Background Patients undergoing transcatheter aortic valve replacement(TAVR) are likely to be discharged to a location other than home. We aimed to determine the association between preoperative risk factors and non-ho...Background Patients undergoing transcatheter aortic valve replacement(TAVR) are likely to be discharged to a location other than home. We aimed to determine the association between preoperative risk factors and non-home discharge after TAVR. Methods Patients discharged alive after TAVR at three centers were identified from a prospectively maintained database randomly divided into 80% derivation and 20% validation cohorts. Logistic regression models were fit to identify preoperative factors associated with non-home discharge in the derivation cohort. Multivariable models were developed and a nomogram based risk-scoring system was developed for use in preoperative counseling. Results Between June 2012 and December 2018, a total of 1,163 patients had TAVR at three centers. Thirty-seven patients who died before discharge were excluded. Of the remaining 1,126 patients(97%) who were discharged alive, the incidence of non-home discharge was 25.6%(n = 289). The patient population was randomly divided into the 80%(n = 900) derivation cohort and 20%(n = 226) validation cohort. Mean ± SD age of the study population was 83 ± 8 years. In multivariable analysis, factors that were significantly associated with non-home discharge were extreme age, female sex, higher STS scores, use of general anesthesia, elective procedures, chronic liver disease, non-transfemoral approach and postoperative complications. The unbiased estimate of the C-index was 0.81 and the model had excellent calibration. Conclusions One out of every four patients undergoing TAVR is discharged to a location other than home. Identification of preoperative factors associated with non-home discharge can assist patient counseling and postoperative disposition planning.展开更多
<strong>Background:</strong> There are about 200,000 patients in China who need to undergo valve replacement surgery each year. With the promotion and application of the Fast-Track Surgery concept and the ...<strong>Background:</strong> There are about 200,000 patients in China who need to undergo valve replacement surgery each year. With the promotion and application of the Fast-Track Surgery concept and the increase in hospital bed turnover rate, the average hospital stay of patients undergoing CVR surgery has been significantly shortened, and thus the patients are still in the recovery stage rather than fully recovered when they are discharged from the hospital. Good preparation for discharge can improve patients’ post-discharge self-care ability, reduce the risk of re-admission, and save medical resources. <strong>Objective: </strong>To describe the status of readiness for hospital discharge among postoperative patients that have undergone CVR, and to explore its influencing factors.<strong> Methods:</strong> The general information questionnaire, the Readiness for Hospital Discharge Scale and the Quality of discharge Teaching Scale were utilized to investigate 130 post-CVR patients admitted to the Cardiothoracic Surgery Department of a tertiary A-Class hospital in Guangzhou from July 2019 to October 2020. <strong>Results: </strong>The Readiness for Hospital Discharge Scale was at a moderate level with a total score of 163.88 ± 39.082, while the Quality of Discharge Teaching Scale was also at a moderate level with a total score of 194.09 ± 40.643. Multiple linear regression analysis revealed that the quality of discharge guidance, gender, and occupation were the influencing factors of CVR patient’s readiness for hospital discharge. These three variables jointly explained 45.8% of the total variation. <strong>Conclusion: </strong>The level of CVR patients’ readiness for hospital discharge is at a moderate level, and the quality of discharge guidance positively affects patients’ readiness for discharge. Therefore, in clinical work, attention should be paid to patient discharge guidance. Personalized health education should be implemented to improve the quality of patient guidance.展开更多
With recent advancements in imaging modalities and techniques and increased recognition of the long-term impact of several structural heart disease interventions,the number of procedures has significantly increased.Wi...With recent advancements in imaging modalities and techniques and increased recognition of the long-term impact of several structural heart disease interventions,the number of procedures has significantly increased.With the increase in procedures,also comes an increase in cost.In view of this,efficient and cost-effective methods to facilitate and manage structural heart disease interventions are a necessity.Same-day discharge(SDD)after invasive cardiac procedures improves resource utilization and patient satisfaction.SDD in appropriately selected patients has become the standard of care for some invasive cardiac procedures such as percutaneous coronary interventions.This is not the case for the majority of structural heart procedures.With the coronavirus disease 2019 pandemic,safely reducing the duration of time spent within the hospital to prevent unnecessary exposure to pathogens has become a priority.In light of this,it is prudent to assess the feasibility of SDD in several structural heart procedures.In this review we highlight the feasibility of SDD in a carefully selected population,by reviewing and summarizing studies on SDD among patients undergoing left atrial appendage occlusion,patent foramen ovale/atrial septal defect closure,Mitra-clip,and trans-catheter aortic valve replacement procedures.展开更多
An experimental apparatus including a dipleg and a trickle valve was established to simulate the operation of a suspended dipleg-trickle valve system of cyclone used in fluid catalytic cracking(FCC)unit.The flow regim...An experimental apparatus including a dipleg and a trickle valve was established to simulate the operation of a suspended dipleg-trickle valve system of cyclone used in fluid catalytic cracking(FCC)unit.The flow regimes in the dipleg and the discharge modes in the trickle valve were studied by combining the observation of experimental phenomena with the analysis of transient pressure fluctuation.The results show that the flow regimes in the dipleg have two types-the dilute–dense phase coexisting falling flow and the dilute falling flow.Correspondingly,the trickle valve also has two discharge modes-the intermittent periodic dumping discharge and the continuous trickling discharge.The power spectrum density of pressure fluctuation displays that the gas–solids flow in the dipleg-trickle valve system is characterized by a low-frequency pulsation.The coherence coefficient explains the origin and propagation of pressure fluctuation in the system.Eventually,a map describing the flow regimes and discharge modes related to the operation parameters was proposed,which can provide a helpful guidance for the operation of cyclone dipleg-trickle valve system in FCC unit.展开更多
