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Objective:To evaluate the effect of hierarchical diagnosis and treatment model of childhood bronchial asthma in Shanghai Pudong New Area.Methods:According to the principle of proximity, children aged 6 months-17 years who were diagnosed with bronchial asthma at Shanghai Children′s Medical Center from July 2016 to May 2017 were divided into two cohorts: the specialized hospital group and the community hospital group.Twelve months of treatment and follow-up were conducted.The asthma control level, Childhood Asthma Control Test (C-ACT) score, medication adherence and health economic indicators were collected.Results:A total of 524 children were included for data analysis and divided into the specialized hospital group (300 cases) and the community hospital group (224 cases). According to the Global Initiative for Asthma(GINA) criteria, there was no statistical difference in monthly asthma control level between the two groups (all P>0.05). In the 12 th month, the well-controlled rate of the specialized hospital group increased by 12.4% ( P<0.01), and that of the community hospital group increased by 22.9% ( P= 0.015). According to the C-ACT criteria, there was no statistical difference in the monthly well-controlled rate between the two groups (all P>0.05), and the rate maintained an upward trend.The rates of patients with good compliance in the specialized hospital group and the community hospital group at the 12 th month of hierarchical diagnosis and treatment were 78.3%(235/300 cases) and 75.0%(168/224 cases), respectively, and the difference was not statistically significant ( P=0.370). After 12 months of hierarchical diagnosis and treatment, the number of asthma attacks were 1.0 and 2.0 ( P=0.269), and the hospitalization rates for asthma were 3.0%(9/300 cases) and 4.9%(11/224 cases), respectively in the specialized hospital group and the community hospital group, and the diffe-rence was not statistically significant ( P=0.259); the number of respiratory infections in the specialized hospital group (2.0 times) was lower than that in the community hospital group (3.0 times), and the total cost of treatment in the community hospital group (2 471.5 Yuan) was lower than that in the specialized hospital group (3 445.5 Yuan), and the difference was statistically significant ( Z=-3.308, -3.336, all P<0.01). Twelve months after hierarchical diagnosis and treatment, the number of asthma attacks, the number of respiratory infections and the hospitalization rate for asthma in the two groups were all lower than those in the first 12 months of hierarchical diagnosis and treatment, and the difference was statistically significant (all P<0.01). Conclusions:Hierarchical diagnosis and treatment model of childhood asthma in Shanghai Pudong New Area can improve asthma control level, C-ACT score and asthma medication adherence, and enhance health economic benefits, thus it′s an effective way to manage childhood asthma.
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Objective To investigate the influence of Chinese medicine ( CM) treatment on life span of middle-late primary hepatic carcinoma (PHC) patients. Results A multicenter retrospective cohort study was carried out in 489 PHC patients at the stages of Ⅱb, Ⅲa and Ⅲb collected from 15 domestic hospitals. With CM treatment as the exposure factor, the enrolled patients were divided into CM group, western medicine (WM) group and the CM-WM combination group. The main outcomes included median survival time (MST) and survival rate, and the effects of CM treatment and minimally invasive therapy on MST were observed. Results Half-a-year survival rate, one-year survival rate and two-year survival rate were 50%, 9%, 1% in CM group, 70%, 30%, 6% in CM-WM combination group, and 50%, 10%, 0% in WM group, respectively. The survival rates in CM-WM combination group differed from those in CM group and WM group (P0.05) . MST at the stages of Ⅱb, Ⅲa, Ⅲb in CM-WM group was obviously prolonged as compared with the other two groups (P0.05) . CM treatment and minimally invasive therapy were effective on prolonging the survival time of PHC patients ( P<0.01) . The results of COX regressionanalysis showed that Karnofsky scores, CM treatment and minimally invasive therapy were the preventive factors for the prognosis. Conclusion CM-WM combination group has the best long -term therapeutic effect. CM -WM combination treatment is effective on increasing MST and long-term survival rate, in particular for PHC patients at the stages ofⅡb, Ⅲa and Ⅲb. CM treatment and minimally invasive therapy are helpful for the prolongation of the survival time of PHC patients.
