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Objective:To explore the influencing factors of bowel preparation quality in hospitalized elderly patients, and to find the appropriate waiting time from the end of bowel preparation to the beginning of colonoscopy.Methods:Baseline and clinical data of elderly patients over 60 years old who underwent colonoscopy in the Tenth People′s Hospital, Tongji University from February 2021 to August 2021 were collected. Multivariate analysis was used to screen the factors that might affect the quality of bowel preparation in hospitalized elderly patients. Patients were grouped according to waiting time before colonoscopy. After eliminating confounding factors using propensity matching analysis, the difference of bowel preparation quality among groups was compared.Results:251 patients were included in the study. Multivariate analysis revealed that, hypertension ( OR=3.530, 95% CI 1.295-9.618), chronic constipation ( OR=3.302,95% CI 1.132-9.632), dietary compliance ( OR=0.161, 95% CI 0.070-0.371), medication and drinking water compliance ( OR=0.167, 95% CI 0.070-0.397), exercise compliance after medication ( OR=2.245, 95% CI 1.040-4.845), The frequency of defecation after medication ( OR=0.446, 95% CI 0.308-0.647) and waiting time ( OR=0.537, 95% CI 0.387-0.745) were important factors affecting the quality of bowel preparation in hospitalized elderly patients ( P<0.05). There were differences in bowel preparation quality between groups of waiting times. The overall quality of bowel preparation in 120-180 min group was significantly better than that in 241-300 min group, 301-360 min group and>360 min group ( P<0.05). The overall quality of bowel preparation in 181-240 min group was better than that in >360 min group ( P<0.05). There were no significant differences among other groups( P>0.05). The scores of cecum and ascending colon were the best in 120-180 min group, and the cleanliness of descending colon, sigmoid colon and rectum was significantly higher in 241-300 min group, 301-360 min group and > 360 min group. The scores of descending colon, sigmoid colon and rectum showed that the intestinal preparation quality of 181-240 min group was better than that of 301-360 min group and > 360 min group. Conclusions:The best examination time for elderly patients is about 180 minutes after bowelpreparation. Medical workers should flexibly guide the medication time to ensure that patients are in the best clean state of intestinal tract during examination.
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Objective:To analyze the status of secondary maternal and child health hospital accreditation in China and the impact of such accreditation on their service improvement.Methods:The paper used the propensity score matching method to match the accreditation group and the non-accreditation group in 1∶1 ratio, and compared the related indicators of service capability of maternal and child health hospitals between the two groups by non-parametric test and Chi-square test.Results:A total of 842 maternal and child health care hospitals were matched. A comparison was made between the accreditation group and the non-accreditation group, and the differences of the following indicators of individual services within the hospital were statistically significant( P<0.01). These indicators were annual emergency attendance, the number of types of health services for women and children, the utilization rate of beds, the average daily hospital bed of each practicing physician; the following indicators of service management within their coverage were statistically significant: namely the proportion of institutions carrying out health education evaluation within their coverage, that of institutions producing uniform " Mother and Child Health Handbook", that of institutions carrying out information quality control, as well as analysis and utilization.These indicators of the accreditation group were higher than those in the non-accreditation group( P<0.01). Conclusions:Given the role played by maternal and child health institution accreditation in promoting secondary maternal and child health hospital regarding better service content, quantity, efficiency and the quality of business management within their coverage, there is still room for improvement.
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Objective:To investigate the risk factors of death in patients with cardiogenic shock (CS) in the Intensive Care Unit (ICU).Methods:This retrospective cohort study was conducted to collect the clinical data on critically ill patients from a number of hospitals in the United States released by the eICU Collaborative Research Database v2.0 (eICU-CRD v2.0) as of May 2018. The patients diagnosed with CS were selected and categorized into the survival and death groups according to the death in the hospital. The age, sex, and body mass index (BMI) of the enrolled patients were recorded, along with the acute physiology and chronic health evaluation Ⅳ (APACHE Ⅳ) score, simplified acute physiology score Ⅱ (SAPS Ⅱ), ethnicity, ICU type, clinical complications, diagnosis at admission, hemodynamic parameters, important treatments, and clinical outcomes. A propensity score was used to match age, BMI, and APACHE Ⅳ score, and SAPS Ⅱ. Multivariate Logistic regression analysis was performed to analyze the risk factors influencing ICU and hospital mortality, and the receiver operator characteristic (ROC) curve was used to evaluate its clinical utility.Results:In total, 33 998 in-hospital patients were included, among whom 27 596 patients survived and 6 402 died (18.83%), and 6 301 pairs were matched in preference. After matching, there were statistically significant differences between the two groups in the incidence of acute renal failure (29.33% vs. 31.82%), duration of mechanical ventilation [(6.05 ± 5.77) d vs (4.97 ± 5.11) d], length of ICU stay [(101.35 ± 154.59) h vs (110.15 ± 175.58) h] and length of hospital stay[ (12.73 ± 10.53) d vs (9.53 ± 10.35) d, P<0.01]. Multivariable logistic regression analysis revealed that age, BMI, APACHE Ⅳ score, SAPS Ⅱ, partial complications (except pacemaker implantation), diagnosis at admission (cardiac arrest, acute myocardial infarction, heart failure, respiratory system diseases, and digestive tract bleeding), and some treatments (noninvasive mechanical ventilation, blood purification, coronary artery bypass graft surgery, and vascular active drug application) were risk factors for hospital mortality in patients with CS ( P<0.05). Implantation of a ventricular assist device (VAD) was a protective measure against in-hospital death in patients with CS [hazard ratio ( HR)=0.49; 95% confidence interval (95% CI): 0.24-0.98; P=0.045). Multivariate ROC curve analysis revealed that the model could better predict ICU mortality [the area under the curve (AUC) =0.80 (95% CI: 0.784-0.816)] and hospital mortality [AUC=0.779 (95% CI, 0.765-0.793)] ( P <0.01). Conclusions:For patients with CS in ICU, age, BMI, APACHE Ⅳ score, SAPS Ⅱ, partial complications, diagnosis at admission (cardiac arrest, acute myocardial infarction, heart failure, respiratory system diseases and digestive tract bleeding), and some treatments (noninvasive mechanical ventilation, blood purification, CABG surgery, vascular active drug application) are independent risk factors for death. Implantation of a VAD can reduce the hospital mortality rate of patients with CS. The ROC curve of the related factors revealed that the model can better predict the clinical outcomes.
