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Objective:To explore the relationship between death indicators and unplanned return indicators on healthcare quality evaluation.Methods:A total of 836 976 medical record data were collected from 31 tertiary public general hospitals in a diagnosis-related groups(DRG) data platform in 2017. Multiple death indices(low and low-risk risk group mortality, high-risk group mortality, crude mortality, and risk adjusted mortality) and unplanned return indices(31-day unplanned readmission rate and 31-day unplanned return to surgery rate) were calculated. Pearson′s correlation coefficient was used to examine the relationships among those indices.Results:Death indicators were correlated with each other, but the unplanned readmission rate was not correlated with the unplanned reoperation rate( r=0.305). There was no correlation between unplanned re-entry rate and death rate. The correlation coefficients were as follows: unplanned readmission rate versus low and low-risk group mortality( r=-0.227), versus high-risk group mortality( r=-0.098), versus actual mortality( r=-0.130), versus risk adjusted mortality( r=0.010); unplanned reoperation rate versus low and low-risk group mortality( r=0.105), versus high-risk group mortality( r=0.030), versus actual mortality( r=-0.004), versus risk adjusted mortality( r=-0.141). Conclusions:The indicators of death and the indicators of unplanned return are not the same in terms of actual management technology and evaluation effect. They are complementary to each other and can form an ideal combination of quality evaluation indicators.
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BACKGROUND:Previous studies have documented that,the increase of anti-cardiolipin(aCL) antibody titer has an obvious positive relaltionship with the vascular thrombosis,thrombocytopenia and repeated abortion in the patients with systemic lupus erythematosus and antiphospholipid syndrome,but there is little information on the aCL antibodies in lupus nephritis(LN).OBJECTIVE:To ascertain the preyalence and significance of aCL antibodies in Chinese patients with LN.DESIGN:Prospective follow-up study of one sample.SETTING:Department of Rheumatology in Xiangmihu Branch of Shenzhen Fourth People's Hospital,Shenzhen Institute of Rheumatology in Guangdong Medical College.PARTlCIPANTS:The study was performed in 97 LN Patients consecutively recruited in the Department of Rheumatology in Xiangmihu Branch of Shenzhen Fourth People's Hospital between March 2001 and October 2003.All the included patients met the revised criteria of American College of Rheumatology for the diagnosis and classification of LN.And they all knew the fact saying yes.METHODS:The clinical data and auxiliary examination result were recorded when hospitalizalion.The aCL antibodies were measured by the enzyme-linked immunosorbent assay,and Were considered as positive if over 100 U/mL.High-dose oral administration of prednisonc combined with cyclophosphamide intravenous pulse therapy were applied for inducing release.The curative effect was remained by using azathioprine and prednisone at a decreasing dose.Meanwhile the complications such as hypertension,hyperlipemia and arthralgia were prevented by drugs.All the patients had routine visits at six-month intervals for a total of 3 years,Clinical and seroIogic manifestations of Patients with LN were tested and recorded regularly.MAIN OUTCOME MEASURES:Gender,age,systemic lupus erythematosus disease activity index,clinical manifestations,vascular thrombosis,pregnancy outcome and renal function.RESULTS:All the 97 LN Patients were included in the study.and 83 of them entered the result analysis while the other 14 cases were lost.The overall prevalence of aCL antibodies in 97 subjects was 39%(38 cases).Hypertension,thrombocytopenia and Raynaud's phenomenon were more frequent in LN Patients with aCL antibodies.The aCL IgG antibody-positive Patients showed a greater risk for the occurrence of vascular thrombosis;Pregnancy morbidity of miscarriages,premature birth,fetal death and the probabmty of developing irreversible renal function deterioration occurred at a greater frequency in aCL antibody-positive patients.CoNCLUSIoN:The prevalence of aCL antibodies in LN Patients is 39%.A higher incidence of hypertension.thrombocytopenia and Raynaud's phenomenon is found in patients with aCL antibodies.Detection of aCL antibodies in Patients with LN may be usefol to predict the development of vascular thrombosis,pregnancy morbidity and irreversible chronic renal function deterioration.
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In this paper, we designed to investigate the frequencies of tumor necrosis factor receptor 2 (TNFR2) polymorphisms at nt587 and nt694 in south Chinese SLE patients and healthy individuals and explore whether genetic variants in TNFR2 gene is involved in the pathogenesis of SLE. The results showed that the nt587G allele frequency was 21.1% in the 128 SLE patients and the allele frequency was 13.0% in the 135 healthy individuals, the former was significantly higher than the latter in the allele frequency (P ＜ 0.05). People with the nt587 G variant showed high risk to SLE. The frequency of nt694 was slightly but not statistically significantly increased in SLE patients compared with healthy controls(16.0% versus 11.9%, P= 0.149). These results indicate that the polymorphism at nt587 of TNFR2 is associated with the south Chinese SLE patients. The polymorphism at nt694 is not associated with SLE.
