American journal of medicine open最新文献_第3页

Collective Weakness and Fluidity in Weakness Status Associated With Basic Self-Care Limitations in Older Americans 美国老年人的集体乏力和乏力状态的不稳定性与基本自理能力受限有关

American journal of medicine open

Pub Date : 2024-01-22 DOI: 10.1016/j.ajmo.2024.100065

Ryan McGrath , Brenda M. McGrath , Soham Al Snih , Peggy M. Cawthon , Brian C. Clark , Halli Heimbuch , Mark D. Peterson , Yeong Rhee

Aims

To examine the associations of (1) absolute and normalized weakness cut-points, (2) collective weakness categories, and (3) changes in weakness status on future activities of daily living (ADL) limitations in older Americans.

Methods

The analytic sample included 11,656 participants aged ≥65 years from the 2006-2018 waves of the RAND Health and Retirement Study. ADL were self-reported. A handgrip dynamometer was used to measure handgrip strength (HGS). Males were classified as weak if their HGS was <35.5 kg (absolute), <0.45 kg/kg (body mass normalized), or <1.05 kg/kg/m² (body mass index [BMI] normalized); females were considered weak if their HGS was <20.0 kg, <0.337 kg/kg, or <0.79 kg/kg/m². Participants were similarly categorized as being below 1, 2, or all 3 absolute and normalized cut-points. These collective categories were also used to classify observed changes in weakness status over time (onset, persistent, progressive, recovery).

Results

Older Americans below absolute and normalized weakness cut-points had greater future ADL limitations odds: 1.34 (95% confidence interval [CI]: 1.22-1.47) for absolute, 1.36 (CI: 1.24-1.50) for BMI normalized, and 1.56 (CI: 1.41-1.73) for body mass normalized. Persons below 1, 2, or 3 cut-points had 1.36 (CI: 1.19-1.55), 1.60 (CI: 1.41-1.80), and 1.70 (CI: 1.50-1.92) greater odds for future ADL limitations, respectively. Those in each changing weakness classification had greater future ADL limitation odds: 1.28 (CI: 1.01-1.62) for onset, 1.53 (CI: 1.22-1.92) for persistent, 1.72 (CI: 1.36-2.19) for progressive, and 1.34 (CI: 1.08-1.66) for recovery.

Conclusions

The presence of weakness, regardless of cut-point and change in status over time, was associated with greater odds for future ADL limitations.

目的研究(1)绝对和归一化虚弱切点、(2)集体虚弱类别以及(3)虚弱状态变化对美国老年人未来日常生活活动（ADL）限制的影响。ADL均为自我报告。使用手握力计测量手握力（HGS）。如果男性的 HGS 为<35.5 kg（绝对值）、<0.45 kg/kg（体重正常化）或<1.05 kg/kg/m2（体重指数 [BMI] 正常化），则被归类为体力弱；如果女性的 HGS 为<20.0 kg、<0.337 kg/kg或<0.79 kg/kg/m2，则被视为体力弱。同样，参与者也被分为低于 1、2 或全部 3 个绝对值和归一化切点。这些集体类别也用于对观察到的虚弱状态随时间的变化进行分类（开始、持续、进行性、恢复）。结果低于绝对和正常化虚弱临界点的美国老年人未来ADL受限的几率更大：绝对值为 1.34（95% 置信区间 [CI]：1.22-1.47），BMI 正常化值为 1.36（CI：1.24-1.50），体重正常化值为 1.56（CI：1.41-1.73）。低于 1、2 或 3 个切点的人未来出现 ADL 受限的几率分别为 1.36（CI：1.19-1.55）、1.60（CI：1.41-1.80）和 1.70（CI：1.50-1.92）。在每个不断变化的虚弱分类中，未来 ADL 受限的几率都更大：结论无论切点和状态随时间的变化如何，存在虚弱都与未来ADL受限的几率增大有关。

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引用次数: 0

The Impact of Iron Deficiency on Disease Severity and Myocardial Function in Cardiac Amyloidosis 缺铁对心脏淀粉样变性疾病严重程度和心肌功能的影响

American journal of medicine open

Pub Date : 2023-12-19 DOI: 10.1016/j.ajmo.2023.100063

Pieter Martens , Lauren Ives , Christopher Nguyen , Deborah Kwon , Mazen Hanna , W. H. Wilson Tang

Background

Reduced cardiac energy is a hallmark feature of heart failure and is common in cardiac amyloidosis (CA) and can be aggravated by the presence of iron deficiency.

