Cronbach's a reliability, concurrent validity, and factorial structure of the Death Depression Scale in an Iranian hospital staff sample

Objective: Death depression is an important component in the process of death and dying. Death depression is the second element of death. Depression is one of the important features in death distress. The aim of this study was to explore the performance of the Farsi version of the Death Depression Scale with an Iranian convenience sample of nurses (n =106).Methods: Nurses were selected using a convenience sampling method, and completed the Death Depression Scale (DDS), Death Concern Scale (DCS), Collett-Lester Fear of Death Scale (CLFDS), Reasons for Death Fear Scale (RDFS), Templer's Death Anxiety Scale (DAS), and Death Obsession Scale (DOS). Results: The results of exploratory factor analysis on DDS identified 4 factors (56.16%of variance). Factor 1 labeled"Death sadness", Factor 2 labeled"Death finality/end and Death dread/fear", Factor 3 labeled"Death despair and Death depression", and Factor 4 labeled"Death loneliness". Cronbach's a coefficient was 0.84, Spearman-Brown coefficient 0.85, and Guttman Split-Half coefficient 0.81 The DDS correlated 0.40 with the DCS, 0.39 with the CLFDS, 0.50 with the DAS, 0.35 with the RDFS, and 0.44 with the DOS, indicating good construct and criterion-related validity. Concurrent validity for the DDS with the other scales were significant. Conclusions: The DDS has good validity and reliability, and it can use in clinical and research settings.

Development of Self-Rated Nursing Record Frequency for Delirium Care of Nurses in Acute Care Hospitals (NRDC-Acute)

Background: Nursing records play an important role in multidisciplinary collaborations in delirium care. This study aims to develop a self-rated nursing record frequency scale for delirium care among nurses in acute care hospitals (NRDC-Acute). Methods: A draft of the scale was developed after a literature review and meeting with researchers with experience in delirium care, and a master’s or doctoral degree in nursing. We identified 25 items on a 5-point Likert scale. Subsequently, an anonymous self-administered questionnaire survey was administered to 520 nurses from 41 acute care hospitals in Japan, and the reliability and validity of the scale were examined. Results: There were 232 (44.6%) respondents and 218 (41.9%) valid responses. The mean duration of clinical experience was 15.2 years (SD = 8.8). Exploratory factor analysis extracted 4 factors and 13 items for this scale. The model fit indices were GFI = 0.991, AGFI = 0.986, and SRMR = 0.046. The Cronbach’s alpha coefficient for the entire scale was .888. The four factors were named “Record of Pharmacological Delirium Care on Pro Re Nata (PRN)”, “Record of Non-Pharmacological Delirium Care”, “Record of Pharmacological Delirium Care on Regular Medication”, and “Record of Collaboration for Delirium Care”. Conclusion: The scale was relatively reliable and valid. Nurses in acute care hospitals can use this scale to identify and address issues related to the documentation of nursing records for delirium care.

Clinical Outcomes Associated with Use of Subcutaneous Sliding Scale Insulin Compared to Other Insulin Regimens in Hospitalized Patients

Background: Hyperglycemia in hospitalized patients is managed through one of the following approaches: sliding scale insulin (SSI) alone;SSI plus long-acting insulin and basal-bolus insulin (BBI). The optimal insulin treatment regimen is still debated. Objectives: To evaluate the clinical outcomes associated with the use of SSI compared to other regimens. Setting: The general medical wards in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Methods: Medical charts for adult patients admitted between October 2014-December 2015 with type 2 diabetes or uncontrolled hyperglycemia with insulin treatment were reviewed. Data from capillary blood glucose were measured daily for the first 5 days of hospitalization and recorded. Demographics and blood glucose levels were compared by group using one-way ANOVA or Chi-square test. The number of hyperglycemic/hypoglycemic episodes was analyzed using the Kruskal-Wallis test. Results: A total of 240 patients were included. The three insulin regimen groups were not statistically different in terms of the number of days with episodes of hyper- or hypoglycemia (p > 0.05). However, a significantly bigger change from baseline (improvement) in random blood glucose (RBG) levels was observed in BBI and SSI plus glargine patients compared to SSI (p = 0.014). Conclusion: Our study showed no significant difference in the number of days with episodes of hyper- or hypoglycemia for SSI vs. other insulin regimens. However, SSI patients had less improvement in their RBG levels compared to other insulin regimen groups. Further studies with a larger sample size are needed to confirm these findings.

