Correlation between body mass index and pulmonary function indexes in patients with bronchial asthma and suggestions for patient management / 中华健康管理学杂志

Objective:To analyze the correlation between body mass index (BMI) and lung function in patients with bronchial asthma (asthma).Methods:This study was a retrospective study. A total of 828 patients with asthma were included from March 2013 to November 2022 in the first affiliated Hospital of Guangxi Medical University, including 292 males and 536 females, aged 21-82 years, with a median age of 47 years. According to BMI, these asthma patients were divided into high BMI group (BMI≥24 kg/m 2), normal BMI group (18.5 kg/m 2≤BMI<24 kg/m 2) and low BMI group (BMI<18.5 kg/m 2). Forced vital capacity (FVC), forced expiratory volume in first second (FEV 1), FEV 1/FVC, maximum mid-expiratory flow (MMEF), forced expiratory flow at 25%, 50% and 75% of FVC (FEF 25%, FEF 50%, FEF 75%), peak expiratory flow (PEF), absolute increases in measured values of FVC and FEV 1 and percentage increases in FVC%pred (“%pred” represents the percentage of related indicators to expected value) and FEV 1%pred after inhalation of bronchodilator (salbutamol) were measured by pulmonary function meter. The correlation between BMI and the above indexes was analyzed. Results:In the high BMI group, FEV 1%pred, MMEF, FEF 25%, FEF 50% and FEF 75% were significantly lower than those in the normal BMI group and the low BMI group (all P<0.05), FVC% pred was significantly lower than those in the normal BMI group( P<0.05), and the percentage increase of FEV 1%pred was significantly lower than those in low BMI group ( P<0.05). FVC% pred in the normal BMI group was significantly higher than that in the low BMI group ( P<0.05). In male patients, BMI was negatively correlated with the absolute increase of FEV 1 ( r=-0.148, P<0.05); In female patients, BMI was negatively correlated with FEV 1%, FEV 1/FVC, MMEF, FEF 25%, FEF 50%, FEF 75% and the percentage increase of FEV 1%pred ( r=-0.124, -0.127, -0.165, -0.138, -0.156, -0.162, -0.106, all P<0.05). Conclusion:There is a significant correlation between BMI and lung function in patients with asthma, and the lung function in patients with high BMI is relatively worse; and in female patients, the effect of BMI on lung function is more significant; the increase of BMI can lead to the decrease of lung function and airway reversibility, suggesting that attention should be paid to the management of BMI in asthma management.

Interpretation of outpatient respiratory management of infants, children, and adolescents with post-prematurity respiratory disease: an official American Thoracic Society clinical practice guideline / 中华实用儿科临床杂志

In recent years, the management of respiratory diseases related to preterm birth has received extensive attention.In 2021, the American Thoracic Society brought together multidisciplinary experts in respiratory, neonato-logy, otolaryngology, sleep medicine, radiology and nursing specialties to develop Guidelines for outpatient respiratory management in infants, children, and adolescents with post-preterm respiratory disease (hereinafter referred to as the " Guideline" ), aiming to provide evidence-based medical evidence for standardized outpatient management of respiratory diseases associated with preterm birth at different ages.The Guideline was interpreted and summarized so that pediatric clinicians could correctly diagnose and treat these diseases, and understand and implement standardized outpatient management on the basis of evidence.

Consenso de manejo del paciente con diabetes mellitus y patología cardiovascular / Consensus on the management of patients with diabetes mellitus and cardiovascular disease

