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This research focused on the doctors' changes based on the performance-payment reform from a district public hospital of Chongqing.The work compared the doctors' work efficiency,medical quality,scientific research,new technology and new project,cost control and patients burden.Performance-payment reform significantly activated doctors' self-study initiative and quality.The main running quotas of hospital,including stuff's positivity,work efficiency,medical quality,scientific research,new technology and new project,presented a better improvement trend.This not only reduced the patient cost burden,relieved the doctor-patient relationship,but also improved the hospital personnel cohesion,and strengthened the core competitiveness of the hospital.
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<p><b>OBJECTIVE</b>To assess the value of blood glucose at different time points in oral glucose tolerance test (OGTT), particularly one?hour post load plasma glucose (1 hPG), in evaluating glucose metabolism in adult patients with obstructive sleep apnea (OSA).</p><p><b>METHODS</b>Eighty nine adultswith newly diagnosed OSA were analyzed retrospectively for sleep architecture assessed using polysomnography and glucose metabolism assessed by OGTT at different time points (0, 30, 60, 120, and 180 min). Pearson's correlatives and multiple linear regression models were established to investigate the correlations between glucose metabolism and other indices including sleep architecture, apnea hypopnea index (AHI), mean and lowest oxygen saturation (MSOand LSO) and obesity measurements.</p><p><b>RESULTS</b>The majority (67.4%) of the patients had abnormal 1 hPG, and 41.6% had abnormal 2 hPG. 1 hPG was positively correlated with neck circumference (r=0.245), abdomen circumference (r=0.231), systolic blood pressure (r=0.213), diastolic blood pressure (r=0.276) and AHI (r=0.324), and was negatively associated with MSO(r=-0.341) and LSO(r=-0.387) (all P<0.05). After controlling for age, BMI, neck and abdomen circumferences, 1 hPG was found to inversely correlated with MSO(r=-0.253, P=0.032) and LSO(r=-0.311, P=0.008). In non-obese OSA subgroup, 1 hPG was significantly associated with OSA-related indices, and regression models showed that LSOand N2 were the two most important contributors to 1 hPG (adjusted R=0.349, P<0.001); plasma glucose at other time points did not show such correlations.</p><p><b>CONCLUSIONS</b>1 hPG abnormality occurs earlier than 2 hPG in OSA patients. 1 hPG is significantly associated with OSA independent of obesity and may serve as a better index for measuring OSA-related glucose disorder.</p>
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<p><b>BACKGROUND</b>The currently available polysomnography (PSG) equipments and operating personnel are facing increasing pressure, such situation may result in the problem that a large number of obstructive sleep apnea (OSA) patients cannot receive timely diagnosis and treatment, we sought to develop a nomogram quantifying the risk of OSA for a better decision of using PSG, based on the clinical syndromes and the demographic and anthropometric characteristics.</p><p><b>METHODS</b>The nomogram was constructed through an ordinal logistic regression procedure. Predictive accuracy and performance characteristics were assessed with the area under the curve (AUC) of the receiver operating characteristics and calibration plots, respectively. Decision curve analyses were applied to assess the net benefit of the nomogram.</p><p><b>RESULTS</b>Among the 401 patients, 73 (18.2%) were diagnosed and grouped as the none OSA (apnea-hypopnea index [AHI] <5), 67 (16.7%) the mild OSA (5 ≤ AHI < 15), 82 (20.4%) the moderate OSA (15 ≤ AHI < 30), and 179 (44.6%) the severe OSA (AHI ≥ 30). The multivariable analysis suggested the significant factors were duration of disease, smoking status, difficulty of falling asleep, lack of energy, and waist circumference. A nomogram was created for the prediction of OSA using these clinical parameters and was internally validated using bootstrapping method. The discrimination accuracies of the nomogram for any OSA, moderate-severe OSA, and severe OSA were 83.8%, 79.9%, and 80.5%, respectively, which indicated good calibration. Decision curve analysis showed that using nomogram could reduce the unnecessary polysomnography (PSG) by 10% without increasing the false negatives.</p><p><b>CONCLUSIONS</b>The established clinical nomogram provides high accuracy in predicting the individual risk of OSA. This tool may help physicians better make decisions on PSG arrangement for the patients referred to sleep centers.</p>
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Adult , Female , Humans , Male , Multivariate Analysis , Polysomnography , ROC Curve , Sleep Apnea, Obstructive , DiagnosisABSTRACT
<p><b>OBJECTIVE</b>To explore the relationship of continuous positive airway pressure and pulmonary function in patients with obstructive sleep apnea hypopnea syndrome (OSAHS), and formulate the prediction equation for the effective therapeutic pressure.</p><p><b>METHODS</b>In a retrospective cross-sectional study of 48 patients with established OSAHS, all the patients were carefully examined for their medical history, and overnight sleep monitoring was carried out to measure the sleep apnea-hypopnea index, mean oxygen saturation, minimum oxygen saturation, and oxygen drop index. The data of manual pressure titration (effective pressure) and pulmonary function tests (tidal volume, one second forced expiratory volume, central airway resistance, and peripheral airway resistance were collected for multiple linear regression analysis.</p><p><b>RESULTS</b>The effective therapeutic pressure was not correlated with the indices of the pulmonary functions in the patients, but showed correlations with the neck circumference, abdominal circumference, apnea-hypopnea index, mean oxygen saturation, least oxygen saturation, and oxygen desaturation index. Multiple linear regression (α=0.05 test level) identified only oxygen desaturation index (P=0.012) and mean oxygen saturation (P=0.036) as the dependent variables of the effective therapeutic pressure. Linear regression analysis showed that the effective therapeutic pressure had a linear relationship with the oxygen drop index and mean oxygen saturation, and was inversely correlated with the mean oxygen saturation.</p><p><b>CONCLUSIONS</b>In patients with OSAHS, the pulmonary function indices are not correlated with the effective therapeutic pressure. In the absence of manual pressure titration, the effective therapeutic pressure can be predicted using the prediction equation: effective therapy pressure = 24.262+0.044×oxygen desaturation index -0.19×average oxygen saturation.</p>
Subject(s)
Adult , Aged , Humans , Middle Aged , Continuous Positive Airway Pressure , Forced Expiratory Volume , Polysomnography , Respiratory Function Tests , Retrospective Studies , Sleep Apnea, Obstructive , TherapeuticsABSTRACT
Objective To analyze the epidemiology,clinical and imageological characteristics,diagnosis,misdiagnosis,treatment and prognosis of pulmonary alveolar proteinosis (PAP) reported in China in recent 20 years,in an attempt to provide important clues for prompt and accurate diagnosis of PAP.Methods Clinical data of PAP from 1988 to 2008 in China were retrospectively analyzed and the clinical data of 126 patients with PAP which were misdiagnozed were summarized.Results There were 19 cases misdiagnozed with pneumonia,24 cases with pulmonary cancer,18 cases with bronchitis,19 cases with idiopathic pulmonary fibrosis,15 cases with pulmonary tuberculosis,10 cases with eosinophilic pneumonia,9 cases with sarcoidosis,5 cases with fungus pneumonia.The clinical manifestations of PAP had no specificity and the imageology manifestation was various.Its final diagnosis mainly depended on the examination of brochoalveolar lavage fluid and/or lung biopsy,and pathologic examination.Conclusions The diversity of clinical manifestations of PAP has resulted in higher clinical misdiagnosis rate.WhoLe lung irrigation is the safest and the most effective way to treat PAP.