Hospital-acquired insomnia scale:A validity and reliability study

BACKGROUND Sleep breathing,one of the basic human needs,is a physiological need that affects cardiac functions,body temperature,daily vitality,muscle tone,hormone secretion,blood pressure,and many more.In the international literature,studies reported that patients have had sleep problems in the hospital since the 1990s,but no measurement tool has been developed to determine the causes of hospitalacquired insomnia in individuals.These findings suggest that sleep remains in the background compared to activities such as nutrition and breathing.Although patients generally experience hospital-acquired sleep problems,there is no measurement tool to determine hospital-acquired sleep problems.These features show the originality of the research.AIM To develop a measurement tool to determine the sleep problems experienced by patients in the hospital.METHODS A personal information form,hospital-acquired insomnia scale(HAIS),and insomnia severity index(ISI)were used to collect research data.The study population consisted of patients hospitalized in the internal and surgical clinics of a research hospital in Turkey between December 2021 and March 2022.The sample consisted of 64 patients in the pilot application stage and 223 patients in the main application stage.Exploratory factor analysis and confirmatory factor analysis(CFA)analyses were performed using the SPSS 20 package program and the analysis of moment structure(AMOS)package program.Equivalent forms method used.RESULTS The HAIS consisted of 18 items and 5 subscales.The Cronbach alpha values of the subscales ranged between 0.672 and 0.842 and the Cronbach alpha value of the overall scale was 0.783.The scale explained 58.269%of the total variance.The items that constitute the factors were examined in terms of content integrity and named as physical environmental,psychological,safety,socioeconomic,and nutritional factors.CFA analysis of the 5-factor structure was performed in the AMOS package program.The fit indices of the obtained structure were examined.It was determined that the values obtained from the fit indices were sufficient.A significant correlation was determined between the HAIS and the ISI,which was used for the equivalent form method.CONCLUSION The HAIS is a valid and reliable measurement tool for determining patients’level of hospitalacquired insomnia.It is recommended to use this measurement tool to determine the insomnia problems of patients and to adapt it in other countries.

Effects of the Treatment of Carpal Tunnel Syndrome with Surgery and Injections on the Hospital Anxiety and Depression Scale (HADS)

Background: The prevalence of carpal tunnel syndrome (CTS) and of anxiety and depression in primary care practice are high. Different studies had shown an increased prevalence of anxiety and depression in CTS patients. Nevertheless, few papers had been published studying the anxiety and depression scales in the treatment of CTS, either with corticosteroid injections (I) or with surgical decompression (S). Objective: To assess whether clinical improvement observed after the treatment of CTS either with I or with S correlates with an improvement in the punctuations of the Hospital Anxiety and Depression scales (HADS), at 3, 6 and 12-month follow-up. Methods: Randomized and open-label clinical trial, comparing I and S. Patients with symptoms suggestive of CTS (nocturnal paraesthesias) of at least 3 months duration and neurophysiological confirmation were included. Patients with clinically apparent motor impairment were excluded. The subjective evaluation of symptoms was carried out using the visual-analogue scale of pain (VAS-p). Clinical reviews were performed 3, 6 and 12 months after treatment. Each patient completed the HADS questionnaire and a VAS-p at 0, 3, 6, and 12 months. Statistical significance was established using the Student’s t test and the Mann-Whitney U test when necessary. A linear regression analysis was used to know the effect of the treatment adjusted for the initial score of both scales. Results: 65 patients were included (30 in group I and 35 in group S). There was no statistical difference between both groups in terms of age, gender distribution, disease duration, VAS-p, neurophysiological testing severity of CTS or the 8 subscales of HADS. Both groups improved significantly in relation to the baseline VAS-p values, in the reviews at 3, 6 and 12 months, with no significant differences between I and S. At 6 months, the reduction in the anxiety scale was around 3 points for both treatments (S = 3.6 and I = 3.2), without reaching significant differences. At 12 months, it was somewhat higher for those treated with I, but always around 3 points and without significant differences. The Depression scale score was slightly reduced at 6 months, and in a similar way for both groups (I = 1 and S = 1.19;p = 0.8). After 12 months, group I doubled the previous reduction, with group S experiencing a very slight change (I = 1.96 and S = 1.03;p = 0.3). When analysing the effect of group S on group I, the result was a reduction of 0.25 points for Anxiety (p = 0.7) and of 0.02 points for Depression (p = 0.9). Conclusions: Treatment of CTS with I or S results in a similar and discrete improvement in Anxiety scores on the HADS scale at 6 and 12 months. For both types of treatment, the Depression scores barely changed at 6 months, being somewhat higher in group I after 12-month follow-up. The independent effect of the S on both scales is small and not significant.