Este Consenso sale a la luz en medio de una de las peores crisis sanitarias globales de los últimos 100 años. El SARS-CoV-2 y su manifestación clínica, la COVID-19, han provocado una disrupción en cómo médicos y pacientes nos relacionamos. Si bien se trata de una enfermedad infecciosa, una de las características más notables es que su mortalidad se acrecienta en pacientes con enfermedades crónicas no transmisibles y, en particular, con antecedentes de diabetes y enfermedad cardiovascular. En tal contexto, entonces, creemos que cobran más relevancia las recomendaciones vertidas en este documento, que apuntan a identificar y proteger a estos pacientes, al tiempo que se vuelve prioritaria la implementación, más allá de los enunciados, de políticas concretas de prevención cardiometabólica. Metodología: este consenso es el fruto de la voluntad de dos Sociedades Científicas que han reconocido la necesidad de complementar el enfoque sobre una misma problemática: la de los pacientes con diabetes mellitus (DM) y con enfermedad cardiovascular (ECV), o bien que están en riesgo de sufrirla. Tanto la Sociedad Argentina de Cardiología (SAC) como la Sociedad Argentina de Diabetes (SAD) tienen una reconocida trayectoria en la producción de guías de práctica y documentos de consenso, aunque cada una tiene prácticas y culturas de trabajo diferentes. En consecuencia, la primera tarea que se afrontó fue la de acordar, no solamente el temario y el abordaje de los diferentes asuntos, sino también modalidades de trabajo comunes: objetivo general del documento, forma de analizar y evaluar el peso de la información, definir los niveles de evidencia y determinar los grados de recomendación. Se acordó adoptar la modalidad utilizada por la SAC en todos los documentos producidos por el Área de Consensos y Normas, expuestos en el siguiente cuadro: Grado de recomendación • Clase I: condiciones para las cuales hay evidencia y/o acuerdo general en que el tratamiento/procedimiento es beneficioso, útil y eficaz. • Clase II: evidencia conflictiva y/o divergencia de opinión acerca de la utilidad, eficacia del método, procedimiento y/o tratamiento. - IIa: el peso de la evidencia/opinión está a favor de la utilidad/eficacia. - IIb: la utilidad/eficacia está menos establecida. • Clase III: evidencia o acuerdo general que el tratamiento método/procedimiento no es útil/eficaz y en algunos casos puede ser perjudicial. Nivel de evidencia • A: evidencia sólida, proveniente de estudios clínicos aleatorizados o de cohortes con diseño adecuado para alcanzar conclusiones estadísticamente conectadas y biológicamente significativas. • B: datos procedentes de un único ensayo clínico aleatorizado o de grandes estudios no aleatorizados. • C: consenso de opinión de expertos. Los expertos que colaboraron en la redacción del Consenso fueron seleccionados e invitados a participar con el acuerdo unánime del grupo de Directores y Secretarios pertenecientes a ambas Sociedades Científicas. Se convocó a colegas con reconocida trayectoria en las disciplinas abordadas para el análisis de la evidencia y la redacción de las recomendaciones. Todos los aspectos metodológicos y las recomendaciones finales de este documento fueron definidos por acuerdo entre el grupo de Directores y Secretarios del Consenso. El proceso de consolidación de la información fue lento: desde la decisión de ambas sociedades hasta la redacción de este documento, el campo del manejo de la DM y la ECV sufrió profundas transformaciones que trascienden la aparición de nuevos agentes terapéuticos. Lo que se ha desarrollado es un nuevo modelo de abordaje que es, según las palabras de la Dra. Alicia Elbert, transdisciplinario. Esto ha implicado esperar y poder entender y "procesar" toda la información surgida en estos años. Este documento, que pretende asistir a los médicos en la práctica diaria, ha intentado adoptar esa nueva mirada integradora