Methods

Retrospective analysis of a single tertiary care center CA registry. Prevalence of iron deficiency was determined based on two definitions: (1) Classic definition, ferritin < 100 µg/L irrespective of transferin saturation (TSAT) or ferritin between 100 and 300 µg/L with a TSAT < 20%, and (2) TSAT-based definition, TSAT < 20%.

Results

Out of a total of 393 CA patients who had a full set of iron indices (44% light chain [AL]-CA, 50% transthyretin [ATTR]-CA, remainder other or unspecified CA subtype), 56% had iron deficiency according to the classic definition and 58% according to the TSAT definition, with similar prevalence in AL-CA vs ATTR-CA (p = .135). Per both definitions 58% had anemia. Only the TSAT-based definition was associated with worse functional status (p = .039) and worse cardiac function. CA patients with a TSAT < 20% illustrated features of more pronounced right ventricular (RV) failure including lower TAPSE on echocardiography, lower RV ejection fraction and RV stroke volume index on CMR, increased right-sided filling pressures, lower pulmonary artery pulsatility index, and higher RAP/PCWP ratio by right heart catheterization. Neither the classic nor the TSAT-based definition was associated with a higher risk of all-cause mortality after covariate adjustment.

Conclusion

Iron deficiency is common in cardiac amyloidosis and, when identified with a TSAT < 20%, is associated with worse functional status and more pronounced RV disease, but not with a higher risk of all-cause mortality.

背景心脏能量下降是心力衰竭的一个标志性特征，在心脏淀粉样变性（CA）中很常见，缺铁可加重心力衰竭。铁缺乏症的患病率根据两种定义确定：(1) 经典定义，铁蛋白大于等于 100 微克/升，无论转铁蛋白饱和度（TSAT）如何，或铁蛋白在 100 至 300 微克/升之间，TSAT 大于等于 20%；(2) 基于 TSAT 的定义，TSAT 大于等于 20%。结果在393名具有全套铁指标的CA患者中（44%轻链[AL]-CA，50%转甲状腺素[ATTR]-CA，其余为其他或未指定的CA亚型），根据经典定义，56%患有铁缺乏症，根据TSAT定义，58%患有铁缺乏症，AL-CA与ATTR-CA的患病率相似（p = .135）。根据这两种定义，58% 的人患有贫血。只有基于 TSAT 的定义与较差的功能状态（p = .039）和较差的心脏功能有关。TSAT≥lt; 20% 的 CA 患者具有更明显的右心室 (RV) 功能衰竭特征，包括超声心动图上较低的 TAPSE、CMR 上较低的 RV 射血分数和 RV 搏出量指数、右侧充盈压升高、肺动脉搏动指数降低以及右心导管检查中较高的 RAP/PCWP 比值。结论铁缺乏在心脏淀粉样变性中很常见，当 TSAT≥lt; 20% 时，铁缺乏与更差的功能状态和更明显的 RV 病变有关，但与更高的全因死亡风险无关。

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引用次数: 0

Risk Prediction Models for Hospital Mortality in General Medical Patients: A Systematic Review. 普通内科病人住院死亡率风险预测模型:系统综述

American journal of medicine open

Pub Date : 2023-12-01 Epub Date: 2023-06-05 DOI: 10.1016/j.ajmo.2023.100044

Yousif M Hydoub, Andrew P Walker, Robert W Kirchoff, Hossam M Alzu'bi, Patricia Y Chipi, Danielle J Gerberi, M Caroline Burton, M Hassan Murad, Sagar B Dugani

Objective: To systematically review contemporary prediction models for hospital mortality developed or validated in general medical patients.

Methods: We screened articles in five databases, from January 1, 2010, through April 7, 2022, and the bibliography of articles selected for final inclusion. We assessed the quality for risk of bias and applicability using the Prediction Model Risk of Bias Assessment Tool (PROBAST) and extracted data using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist. Two investigators independently screened each article, assessed quality, and extracted data.

Results: From 20,424 unique articles, we identified 15 models in 8 studies across 10 countries. The studies included 280,793 general medical patients and 19,923 hospital deaths. Models included 7 early warning scores, 2 comorbidities indices, and 6 combination models. Ten models were studied in all general medical patients (general models) and 7 in general medical patients with infection (infection models). Of the 15 models, 13 were developed using logistic or Poisson regression and 2 using machine learning methods. Also, 4 of 15 models reported on handling of missing values. None of the infection models had high discrimination, whereas 4 of 10 general models had high discrimination (area under curve >0.8). Only 1 model appropriately assessed calibration. All models had high risk of bias; 4 of 10 general models and 5 of 7 infection models had low concern for applicability for general medical patients.