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BACKGROUND: The data of epidemiological survey on rheumatic diseases such as ankylosing spondylitis (AS) are very rare in China, especially in Shenzhen. The comprehensive understanding of epidemiological situation of AS in Shenzhen can be used to draw up treatment plans by Shenzhen Health Bureau and some other health organizations.OBJECTIVE: To investigate the epidemiological features of AS.DESIGN: Randomized complete collection and cross-sectional investigation.SETTING: Shenzhen Rheumatism Institute of Guangdong Medical College. PARTICIPANTS: From December 2001 to April 2004, totally 6 684 adults aged over 16 years were selected from three regions (one region of river and lakes, one local mountain region and one inhabitant region) of Shenzhen. Among them, 5 922 adults (2 659 males and 3 263 female) were actually investigated and the investigative rate was 88.6%. Males were accounted for 44.9% and females were 55.1%, and the ratio was 1:1.23.METHODS: Step 1 and 2, the investigated individuals were questioned and their answers were recorded by the investigators. The questionnaire proceeded one by one for every individual and proceeded at homes. Step 3,the individuals with positive findings at steps 1 and 2 were examined by rheumatologic doctors. Step 4, individuals with suspected AS were subjected to human leukocyte antigen B27 (HLA-B27) assays, radiographies including plain pelvic films, plain lumbar-vertebral films and if necessary, radiographies at other areas of spinal column as well as peripheral joints.MAIN OUTCOME MEASURES: Frequencies of rheumatic complaints,prevalence rate of AS, positive frequencies of hum an HLA-B27, and comparisons with relevant data abroad.RESULTS: ① General frequency of rheumatism was 21.6%, and the highest complaint was at knee joint, then at waist, shoulder, neck and hand. In female, the frequencies of complaints at every joint mentioned above were higher than those in male (P ＜ 0.05). A total of 13 patients (4.7%) had to discontinue their work because of rheumatic diseases. ②Prevalence rate of AS was accounted for 0.37%, and the ratio between male and female was 4.5: 1. The onset of AS began at middle age in majority patients. ③ Positive frequency of HLA-B27 was 5.0%. ④ Rate of misdiagnosis, the rate of early diagnosis and the rate of long-term irrational drug-usage were 64%, 27% and 73%, respectively.CONCLUSION: In Shenzhen, the prevalence rate of AS (0.37%) is ranked higher than that in Beijing (0.26%), Shantou (0.26%), America(0.20%) and the whites of Greece (0.24%). The differences among them may be connected with the fact that in Shenzhen the young people occupy a large proportion of population.
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Objective To evaluate the therapeutic effects and side effects of MMF on severe SLE patients compared with CTX.Method All 106 severe SLE patients were randomly allocated to 2 groups:MMF treatment group (53 patients):1 5 g/d for 3 months,1 0 g/d for following 3 months,and then 0 5～0 75 g/d;IVCTX treatment group:0 75 g/m 2 per month for 6～12 months.Prednisone was used in all patients.Clinical and laboratory parameters including SLE DAI,Hb,platelet,urine protein,albumin,SCr,aCL,ANA and anti dsDNA were observed.Results After 3 month treatment,all clinical and laboratory parameters were significantly improved in MMF group,while only partial parameters were improved in CTX group.Hb and platelet increased and urine protein and anti dsDNA decreased faster in MMF group than in CTX group.At month 6 the clinical and laboratory parameters improved significantly in both groups ( P
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Objective To understand the clinical features of primary Sjgren′s syndrome (pSS) in both sex,thus to improve the level of diagnosis and treatment.Methods Clinical data of 77 cases of pSS were collected and analyzed.Results No significant difference was found between male and female in mean age of onset and average disease duration at the time of diagnosis.Patients with dry mouth/eye as a complaint for seeing a doctor accounted for only less than a half;whereas,hyper ? globulinemia existed in more than 90% of the patients.The onset symptom in male was more different from female.Dry mouth/eye,arthralgia,pulmonary manifestations,renal tubular acidosis,and dermatic manifestations were the frequent presentations.Dry mouth/eye presented latter,uncommon,and milder in male than in female.However,no difference was found between male and female in the incidence of salivary gland involvement.Pulmonary symptoms presented earlier,and the incidence of pulmonary fibrosis was higher in male than in female.Whereas,the pulmonary symptom occurred earlier in male patients,and the incidence of pulmonary interstitial fibrosis was higher in male than in female.The incidence of positive RF and anti SSA/SSB antibody was significantly lower in male than in female.Conclusion Primary Sjgren′s syndrome is one of the systemic immune diseases.It′s clinical manifestations were diverse.Less than a half of patients see a doctor because of dry mouth/eye.There are many differences between male and female patients in clinical presentations;and the incidence of positive auto antibodies is lower in male patients than in female.