic patients occurs earlier and is often more severe and diffuse;however,it is largely underdiagnosed and untreated.The purposes of this study were to investigate and analyze LEAD situation of hospitalized elderly type 2 diabetic patients.Methods:The ankle-brachial index (ABI) was used to screen LEAD in hospitalized elderly type 2 diabetic patients.The patients were divided into 5 groups based on the screening results:non-LEAD group and LEAD group;the LEAD group was divided into mild stenosis group,moderate stenosis group,and severe stenosis group.Results:The percentage of patients who had LEAD was 43%.Significant difference in age,diabetes duration,peak velocity,microalbuminuria,and vibratory sensory neuropathy was observed between patients with and without LEAD;regression analysis showed that urinary albumin and vibratory sensory neuropathy were independent risk factors for LEAD.Significant difference in age,body mass index (BMI),peak velocity,urinary albumin,and high-density lipoprotein cholesterol (HDL-C) was observed between mild stenosis group,moderate stenosis group,and severe stenosis group;regression analysis showed that urinary albumin,BMI,and HDL-C were independent risk factors for accelerating vascular stenosis.Conclusions:The incidence of LEAD in hospitalized elderly type 2 diabetic patients is high;age,diabetes duration,peak velocity,BMI,urinary microalbumin,vibratory sensory neuropathy,and HDL-C are the maior risk factors for LEAD.Active control of risk factors is helpful to reduce or delay LEAD.

医院-社区-家庭一体化护理对2型糖尿病患者自我管理效能、血糖控制效果的影响研究

目的研究医院-社区-家庭一体化护理对2型糖尿病患者自我管理效能、血糖控制的效果影响。方法简单随机选取2019年11月—2021年11月三明市第二医院收治的150例2型糖尿病患者作为研究对象,根据不同的护理方法分为两组,对照组(n=75)实施常规护理,观察组(n=75)实施医院-社区-家庭一体化护理。比较两组患者的自我管理能力、血糖控制水平、心理状态及护理满意度。结果观察组护理1个月、护理3个月后的自我管理效能均高于对照组,差异有统计学意义(P均<0.05)。护理干预前,两组患者的空腹血糖、糖化血红蛋白对比,差异无统计学意义(P均>0.05),观察组护理3个月后的空腹血糖、糖化血红蛋白指标均低于对照组,差异有统计学意义(P均<0.05)。护理后,两组患者的焦虑自评量表评分及抑郁自评量表评分均有所降低,且观察组低于对照组,差异有统计学意义(P均<0.05)。观察组总满意度为98.67%,高于对照组的89.33%,差异有统计学意义(χ^(2)=4.255,P<0.05)。结论采用“医院-社区-家庭”一体化护理模式对2型糖尿病患者进行护理干预,能够有效提高患者的自我管理能力和血糖水平,缓解其不良情绪,改善护理满意度。

Relationship between Atmospheric CO₂Concentration and Vegetation in a Hospital Area: The Policlinico Umberto I in Rome

The capability of the plants growing in the Policlinico Umberto I, one of the most important hospitals in Rome, to lower carbon dioxide (CO2) and air temperature was analyzed. The CO2 concentration inside and outside the hospital and traffic density in the streets surrounding the area was monitored monthly. Measurements of structural plant traits were carried out. The highest CO2 concentration was monitored in winter-spring (425 ± 8 ppm, mean value) when traffic density peaks, decreasing by 17% in summer. During the day-time, the highest CO2 concentration (433 ± 61 ppm, mean value) was measured in the first hours of the morning (9:00) decreasing by 12% from 11.00 to 13.00 in relationship with traffic density decreasing (p 0.05). Among the greening present in the hospital area, the “group of trees” plays an important role in lowering CO2 concentration compared to meadows. Moreover, outside the Policlinico air temperature was, on average, 17% higher compared to the inside. The results show the effectiveness of plants in improving air quality and suggest that greening traits may be used to realise an inventory available for tree planting programs to ameliorate the quality of life.

社区医院药学治疗管理服务对2型糖尿病患者的影响

目的探讨在社区医院2型糖尿病患者的治疗中,实施药学治疗管理服务对患者的影响。方法选取2021年5月至2023年1月在北京丰台区和义社区卫生服务中心就诊的86例2型糖尿病患者作为研究对象,采用随机数字表法将患者分为对照组和观察组,对照组接受常规药物干预,观察组接受社区医院药学治疗管理服务。对比用药依从性、不良反应发生率,统计管理前后血糖,并分析干预前后患者心理状态、生活质量。结果观察组患者用药依从性高于对照组,不良反应发生率低于对照组(P<0.05)。干预前,两组患者血糖水平无明显差异(P>0.05);干预后,观察组空腹血糖(FPG)、餐后2 h血糖(2 hPG)以及糖化血红蛋白(HbA1c)指标低于对照组(P<0.05)。干预前,两组患者SDS评分、SAS评分及QOL评分对比差异无统计学意义(P>0.05)。干预后,观察组SDS评分、SAS评分均低于对照组,QOL评分高于对照组(P<0.05)。结论2型糖尿病患者用药治疗过程中,展开社区医院药学治疗管理服务可提高其用药依从性,同时改善其血糖水平,避免血糖波动较大影响患者身心状态及生活质量。