Conclusion: Mortality prediction models for general medical patients were sparse and differed in quality, applicability, and discrimination. These models require hospital-level validation and/or recalibration in general medical patients to guide mortality reduction interventions.

目的系统回顾针对普通内科病人开发或验证的当代住院死亡率预测模型：我们筛选了五个数据库中从 2010 年 1 月 1 日至 2022 年 4 月 7 日的文章，并筛选出最终纳入文章的参考文献。我们使用预测模型偏倚风险评估工具（PROBAST）评估了偏倚风险和适用性的质量，并使用预测模型研究系统性回顾的关键评估和数据提取清单（CHARMS）提取了数据。两名研究人员独立筛选每篇文章、评估质量并提取数据：从 20424 篇文章中，我们确定了 10 个国家 8 项研究中的 15 个模型。这些研究包括 280,793 名普通内科病人和 19,923 例医院死亡病例。模型包括 7 个预警评分、2 个合并症指数和 6 个组合模型。其中 10 个模型针对所有普通内科病人（普通模型），7 个针对有感染的普通内科病人（感染模型）。在这 15 个模型中，有 13 个是使用逻辑或泊松回归法开发的，2 个是使用机器学习方法开发的。此外，15 个模型中有 4 个报告了缺失值的处理方法。没有一个感染模型具有较高的区分度，而 10 个一般模型中有 4 个具有较高的区分度（曲线下面积大于 0.8）。只有 1 个模型对校准进行了适当的评估。所有模型的偏倚风险都很高；10 个普通模型中的 4 个和 7 个感染模型中的 5 个对普通内科病人的适用性关注度较低：结论：普通内科病人的死亡率预测模型数量稀少，且在质量、适用性和区分度方面存在差异。这些模型需要在普通内科病人中进行医院层面的验证和/或重新校准，以指导降低死亡率的干预措施。

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引用次数: 0

Predictors of All-Cause 30-Day Readmissions in Patients with Heart Failure at an Urban Safety Net Hospital: The Importance of Social Determinants of Health and Mental Health 城市安全网医院心力衰竭患者30天再入院的全因预测因素:健康和心理健康的社会决定因素的重要性

American journal of medicine open

Pub Date : 2023-09-30 DOI: 10.1016/j.ajmo.2023.100060

Alexandra B. Steverson MD, MPH , Paul J. Marano MD , Caren Chen MPH , Yifei Ma MS , Rachel J. Stern MD , Jean Feng MS, PhD , Efstathios D. Gennatas MBBS, PhD , James D. Marks MD, PhD , Matthew S. Durstenfeld MD, MAS , Jonathan D. Davis MD, MPHS , Priscilla Y. Hsue MD , Lucas S. Zier MD, MS

Introduction

Heart failure (HF) is a frequent cause of readmissions. Despite caring for underresourced patients and dependence on government funding, safety net hospitals frequently incur penalties for failing to meet pay-for-performance readmission metrics. Limited research exists on the causes of HF readmissions in safety net hospitals. Therefore, we sought to investigate predictors of 30-day all-cause readmission in HF patients in the safety net setting.

Methods

We performed a retrospective chart review of patients admitted for HF from October 2018 to April 2019. We extracted data on demographics and medical comorbidities and performed patient-specific review of social determinants and mental health in 4 domains: race/ethnicity, housing status, substance use, and mental illness. Multivariable Poisson regression modeling was employed to evaluate associations with 30-day all-cause readmission.

Results

The study population included 290 patients, among whom the mean age was 59 years and 71% (n = 207) were male; 42% (120) were Black/African American (AA), 22% (64) were Hispanic/Latino, and 96% (278) had public insurance; 28% (79) were not housed, 19% (56) had a diagnosis of mental illness, and active substance use was common. The 30-day readmission rate was 25.5% (n = 88). Factors that were associated with increased risk of readmission included self-identifying as Black/AA (relative risk 2.28, 95% confidence interval 1.00-5.20) or Hispanic/Latino (2.53, 1.07-6.00), experiencing homelessness (2.07, 1.21-3.56), living in a shelter (3.20, 1.27-8.02), or intravenous drug use (IVDU) (2.00, 1.08-3.70).