Evaluation and Analysis of Hospital Disaster Preparedness in Jeddah

Introduction: Disaster damage to health systems is a human and health tragedy, results in huge economic losses, deals devastating blows to development goals, and shakes social confidence. Hospital disaster preparedness presents complex clinical operation. It is difficult philosophical challenge. It is difficult to determine how much time, money, and effort should be spent in preparing for an event that may not occur. Health facilities whether hospitals or rural health clinics, should be a source of strength during emergencies and disasters. They should be ready to save lives and to continue providing essential emergencies and disasters. Jeddah has relatively a level of disaster risk which is attributable to its geographical location, climate variability, topography, etc. This study investigates the hospital disaster preparedness (HDP) in Jeddah. Methods: Questionnaire was designed according to five Likert scales. It was divided into eight fields of 33 indicators: structure, architectural and furnishings, lifeline facilities’ safety, hospital location, utilities maintenance, surge capacity, emergency and disaster plan, and control of communication and coordination. Sample of six hospitals participated in the study and rated to the extent of disaster preparedness for each hospital disaster preparedness indicators. Two hazard tools were used to find out the hazards for each hospital. An assessment tool was designed to monitor progress and effectiveness of the hospitals’ improvement. Weakness was found in HDP level in the surveyed hospitals. Disaster mitigation needs more action including: risk assessment, structural and non-structural prevention, and preparedness for contingency planning and warning and evacuation. Conclusion: The finding shows that hospitals included in this study have tools and indicators in hospital preparedness but with lack of training and management during disaster. So the research shed light on hospital disaster preparedness. Considering the importance of preparedness in disaster, it is necessary for hospitals to understand that most of hospital disaster preparedness is built in the hospital system.

Relationship between Level of Knowledge on Anger Control and Occurrence of Real Assaultive Behaviour in Patients (20 - 45 Years) Admitted at a National Referral Psychiatric Hospital in Zimbabwe

Background: Aggressive tendencies from psychiatric inpatients are increasingly becoming problematic at a national referral psychiatric hospital in Zimbabwe. No research has been done in this context to determine the dynamics around this disturbing phenomenon. Objectives: To determine the level of knowledge on anger control, to determine the occurrence of real assaultive behaviour and to examine the relationship between level of knowledge on anger control and occurrence of real assaultive behaviour in patients aged 20 - 45 years admitted at a national referral psychiatric hospital in Zimbabwe. Method: A descriptive correlational design was used. Seventy-six respondents aged between 20 and 45 years were selected using simple random sampling. A structured interview was used to collect data. The occurrence of real assaultive behaviour was adapted from the Staff Observation and Aggression Scale completed by observing patients during the assaultive behaviour occurrence. Patient observation was done by the psychiatric trained nurses who were specifically trained for this study to fill the part of the data collection instrument that needed observation. Data were analysed using descriptive statistics, Pearson Correlation Coefficient test and simple regression analysis. Results: Results showed a Pearson coefficient test of (r = -3.47, p Conclusions: Results call for collaboration of mental health practitioners to empower patients with anger control skills.