This Consensus comes to light in the midst of one of the worst global health crises in the last 100 years. SARS-CoV-2 and its clinical manifestation, COVID-19, have caused a disruption in how doctors and patients interact. Although it is an infectious disease, one of the most notable characteristics is that its mortality increases in patients with chronic non-communicable diseases and, in particular, with a history of diabetes and cardiovascular disease. In this context, then, we believe that the recommendations made in this document, which aim to identify and protect these patients, become more relevant, while the implementation, beyond the statements, of specific cardiometabolic prevention policies becomes a priority. Methodology: this consensus is the result of the will of two Scientific Societies that have recognized the need to complement the focus on the same problem: that of patients with diabetes mellitus (DM) and cardiovascular disease (CVD), or who are at risk to suffer it. Both the Argentine Society of Cardiology (SAC) and the Argentine Society of Diabetes (SAD) have a recognized track record in the production of practice guidelines and consensus documents, although each has different work practices and cultures. Consequently, the first task that was faced was to agree, not only on the agenda and the approach to the different issues, but also on common working methods: general objective of the document, how to analyze and evaluate the weight of the information, define the levels of evidence and determine the degrees of recommendation. It was agreed to adopt the modality used by the SAC in all the documents produced by the Consensus and Standards Area, set out in the following table: Grade of recommendation • Class I: conditions for which there is evidence and/or general agreement that the treatment/procedure is beneficial, useful and effective. • Class II: conflicting evidence and/or divergence of opinion about the usefulness, efficacy of the method, procedure and / or treatment. - IIa: the weight of evidence/opinion is in favor of utility/ efficacy. - IIb: utility/efficacy is less established. • Class III: evidence or general agreement that the treatment method/procedure is not useful/effective and in some cases may be harmful. Level of evidence • A: solid evidence, from randomized clinical studies or from cohorts with adequate design to reach statistically connected and biologically significant conclusions. • B: data from a single randomized clinical trial or large nonrandomized studies. • C: consensus of expert opinión. The experts who collaborated in the drafting of the Consensus were selected and invited to participate with the unanimous agreement of the group of Directors and Secretaries belonging to both Scientific Societies. Colleagues with recognized experience in the disciplines addressed were summoned to analyze the evidence and write the recommendations. All the methodological aspects and the final recommendations of this document were defined by agreement between the group of Directors and Consensus Secretaries. The information consolidation process was slow: from the decision of both companies until the writing of this document, the field of DM and CVD management underwent profound transformations that transcend the appearance of new therapeutic agents. What has been developed is a new approach model that is, in the words of Dr. Alicia Elbert, transdisciplinary. This has implied waiting and being able to understand and "process" all the information that has emerged in these years. This document, which aims to assist physicians in daily practice, has tried to adopt this new integrative perspective

UP Philippine General Hospital Division of Endocrinology, Diabetes & Metabolism Consensus recommendations for in-Patient managementof Diabetes Mellitus among persons with COVID-19 / Journal of the ASEAN Federation of Endocrine Societies

@#Diabetes mellitus (DM) is a known risk factor for morbidity and mortality among patients with COVID-19 based on recent studies. While there are many local and international guidelines on inpatient management of diabetes, the complicated pathology of the virus, the use of glucose-elevating drugs such as glucocorticoids, antivirals and even inotropes, and various other unique problems has made the management of in-hospital hyperglycemia among patients with COVID-19 much more difficult than in other infections. The objective of this guidance is to collate and integrate the best available evidence that has been published regarding in-patient management of diabetes among patients with COVID-19. A comprehensive review of literature was done and recommendations have been made through a consensus of expert endocrinologists from the University of the Philippines-Philippine General Hospital (UP-PGH) Division of Endocrinology, Diabetes and Metabolism. These recommendations are evolving as we continue to understand the pathology of the disease and how persons with diabetes are affected by this virus.

Innovaciones internacionales en robótica médica para mejorar el manejo del paciente en Perú / International innovations in medical robotics to improve the patient management in Peru

Surgical Engineering Society realizó una investigación, la primera revisión como pioneros en LATAM, desde el año 2015, que desarrolla el tema de las últimas tecnologías de robótica médica creadas en América del Norte, Europa y Asia, que se importan para aplicarlas en el sistema de salud de Perú y América Latina Los sistemas robóticos para cirugía, rehabilitación y asistencia se presentan cubriendo la descripción del diseño del control y las especificaciones técnicas. Además, el manejo del paciente mediante robots se analiza con herramientas de diagnóstico, pronóstico y tratamiento. El proceso para evaluar los nuevos inventos de los dispositivos robóticos y llevarlo al mercado se introduce donde en las tres etapas que se muestran a continuación: innovación, asuntos regulatorios y aplicación biomédica. Además, hay un alto porcentaje de población con discapacidad en América Latina, por lo tanto, es necesario que más científicos biomédicos se especialicen en robótica para comenzar a desarrollar nuevas ideas y mejorar el manejo del paciente. Finalmente, las nuevas tecnologías creadas en América Latina deben ser asequibles, simples y eficientes para apoyar la situación económica de la atención médica en el continente y brindar los mejores estándares de calidad para mejorar los resultados del tratamiento en los pacientes.