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Background: Currently, there are no drugs that have been proven to be effective against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Because of its broad antiviral activity, interferon (IFN) should be evaluated as a potential therapeutic agent for treatment of coronavirus disease 2019 (COVID-19), especially while COVID-19-specific therapies are still under development. Methods: Confirmed COVID-19 patients hospitalized in the First Affiliated Hospital, School of Medicine, Zhejiang University in Hangzhou, China, from January 19 to February 19, 2020 were enrolled in a retrospective study. The patients were separated into an IFN group and a control group according to whether they received initial IFN-α2b inhalation treatment after admission. Propensity-score matching was used to balance the confounding factors. Results: A total of 104 confirmed COVID-19 patients, 68 in the IFN group and 36 in the control group, were enrolled. Less hypertension (27.9% vs. 55.6%, P=0.006), dyspnea (8.8% vs. 25.0%, P=0.025), or diarrhea (4.4% vs. 19.4%, P=0.030) was observed in the IFN group. Lower levels of albumin and C-reactive protein and higher level of sodium were observed in the IFN group. Glucocorticoid dosage was lower in the IFN group (median, 40 vs. 80 mg/d, P=0.025). Compared to the control group, fewer patients in the IFN group were ventilated (13.2% vs. 33.3%, P=0.015) and admitted to intensive care unit (ICU) (16.2% vs. 44.4%, P=0.002). There were also fewer critical patients in the IFN group (7.4% vs. 25.0%, P=0.017) upon admission. Although complications during admission process were comparable between groups, the discharge rate (85.3% vs. 66.7%, P=0.027) was higher and the hospitalization time (16 vs. 21 d, P=0.015) was shorter in the IFN group. When other confounding factors were not considered, virus shedding time (10 vs. 13 d, P=0.014) was also shorter in the IFN group. However, when the influence of other factors was eliminated using propensity score matching, virus shedding time was not significantly shorter than that of the control group (12 vs. 15 d, P=0.206). Conclusions: IFN-α2b spray inhalation did not shorten virus shedding time of SARS-CoV-2 in hospitalized patients.
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We analyzed the trend of flu incidence in Chongqing,explored the independent influence of low temperature on the incidence of influenza and provided reference for the development of influenza prevention and control measures and strategies.Based on the epidemiological data of influenza from 2010-2015 in Chongqing and the meteorological data in the same period of time,using the temperature as the independent variable and the morbidity rate of daily flu as the dependent variable,we use the propensity value to match the balance of pressure,air flow and other confounding factors,establishing four negative binomial regression models.Confounding meteorological factors were balanced by the propensity score.The negative binomial regression model was better than the corresponding model before matching in Chi-square test,Deviance,Scale deviance,AIC and AICC.The lower the daily minimum temperature,the higher the incidence of influenza.The influence of meteorological factors on the incidence of influenza is lagging,and the use of negative binomial regression to control confounding factors before matching may underestimate the impact of temperature on the incidence of influenza.In addition,low temperature may be an important meteorological factor that leads to an increased incidence of influenza.
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Recent studies reported that early initiation of hemodialysis may increase mortality. However, studies that assessed the influence of early initiation of peritoneal dialysis (PD) yielded controversial results. In the present study, we evaluated the prognosis of early initiation of PD on the various outcomes of end stage renal failure patients by using propensity-score matching methods. Incident PD patients (n = 491) who started PD at SNU Hospital were enrolled. The patients were divided into 'early starters (n = 244)' and 'late starters (n = 247)' on the basis of the estimated glomerular filtration rate (eGFR) at the start of dialysis. The calculated propensity-score was used for one-to-one matching. After propensity-score-based matching (n = 136, for each group), no significant differences were observed in terms of all-cause mortality (P = 0.17), technique failure (P = 0.62), cardiovascular event (P = 0.96) and composite event (P = 0.86) between the early and late starters. Stratification analysis in the propensity-score quartiles (n = 491) exhibited no trend toward better or poorer survival in terms of all-cause mortality. In conclusion, early commencement of PD does not reduce the mortality risk and other outcomes. Although the recent guidelines suggest that initiation of dialysis at higher eGFR, physicians should not determine the time to initiate PD therapy simply rely on the eGFR alone.