Psychometric characteristics of the Reasons for Death Fear Scale among Iranian nurses

Objectives:Death fear is the main subject in thanatology.Several researchers have defined different reasons for fear of death.This study aimed to explore the performance of the Farsi version of the Reasons for Death Fear Scale(RDFS)among a convenience sample of Iranian nurses(n=106).Methods:The nurses were selected by the convenience sampling method and were asked to complete the RDFS,Death Concern Scale,Collett-Lester Fear of Death Scale,Death Anxiety Scale,Death Depression Scale,and Death Obsession Scale.Results:For the RDFS,the Cronbach's a coefficient was 0.90,and the 2-week test-retest reliability was 0.64.The RDFS was correlated at 0.34,0.39,0.50,0.35,and 0.39 to the above-mentioned five scales,indicating its good construct and criterion-related validity.Based on the exploratory factor analysis,the RDFS-identified four factors accounted for 66.20%of the variance and were labeled as"Fear of Pain and Punishment,""Fear of Losing Worldly Involvements,""Religious Transgressions and Failures,"and"Parting from Loved Ones."Conclusions:The RDFS presents good validity and reliability and can be used in clinical and research settings in Iran.

基于QoE理论的智慧医院平台可用性量表开发

目的基于体验质量(Quality of Experience,QoE)理论构建智慧医院平台可用性量表,为智慧医院建设提供科学测量工具。方法采用文献回顾、焦点会议法、预调查对量表条目进行筛选、修订,形成正式量表。便利选取山东省8所智慧医院平台的1000名用户进行调查,评价量表的信度和效度。结果智慧医院平台可用性量表包括6个维度24个条目。探索性因子提取出6个公因子:安全性、易用性、影响性、响应性、可靠性、灵活性。累计方差贡献率为64.045%,总体Cronbach’sα系数为0.941,6个维度的Cronbach’sα系数为0.782~0.963,重测信度为0.967。平均内容效度指数为0.972,条目水平内容效度指数为0.86~1.00。量表6个维度和系统可用性量表相关性系数为0.606~0.653,总体相关系数为0.647。结论基于QoE理论的智慧医院平台可用性量表具有较好的信度和效度,可作为用户对智慧医院平台体验情况的测量工具。

我国公立医院医生的价值医疗服务动机探究——概念建构与量表测度

健康中国建设行动彰显了以患者为中心的价值医疗理念,对医生医疗服务行为的价值诉求也日益提高。本研究试图将一般公共组织中公共服务动机概念引入公立医院之中,提出“价值医疗服务动机”概念,作为公立医院医生的一种公共服务动机表达。本文通过质性分析和量化测度,建构出“公立医院医生价值医疗服务动机”的概念,包含责任承诺、专业坚守、声誉维护、规范遵从四个概念维度,据此形成价值医疗服务动机量表。研究发现我国公立医院医生具有多维价值特征的医疗服务动机,呈现不同动机表达或行为倾向,在实现以患者为中心的价值医疗目标实践中,不断处理与平衡其中的公共价值冲突。该量表能够为测度医生价值医疗服务动机提供有效工具,为进一步发现医生价值医疗服务动机的影响因素,提升公立医院医疗服务能力、改善医疗行为、促进医患信任等提供理论与实践支持。

