Sepsis patient evaluation emergency department (SPEED) score & mortality in emergency department sepsis (MEDS) score in predicting 28-day mortality of emergency sepsis patients / 中华创伤杂志(英文版)

Purpose:@#Sepsis is a common acute life-threatening condition that emergency physicians routinely face. Diagnostic options within the Emergency Department (ED) are limited due to lack of infrastructure, consequently limiting the use of invasive hemodynamic monitoring or imaging tests. The mortality rate due to sepsis can be assessed via multiple scoring systems, for example, mortality in emergency department sepsis (MEDS) score and sepsis patient evaluation in the emergency department (SPEED) score, both of which quantify the variation of mortality rates according to clinical findings, laboratory data, or therapeutic interventions. This study aims to improve the management processes of sepsis patients by comparing SPEED score and MEDS score for predicting the 28-day mortality in cases of emergency sepsis.@*Methods:@#The study is a cross-sectional, prospective study including 61 sepsis patients in ED in Suez Canal University Hospital, Egypt, from August 2017 to June 2018. Patients were selected by two steps: (1) suspected septic patients presenting with at least one of the following abnormal clinical findings: (a) body temperature higher than 38℃ or lower than 36℃, (b) heart rate higher than 90 beats/min, (c) hyperventilation evidenced by respiratory rate higher than 20 breaths/min or PaCO2 lower than 32 mmHg, and (d) white blood cell count higher than 12,000/μL or lower than 4000/μL; (2) confirmed septic patients with at least a 2-point increase from the baseline total sequential organ failure assessment (SOFA) score following infection. Other inclusion criteria included adult patients with an age ≥18 years regardless of gender and those who had either systemic inflammatory response syndrome or suspected/confirmed infection. Patients were shortly follow-up for the 28-day mortality. Each patient was subject to SPEED score and MEDS score and then the results were compared to detect which of them was more effective in predicting outcome. The receiver operating characteristic curves were also done for MEDS and SPEED scores.@*Results:@#Among the 61 patients, 41 died with the mortality rate of 67.2%. The mortality rate increased with a higher SPEED and MEDS scores. Both SPEED and MEDS scores revealed significant difference between the survivors and nonsurvivors (p = 0.004 and p < 0.001, respectively), indicating that both the two systems are effective in predicting the 28-day mortality of sepsis patients. Thereafter, the receiver operating characteristic curves were plotted, which showed that SPEED was better than the MEDS score when applied to the complete study population with an area under the curve being 0.87 (0.788-0.963) as compared with 0.75 (0.634-0.876) for MEDS. Logistic regression analysis revealed that the best fitting predictor of 28-day mortality for sepsis patients was the SPEED scoring system. For every one unit increase in SPEED score, the odds of 28-day mortality increased by 37%.@*Conclusion:@#SPEED score is more useful and accurate than MEDS score in predicting the 28-day mortality among sepsis patients. Therefore SPEED rather than MEDS should be more widely used in the ED for sepsis patients.

A study on the effect of the Luohu healthcare group reform:An analysis based on the patients'perspective / 中国卫生政策研究

Objective: The study aimed to explore the initial effect of the Luohu healthcare group reform in Shenzhen based on the patient’s perspective. Methods: The questionnaire survey was conducted to investigate the views of patients in 3 hospitals and 23 community health centers in Luohu district. Results: A total of 936 valid ques-tionnaires were collected and analyzed. The valid response rate was 94. 55% . More than 90 percent of the total sur-veyed patients provided a good or very good evaluation on the healthcare services, service attitude, medical referral services and interpretation, communication skills, and better family doctor skills. More than 80 percent of the sur-veyed patients perceived well or very well on medical treatment, the convenience of medical referral, the referral process of the community health centers, and the specialists serving in community health centers mechanism. Conclu-sions: The results showed that patients had a slightly high satisfaction with family doctors and community health cen-ter, and after the group was founded, the proportion of patients who preferred going to community health centers after illness has been increasing significantly more than before. In future, a further development of the advantages of healthcare group should be brought into action and improve the relevant supporting policies. The long-term effect de-serves a further observation.

Comparison between denture wearer's evaluation and clinician's rating for complete denture / 대한치과보철학회지

PURPOSE: The aim of this study was to compare denture wearer's evaluation and clinician's technical rating for complete denture used on edentulous patients. MATERIALS AND METHODS: Total 43 edentulous patients who had complete denture fabricated more than one year ago were recalled. The questionnaire based on the various literatures was modified and applied to patients for subjective assessments. Functional aspects related to retention, stability, occlusion and denture condition were included in operator's evaluation. In addition, correlations were evaluated between patient's subjective and operator's objective assessments. Friedman test and Cohen's Kappa value were used for statistical analysis. RESULTS: It was found that denture wearers' evaluations were slightly or fairly agree to clinician's rating for complete denture. More differences were found in maxillary denture than mandibular denture and moderate difference was found in esthetic, occlusion aspects. CONCLUSION: There were slightly or fairly agreement between subjective and objective evaluations.

