BACKGROUND Little is known about health status and quality of life(QoL)after implantable cardioverter-defibrillator(ICD)generator exchange(GE).METHODS We prospectively followed patients undergoing first-time ICD GE.Se...BACKGROUND Little is known about health status and quality of life(QoL)after implantable cardioverter-defibrillator(ICD)generator exchange(GE).METHODS We prospectively followed patients undergoing first-time ICD GE.Serial assessments of health status were performed by administering the 36-Item Short Form Survey(SF-36).RESULTS Mean age was 67.5±14.3 years,left ventricle ejection fraction(LVEF)was 36.5%±15.0%and over 40%of the cohort had improved LVEF to>35%at the time of GE.SF-36 scores were significantly worse in physical/general health domains compared to domains of emotional/social well-being(P<0.001 for each comparison).Physical health scores were significantly worse among those with medical comorbidities including diabetes,chronic obstructive pulmonary disease and atrial fibrillation.Mean follow-up was 1.6±0.5 years after GE.Overall SF-36 scores remained stable across all domains during follow-up.Survival at 3 years post-GE was estimated at 80%.Five patients died during follow-up and most deaths were adjudicated as non-arrhythmic in origin.Four patients experienced appropriate ICD shocks after GE,three of whom had LVEF which remains impaired LVEF(i.e.,<35%)at the time of GE.CONCLUSION Patients undergoing ICD GE have significantly worse physical health compared to emotional/social well-being,which is associated with the presence of medical comorbidities.In terms of clinical outcomes,the incidence of appropriate shocks after GE among those with improvement in LVEF is very low,and most deaths post-procedure appear to be non-arrhythmic in origin.These data represent an attempt to more fully characterize the spectrum of QoL and clinical outcomes after GE.展开更多
目的初步调查肺移植(lung transplant,LT)受者术后健康相关生活质量(health-related quality of life,HRQOL)的纵向变化特点,并分析影响因素。方法2022年10月至2023年12月,采用便利抽样法选取广州市某三级甲等医院收治的62例LT受者为研...目的初步调查肺移植(lung transplant,LT)受者术后健康相关生活质量(health-related quality of life,HRQOL)的纵向变化特点,并分析影响因素。方法2022年10月至2023年12月,采用便利抽样法选取广州市某三级甲等医院收治的62例LT受者为研究对象,分别于出院前1 d、术后3个月及6个月3个时间点采用简明健康调查量表(medical outcomes study 36-item short form health survey,SF-36)、广泛性焦虑障碍量表(generalized anxiety disorder-7,GAD-7)、患者健康问卷(patient health questionnaire-9,PHQ-9)、移植症状发生和症状困扰量表(modified transplant symptom occurrence and symptom distress scale,MTSOSD)对其开展纵向调查。结果62例LT受者3个时间点的SF-36总分中位数分别为37.39(24.48,50.29)、59.43(45.48,74.77)、66.86(44.38,83.66)分,随时间推移逐渐升高(P<0.05)。线性混合模型显示,年龄增长、付费方式、术后住院时间延长、抑郁情绪越重是LT受者HRQOL的危险因素(均P<0.05),原发疾病诊断、轻度经济负担是其HRQOL的保护因素(均P<0.05)。结论LT受者术后HRQOL随时间推移逐渐改善,医护人员应针对其年龄、经济负担程度、付费方式、抑郁情绪等因素,制订个体化干预措施,进一步改善其HRQOL。展开更多
Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management.It is a common requirement to reuse the data for clinical research.However,we have to face ...Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management.It is a common requirement to reuse the data for clinical research.However,we have to face challenges like the inconsistence of terminology in electronic health records (EHR) and the complexities in data quality and data formats in regional healthcare platform.In this paper,we propose methodology and process on constructing large scale cohorts which forms the basis of causality and comparative effectiveness relationship in epidemiology.We firstly constructed a Chinese terminology knowledge graph to deal with the diversity of vocabularies on regional platform.Secondly,we built special disease case repositories (i.e.,heart failure repository) that utilize the graph to search the related patients and to normalize the data.Based on the requirements of the clinical research which aimed to explore the effectiveness of taking statin on 180-days readmission in patients with heart failure,we built a large-scale retrospective cohort with 29647 cases of heart failure patients from the heart failure repository.After the propensity score matching,the study group (n=6346) and the control group (n=6346) with parallel clinical characteristics were acquired.Logistic regression analysis showed that taking statins had a negative correlation with 180-days readmission in heart failure patients.This paper presents the workflow and application example of big data mining based on regional EHR data.展开更多