Conclusion

Race/ethnicity, housing status, and substance use were associated with increased risk of 30-day all-cause readmission in HF patients in a safety net hospital. In contrast to prior studies, medical comorbidities were not associated with increased risk of readmission.

心衰(HF)是再入院的常见原因。尽管照顾资源不足的病人并依赖政府资助，但安全网医院经常因未能达到按绩效付费的再入院指标而受到处罚。关于安全网医院HF再入院原因的研究有限。因此，我们试图研究在安全网设置下HF患者30天全因再入院的预测因素。方法对2018年10月至2019年4月收治的心衰患者进行回顾性图表分析。我们提取了人口统计学和医疗合并症的数据，并对种族/民族、住房状况、物质使用和精神疾病等4个领域的社会决定因素和精神健康进行了患者特异性回顾。采用多变量泊松回归模型评估与30天全因再入院的关系。结果共纳入290例患者，平均年龄59岁，男性占71% (n = 207);42%(120人)为黑人/非裔美国人(AA)， 22%(64人)为西班牙裔/拉丁裔，96%(278人)有公共保险;28%(79人)没有住房，19%(56人)被诊断患有精神疾病，积极使用药物很常见。30天再入院率为25.5% (n = 88)。与再入院风险增加相关的因素包括自认为是黑人/AA(相对风险2.28,95%置信区间1.00-5.20)或西班牙裔/拉丁裔(2.53,1.07-6.00)、无家可归(2.07,1.21-3.56)、住在收容所(3.20,1.27-8.02)或静脉吸毒(IVDU)(2.00, 1.08-3.70)。结论:种族/民族、住房状况和药物使用与安全网医院HF患者30天全因再入院风险增加相关。与先前的研究相反，医学合并症与再入院风险增加无关。

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引用次数: 0

Catatonia: A Narrative Review for Hospitalists 紧张症:对医院医生的叙述回顾

American journal of medicine open

Pub Date : 2023-09-28 DOI: 10.1016/j.ajmo.2023.100059

Alyssa C. Smith, Emily G. Holmes

Background

Catatonia is a complex psychomotor syndrome commonly associated with psychiatric disorders. However, hospitalists encounter this condition on medical floors, where it is typically due to an underlying medical, especially neurological, etiology. Delays in the diagnosis of catatonia are common and lead to worsened outcomes for patients, including a multitude of medical complications, such as venous thromboembolism and stasis ulcers. Catatonia due to a medical condition is less likely to respond to benzodiazepine therapy; identification and treatment of the underlying cause is crucial.

Methods

This article provides a practical review of the catatonia literature, with a focus on diagnosis, workup, and management of catatonia for patients admitted to medical hospitals.

Conclusions

With greater knowledge about catatonia, internists are uniquely positioned to recognize and initiate treatment.

背景强直是一种复杂的精神运动综合征，通常与精神障碍有关。然而，住院医生在医疗楼层遇到这种情况，通常是由于潜在的医学病因，尤其是神经病因。紧张症的诊断延迟是常见的，并导致患者的预后恶化，包括许多医疗并发症，如静脉血栓栓塞和淤滞性溃疡。由于某种疾病引起的强直不太可能对苯二氮卓类药物治疗产生反应；识别和治疗根本原因至关重要。方法本文对紧张症的文献进行了实用的回顾，重点介绍了入院患者的紧张症诊断、治疗和管理。结论内科医生对紧张症有了更多的了解，就可以识别并开始治疗。

引用次数: 0

Clinical Features and Impact on One Year Prognosis of Prescribing Low Doses of Direct Oral Anticoagulant Agents in a Middle Eastern Population with Atrial Fibrillation: Analysis from the Jordan Atrial Fibrillation Study 中东地区房颤患者直接口服低剂量抗凝药物的临床特点及对一年预后的影响:来自约旦房颤研究的分析

American journal of medicine open

Pub Date : 2023-09-24 DOI: 10.1016/j.ajmo.2023.100058

Ahmad Alayyat , Munir Zaqqa , Ayman Hammoudeh , Daria Jaarah , Mohammad Bahhour , Mohammed Nawaiseh , Imad Alhaddad

Introduction

Direct oral anticoagulant agents (DOACs) are indicated for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). Reduced doses of DOACs are indicated in patients who have renal impairment and according to age and weight criteria. The aim of this study was to investigate the frequency, clinical factors, and impact on 1-year prognosis of underdosing DOACs.