Preparation and Patient Evaluation for Safe Gastrointestinal Endoscopy

Patient evaluation and preparation is the first and mandatory step to ensure safety and quality of endoscopic procedures. This begins and ends with identifying the patient, procedure type, and indication. Every patient has the right to be fully informed about risks and benefits of what is to be performed on them, and the medical personnel should respect the decision made by the patients. Thoroughly performed history taking and physical examination will guide the endoscopists to better stratify risk and plan sedation. Special attention should be given to higher-risk patients with higher-risk condition undergoing higher-risk procedures. Making preparations to monitor the patients and being ready to handle emergency situations throughout the endoscopic procedure are sine qua non to warrant safe endoscopy.

Correlation evaluation between questionnaire and clinical examination in dry eye / 中华实验眼科杂志

Background There are two types of different questionnaires in dry eye diagnosis.But the associations about two questionnaires or questionnaire and clinical examination are still unclear.To effectively quantize the symptoms is helpful for a correct diagnosis of dry eye disease.Objective This survey was to evaluate the Standard Patient Evaluation of Eye Dryness (SPEED) and Ocular Surface Disease Index(OSDI) questionnaire for the diagnosis of dry eye and investigate the correlation between the clinical examinations and questionnaires. Methods A perspective cohort study was designed.Sixty-six patients were enrolled in this study.This study was approved by the Ethic Committee of Peking University First Hospital,and written informed consent was obtained from each subject before any ocular examination.SPEED-based and OSDI-based questionnaires were used to score the dry eye symptom and grouped according to severity of complains.Corneal fluorescence staining,tear film breakup time(BUT),Schirmer I test and tear film interferometry were performed in all patients.The correlations between two questionnaires scores and their association with clinical examinations were evaluated.Results The negative correlations were found between the SPEED-based score or OSDI-based score with BUT value(r=0.390,P=0.001 ;r=-0.395,P=0.001 ),but no significant correlations were seen between the SPEED-based score or OSDI-based score with Schirmer test( r=-0.081,P=0.515; r=-0.080,P=0.525)and tear film interferometry score(r=0.158,P=0.204;r=0.219,P=0.077).The BUT was significantly prolonged in mild symptom group compared with serious group(t=2.339,P=0.022),but no significant difference was seen in Schirmer Ⅰ test and tear film interferometry scores using SPEED-based questionnaire ( t =0.404,P =0.687 ; t =- 0.947,P =0.347 ) ; while the positive fluorescence staining rate between two groups was significantly different (x2 =0.164,P =0.685 ).When using OSDI-based questionnaire,significant difference in BUT was seen among mild,moderate and serious symptom groups ( F =11.871,P =0.000 ),and BUT in mild symptom group was delayed in comparison with moderat and serious groups( P=0.000,0.000).No significant differences were found in Schirmer Ⅰ test,tear film interferometry scores and fluorescence staining rate among three groups(F=1.432,P =0.246; F =2.799,P =0.068; x2 =6.026,P =0.050).SPEED score showed a positive correlation with OSDI score ( r =0.697,P =0.000 ). Conclusions Both OSDI and SPEED are effective tools for the evaluation of symptoms of dry eye.The two types of questionnaires are consistent in symptoms evaluation.

Analysis of Cause for Cancellation of Elective Operation / 대한마취과학회지

BACKGROUND: Cancellations of elective operations are due to various reasons, which can be categorized into those initiated by patients or their guardians and those initiated by hospital staff. Cancellations of elective operations result not only in time and economic loss but also in negative psychological effects for patients and guardians and operational inefficiency for hospitals among other problems. As such, by studying and analyzing the causes of such cancellations, one may categorize them into involuntary ones and preventable ones, with the aim to reduce the occurrence of the latter that will lead to reduction in cancellation of elective operations. METHODS: 11,082 cases of elective operation were reviewed and analyzed retrospectively from January 2002 to December 2006. Total number, department, anesthetic type and cause of cancellation were recorded daily. Emergency operation and operation under local anesthesia were excluded. RESULTS: Total number of cancellation was 762 cases and mean cancellation rate was 6.9%. The most common cause of cancellation was co-existing disease or abnormal laboratory finding (25.3%). Especially in urology the most common cause of cancellation was the relief from diseases or symptoms. Plastic surgery showed the highest cancellation rate among all at 12%. CONCLUSIONS: Setting up standards that help determine the driving factors behind cancellations of elective operations within anesthesiology departments and utilizing a patient evaluation system, after categorizing the causes of cancellations into involuntary and preventable ones and analyzing them, will lead to reduction in cancellation of operations and solve problems faced by patients and guardians, and hospitals and their staff.

The Evaluation of the Incidence of Intraoperative Awareness, the Degree of Difficulty with Intubation and Postanesthetic Complication in Surgical Patients / 대한마취과학회지

Randomly selected 193 patients who received elective operation under general anesthesia and were able to communicate with anesthesiologists and follow up for 5 days between May and September 1994 at Chonnam University Hospital, were interviewed and evaluated on the night before, 2 and 5 days after their operation. Distribution of physieal status by ASA was that more than half the total patients belongs to class I and 36.8% of patients were under class II. Sedation scores did not chang between on the night before and the day of operation. A significant correlation existed among the visibility of pharyngeal structures, the exposure of glottis by laryngoscopy, and the degree of difficulty with intubation. About 83% of patients was readily intubated, and none of patient was impossible to intubate. All of the patients lost consciousness during induction of anesthesia, and did not recall during operation. Postanesthetic complications were sore throat(30%), nausea and vomiting(28%), lumbago(15%), urticaria(3%), and dizziness(3%).