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Background@#and Purpose Despite administration of evidence-based therapies, residual risk of stroke recurrence persists. This study aimed to evaluate the residual risk of recurrent stroke in acute ischemic stroke or transient ischemic attack (TIA) with adherence to guideline-based secondary stroke prevention and identify the risk factors of the residual risk. @*Methods@#Patients with acute ischemic stroke or TIA within 7 hours were enrolled from 169 hospitals in Third China National Stroke Registry (CNSR-III) in China. Adherence to guideline-based secondary stroke prevention was defined as persistently receiving all of the five secondary prevention medications (antithrombotic, antidiabetic and antihypertensive agents, statin and anticoagulants) during hospitalization, at discharge, at 3, 6, and 12 months if eligible. The primary outcome was a new stroke at 12 months. @*Results@#Among 9,022 included patients (median age 63.0 years and 31.7% female), 3,146 (34.9%) were identified as adherence to guideline-based secondary prevention. Of all, 864 (9.6%) patients had recurrent stroke at 12 months, and the residual risk in patients with adherence to guidelinebased secondary prevention was 8.3%. Compared with those without adherence, patients with adherence to guideline-based secondary prevention had lower rate of recurrent stroke (hazard ratio, 0.85; 95% confidence interval, 0.74 to 0.99; P=0.04) at 12 months. Female, history of stroke, interleukin-6 ≥5.63 ng/L, and relevant intracranial artery stenosis were independent risk factors of the residual risk. @*Conclusions@#There was still a substantial residual risk of 12-month recurrent stroke even in patients with persistent adherence to guideline-based secondary stroke prevention. Future research should focus on efforts to reduce the residual risk.
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Objective To evaluate the association between hemoglobin concentration and stroke severity on admission in ischemic stroke without diabetes. Methods Based on the China National Stroke Registry,the information of acute stroke patients were collected by trained research coordinators and investigators with the methods of review clinical records or interview. Demography, disease history, behavior and habits, hemoglobin concentration,and NIHSS score on admission were collected in this study. The iIncluded patients with the integri?ty of the information of non diabetes,3 h to the hospital,no gastrointestinal bleeding and Hb concentration and NIHSS score at admission. Hemoglobin concentration was classed according to quintiles and the outcome was grouped into ≤3 and >3 groups. The method of logistic regression was used to explore the association between hemoglobin and NIHSS. Results A total of 1 419 individuals was included in this study,including 883 males and 536 females. The mean age was 67. 24±12. 46 years old and the proportion of NIHSS>3 was 67. 51% (958/1419). With respect to non?minor stroke (NIHSS>3),the odds rations and 95% confident intervals of patients with hemoglobin ≤121. 0 g/L(Q1),>122. 1-≤132. 0 g/L(Q2),>141. 0-≤152. 0 g/L(Q4),≥152. 1 g/L (Q5) were 1. 84(95%CI 1. 21-2. 79,P=0. 004),1. 24(95%CI 0. 83-1. 86,P=0. 294),1. 32(95%CI 0. 88-1. 96,P=0. 178) ,1. 52( 95%CI 1. 01-2. 28,P=0. 044) respectively,compared with hemoglobin between 132. 0 and 141. 0 g/L( Q3) . Conclusion Stroke severity is associated with lower and higher hemoglobin concentration in acute ischemic stroke without diabetes.
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Objective To explore the establishment of evaluation index system of healthcare-associated infection (HAI) control in stomatological medicine.Methods The evaluation index framework based on theme framework approach was pre-liminarily formed,Delphi method and analytic hierarchy process (AHP)were used to construct grading evaluation index, judgement matrix was adopted to calculate the weight coefficient of index.Results The qualitative and quantitative com-bined evaluation system,a three-level evaluation index system with 47 indicators,was built,which was composed of six fol-lowing dimensions:organization management,diagnosis and treatment environment,isolation measures,disinfection area, disinfectant medical devices and hygiene products,and medical waste.Among the tertiary indexes,complete documents of disinfectant medical devices and hygiene products (0.0362),object surface cleaning and disinfection(0.0344),medical waste classification and collection (0.0326),supervision and management(0.0323),flushing and disinfection of dental unit water lines (0.0321)were of higher weight coefficients.Conclusion The preliminarily established evaluation index system can provide a scientific basis and practical tool for carrying out evaluation and supervision,formulating standards,as well as developing curriculum content for HAI control in stomatological medicine.
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BACKGROUND AND PURPOSE: It is unclear whether postthrombolytic antiplatelet (AP) therapy after thrombolytic-related hemorrhage without extensive parenchymal involvement (THEPI) affects the clinical outcome. This study explored whether AP administration in patients with THEPI affects short- and long-term outcomes. METHODS: All of the data for this study were collected from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) registry. Patients with THEPI were assigned to either the AP (AP therapy should be commenced 24 h after intravenous thrombolysis) or AP-naive groups. THEPI was defined according to European-Australasian Acute Stroke Study II criteria. The 90-day functional outcome, 7-day National Institutes of Health Stroke Scale (NIHSS) score, and 7-day and 90-day mortalities were compared between the AP and AP-naive groups. Logistic regression analysis was used to evaluate the effects of AP therapy on the short- and long-term clinical outcomes. RESULTS: Of the 928 patients enrolled from those in the TIMS-China registry (n=1,440), 89 (9.6%) had nonsymptomatic intracerebral hemorrhage (ICH) within 24-36 h after thrombolysis; 33 (37%) of these patients were given AP therapy (AP group) and 56 (63%) were not (AP-naive group). No significant differences were found for the risk of 7-day aggravated ICH (p=0.998), 7-day NIHSS score (p=0.5491), 7-day mortality [odds ratio (OR)=3.427; 95% confidence interval (95% CI)=0.344-34.160; p=0.294], 90-day mortality (OR=0.788, 95% CI=0.154-4.040, p=0.775), or modified Rankin score 5 or 6 at 90-days (OR=1.108, 95% CI=0.249-4.928, p=0.893) between the AP and AP-naive groups after THEPI. CONCLUSIONS: Early administration of postthrombolytic AP therapy after THEPI does not worsen either the short- or long-term outcome. AP therapy may be a reasonable treatment option for patients with THEPI to reduce the risk of ischemic stroke recurrence.
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Humans , Cerebral Hemorrhage , China , Hemorrhage , Logistic Models , Mortality , Recurrence , StrokeABSTRACT
rvice employees had a low scores as comparing with their salaries, benefits and workloads.And 28.2% employees had once the idea of resigning.
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Objective To learn the current culture of the hospital and identify its future development pathway. Methods The current culture types of the hospital are evenly distributed among the four quadrants. Results These types are found to be identically distributed among the tribe type, temporary system type, hierarchy type and market-oriented type of culture. Among these four type, the hierarchy type and market-oriented type score higher (27 scores both) and take the lead. Conclusions Hospitals are expected to enhance its exchange and communication with the employees, and head to its desired direction of a hospital culture type.
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The concept of the health promoting hospital, a modern mode of medical service that has turned from the formerly unitary pattern of medical treatment to the health promoting and life quality improving pattern of medical treatment, prevention and health care, was proposed by modern medical institutions so as to keep up with the change in medical modes and medical socialization. In recent years, many countries in the world have adopted the advanced service ideas of the health promoting hospital and conducted active research on various specific subjects. The paper gives an account of the concept, basic theories, development history, and latest progress both at home and abroad of the health promoting hospital so as to give an impetus to health education and health promotion in China.