Methods

Data of patients enrolled in the Jordan AF (JoFib) study and who were followed for 1 year was used to compare patients prescribed standard dose with those who were underdosed.

Results

There were 672 patients (76.2%) who were prescribed standard dose and 210 patients (23.8%) who were underdosed. Baseline characteristics were similar between the 2 groups. Factors associated with underdosing were enrollment from an outpatient vs hospital site, moderate- or high-risk HAS-BLED score, an abnormal left ventricular ejection fraction (LVEF <50%), a history of heart failure, or current use of diuretics. At 1 year, the incidence of all-cause mortality was 12.2% in standard dose vs 13.3% in the underdose group (P = .82), stroke or systemic embolism was 3.6% in the standard dose vs 3.8% in the underdose group (P = .67), and major bleeding was 2.2% in the standard dose vs 3.3% in the underdose group (P = .35).

Conclusions

About (25%) of patients were underdosed. Factors associated with underdosing were outpatient (vs hospital) center enrollment, moderate- or high-risk HAS-BLED score, abnormal LVEF (<50%), history of heart failure, and current use of diuretics. There were no significant differences in the incidence of adverse events of mortality and major morbidity at 1-year follow-up between the standard dose and the underdose groups.

引言直接口服抗凝剂（DOAC）适用于非瓣膜性心房颤动（NVAF）患者的卒中预防。根据年龄和体重标准，肾功能受损的患者需要减少DOAC的剂量。本研究的目的是调查剂量不足的DOAC的频率、临床因素以及对1年预后的影响。结果672例（76.2%）患者服用标准剂量，210例（23.8%）患者服用不足。两组的基线特征相似。与剂量不足相关的因素包括门诊与医院的登记、中高风险HAS-BLED评分、左心室射血分数异常（LVEF＜50%）、心力衰竭史或目前使用利尿剂。1年时，标准剂量组全因死亡率为12.2%，低于剂量组为13.3%（P=.82），标准剂量的中风或全身栓塞发生率为3.6%，低于剂量的组为3.8%（P=.67），严重出血发生率为2.2%，低于剂量（P=.35）组为3.3%。与给药不足相关的因素包括门诊（与医院）中心登记、中高风险HAS-BLED评分、LVEF异常（<；50%）、心力衰竭史和目前利尿剂的使用情况。在1年随访中，标准剂量组和剂量不足组的死亡率和主要发病率的不良事件发生率没有显著差异。

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引用次数: 0

The Impact of Online vs Blended Clinical Skill Laboratory Learning on Student Academic Performance: A Case Study in Indonesia. 在线与混合临床技能实验室(CSL)学习对学生学业成绩的影响:印度尼西亚的案例研究

American journal of medicine open

Pub Date : 2023-08-26 eCollection Date: 2023-12-01 DOI: 10.1016/j.ajmo.2023.100054

Zulvikar Syambani Ulhaq, Ferry Nur Nasyroh, Amalia Nur Aisa, Achmad Arief Hidayatullah, Lola Ayu Istifiani, Syafrizal Aji Pamungkas, Achmad Rilyadi Sholeh, Gita Vita Soraya

Objective: Online and blended learning methods have experienced rapid growth in higher education due to the COVID-19 pandemic. Our study aimed to compare students' academic performance between online and blended Clinical Skill Laboratories (CSL) learning in undergraduate medical students.

Methods: A total of 101 undergraduate medical students at Maulana Malik Ibrahim State Islamic University, Malang, Indonesia, were enrolled (50 students from the academic year 2020 [group 1: online CSL]; 51 students from the academic year 2020 [group 2: blended CSL]). The main outcome was students' academic performance collected from the Objective Structured Clinical Examination (OSCE) score. Additionally, students also completed an evaluation questionnaire to assess the quality of the learning scheme.

Results: Both groups agreed that CSL is an important subject and clinical video demonstration is useful for their OSCE preparation. However, students who received online learning felt that online CSL was ineffective and scored lower in the OSCE compared to the blended CSL. Qualitative data also supported these findings.

Conclusion: Blended learning provides more value than online learning in terms of teaching clinical skills for undergraduate medical students. Additionally, online CSL may not be sufficient for medical students to attain critical skills.