Surgical Engineering Society conducted a research, the First Review as the pioneers in LATAM, since year 2015, which develops the topic of the latest Medical Robotics technologies created in North América, Europe and Asia, which are imported to apply in the Healthcare System of Peru and Latin America. The robotic systems for surgery, rehabilitation and assistance are presented covering the description of control design and technical specifications. Besides, the patient management using robots is analyzed with diagnosis, prognosis and treatment tools. The process to evaluate the new inventions of robotic devices and bring to the market is introduced where three stages are shown as the following: innovation, regulatory affairs and biomedical application. Moreover, there is a high percentage of population with disability in Latin America, therefore, it is necessary that more biomedical scientists be specialized in robotics to start developing new ideas to improve the patient management. Finally, the new technologies created in Latin America must be affordable, simply and effcient in order to support the healthcare economic situation in the continent and give the best quality standards to improve treatment outcomes on patients.

Effects of continuous nursing on rehabilitation of patients with hypertensive cerebral hemorrhage after puncture drainage / 中国实用护理杂志

Objective@#To observe the effects of continuous nursing(CN) on rehabilitation of patients with hypertensive intracerebral hemorrhage (HICH) and to explore the effective interventive measures for CN.@*Methods@#Totally 129 admitted HICH patients from January to December 2017 were selected and randomly divided into study group (63 cases) and control group (66 cases), the control group was handed with Handbook of stroke prevention and control before discharge, the study group received CN intervention, which included pre-discharge health education, family visits, patient management and video interview via WeChat App, group lecture and psychological support, self-nursing ability, motor function and ability of daily life and emotional condition were evaluated before and post discharge, and the disabled ratio 6 months after discharge between the 2 groups were compared.@*Results@#The 2 groups with the scores of exercise of self-care agency scale (ESCA) were increased significantly compared with before discharge (all P<0.05) ; the study group with the ESCA scores 3 months and 6 months after discharge were significantly higher than the control group [3months:118.5±8.2 vs. 112.3±7.5; 6 months: 127.7±8.7 vs. 119.3±9.1] (all P<0.05) . Fugl Meyer score and Barthel index of the 2 group after discharge were both lower than the pre-discharge levels (all P<0.05); Fugl Meyer score and Barthel index of the study group 3 months and 6 months after discharge were significantly higher than the control group [3 months: Fugl Meyer score 73.3±7.3 vs. 69.4±6.9; Barthel index 56.5±8.0 vs. 51.8±7.3; 6 months: Fugl Meyer score77.6±8.0 vs. 74.5±7.2; Barthel index 67.5±8.7 vs. 63.0±7.4] (all t=2.291-3.454, P<0.05). Two groups with HAD score after discharge were significantly decreased compared with before discharge (P<0.05); the study group with the HAD-A and HAD-D scores 3 and 6 months after discharge were significantly lower than the control group[3 months: HAD-A 6.75±2.23 vs. 8.02±2.85; HAD-D 6.07±1.75 vs. 7.23±1.94; 6 months: HAD-A 5.93±2.04 vs. 6.84±2.37; HAD-D 5.86±1.47vs. 6.75±1.76] (all P<0.05) . The study group with the re-admission rate and disabled ratio within 6 months after discharge were both lower than the control group, but the differences without statistical significance (all P>0.05).@*Conclusion@#The HICH patients added with CN can significantly improve self-care ability, improve prognosis; patient management via WeChat App and group lecture & psychological support are effective measures to carry out CN.