文摘Background Patients undergoing transcatheter aortic valve replacement(TAVR) are likely to be discharged to a location other than home. We aimed to determine the association between preoperative risk factors and non-home discharge after TAVR. Methods Patients discharged alive after TAVR at three centers were identified from a prospectively maintained database randomly divided into 80% derivation and 20% validation cohorts. Logistic regression models were fit to identify preoperative factors associated with non-home discharge in the derivation cohort. Multivariable models were developed and a nomogram based risk-scoring system was developed for use in preoperative counseling. Results Between June 2012 and December 2018, a total of 1,163 patients had TAVR at three centers. Thirty-seven patients who died before discharge were excluded. Of the remaining 1,126 patients(97%) who were discharged alive, the incidence of non-home discharge was 25.6%(n = 289). The patient population was randomly divided into the 80%(n = 900) derivation cohort and 20%(n = 226) validation cohort. Mean ± SD age of the study population was 83 ± 8 years. In multivariable analysis, factors that were significantly associated with non-home discharge were extreme age, female sex, higher STS scores, use of general anesthesia, elective procedures, chronic liver disease, non-transfemoral approach and postoperative complications. The unbiased estimate of the C-index was 0.81 and the model had excellent calibration. Conclusions One out of every four patients undergoing TAVR is discharged to a location other than home. Identification of preoperative factors associated with non-home discharge can assist patient counseling and postoperative disposition planning.
文摘<strong>Background:</strong> There are about 200,000 patients in China who need to undergo valve replacement surgery each year. With the promotion and application of the Fast-Track Surgery concept and the increase in hospital bed turnover rate, the average hospital stay of patients undergoing CVR surgery has been significantly shortened, and thus the patients are still in the recovery stage rather than fully recovered when they are discharged from the hospital. Good preparation for discharge can improve patients’ post-discharge self-care ability, reduce the risk of re-admission, and save medical resources. <strong>Objective: </strong>To describe the status of readiness for hospital discharge among postoperative patients that have undergone CVR, and to explore its influencing factors.<strong> Methods:</strong> The general information questionnaire, the Readiness for Hospital Discharge Scale and the Quality of discharge Teaching Scale were utilized to investigate 130 post-CVR patients admitted to the Cardiothoracic Surgery Department of a tertiary A-Class hospital in Guangzhou from July 2019 to October 2020. <strong>Results: </strong>The Readiness for Hospital Discharge Scale was at a moderate level with a total score of 163.88 ± 39.082, while the Quality of Discharge Teaching Scale was also at a moderate level with a total score of 194.09 ± 40.643. Multiple linear regression analysis revealed that the quality of discharge guidance, gender, and occupation were the influencing factors of CVR patient’s readiness for hospital discharge. These three variables jointly explained 45.8% of the total variation. <strong>Conclusion: </strong>The level of CVR patients’ readiness for hospital discharge is at a moderate level, and the quality of discharge guidance positively affects patients’ readiness for discharge. Therefore, in clinical work, attention should be paid to patient discharge guidance. Personalized health education should be implemented to improve the quality of patient guidance.
文摘With recent advancements in imaging modalities and techniques and increased recognition of the long-term impact of several structural heart disease interventions,the number of procedures has significantly increased.With the increase in procedures,also comes an increase in cost.In view of this,efficient and cost-effective methods to facilitate and manage structural heart disease interventions are a necessity.Same-day discharge(SDD)after invasive cardiac procedures improves resource utilization and patient satisfaction.SDD in appropriately selected patients has become the standard of care for some invasive cardiac procedures such as percutaneous coronary interventions.This is not the case for the majority of structural heart procedures.With the coronavirus disease 2019 pandemic,safely reducing the duration of time spent within the hospital to prevent unnecessary exposure to pathogens has become a priority.In light of this,it is prudent to assess the feasibility of SDD in several structural heart procedures.In this review we highlight the feasibility of SDD in a carefully selected population,by reviewing and summarizing studies on SDD among patients undergoing left atrial appendage occlusion,patent foramen ovale/atrial septal defect closure,Mitra-clip,and trans-catheter aortic valve replacement procedures.
基金the supports by the National Natural Science Foundation of China(Grant Nos.21776305,21978322)the China Petrochemical Joint Foundation(Grant No.U1862202)
文摘An experimental apparatus including a dipleg and a trickle valve was established to simulate the operation of a suspended dipleg-trickle valve system of cyclone used in fluid catalytic cracking(FCC)unit.The flow regimes in the dipleg and the discharge modes in the trickle valve were studied by combining the observation of experimental phenomena with the analysis of transient pressure fluctuation.The results show that the flow regimes in the dipleg have two types-the dilute–dense phase coexisting falling flow and the dilute falling flow.Correspondingly,the trickle valve also has two discharge modes-the intermittent periodic dumping discharge and the continuous trickling discharge.The power spectrum density of pressure fluctuation displays that the gas–solids flow in the dipleg-trickle valve system is characterized by a low-frequency pulsation.The coherence coefficient explains the origin and propagation of pressure fluctuation in the system.Eventually,a map describing the flow regimes and discharge modes related to the operation parameters was proposed,which can provide a helpful guidance for the operation of cyclone dipleg-trickle valve system in FCC unit.
