EDITOR’S NOTE: They returned With an upset mind. Once they set foot on the soil where they were born and brought up, they found themselves enveloped in familylike warmth. All these help ease their suspective mind.
Background Frailty is a new prognostic factor in cardiovascular medicine due to the aging and increasingly complex nature of elderly patients. It is useful and meaningful to prospectively analyze the manner in which f...Background Frailty is a new prognostic factor in cardiovascular medicine due to the aging and increasingly complex nature of elderly patients. It is useful and meaningful to prospectively analyze the manner in which frailty predicts short-term outcomes for elderly patients with acute coronary syndrome （ACS）. Methods Patients aged 〉 65 years, with diagnosis of ACS from cardiology department and geriatrics department were included from single-center. Clinical data including geriatrics syndromes were collected using Comprehensive Geriatrics Assessment. Frailty was defined according to the Clinical Frailty Scale and the impact of the co-morbidities on risk was quantified by the coronary artery disease （CAD）--specific index. Patients were followed up by clinical visit or telephone consultation and the median follow-up time is 120 days. Following-up items included all-cause mortality, unscheduled return visit, in-hospital and recurrent major adverse cardiovascular events. Multivariable regression survival analysis was performed using Cox regression. Results Of the 352 patients, 152 （43.18%） were considered frail according to the study instrument （5-7 on the scale）, and 93 （26.42%） were considered moderately or se- verely frail （6-7 on the scale）. Geriatrics syndromes including incontinence, fall history, visual impairment, hearing impairment, constipation, chronic pain, sleeping disorder, dental problems, anxiety or depression, and delirium were more frequently in frail patients than in non-frail patients （P = 0.000, 0.031, 0.009, 0.014, 0.000, 0.003, 0.022, 0.000, 0.074, and 0.432, respectively）. Adjusted for sex, age, severity of coro- nary artery diseases （left main coronary artery lesion or not） and co-morbidities （CAD specific index） by Cox survival analysis, frailty was found to be strongly and independently associated with risk for the primary composite outcomes： all-canse mortality [Hazard Ratio （HR） = 5.393; 95% CI： 1.477-19.692, P = 0.011] and unscheduled return visit （HR - 2.832; 95% CI： 1.140-7.037, P = 0.025）. Conclusions Comprehensive Geriatrics Assessment and Clinical Frail Scale were useful in evaluation of elderly patients with ACS. Frailty was strongly and independently associated with short-term outcomes for elderly patients with ACS.展开更多
BACKGROUND: Feedback on patient outcomes is invaluable to the practice of emergency medicine but examples of effective forms of feedback have not been well characterized in the literature. We describe one system of em...BACKGROUND: Feedback on patient outcomes is invaluable to the practice of emergency medicine but examples of effective forms of feedback have not been well characterized in the literature. We describe one system of emergency department(ED) outcome feedback called the return visit report(RVR) and present the results of a survey assessing physicians' perceptions of this novel form of feedback. METHODS: An Opinio web-based survey was conducted in 81 emergency physicians(EPs) at three EDs.RESULTS: Of the 81 physicians surveyed, 40(49%) responded. Most participants indicated that they frequently review their RVRs(83%), that RVRs are valuable to their practice of medicine(80%), and that RVRs alter their practice in future encounters(57%). Respondents reported seeking other forms of outcome feedback including speaking with other EPs(83%) and reviewing discharge summaries of admitted patients(87%). There was no correlation between demographic data and use of RVRs.CONCLUSION: EPs value RVRs as a form of feedback. RVRs could be improved by reducing the observational interval and optimizing report relevance and differential weighting.展开更多
文摘EDITOR’S NOTE: They returned With an upset mind. Once they set foot on the soil where they were born and brought up, they found themselves enveloped in familylike warmth. All these help ease their suspective mind.
文摘Background Frailty is a new prognostic factor in cardiovascular medicine due to the aging and increasingly complex nature of elderly patients. It is useful and meaningful to prospectively analyze the manner in which frailty predicts short-term outcomes for elderly patients with acute coronary syndrome （ACS）. Methods Patients aged 〉 65 years, with diagnosis of ACS from cardiology department and geriatrics department were included from single-center. Clinical data including geriatrics syndromes were collected using Comprehensive Geriatrics Assessment. Frailty was defined according to the Clinical Frailty Scale and the impact of the co-morbidities on risk was quantified by the coronary artery disease （CAD）--specific index. Patients were followed up by clinical visit or telephone consultation and the median follow-up time is 120 days. Following-up items included all-cause mortality, unscheduled return visit, in-hospital and recurrent major adverse cardiovascular events. Multivariable regression survival analysis was performed using Cox regression. Results Of the 352 patients, 152 （43.18%） were considered frail according to the study instrument （5-7 on the scale）, and 93 （26.42%） were considered moderately or se- verely frail （6-7 on the scale）. Geriatrics syndromes including incontinence, fall history, visual impairment, hearing impairment, constipation, chronic pain, sleeping disorder, dental problems, anxiety or depression, and delirium were more frequently in frail patients than in non-frail patients （P = 0.000, 0.031, 0.009, 0.014, 0.000, 0.003, 0.022, 0.000, 0.074, and 0.432, respectively）. Adjusted for sex, age, severity of coro- nary artery diseases （left main coronary artery lesion or not） and co-morbidities （CAD specific index） by Cox survival analysis, frailty was found to be strongly and independently associated with risk for the primary composite outcomes： all-canse mortality [Hazard Ratio （HR） = 5.393; 95% CI： 1.477-19.692, P = 0.011] and unscheduled return visit （HR - 2.832; 95% CI： 1.140-7.037, P = 0.025）. Conclusions Comprehensive Geriatrics Assessment and Clinical Frail Scale were useful in evaluation of elderly patients with ACS. Frailty was strongly and independently associated with short-term outcomes for elderly patients with ACS.
文摘BACKGROUND: Feedback on patient outcomes is invaluable to the practice of emergency medicine but examples of effective forms of feedback have not been well characterized in the literature. We describe one system of emergency department(ED) outcome feedback called the return visit report(RVR) and present the results of a survey assessing physicians' perceptions of this novel form of feedback. METHODS: An Opinio web-based survey was conducted in 81 emergency physicians(EPs) at three EDs.RESULTS: Of the 81 physicians surveyed, 40(49%) responded. Most participants indicated that they frequently review their RVRs(83%), that RVRs are valuable to their practice of medicine(80%), and that RVRs alter their practice in future encounters(57%). Respondents reported seeking other forms of outcome feedback including speaking with other EPs(83%) and reviewing discharge summaries of admitted patients(87%). There was no correlation between demographic data and use of RVRs.CONCLUSION: EPs value RVRs as a form of feedback. RVRs could be improved by reducing the observational interval and optimizing report relevance and differential weighting.
