Correlation between blood pressure indexes and prognosis in sepsis patients: a cohort study based on MIMIC-III database / 中华危重病急救医学

OBJECTIVE@#To investigate the correlation between early-stage blood pressure indexes and prognosis in sepsis patients.@*METHODS@#A retrospective cohort study was conducted on the medical records of patients diagnosed with sepsis from 2001 to 2012 in the Medical Information Mart for Intensive Care-III (MIMIC-III) database. Patients were divided into survival group and death group according to the 28-day prognosis. General data of patients and heart rate (HR) and blood pressure at admission to ICU and within 24 hours after admission were collected. The blood pressure indexes including the maximum, median and mean value of systolic index, diastolic index and mean arterial pressure (MAP) index were calculated. The data were randomly divided into training set and validation set (4 : 1). Univariate Logistic regression analysis was used to screen covariates, and multivariate Logistic stepwise regression models were further developed. Model 1 (including HR, blood pressure, and blood pressure index related variables with P < 0.1 and other variables with P < 0.05) and Model 2 (including HR, blood pressure, and blood pressure index related variables with P < 0.1) were developed respectively. The receiver operator characteristic curve (ROC curve), precision recall curve (PRC) and decision curve analysis (DCA) curve were used to evaluate the quality of the two models, and the influencing factors of the prognosis of sepsis patients were analyzed. Finally, nomogram model was developed according to the better model and effectiveness of it was evaluated.@*RESULTS@#A total of 11 559 sepsis patients were included in the study, with 10 012 patients in the survival group and 1 547 patients in the death group. There were significant differences in age, survival time, Elixhauser comorbidity score and other 46 variables between the two groups (all P < 0.05). Thirty-seven variables were preliminarily screened by univariate Logistic regression analysis. After multivariate Logistic stepwise regression model screening, among the indicators related to HR, blood pressure and blood pressure index, the HR at admission to ICU [odds ratio (OR) = 0.992, 95% confidence interval (95%CI) was 0.988-0.997] and the maximum HR (OR = 1.006, 95%CI was 1.001-1.011), maximum MAP index (OR = 1.620, 95%CI was 1.244-2.126), mean diastolic index (OR = 0.283, 95%CI was 0.091-0.856), median systolic index (OR = 2.149, 95%CI was 0.805-4.461), median diastolic index (OR = 3.986, 95%CI was 1.376-11.758) were selected (all P < 0.1). There were 14 other variables with P < 0.05, including age, Elixhauser comorbidity score, continuous renal replacement therapy (CRRT), use of ventilator, sedation and analgesia, norepinephrine, norepinephrine, highest serum creatinine (SCr), maximum blood urea nitrogen (BUN), highest prothrombin time (PT), highest activated partial thromboplastin time (APTT), lowest platelet count (PLT), highest white blood cell count (WBC), minimum hemoglobin (Hb). The ROC curve showed that the area under the curve (AUC) of Model 1 and Model 2 were 0.769 and 0.637, respectively, indicating that model 1 had higher prediction accuracy. The PRC curve showed that the AUC of Model 1 and Model 2 were 0.381 and 0.240, respectively, indicating that Model 1 had a better effect. The DCA curve showed that when the threshold was 0-0.8 (the probability of death was 0-80%), the net benefit rate of Model 1 was higher than that of Model 2. The calibration curve showed that the prediction effect of the nomogram model developed according to Model 1 was in good agreement with the actual outcome. The Bootstrap verification results showed that the nomogram model was consistent with the above results and had good prediction effects.@*CONCLUSIONS@#The nomogram model constructed has good prediction effects on the 28-day prognosis in sepsis patients, and the blood pressure indexes are important predictors in the model.

Effect of preview guidance mode on "medical statistics" teaching / 中华医学教育探索杂志

Objective:To investigate the feedback of students towards the application of knowledge-points based preview guidance mode and knowledge-outline based preview guidance mode in medical statistics teaching.Methods:Totally 126 undergraduate students from Batch 2018 five-year clinical medicine were randomly assigned to two groups according to their dormitory number. Before class, knowledge-points focused and knowledge-outline focused preview guidance materials were given to the students in the two groups respectively to assist them in pre-class preview through "Rain Classroom" teaching assistant software. The utilization of preview guidance materials was evaluated and collected. The students' attitudes towards the preview guidance modes they received were collected through questionnaire. In this study, Wilcoxon rank sum test and chi-square test were carried out by SAS9.4 statistical software.Results:The reading completion rate of preview guidance materials in the knowledge-points based preview guidance group was lower than that of the knowledge-outline based preview guidance group (62.78% vs. 80.30%, P<0.001). The median of students' satisfaction score in knowledge-points group and knowledge-outline group were 89.50 and 90.00 respectively, and there was no statistical significance between the two groups ( P=0.252). Of all the students, 61.90%(78/126) of the students strongly liked or liked to receive preview guidance, 75.40%(95/126) of the students thought that preview guidance was very helpful or helpful to classroom learning, 62.70%(79/126) of the students thought that the preview guidance could strongly improve or improve the efficiency of pre-class preview process. The rating results of the above three aspects were similar between the two groups. Conclusion:Both the two preview guidance modes are feasible and effective. The completion rate and evaluation results of the students in the knowledge-points focused preview guidance group are better than those of the knowledge-outline focused preview guidance group. We suggest that knowledge-outline based preview guidance mode might be prioritized in medical statistics teaching.

Design and evaluation of ideological and political teaching of Medical Statistics for postgraduates / 上海预防医学

ObjectiveTo design and evaluate the ideological and political teaching in the Medical Statistics as a public basic course for postgraduates in a medical school. MethodsThrough expert consultation， literature review， investigation， we designed the main points in the ideological and political teaching for the Medical Statistics. Students' satisfaction and demand of ideological and political teaching were investigated by a questionnaire. Furthermore， effect of ideological and political teaching was evaluated. ResultsA total of 178 out of 201 graduate students in Grade 2020 in a medical university completed the survey， accounting for 88.56%， with a response rate of 100%. Among them， 84.27% of the students believed it was necessary to implement ideological and political teaching for the Medical Statistics， and 90.45% expected that ideological and political teaching could be combined with case studies. The comparison before and after class showed that the students’ correct understanding of data acquisition has been greatly improved from 78.65% to 100%. In addition， the proportion of those who were dedicated to studying increased from 89.88% to 97.75%. ConclusionThe ideological and political teaching for Medical Statistics can be implemented in combination with case studies. Ideological and political teaching may improve the courses with practical operation of knowledge and skills.