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Objective:To investigate the characteristics, contents and effects of outpatients′ telephone counseling during COVID-19 pandemic, and to promote the development of outpatient service.Methods:Frequency Retrospective analysis was made on contents of such consultations ranging from February to April 2020, to learn their medical consultation, epidemic consultation, outpatient registration and non-attendance consultation, inspection consultation and other 5 aspects.Results:72 525 cases of outpatient telephone consultations were received, and 98.48 percent of the problems had been solved. The evaluation of outpatient satisfaction was as high as 4.60 points. The quantity of consultation at 8-11 am and 14-17 pm on weekdays was the largest. The highest proportion of information content was about COVID-19.Conclusions:Telephone consultation during COVID-19 can not only effectively reduce outpatient visits, but also effectively diverse patient flow and prove conducive to extension services of outpatients in the future.
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Objective:Through literature search,this paper aims to understand the current situation of social trust mechanism and the research progress of trust evaluation methods,and thus to provide theoretical reference for further researches.Methods:Using the literature search method,this paper sorted out,analyzed and concluded the domestic and foreign literatures and information about social trust mechanism and trust evaluation.Results:The domestic research on social trust mechanism could be mainly divided into two parts,while the foreign research path was different and mainly related to the field of electronic commerce,government departments,medical behavior,and so on.Evaluation methods in doctor-patient trust mainly included trust scale evaluation and trust model.Conclusion:There is a certain development of the domestic researches on social trust mechanism and evaluation,but still need further improvement.The limitation of doctor-patient trust evaluation is prominent and efforts should be made to research on the improvement measures of medical social trust mechanism.
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Objective To compare the distribution of KCNJ11 polymorphisms between elderly Chinese population with and without hypertension. Methods We examined the mutation of KCNJ11 gene by directly sequencing. Data for the present study were obtained from 250 hypertensive subjects (60 to 83 years old) as well as 250 normotensive subjects (60 to 86 years old). Results We found nine different mutations in KCNJ11, including six novel mutations (I131M, L147I, L147V, L147L, Q235H, G245C). None of the novel mutations were found in the normotensive subjects, and all the residues were conserved in other species. These sequence variants in Chinese population indicate the diversity of the human library and the complexity of hypertension. Conclusions The consistent finding of our present study provided a basis for the development of new strategies to diagnosis and treat hypertension in the elderly.
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Backgroud Numerous studies have confirmed the effectiveness of slowing the progression of atherosclerosis by blood pressure (Bp)control in patients with hypertension and several studies also showed the efficacy of intensive glycemic control in decreasing progression of carotid intima-media thickness (CIMT) in patients with type 1 and type 2 diabetes. However, few studies have compared the relative importance of glycemic vs. Bp control in patients with diabetes and hypertension. We aimed to investigate the association between Bp and glycemic control and subclinical carotid atherosclerosis in older patients with hypertension and type 2 diabetes. Methods In a cross-sectional study, B-mode high-resolution ultrasonography of the carotid artery was performed in 670 subjects (508 males and 162 females) aged 60 years or over who had self-reported hypertension and diabetes but no history of coronary heart disease or stroke. Subjects were categorized by their systolic blood pressure: tight control, 140 mmHg, and by their hemoglobin Alc (HbAlc) level: tight control, 7.5%, respectively. Results The mean CIMT was 8.20±0.11 mm, and carotid plaque was found in 52.5% (352/670) subjects. Overall, 62.1% of the subjects had subclinical carotid atherosclerosis, defined as having either carotid plaque or elevated CIMT (≥ 1.1 mm). The mean CIMT was significantly different between Bp control categories (7.60 ± 0.09 mm, 7.90 ± 0.08 mm, and 8.60±0.12 nun, respectively, P = 0.03) but not between glycemic control categories (8.20 ± 0.10 ram, 8.1 ± 0.08 mm, and 8.40 ± 0.14 mm, respectively, P = 0.13) using ANCOVA analysis. Multivariable logistic regression adjusting for potential confounding factors showed that usual or uncontrolled Bp control were associated with having carotid plaque (OR = 1.08 and OR = 1.42, respectively), or elevated CIMT [Odd ratio (OR) = 1.17, 95% confidence interval (CI)1.04-2.24, and OR = 1.54, 95% CI 1.36-2.96, respectively compared to tight Bp control; but did not show glycemic control as independent predictor of either having carotid plaque or elevated CIMT. Conclusions In older patients with hypertension and diabetes, blood pressure control, but not glycemic control is associated with subclinical carotid atherosclerosis.
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Objective Brachial-ankle pulse wave velocity (baPWV) is widely used as a simple noninvasive measure of arterial stiffness. The aim of this study was to evaluate the usefulness of baPWV as a predictor of the carotid artery atherosclerosis in the elderly. Methods A total of 721 elderly participants (mean±SD age, 70.3 5.6years) were enrolled in the current study. All participant underwent both baPWV measurement and B-mode ultrasound for the intima-media thickness. Carotid atherosclerosis (CAS) was defined as the present of carotid plaque or and/or intima media thickness for at least 1.1 mm. Results A multivariate logistic regression analysis reveals that age, sex, brachial-ankle pulse wave velocity, smoking and LDL-C level showed a significant correlation with the presence of CAS. The odds ratios of CAS associated with a 500cm/s increase of brachial-ankle pulse wave velocity were 2.378 [95% confidence interval, 1.36 to 4.00, P<0.05], 3.733 [95% confidence interval, 1.729 to 8.058, P<0.01], 4.438 [95% confidence interval, 1.659 to 11.803, P<0.01]. The baPWV significantly correlated with IMT by bivariate correlation analysis (r=0.39; p=0.001). After adjusting for factors influencing, baPWV all the same correlated with IMT (r=0.35; p=0.001).Conclusion These results indicate that brachial-ankle PWV is an independent predictor of CAS in the elderly.It also means that the direct measurement of arterial stiffness by this simple method may be of great help for the evaluation of carotid artherosclerosis, at least in the elderly.
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Overt gastrointestinal bleeding (GIB) is one of the noncardiac complications in patients with acute myocardial infarction (AMI).Identification of patients at increased risk of overt GIB could aid in targeting more aggressive treatment,and lead to improved outcomes.The aim of this study is to determine the frequency,risk factors,and prognostic significance of overt GIB in patients with AMI.Methods A retrospective review of the medical records of 1443 patients admitted to the Chinese PLA General Hospital with AMI was conducted.Charts were reviewed for clinical characteristics,possible precipitating factors and complications.Patients were categorized as having or not having overt GIB(GIB associated with hemodynamic changes or the need for transfusions).Results Twenty nine (2.0%) patients developed overt GIB within 30 days after AMI.Patients with overt GIB had higher 30-day mortality rate than those without (44.8% vs.9.9%,P ＜ 0.001).Multivariate logistic regression analysis showed major determinants of in-hospital overt GIB secondary to AMI were gender of female (odds ratio 2.41,95% confidence interval [CI] 1.08 to 5.37),age=75 years (odds ratio 1.58,95% CI 1.13 to 2.20),prior history of AMI (odds ratio 2.28,95% CI 1.17 to 4.88),pneumonia (odds ratio 3.47,95% CI 1.50 to 8.03) and anemia at admission (odds ratio 2.37,95% CI 1.04 to 5.37).Conclusions In patients with AMI,overt GIB is associated with higher in-hospital mortality,and female sex,older age,prior AMI,pneumonia and anemia at admission are predictors of overt GIB during hospitalization.(J Geriatr Cardiol 2008;5:195-198)