Effects of continuous nursing on rehabilitation of patients with hypertensive cerebral hemorrhage after puncture drainage / 中国实用护理杂志

Objective To observe the effects of continuous nursing(CN) on rehabilitation of patients with hypertensive intracerebral hemorrhage (HICH) and to explore the effective interventive measures for CN. Methods Totally 129 admitted HICH patients from January to December 2017 were selected and randomly divided into study group (63 cases) and control group (66 cases), the control group was handed with Handbook of stroke prevention and control before discharge, the study group received CN intervention, which included pre-discharge health education, family visits, patient management and video interview via WeChat App, group lecture and psychological support, self-nursing ability, motor function and ability of daily life and emotional condition were evaluated before and post discharge, and the disabled ratio 6 months after discharge between the 2 groups were compared. Results The 2 groups with the scores of exercise of self-care agency scale (ESCA) were increased significantly compared with before discharge(all P<0.05); the study group with the ESCA scores 3 months and 6 months after discharge were significantly higher than the control group [3months:118.5±8.2 vs. 112.3±7.5;6 months:127.7±8.7 vs. 119.3±9.1](all P<0.05). Fugl Meyer score and Barthel index of the 2 group after discharge were both lower than the pre-discharge levels (all P<0.05); Fugl Meyer score and Barthel index of the study group 3 months and 6 months after discharge were significantly higher than the control group [3 months:Fugl Meyer score 73.3±7.3 vs. 69.4±6.9;Barthel index 56.5±8.0 vs. 51.8±7.3;6 months:Fugl Meyer score77.6± 8.0 vs. 74.5±7.2;Barthel index 67.5±8.7 vs. 63.0±7.4] (all t=2.291-3.454, P<0.05). Two groups with HAD score after discharge were significantly decreased compared with before discharge (P<0.05); the study group with the HAD-A and HAD-D scores 3 and 6 months after discharge were significantly lower than the control group[3 months:HAD-A 6.75±2.23 vs. 8.02±2.85;HAD-D 6.07±1.75 vs. 7.23±1.94;6 months:HAD-A 5.93±2.04 vs. 6.84±2.37;HAD-D 5.86±1.47vs. 6.75±1.76](all P<0.05). The study group with the re-admission rate and disabled ratio within 6 months after discharge were both lower than the control group, but the differences without statistical significance (all P>0.05). Conclusion The HICH patients added with CN can significantly improve self-care ability, improve prognosis; patient management via WeChat App and group lecture&psychological support are effective measures to carry out CN.

Rapid detection of the commonly encountered carbapenemases (New Delhi metallo-?-lactamase, OXA-48/181) directly from various clinical samples using multiplex real-time polymerase chain reaction assay

Background: Resistance due to New Delhi metallo-?-lactamase (NDM) and OXA-48/181 continues to emerge as a threat which is associated with nosocomial outbreaks and is a serious healthcare concern. Phenotypic detection being laborious and time-consuming requires rapid detection of NDM and OXA-48/181, which is achieved through real-time polymerase chain reaction (RT-PCR). Materials and Methods: In this study, RT-PCR assay was developed to simultaneously detect NDM and OXA-48/181. The assay was validated on 102 non-duplicate, phenotypically characterised clinical samples. Results: The assay showed a sensitivity and specificity of 97% and 100% for the detection of carbapenemases in comparison to conventional PCR. The in-house developed multiplex RT-PCR would help to rule-in the presence of NDM and OXA-48/181. Conclusions: Rapid detection of these carbapenemases would be assist in better patient management, in terms of accurate antimicrobial treatment, help in cohorting infected from uninfected patient to prevent spread.

The experts consensus on the surgical treatment and perioperative management of cervical spondylosis (2018) / 中华外科杂志

In order to standardize the surgical care and perioperative management for patients with cervical spondylosis, the Editorial Board of Chinese Journal of Surgery has organized the several meetings with certain experienced spine surgeons regarding prevent complications related to surgical procedure, ensure the treatment safety as well as in improving the outcome efficacy. In the meantime, the relevant focused issues and repeated consulting have been reviewed and presented on a larger spectrum. By 2 years efforts, the consensus has been developed for patients with different types of cervical spondylosis. The principle of surgical treatment, including surgical approach, operating procedures, technical consideration, the patient selection and evaluation criteria of cervical spondylosis have been elucidated. The decision-making and management have been also recommended during preoperative, intraoperative, and postoperative respectively. For the controversies of surgical strategy and related clinical issues of cervical spondylosis, the principled and guided advices have been addressed. Due to certain limitation, this consensus is only attempted to provide a recommend conclusion either for the clinical practice or related studies in treatment strategy for patients with cervical spondylosis. This consensus only provides academic guidance.