老年住院2型糖尿病合并认知功能障碍病人防护最佳证据总结

目的:总结老年住院2型糖尿病(T2DM)合并认知功能障碍病人防护最佳证据,为医护人员、管理者、病人及家属临床实践提供参考。方法:采取研究对象-干预措施-专业人员-研究结局-证据应用场所-证据类型(PIPOST)模式构建循证问题,计算机检索苏格兰校际间指南网(SIGN)、英国国家临床医学研究所指南库(NICE)、JBI Summary、BMJ Best Practice、Up To Date、美国糖尿病协会(ADA)、国际糖尿病联盟(IDF)、Cochrane Library、PubMed、Embase、Web of Science、中国知网(CNKI)、万方、中国生物医学文献数据库(CBM)中关于老年住院T2DM合并认知功能障碍病人防护的所有证据,由2名研究者对纳入文献的质量进行独立评价,证据提取、综合。结果:最终纳入高质量文献7篇,包含指南1篇,系统评价2篇,基础综述1篇,类试验研究2篇,随机对照试验1篇,形成20条最佳证据。从认知功能障碍识别、危险因素、预防策略、综合护理措施4个方面以及综合护理措施包括的膳食指导、认知训练、心理护理、社区延伸护理、个性化护理措施、中医调摄护理、早期家庭干预7个维度进行阐述。结论:老年住院T2DM合并认知功能障碍病人认知功能障碍识别、危险因素、预防策略、综合护理措施4个方面的最佳证据能够为临床护理人员防护工作提供科学指导,满足不同状态老年住院T2DM病人认知功能障碍的防护与管理。

基于分类树模型的2型糖尿病患者住院费用影响因素研究

目的 采用分类树模型对佛山市某三级医院2型糖尿病患者住院费用进行影响因素分析,为医院控制医疗费用、优化资源配置、完善制度设计提供依据。方法 以该院2021年1月至12月出院的2型糖尿病患者为研究对象,采用χ2检验进行单因素分析,分类树模型进行多因素分析。结果 2型糖尿病患者住院费用的中位数为6 370.64元,诊断费用最高,药品费用居第2位。住院费用与住院天数、并发症数量、支付方式和入院途径有关。结论 2型糖尿病患者住院费用结构不合理,需要进一步优化,应通过缩短住院时间、提高医疗水平、加强宣传教育、制定相关政策来降低住院费用。

广西某三甲医院2017—2019年2型糖尿病患者住院费用分析

目的通过对广西某三甲医院2型糖尿病患者住院费用的构成和主要影响因素进行分析,为控制住院费用增长、减轻疾病经济负担、合理配置卫生资源提供参考。方法收集广西某三甲医院2017—2019年2325例2型糖尿病患者的住院费用资料,按照性别、年度、年龄、住院天数、报销类别及亚型分组进行描述性统计及方差分析。结果住院患者和费用整体呈增加趋势,费用增长幅度为28.07%。诊查费占比逐年增加,由53.92%增长至54.38%,药品费稳定占比30%左右。50~60岁年龄段例数最多且费用最高,住院天数越多,费用也越高。外埠医保病人的费用要高于本地医保组、自费组及其他组,不同报销类别之间费用具有差异性(F=7.746,P<0.001)。不同诊断亚目之间费用具有差异性(F=8.431,P<0.001)。结论2型糖尿病患者的住院费用与构成不合理、年龄、住院天数、报销类别及并发症类别等因素有关。应不断优化住院费用结构,规范临床路径,缩短住院时间,加强医保异地就医管理,提高全民预防意识,有效控制住院费用,合理分配医疗资源、降低疾病经济负担。

基于互联网的社区—医院一体化慢性病管理模式在2型糖尿病患者中的应用效果

目的:探讨基于互联网的社区—医院一体化慢性病管理模式在2型糖尿病患者中的应用效果。方法:2020年1—12月,选取上海市浦东新区塘桥社区卫生服务中心收治的2型糖尿病患者244例作为研究对象,将其随机分为对照组(n=122)和观察组(n=122)。对照组:给予患者常规糖尿病护理模式;观察组:在对照组常规糖尿病护理模式的基础上,给予患者基于互联网的社区—医院一体化慢性病管理模式。干预6个月后比较两组患者的健康管理效果。结果:干预后观察组患者的血糖、血脂及肾功能指标下降幅度均高于对照组,观察组患者自我管理行为各项评分提高幅度均高于对照组,观察组患者的生理领域、心理领域、环境领域、社会关系领域评分提高幅度均高于对照组。结论:基于互联网的社区—医院一体化慢性病管理模式可以显著改善2型糖尿病患者的血糖、血脂、肾功能指标,从而提高了患者的自我管理能力和生活质量。