五种院前卒中筛查量表对院内急性大血管闭塞性缺血性卒中的预测价值

目的探讨并分析5种院前卒中筛查量表对院内急性大血管闭塞性缺血性卒中的预测价值。方法回顾性纳入2015年1月—2022年12月,因非卒中相关疾病收入东台市人民医院并在住院期间因疑似卒中症状激活院内卒中绿色通道的所有患者。采用ROC曲线评估筛查量表对院内急性大血管闭塞性缺血性卒中的预测价值。5种筛查量表分别为卒中现场评估和分类转运量表(field assessment stroke triage for emergency destination,FAST-ED)、快速动脉闭塞评估量表(rapid arterial occlusion evaluation,RACE)、洛杉矶运动量表(Los Angeles motor scale,LAMS)、辛辛那提院前卒中严重程度量表(Cincinnati prehospital stroke severity scale,CPSSS)和院前急性卒中严重程度量表(prehospital acute stroke severity scale,PASS)。结果本研究共纳入174例患者,其中54例(31.0%)患者诊断为急性大血管闭塞性缺血性卒中。RACE(AUC 0.888,95%CI 0.849~0.928)和LAMS(AUC 0.859,95%CI 0.812~0.905)对急性大血管闭塞性缺血性卒中的预测效能最高,其次是FAST-ED(AUC 0.820,95%CI 0.768~0.872)、CPSSS(AUC 0.810,95%CI 0.756~0.863)和PASS(AUC 0.786,95%CI 0.727~0.844),三者之间差异无统计学意义。结论院前卒中筛查量表在预测院内急性大血管闭塞性缺血性卒中方面均显示出良好的预测能力,其中RACE和LAMS的预测效能最高。

新制度经济学视角下我国公立医院规模增长解释框架研究

新医改以来,我国各级各类公立医院规模迅速增长,衍生出财政负担持续加重、卫生费用过快增长、社会基本医疗保险资金分布严重失衡等一系列问题。囿于对我国公立医院规模内涵和增长根源性动力认知的含混,传统经济学有关对我国公立医院规模增长的解释缺乏说服力。鉴于此,从新的经济学角度揭示我国公立医院规模增长的本质性驱动框架已成为指导我国公立医院下一阶段高质量发展的重大理论问题。采用复杂系统建模法测度了新医改以来我国公立医院规模增长状况;归纳了当代公立医院日渐复杂的制度谱系;借鉴新制度经济学制度自身成本和制度变迁成本的观点,从制度成本分析入手,提出在价格规制的前提下,公立医院通过规模增长补偿制度性成本是最佳策略;最后,围绕新医改以来,公立医院经历的囚徒困境博弈、猎鹿博弈、守规博弈三重情境,探明了我国公立医院规模从单体规模增长到延伸性规模增长、再到协同性规模增长的演进路径。

基于高质量发展的公立医院人才培养策略研究

近年公立医院如何结合医院发展战略及实际情况制定医学人才培养策略,已成为影响医院高质量发展的核心要素,而首都医科大学附属北京安贞医院原有的人事管理制度在人才培养方面体现不够明确,人力资源评价、薪酬管理体系及信息化平台管理方面有待提升。我们相继出台了一系列政策,各部门形成合力,联动推进院内人才培养项目的设立与开展,通过优化整合奖项申报、资金及平台支持、绩效激励等资源,强化人才培养体系建设,完善分层培养模式建设、构建医学人才评价管理制度、提出个性化培养策略;推进基于资源消耗的相对价值比率法人才绩效薪酬改革,针对医护技人才分类评价;加强信息化人才培养平台建设,构建人才数据库,加强医院人力资源线上管理能力。一系列措施的实施使得医院优势学科和综合实力稳步提升。

大型医院建设项目设计概算编制研究

大型医院建设项目是民用建筑项目中最为复杂的类型之一,在投资额度确定和管理控制方面存在一定难度。本文在系统总结大型医院建设项目的特点和设计概算编制程序的基础上,分析大型医院建设项目设计概算编制的重难点及应对措施,并提出设计概算“充裕性”分析理念,以期为同类项目设计概算编制提供经验借鉴。