Variations in the clinical management of multibacillary leprosy patients in selected hospitals in Metro Manila

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> This paper documents the variations in the diagnosis and management of multibacillary leprosy patients in three of the biggest case-holding hospitals in Metro Manila. Furthermore, we aimed to discuss the implications of these variations on the country's leprosy control and elimination program.</p><p style="text-align: justify;"><b>METHODS:</b> Focus group discussions (FGD) were conducted with 23 health professionals composed of doctors and nurses with at least a year of experience in managing leprosy patients. The topics included procedures on patient diagnosis and management such as treatment duration, patient follow-up and definitions of treatment completion and default. The FGD participants provided suggestions to improve treatment compliance of patients. Their responses were compared with the World Health Organization (WHO) standards and/or the 2002 DOH Manual of Operating Procedures (MOP) for leprosy. Transcripts of the recordings of the FGDs were prepared and thematic analysis was then performed.</p><p style="text-align: justify;"><b>RESULTS:</b> There were variations in the hospitals' procedures to diagnose leprosy, in treatment duration, and in patient follow-up. Definitions for treatment completion and default differed not just between hospitals but also with the WHO guidelines and the 2002 MOP. Hospitals extended treatment up to 24 or even 36 months, despite the 12 months stipulated in the MOP. Two hospitals required a slit skin smear and skin biopsy in diagnosis, despite the MOP and WHO provisions that these were not mandatory. One hospital defined default as three consecutive months without treatment, which was different from the MOP and WHO standards and from the other hospitals.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Given the variations in patient management, we recommended that the effectiveness of the standard treatment relative to other regimens being practiced by specialists be evaluated.</p>

The experts consensus on the surgical treatment and perioperative management of cervical spondylosis (2018) / 中华外科杂志

In order to standardize the surgical care and perioperative management for patients with cervical spondylosis, the Editorial Board of has organized the several meetings with certain experienced spine surgeons regarding prevent complications related to surgical procedure, ensure the treatment safety as well as in improving the outcome efficacy. In the meantime, the relevant focused issues and repeated consulting have been reviewed and presented on a larger spectrum. By 2 years efforts, the consensus has been developed for patients with different types of cervical spondylosis. The principle of surgical treatment, including surgical approach, operating procedures, technical consideration, the patient selection and evaluation criteria of cervical spondylosis have been elucidated. The decision-making and management have been also recommended during preoperative, intraoperative, and postoperative respectively. For the controversies of surgical strategy and related clinical issues of cervical spondylosis, the principled and guided advices have been addressed. Due to certain limitation, this consensus is only attempted to provide a recommend conclusion either for the clinical practice or related studies in treatment strategy for patients with cervical spondylosis. This consensus only provides academic guidance.

APPLICABILITY OF ADOPTING MORPHOLOGICAL PATTERNS IN PEDIATRIC ANEMIAS AS ETIOLOGICAL INDICATORS

Background: Pediatric anemia is a global phenomenon. The magnitude of this problem gets exaggerated in developing countries like India wherein majority of the population are vulnerable since they live in rural areas and come under low socio-economic status. Though pediatric anemias can be diagnosed by simple blood tests like complete hemogram and peripheral smear examination, the evaluation of underlying etiological factor to initiate appropriate therapy involves expensive work up which may not be affordable in a rural setup. This need-based study of pediatric anemia was conducted to determine the morphological patterns of anemia by simple baseline investigations and to detect the related etiologic factor. Methodology: The probable etiological factors contributing to the anemias were diagnosed by determining the morphological patterns using simple baseline investigations like complete hemogram and peripheral blood examination and treated accordingly. Conclusion: The etiology of microcytic hypochromic anemia was found out to be iron deficiency as confirmed by serum iron profile studies. Presence of dimorphic anemia suggested combined nutritional deficiency of Iron, vitamin B12 deficiency or folate. Hemolytic anemias detected by routine hematological investigations were confirmed by serum electrophoresis. Morphological examination of red blood cells on peripheral smear examination is thus an effective, simple and cost effective method to determine the etiology of various types of anemia.