目的：由于 COVID-19 的流行，在线和混合式学习方法在高等教育中得到了快速发展。我们的研究旨在比较医学本科生在线学习和混合式临床技能实验室（CSL）学习的学生学业成绩：印度尼西亚玛琅毛拉纳-马利克-易卜拉欣国立伊斯兰大学（Maulana Malik Ibrahim State Islamic University, Malang, Indonesia）共招收了101名医学本科生（2020学年50人[第一组：在线CSL]；2020学年51人[第二组：混合CSL]）。主要结果是从客观结构化临床考试（OSCE）成绩中收集的学生学习成绩。此外，学生还填写了一份评估问卷，以评估学习计划的质量：结果：两组学生都认为 CSL 是一门重要的学科，临床视频演示对他们的 OSCE 准备很有帮助。然而，与混合式 CSL 相比，接受在线学习的学生认为在线 CSL 效果不佳，在 OSCE 中得分较低。定性数据也支持这些发现：结论：就本科医学生的临床技能教学而言，混合式学习比在线学习更有价值。此外，在线 CSL 可能不足以让医学生获得关键技能。

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引用次数: 0

The Impact of Online vs Blended Clinical Skill Laboratory Learning on Student Academic Performance: A Case Study in Indonesia 在线与混合临床技能实验室学习对学生学业成绩的影响:印度尼西亚的案例研究

American journal of medicine open

Pub Date : 2023-08-26 DOI: 10.1016/j.ajmo.2023.100054

Zulvikar Syambani Ulhaq , Ferry Nur Nasyroh , Amalia Nur Aisa , Achmad Arief Hidayatullah , Lola Ayu Istifiani , Syafrizal Aji Pamungkas , Achmad Rilyadi Sholeh , Gita Vita Soraya

Objective

Online and blended learning methods have experienced rapid growth in higher education due to the COVID-19 pandemic. Our study aimed to compare students’ academic performance between online and blended Clinical Skill Laboratories (CSL) learning in undergraduate medical students.

Methods

A total of 101 undergraduate medical students at Maulana Malik Ibrahim State Islamic University, Malang, Indonesia, were enrolled (50 students from the academic year 2020 [group 1: online CSL]; 51 students from the academic year 2020 [group 2: blended CSL]). The main outcome was students’ academic performance collected from the Objective Structured Clinical Examination (OSCE) score. Additionally, students also completed an evaluation questionnaire to assess the quality of the learning scheme.

Results

Both groups agreed that CSL is an important subject and clinical video demonstration is useful for their OSCE preparation. However, students who received online learning felt that online CSL was ineffective and scored lower in the OSCE compared to the blended CSL. Qualitative data also supported these findings.

Conclusion

Blended learning provides more value than online learning in terms of teaching clinical skills for undergraduate medical students. Additionally, online CSL may not be sufficient for medical students to attain critical skills.

由于新冠肺炎大流行，在线和混合学习方法在高等教育中经历了快速增长。我们的研究旨在比较医学本科生在线学习和混合临床技能实验室（CSL）学习的学生学习成绩。方法共有101名印度尼西亚马朗Maulana Malik Ibrahim国立伊斯兰大学的医学本科生入学（2020学年50名学生[第一组：在线CSL]；2020学年51名学生[第二组：混合CSL]）。主要结果是从目标结构化临床考试（OSCE）分数中收集的学生的学习成绩。此外，学生们还完成了一份评估问卷，以评估学习计划的质量。结果两组都认为CSL是一个重要的课题，临床视频演示对其欧安组织的准备工作很有用。然而，接受在线学习的学生认为在线CSL无效，与混合CSL相比，在欧安组织中得分更低。定性数据也支持这些发现。结论在医学本科生临床技能教学方面，混合学习比在线学习更有价值。此外，在线CSL可能不足以让医学生获得关键技能。

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引用次数: 0

Trends and Outcomes of Interhospital Transfer for High-Risk Acute Pulmonary Embolism: A Nationwide Analysis 高危急性肺栓塞院间转院的趋势和结果:一项全国性分析

American journal of medicine open

Pub Date : 2023-08-25 DOI: 10.1016/j.ajmo.2023.100053

Ramy Sedhom , Rafail Beshai , Ahmed Elkaryoni , Michael Megaly , Ayman Elbadawi , Ahmed Athar , Wissam Jaber , Aditya S. Bharadwaj , Vinoy Prasad , Liset Stoletniy , Islam Y. Elgendy

Background

Data on outcomes of patients with high-risk acute pulmonary embolism (PE) transferred from other hospitals are scarce.