To explore the application value of hemodialysis-related nursing sensitive indicators in improving the quality of hemodialysis.Methods Totally 40 outpatients undergoing dialysis treatment from January 2016 to December...To explore the application value of hemodialysis-related nursing sensitive indicators in improving the quality of hemodialysis.Methods Totally 40 outpatients undergoing dialysis treatment from January 2016 to December 2016 served as observation group.Another 40 outpatients who received dialysis from January 2015 to December 2015were selected as control group.Patients in control group received routine nursing and health education on hemodialysis,and those in observation group were given interventions based on nursing sensitive indicators.The hemodialysisrelated nursing sensitive indicators and satisfactory degree of patients on nursing service were compared between two groups.Results Observation group had a better outcome of hemodialysis nursing sensitive indicators compared with control group(observation group:Kt/V[1.30±0.06],Hb[115.0±4.8]g/L,serum Ca[2.31±0.06]mmoL/L,serum P[1.75±0.18]mmoL/L,product of Ca and P[30.95±0.58]mg2/dl,PTH[305±65]pg/mL.control group:Kt/V[1.18±0.07],Hb[99.0±5.2]g/L,serum Ca[2.52±0.07]mmoL/L,serum P[2.07±0.21]mmoL/L,product of Ca and P[39.75±0.74]mg2/dl,PTH[420±84]pg/mL.P<0.05 respectively.)The satisfactory degree of patients on nursing service was97.5%(39/40)in observation group and 80.0%(32/40)in the control group,with a significant difference(P<0.05).Conclusion Hemodialysis-related nursing sensitive indicators provide a scientific basis for nursing quality improvement in patients with hemodialysis,and also play a certain role in promoting high quality nursing service.展开更多
基金supported by a Pilot Translational&Clinical Studies Program grant from the National Center for Advancing Translational Studies of the National Institutes of Health(UL1TR002378)a FAME grant from the Emory University Department of Medicine。
文摘BACKGROUND Little is known about health status and quality of life(QoL)after implantable cardioverter-defibrillator(ICD)generator exchange(GE).METHODS We prospectively followed patients undergoing first-time ICD GE.Serial assessments of health status were performed by administering the 36-Item Short Form Survey(SF-36).RESULTS Mean age was 67.5±14.3 years,left ventricle ejection fraction(LVEF)was 36.5%±15.0%and over 40%of the cohort had improved LVEF to>35%at the time of GE.SF-36 scores were significantly worse in physical/general health domains compared to domains of emotional/social well-being(P<0.001 for each comparison).Physical health scores were significantly worse among those with medical comorbidities including diabetes,chronic obstructive pulmonary disease and atrial fibrillation.Mean follow-up was 1.6±0.5 years after GE.Overall SF-36 scores remained stable across all domains during follow-up.Survival at 3 years post-GE was estimated at 80%.Five patients died during follow-up and most deaths were adjudicated as non-arrhythmic in origin.Four patients experienced appropriate ICD shocks after GE,three of whom had LVEF which remains impaired LVEF(i.e.,<35%)at the time of GE.CONCLUSION Patients undergoing ICD GE have significantly worse physical health compared to emotional/social well-being,which is associated with the presence of medical comorbidities.In terms of clinical outcomes,the incidence of appropriate shocks after GE among those with improvement in LVEF is very low,and most deaths post-procedure appear to be non-arrhythmic in origin.These data represent an attempt to more fully characterize the spectrum of QoL and clinical outcomes after GE.