Management of lower respiratory tract infections (LRTI's): clinical microbiologists' perspective.

In the era of emergence and re-emergence of newer and existing microorganisms, clinical and laboratory diagnosis of LRTI’s requires regular evaluation. Elaborating on possible predisposing factors will be critical to health care workers in the better management of patients suffering with Lower Respiratory Tract Infections (LRTI’s). Microbiologist’s role becomes crucial in deciding the culture methods to be employed to isolate the suspected causative microorganism and identification of the probable pathogen among mixed growth of the isolated bacteria/fungi. Antimicrobial therapy should necessarily be guided by the susceptibility patterns of various antibiotics against different microorganisms from a given geographical region, which should be regularly updated.

Hypertension in the elderly: insights from recent research / 老年心脏病学杂志（英文版）

Hypertension is a leading cause of mortality and morbidity around the world and,prevalence of hypertension is increasing with aging.Hypertension in the elderly is associated with increased occurrence rates of sodium sensitivity,isolated systolic hypertension,and 'white coat effect'.Arterial stiffness and endothelial dysfunction also increase with age.These factors should be considered in selecting antihypertensive therapy.The prime objective of this therapy is to prevent stroke.The fmdings of controlled trials show that there should be no cut-off age for treatment.A holistic program for controlling cardiovascular risks should be fully discussed with the patient,including evaluation to exclude underlying causes of secondary hypertension,and implementation of lifestyle measures.The choice of antihypertensive drug therapy is influenced by concomitant disease and previous medication history,but will typically include a thiazide diuretic as the first-line agent;to this will be added an angiotensin inhibitor and/or a calcium channel blocker.Beta blockers are not generally recommended,in part because they do not combat the effects of increased arterial stiffness.The hypertension-hypoten-sion syndrome requires case-specific management.Drug-resistant hypertension is important to differentiate from faulty compliance with medication.Patients resistant to the third-line drug therapy may benefit from treatment with extended-release isosorbide mononitrate.A trial of spironolactone may also be worthwhile.

Knowledge Extraction from Hospital Information System: Using the Integrated Database of Electronic Medical Record and Patient Management System / 대한의료정보학회지

OBJECTIVE: Using the integrated database in hospital information systems, this study tried to analyze inpatient hospital fees for stroke patients and evaluate the impact of patients' demographic and clinical characteristics on the fees. METHODS: Inpatient charge data from patient management information system were merged to each patient's clinical data from electronic medical record. Demographic, clinical, health service utilization, and hospital fee data of 540 stroke patients were collected in the years 2000 and 2001. Inpatient charges were compared according to patient characteristics; in addition, the impact of those characteristics on hospital charges was analyzed using a multiple regression model. RESULTS: The average length of stay (LOS) was 19.6 days and the total inpatient charge was USD 4 418. Inpatient charges were significantly higher in patients with previous stroke history, diabetes, hemorrhagic type, and severity, respectively. Simultaneously, LOS, ICU use, surgical operations, stroke type, hopeless discharge, lesion location, echocardiography and hypertension were significant factors influencing patient hospital charges (R(2)=0.847). LOS was the most significant factor explaining 81% of variance accounted for the charges. The strategies of reducing LOS need to be developed. CONCLUSION: Hospital information systems and their databases play an important role in a broad spectrum of research in clinical medicine, and can be useful to support retrospective studies and prospective clinical trials. Active utilization of the integrated database in hospital information systems is suggested for knowledge extraction.

Patient management system gateway using HL7 Protocol / 대한의료정보학회지

In this study, using the HL7 protocol, we developed patient management system gateway which is composed of 2 parts; message transferring-receiving and sentcncc generating-parsing part. To make the gateway more transplantable, it was developed on the PC operated with Windows OS. To make the gateway more productive, it was developed with Visual Basic 6.0. The database was built into MS SQL. Server which is most optimized on MS Windows NT system environment. This gateway system has the advantage of easy data-exchange capability between the patient management systems of medical facility and the messages transferred can he managed systematically and he transplanted easily into PC base hospital information system.