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@#This clinical pathway for the diagnosis and risk stratification of patients presenting with acute chest pain, including acute coronary syndromes, provides recommendations and algorithms for clinicians to diagnose, risk stratify, and manage acute chest pain in adult patients. The writing committee reviewed existing international and local guidelines. Modifications to the algorithm following face-to-face and virtual meetings resulted in expert decisions written as recommendations and presented in a flow diagram format. The USTH Chest Pain Pathway provides guidance based on current guidelines and recommendations on assessing and evaluating acute chest pain, tailored to local needs and institution-specific facilities. We recommend its use to ensure quality patient care in the hospital.
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Objective To sum up the diagnosis experience of unexplained hepatitis with hyperbilirubinemia (UHH) for establishing its diagnostic pathways and etiological factors. Methods By referring to the research progress at home and abroad, various examination items were made in order to form the clinical diagnosis pathway of UHH, on the basis of retrospective analysis and follow-up investigation of UHH patients. Using this pathway we carried out prospective diagnosis analysis for 223 patients admitted to Fifth Medical Center of Chinese PLA General Hospital from June 2014 to June 2017, in the order of preliminary, in-depth, and ultimate screening. Results A total of 181 cases were identified through the pathway screening (181/223, 81.17%). Two cases were etiologically diagnosed by primary screening (2/223, 0.90%), 18(18/223, 8.07%) by in-depth screening, and 161(161/223, 72.20%) by ultimate screening. There were still 42 cases (42/223, 18.83%) failing to make a definite diagnosis, among which 14 cases (14/223, 6.28%) failed to make a definite diagnosis after completing the diagnostic pathway, and 28(28/223, 12.55%) failed to complete the diagnostic pathway due to the critical condition and failure of liver puncture or rejection of genetic test. Among the 195 patients who completed diagnostic pathway, 181 cases were identified, and the actual etiology diagnosis rate was 92.82%. Among the 223 cases, 143(64.13%) were caused by drug-induced liver damage, 11(4.93%) by hereditary metabolic liver disease, 8(3.58%) by autoimmune liver disease, 5(2.24%) by infectious diseases, 14(6.28%) by other systemic diseases, and 42(18.83%) by undetermined causes. Conclusion Drug-induced liver damage, and genetic metabolic liver disease are common causes of UHH. The three-step screening pathway is effective for the diagnosis of UHH, and also simple and easy to practice, thus being worthy of promotion on a trial basis.
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OBJECTIVE: The aim of this study is to clarify the characteristics of patients with dementia using long-term care hospitals and the demands of their caregivers. It will provide a perspective for establishing the specialized dementia hospital and appropriate dementia services in the future. METHODS: The survey was performed to the caregivers of the dementia inpatients of 71 public long-term care hospitals and outpatients from local hospitals. We distributed the questionnaires to 3,600 caregivers. Of these, 1,572 returned and then included in the analysis. RESULTS: High number of both inpatients (85.7%) and outpatients (61.5%) were diagnosed with dementia in psychiatric or neurologic department. Time laps from onset of symptoms thought as dementia to actual diagnosis was about a year. Caregivers of dementia inpatients wanted mostly dementia related welfare and care products (85.5%), physical and exercise program (84.0%), specialized dementia ward (83.1%), behavioral management (82.1%), and cognitive rehabilitation (80.5%). CONCLUSION: It is important to provide adequate management to both the patients with dementia and the caregivers. Thus, specialized institutional arrangements and medical service improvement supported by government is needed to reduce the psychological and financial burden of caregivers. We hope these results will be used to establish the principals and standards of specialized dementia hospital.