Methods

We queried the Nationwide Readmissions Database for admissions who were ≥18 years old, and with a primary discharge diagnosis of acute high-risk PE between the years 2016 and 2019. The main outcome of interest was the difference in all-cause in-hospital mortality between patients admitted directly to small/medium hospitals; patients admitted directly to large hospitals; and patients transferred to large hospitals.

Results

Among 11,341 weighted hospitalizations with high-risk PE, 631 (5.6%) patients were transferred to large hospitals. There was no significant change in the rates of transfer during the study period. Transferred patients were younger and had a higher prevalence of comorbidities. They were more likely to present with saddle PE and cor pulmonale and were more likely to receive advanced therapies. In-hospital mortality was not different between patients transferred to large hospitals and those admitted directly to large hospitals (adjusted odd ratio [OR] 1.11, 95% confidence interval [CI] 0.81, 1.54) as well as between patients transferred to large hospitals and those admitted directly to small/medium hospitals (aOR 1.28, 95% CI 0.92, 1.76). The rates of major bleeding and cardiac arrest were higher among transferred patients. Admissions for transferred patients were associated with higher cost and longer length of stay.

Conclusion

Transferred patients with high-risk PE were more likely to receive advanced therapies. There was no difference in-hospital mortality rates compared with patients admitted directly to the large or small/medium hospitals.

背景:从其他医院转来的高风险急性肺栓塞(PE)患者的预后数据很少。方法:我们在全国再入院数据库中查询了2016年至2019年期间入院的≥18岁且初步出院诊断为急性高危PE的患者。研究的主要结局是直接入住中小型医院的患者的全因住院死亡率的差异;直接入住大医院的患者;病人被转移到大医院。结果11341例高危PE加权住院患者中，631例(5.6%)转移至大医院。在研究期间，转移率没有显著变化。转院患者较年轻，合并症发生率较高。他们更有可能出现鞍型PE和肺心病，也更有可能接受先进的治疗。转到大医院的患者与直接入住大医院的患者住院死亡率无差异(调整奇数比[OR] 1.11, 95%可信区间[CI] 0.81, 1.54)，转到大医院的患者与直接入住中小型医院的患者住院死亡率无差异(aOR 1.28, 95% CI 0.92, 1.76)。转院患者大出血和心脏骤停的发生率较高。转院病人的入院费用较高，住院时间较长。结论高危PE转移患者接受先进治疗的可能性较大。与直接入住大医院或中小型医院的患者相比，住院死亡率没有差异。

{"title":"Trends and Outcomes of Interhospital Transfer for High-Risk Acute Pulmonary Embolism: A Nationwide Analysis","authors":"Ramy Sedhom , Rafail Beshai , Ahmed Elkaryoni , Michael Megaly , Ayman Elbadawi , Ahmed Athar , Wissam Jaber , Aditya S. Bharadwaj , Vinoy Prasad , Liset Stoletniy , Islam Y. Elgendy","doi":"10.1016/j.ajmo.2023.100053","DOIUrl":"10.1016/j.ajmo.2023.100053","url":null,"abstract":"<div><h3>Background</h3><p>Data on outcomes of patients with high-risk acute pulmonary embolism (PE) transferred from other hospitals are scarce.</p></div><div><h3>Methods</h3><p>We queried the Nationwide Readmissions Database for admissions who were ≥18 years old, and with a primary discharge diagnosis of acute high-risk PE between the years 2016 and 2019. The main outcome of interest was the difference in all-cause in-hospital mortality between patients admitted directly to small/medium hospitals; patients admitted directly to large hospitals; and patients transferred to large hospitals.</p></div><div><h3>Results</h3><p>Among 11,341 weighted hospitalizations with high-risk PE, 631 (5.6%) patients were transferred to large hospitals. There was no significant change in the rates of transfer during the study period. Transferred patients were younger and had a higher prevalence of comorbidities. They were more likely to present with saddle PE and cor pulmonale and were more likely to receive advanced therapies. In-hospital mortality was not different between patients transferred to large hospitals and those admitted directly to large hospitals (adjusted odd ratio [OR] 1.11, 95% confidence interval [CI] 0.81, 1.54) as well as between patients transferred to large hospitals and those admitted directly to small/medium hospitals (aOR 1.28, 95% CI 0.92, 1.76). The rates of major bleeding and cardiac arrest were higher among transferred patients. Admissions for transferred patients were associated with higher cost and longer length of stay.</p></div><div><h3>Conclusion</h3><p>Transferred patients with high-risk PE were more likely to receive advanced therapies. There was no difference in-hospital mortality rates compared with patients admitted directly to the large or small/medium hospitals.</p></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"10 ","pages":"Article 100053"},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48559756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Randomized Controlled Trial of Acupressure for Perception of Stress and Health-Related Quality of Life Among Health Care Providers During the COVID-19 Pandemic: The Self-Acupressure for Stress (SAS) Trial 穴位按压对COVID-19大流行期间卫生保健提供者压力感知和健康相关生活质量的随机对照试验:自我穴位按压压力(SAS)试验