患者及家属医院文化知晓与体验感量表研究

目的研究编制患者及家属医院文化知晓与体验感量表并验证信度和效度,为了解患者及家属医院文化体验感并促进医院文化建设提供测量工具。方法基于政策要求和实践需求,结合医院顾客满意度理论框架、文献梳理以及专家咨询论证形成量表。选取样本医院患者及家属进行调查,通过项目分析、探索性因子分析和Cronbach’sα系数等检验量表的信度和效度。结果量表包含服务感知、价值认可和文化知晓3个维度29个条目。项目分析结果显示:量表具有较好的区分度;总量表Cronbach’s α系数为0.975,Spearman-Brown系数为0.934,信度较好;探索性因子分析结果显示:共提取3个公因子,累计方差贡献率为76.61%,各因子载荷均大于0.4;验证性因子分析结果显示:模型拟合较好;各维度组合信度大于0.7,平均方差变异大于0.5,聚敛效度较好。结论量表具有较好的信度和效度,可用于量化评估患者及家属对医院文化的知晓和体验感,为从患者视角评价文化引领助力公立医院高质量发展状况提供科学工具。

医务人员医院文化认知与体验感量表研究

目的研究编制医务人员医院文化认知与体验感量表并检验其信、效度,为评估医务人员医院文化认知与体验感提供科学工具。方法参考丹尼森组织文化模型,结合政策文件、文献资料和专家咨询形成量表;选取某医院开展问卷调查,采用项目分析、探索性因子分析、Cronbach’s α系数等检验量表的信度和效度。结果总量表包含制度举措、从业感知、管理培训和使命担当4个子量表及43个条目。项目分析结果显示:量表具有较好的区分度;总量表Cronbach’s α系数为0.992,Spearman-Brown系数为0.979,信度较好;探索性因子分析结果显示:制度举措、从业感知和管理培训子量表均只有1个维度,方差贡献率分别为77.12%、76.33%和85.75%,使命担当子量表提取2个公因子,累计方差贡献率为91.34%,各因子载荷均大于0.4;验证性因子分析结果显示:模型拟合较好;各子量表与维度的平均方差变异大于0.5,组合信度大于0.7,聚敛效度较好。结论量表具有较好的信度和效度,可用于定量评估医务人员医院文化认知与体验感。

美国CDC社区老人跌倒风险自评量表与Morse跌倒评估量表在中国住院老年患者中的应用比较

目的 通过与中文版Morse跌倒评估量表(CMFS)对比,评估美国疾病预防与控制中心公布的社区老人跌倒风险自评量表(FRQ)在中国住院老年患者跌倒风险评估中的适用性。方法 本研究为横断面研究,采用便利抽样法,选取2023年1月至6月湖南省长沙市某三甲医院符合纳入及排除标准的420例住院老年患者为研究对象,收集患者一般资料、中文版FRQ(CFRQ)和CMFS评分及初次调查后90 d内的跌倒发生情况,分析受试者操作特征曲线、灵敏度、特异度、最佳临界值。结果 以“过去1年是否跌倒”为状态变量时,CFRQ和CMFS评分的受试者操作特征曲线下面积(AUC)值分别为0.829和0.767,当CFRQ和CMFS的最佳临界值分别为4.5分和47.5分时,约登指数分别为0.506和0.467,灵敏度分别为81.8%和51.9%,特异度分别为68.8%和94.8%。以“初次调查后90 d内的跌倒发生情况”为状态变量时,最佳临界值下的分组为检验变量时,CFRQ分组和CMFS分的AUC值分别为0.678和0.643,灵敏度分别为75.0%和41.7%,特异度分别为60.5%和87.0%。结论 与CMFS比较,CFRQ的诊断价值、真实性、灵敏度更好。