文摘目的初步调查肺移植(lung transplant,LT)受者术后健康相关生活质量(health-related quality of life,HRQOL)的纵向变化特点,并分析影响因素。方法2022年10月至2023年12月,采用便利抽样法选取广州市某三级甲等医院收治的62例LT受者为研究对象,分别于出院前1 d、术后3个月及6个月3个时间点采用简明健康调查量表(medical outcomes study 36-item short form health survey,SF-36)、广泛性焦虑障碍量表(generalized anxiety disorder-7,GAD-7)、患者健康问卷(patient health questionnaire-9,PHQ-9)、移植症状发生和症状困扰量表(modified transplant symptom occurrence and symptom distress scale,MTSOSD)对其开展纵向调查。结果62例LT受者3个时间点的SF-36总分中位数分别为37.39(24.48,50.29)、59.43(45.48,74.77)、66.86(44.38,83.66)分,随时间推移逐渐升高(P<0.05)。线性混合模型显示,年龄增长、付费方式、术后住院时间延长、抑郁情绪越重是LT受者HRQOL的危险因素(均P<0.05),原发疾病诊断、轻度经济负担是其HRQOL的保护因素(均P<0.05)。结论LT受者术后HRQOL随时间推移逐渐改善,医护人员应针对其年龄、经济负担程度、付费方式、抑郁情绪等因素,制订个体化干预措施,进一步改善其HRQOL。
文摘目的对ICU日记相关的meta分析进行整合,明确ICU日记对重症患者心理健康、睡眠质量及生活质量的影响,以期为ICU日记在我国推广应用提供参考依据。方法计算机检索PubMed、Embase、Cochrane Library、中国知网、万方数据库及维普中文期刊数据库中有关ICU日记对重症患者心理健康、睡眠质量及生活质量应用效果的meta分析,使用RevMan 5.4统计软件进行伞状meta分析。检索时间为建库至2023年5月23日,每项研究均由2名研究者独立根据纳入和排除标准进行评估,通过AMSTAR 2(a measure tool to assess systematic reviews-2)对纳入研究的方法学质量进行评估,采用推荐分级的评估、制定与评价(grades of recommendations assessment,development and evaluation,GRADE)系统对结局指标进行证据质量分级。结果共纳入10篇meta分析,包含107项原始研究、15131例研究对象。伞状meta分析结果显示,ICU日记对降低重症患者创伤后应激障碍[OR=0.58,95%CI(0.52,0.65),Z=9.38,P<0.01]、焦虑[OR=0.41,95%CI(0.29,0.56),Z=5.35,P<0.01]及抑郁[OR=0.56,95%CI(0.47,0.67),Z=6.43,P<0.01]的发生率有明显作用,在改善重症患者的睡眠质量[MD=-3.97,95%CI(-7.71,-0.23),P<0.05]及提高重症患者的健康相关生活质量[MD=11.16,95%CI(6.34,15.98),Z=4.54,P<0.01]方面,差异有统计学意义。结论基于现有证据,ICU日记干预可降低重症患者创伤后应激障碍、焦虑及抑郁的发生率,在改善其睡眠质量、提高其生活质量方面显示出积极效果。以期为ICU日记在我国的推广应用提供参考依据,为改善重症患者心理健康、睡眠质量和生活质量提供有益参考。
基金Supported by the National Major Scientific and Technological Special Project for"Significant New Drugs Development’’(No.2018ZX09201008)Special Fund Project for Information Development from Shanghai Municipal Commission of Economy and Information(No.201701013)
文摘Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management.It is a common requirement to reuse the data for clinical research.However,we have to face challenges like the inconsistence of terminology in electronic health records (EHR) and the complexities in data quality and data formats in regional healthcare platform.In this paper,we propose methodology and process on constructing large scale cohorts which forms the basis of causality and comparative effectiveness relationship in epidemiology.We firstly constructed a Chinese terminology knowledge graph to deal with the diversity of vocabularies on regional platform.Secondly,we built special disease case repositories (i.e.,heart failure repository) that utilize the graph to search the related patients and to normalize the data.Based on the requirements of the clinical research which aimed to explore the effectiveness of taking statin on 180-days readmission in patients with heart failure,we built a large-scale retrospective cohort with 29647 cases of heart failure patients from the heart failure repository.After the propensity score matching,the study group (n=6346) and the control group (n=6346) with parallel clinical characteristics were acquired.Logistic regression analysis showed that taking statins had a negative correlation with 180-days readmission in heart failure patients.This paper presents the workflow and application example of big data mining based on regional EHR data.
文摘To explore the application value of hemodialysis-related nursing sensitive indicators in improving the quality of hemodialysis.Methods Totally 40 outpatients undergoing dialysis treatment from January 2016 to December 2016 served as observation group.Another 40 outpatients who received dialysis from January 2015 to December 2015were selected as control group.Patients in control group received routine nursing and health education on hemodialysis,and those in observation group were given interventions based on nursing sensitive indicators.The hemodialysisrelated nursing sensitive indicators and satisfactory degree of patients on nursing service were compared between two groups.Results Observation group had a better outcome of hemodialysis nursing sensitive indicators compared with control group(observation group:Kt/V[1.30±0.06],Hb[115.0±4.8]g/L,serum Ca[2.31±0.06]mmoL/L,serum P[1.75±0.18]mmoL/L,product of Ca and P[30.95±0.58]mg2/dl,PTH[305±65]pg/mL.control group:Kt/V[1.18±0.07],Hb[99.0±5.2]g/L,serum Ca[2.52±0.07]mmoL/L,serum P[2.07±0.21]mmoL/L,product of Ca and P[39.75±0.74]mg2/dl,PTH[420±84]pg/mL.P<0.05 respectively.)The satisfactory degree of patients on nursing service was97.5%(39/40)in observation group and 80.0%(32/40)in the control group,with a significant difference(P<0.05).Conclusion Hemodialysis-related nursing sensitive indicators provide a scientific basis for nursing quality improvement in patients with hemodialysis,and also play a certain role in promoting high quality nursing service.