American journal of medicine open

Pub Date : 2023-08-25 DOI: 10.1016/j.ajmo.2023.100056

Ryan Abbott , Edward Kwok-Ho Hui , Lan Kao , Vincent Tse , Tristan Grogan , Betty L. Chang , Ka-Kit Hui

Background

The efficacy of providing self-acupressure educational materials in reducing stress and improving health-related quality of life (HRQOL) is uncertain. Evidence-based data to recommend for or against self-acupressure as an intervention for reducing stress and improving HRQOL is needed.

Objective

The Self-Acupressure for Stress (SAS) trial evaluates whether providing self-acupressure educational materials would reduce stress and improve HRQOL among health care providers (HCPs).

Design

Randomized behavioral clinical trial.

Setting

The entire study took place remotely.

Participants

One hundred fifty-nine adult HCPs with no prior experience or training in acupressure.

Intervention

The intervention group received self-acupressure educational materials.

Measurements

Primary outcomes were perception of stress measured by the Perceived Stress Scale (PSS), as well as scores on the physical and mental components of the 12-item Short Form Health Survey version 2 (SF-12v2).

Results

From the baseline to midpoint evaluations, the intervention group significantly reduced their PSS score (P ≤ .001) and increased their SF-12v2 Mental score (P = .002) but not their SF-12v2 Physical score (P = .55). These findings persisted at the final follow-up (both PSS and SF-12v2 Mental changes from baseline P < .001). However, the control group also significantly improved their SF-12v2 Mental from baseline to midpoint (P = .01) which was maintained at final follow-up (P = .02), whereas PSS and SF-12v2 Physical did not significantly change from baseline at either mid or final. Finally, the intervention group improved by significantly more than the control group from baseline to final follow-up for both PSS (P = .007) and SF-12v2 Mental (P = .02) HRQOL measures.

Limitation

The trial was not blinded.

Conclusion

Among HCPs during the coronavirus disease 2019 (COVID-19) pandemic, the provision of self-acupressure educational materials safely improved self-reported assessments of perception of stress and mental health. Self-acupressure represents a promising intervention for other populations. The study findings support the use of self-acupressure to reduce stress and improve HRQOL.

Trial Registration

ClinicalTrials.gov: NCT04472559.

背景:提供自我指压教育材料在减轻压力和改善健康相关生活质量(HRQOL)方面的效果尚不确定。需要循证数据来推荐或反对自我穴位按压作为减轻压力和改善HRQOL的干预措施。目的通过自我穴位按压减压(SAS)试验，评价提供自我穴位按压教材是否能减轻医护人员(HCPs)的压力并改善其HRQOL。设计随机行为临床试验。整个研究都是远程进行的。参与者:159名成人HCPs，没有穴位按压的经验或训练。干预组接受自我指压教育材料。主要结果是通过感知压力量表(PSS)测量的压力感知，以及12项简短健康调查第2版(SF-12v2)的生理和心理部分得分。结果从基线到中点，干预组患者PSS评分显著降低(P≤0.001)，SF-12v2心理评分显著升高(P = 0.002)， SF-12v2生理评分无显著升高(P = 0.55)。这些发现在最后的随访中持续存在(PSS和SF-12v2从基线P和lt的心理变化;措施)。然而，对照组的SF-12v2 Mental从基线到中点也有显著改善(P = 0.01)，并在最终随访时保持(P = 0.02)，而PSS和SF-12v2 Physical在中期和最终随访时均无显著变化。最后，干预组的PSS (P = .007)和SF-12v2 Mental (P = .02) HRQOL指标从基线到最终随访的改善均显著高于对照组。局限性:该试验不是盲法试验。结论在2019冠状病毒病(COVID-19)大流行期间，提供安全的自我指压教育材料可改善自我报告的压力感知和心理健康评估。自我穴位按压对其他人群来说是一种很有希望的干预方法。研究结果支持使用自我指压来减轻压力和改善HRQOL。临床试验注册网站:NCT04472559。

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引用次数: 0