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<p><b>OBJECTIVES</b>To elucidate factors associated with hospital mortality in intensive care unit (ICU) patients and to evaluate the impact of ICU-acquired infection on hospital mortality in the context of the drug resistance of pathogens.</p><p><b>METHODS</b>By using the Japanese Nosocomial Infection Surveillance (JANIS) database, 7,374 patients who were admitted to the 34 participating ICUs between July 2000 and May 2002, were aged 16 years or older, and who stayed in the ICU for 48 to 1,000 hours, did not transfer to another ICU, and did not become infected within 2 days after ICU admission, were followed up until hospital discharge or to Day 180 after ICU discharge. Adjusted hazard ratios (HRs) with the 95% confidence intervals (CIs) for hospital mortality were calculated using Cox's proportional hazard model.</p><p><b>RESULTS</b>After adjusting for sex, age, and severity-of-illness (APACHE II score), a significantly higher HR for hospital mortality was found in ventilator use, central venous catheter use, and ICU-acquired drug-resistant infection, with a significantly lower HR in elective or urgent operations and urinary catheter use. The impact of ICU-acquired infection on hospital mortality was different between drug-susceptible pathogens (HR 1.11,95% CI:0.94-1.31) and drug-resistant pathogens (HR 1.42,95% CI: 1.15-1.77).</p><p><b>CONCLUSIONS</b>The use of a ventilator or a central venous catheter, and ICU-acquired drug-resistant infection were associated with a high risk of hospital mortality in ICU patients. The potential impact on hospital mortality emphasizes the importance of preventive measures against ICU-acquired infections, especially those caused by drug-resistant pathogens.</p>
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<p><b>OBJECTIVE</b>To examine whether nosocomial infection risk increases with APACHE II score, which is an index of severity-of-illness, in intensive care unit (ICU) patients.</p><p><b>METHODS</b>Using the Japanese Nosocomial Infection Surveillance database, 8,587 patients admitted to 34 participating ICUs between July 2000 and May 2002, aged 16 years or older, who had stayed in the ICU for 2 days or longer, had not transferred to another ICU, and had not been infected within 2 days after ICU admission, were followed until ICU discharge, Day 14 after ICU admission, or the development of nosocomial infection. Adjusted odds ratios with their 95% confidence intervals for nosocomial infections were calculated using logistic regression models, which incorporated sex, age, operation, ventilator; central venous catheter, and APACHE II score (0-5, 6-10, 11-15, 16-20, 21-25, 26-30, and 31+).</p><p><b>RESULTS</b>There were 683 patients with nosocomial infections. Adjusted odds ratios for nosocomial infections gradually increased with APACHE II score. Women and elective operation showed significantly low odds ratios, while urgent operation, ventilator, and central venous catheter showed significantly high odds ratios. Age had no significant effect on the development of nosocomial infection.</p><p><b>CONCLUSIONS</b>Nosocomial infection risk increases with APACHE II score. APACHE II score may be a good predictor of nosocomial infections in ICU patients.</p>
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Objective: To examine whether nosocomial infection risk increases with APACHE II score, which is an index of severity-of-illness, in intensive care unit (ICU) patients. Methods: Using the Japanese Nosocomial Infection Surveillance database, 8,587 patients admitted to 34 participating ICUs between July 2000 and May 2002, aged 16 years or older, who had stayed in the ICU for 2 days or longer, had not transferred to another ICU, and had not been infected within 2 days after ICU admission, were followed until ICU discharge, Day 14 after ICU admission, or the development of nosocomial infection. Adjusted odds ratios with their 95% confidence intervals for nosocomial infections were calculated using logistic regression models, which incorporated sex, age, operation, ventilator, central venous catheter, and APACHE II score (0-5, 6-10, 11-15, 16-20, 21-25, 26-30, and 31+). Results: There were 683 patients with nosocomial infections. Adjusted odds ratios for nosocomial infections gradually increased with APACHE II score. Women and elective operation showed significantly low odds ratios, while urgent operation, ventilator, and central venous catheter showed significantly high odds ratios. Age had no significant effect on the development of nosocomial infection. Conclusions: Nosocomial infection risk increases with APACHE II score. APACHE II score may be a good predictor of nosocomial infections in ICU patients.
Subject(s)
Cross Infection , Intensive Care Units , APACHEABSTRACT
Objectives: To elucidate factors associated with hospital mortality in intensive care unit (ICU) patients and to evaluate the impact of ICU-acquired infection on hospital mortality in the context of the drug resistance of pathogens. Methods: By using the Japanese Nosocomial Infection Surveillance (JANIS) database, 7,374 patients who were admitted to the 34 participating ICUs between July 2000 and May 2002, were aged 16 years or older, and who stayed in the ICU for 48 to 1,000 hours, did not transfer to another ICU, and did not become infected within 2 days after ICU admission, were followed up until hospital discharge or to Day 180 after ICU discharge. Adjusted hazard ratios (HRs) with the 95% confidence intervals (CIs) for hospital mortality were calculated using Cox’s proportional hazard model. Results: After adjusting for sex, age, and severity-of-illness (APACHE II score), a significantly higher HR for hospital mortality was found in ventilator use, central venous catheter use, and ICU-acquired drug-resistant infection, with a significantly lower HR in elective or urgent operations and urinary catheter use. The impact of ICU-acquired infection on hospital mortality was different between drug-susceptible pathogens (HR 1.11, 95% CI: 0.94-1.31) and drug-resistant pathogens (HR 1.42, 95% CI: 1.15-1.77). Conclusions: The use of a ventilator or a central venous catheter, and ICU-acquired drug-resistant infection were associated with a high risk of hospital mortality in ICU patients. The potential impact on hospital mortality emphasizes the importance of preventive measures against ICU-acquired infections, especially those caused by drug-resistant pathogens.