两种卒中筛查量表在脑卒中院前急救筛查中的应用价值分析

目的探讨两种卒中筛查量表在脑卒中院前急救筛查中的应用价值。方法202例通过急诊卒中绿色通道接诊的疑似脑卒中患者,按照院前急救中所选取的卒中筛查量表不同分为研究组和对照组,各101例。对照组采用辛辛那提院前卒中量表(CPSS)进行评估,研究组采用改良洛杉矶院前卒中筛查量表(MLAPSS)进行评估。以入院后神经专科医师意见及影像学检查作为最终诊断结果,比较两组筛查量表诊断时间、从呼救到治疗时间,不同筛查量表的诊断结果及诊断效能。结果全部患者经院前急救入院后,参考医生和影像学检查的诊断结果,发现对照组中有67例脑卒中患者,有34例非脑卒中患者;研究组中有72例脑卒中患者,有29例非脑卒中患者。研究组患者的筛查量表诊断时间以及从呼救到治疗时间比对照组稍长,但两组比较无统计学意义(P>0.05)。CPSS共筛查出脑卒中患者58例,非脑卒中患者43例。MLAPSS共筛查出脑卒中患者69例,非脑卒中患者32例。MLAPSS的准确度87.13%、灵敏度88.89%均高于CPSS的75.25%、74.63%,漏诊率11.11%低于CPSS的25.37%,差异存在统计学意义(P<0.05);两种筛查量表的特异度、误诊率比较无统计学意义(P>0.05)。结论在院前急救中筛查脑卒中疾病,CPSS和MLAPSS均有较高的临床价值,两种筛查量表比较,MLAPSS对脑卒中疾病的筛查价值更高,值得推广。

某三级甲等公立医院基层党支部考核评价探索

目的以党内法规为基础,优化某医院党支部工作评价指标体系,以多样化考核方法,使支部建设与医疗教学科研业务发展融合。方法采取文献检索及文本分析方法,搜索相关文献,以质性访谈及方便抽样方式,向医院的各层各级党代表发放问卷25份,回收有效问卷25份。运用Likert 5级评分法对遴选的74项考核指标按重要性进行打分评价。结果建立了一套包含5个一级指标、14个二级指标、53个三级指标的综合考核评价体系。结论现有的党支部综合量化考核体系得以优化,多样化的考评方法促使党支部建设的目标更加明确、清晰、规范,促进了引导激励作用。

临床衰弱指数对急性心肌梗死患者在院心脏康复后远期预后的预测价值

目的·探讨临床衰弱指数(Clinical Frailty Scale,CFS)对急性心肌梗死(acute myocardial infarction,AMI)患者在院心脏康复(cardiac rehabilitation,CR)后远期预后的预测价值。方法·序贯纳入2020年5月至2022年5月在上海交通大学医学院附属第六人民医院心脏中心接受诊治的501例AMI患者。采集患者基本临床信息,制定分级在院CR方案。根据患者出院前的CFS等级将患者分为3组,即正常(norm)组、脆弱(vulnerable)组和衰弱(frail)组,比较3组患者1年主要心血管事件率,包括全因死亡率及心力衰竭(心衰)再住院率。采用Logistic回归分析研究影响主要心血管事件率的危险因素,通过受试者操作特征(receiver operator characteristic,ROC)曲线分析各危险因素对主要心血管事件率的预测价值,建立最佳风险预测模型。结果·AMI患者在院CR后衰弱程度与高龄、B型利钠肽前体峰值(peak pro-B-type natriuretic peptide,peak proBNP)呈正比,与性别差异呈反比(P<0.05)。随患者衰弱程度增加,两种事件率均增高;其中全因死亡率(分别为2.6%、5.6%、15.2%)的组间差异有统计学意义(P=0.002),心衰再住院率(分别为19.6%、22.2%、24.2%)的组间差异无统计学意义。两两比较,frail组全因死亡率显著高于norm组(P=0.004),但vulnerable组与norm组的差异无统计学意义。CFS分级能够敏感预测AMI患者1年后的全因死亡风险(β=1.89,OR=6.61,P=0.001),且叠加CFS分级的风险模型预测效应最佳(AUC=0.845,P=0.000)。结论·接受在院CR的AMI患者出院前进行CFS分级,有助于识别1年内全因死亡风险较高的人群。