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Lupus nephritis (LN) is one of the most common and serious clinical manifestations of systemic lupus erythe-matosus (SLE), which causes serious damage to the kidneys of patients. To effectively assist the pathological diagnosis of LN, many researchers utilize a scheme combining multi-threshold image segmentation (MIS) with metaheuristic algorithms (MAs) to classify LN. However, traditional MAs-based MIS methods tend to fall into local optima in the segmentation process and find it difficult to obtain the optimal threshold set. Aiming at this problem, this paper proposes an improved water cycle algorithm (SCWCA) and applies it to the MIS method to generate an SCWCA-based MIS method. Besides, this MIS method uses a non-local means 2D histogram to represent the image information and utilizes Renyi's entropy as the fitness function. First, SCWCA adds a sine initialization mechanism (SS) in the initial stage of the original WCA to generate the initial solution to improve the population quality. Second, the covariance matrix adaptation evolution strategy (CMA-ES) is applied in the population location update stage of WCA to mine high-quality population information. To validate the excellent performance of the SCWCA-based MIS method, the comparative experiment between some peers and SCWCA was carried out first. The experimental results show that the solution of SCWCA was closer to the global optimal solution and can effectively deal with the local optimal problems. In addition, the segmentation experiments of the SCWCA-based MIS method and other equivalent methods on LN images showed that the former can obtain higher-quality segmented LN images.
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Background:Coronavirus disease 2019 (COVID-19) is a serious and even lethal respiratory illness. The mortality of critically ill patients with COVID-19, especially short term mortality, is considerable. It is crucial and urgent to develop risk models that can predict the mortality risks of patients with COVID-19 at an early stage, which is helpful to guide clinicians in making appropriate decisions and optimizing the allocation of hospital resoureces.Methods:In this retrospective observational study, we enrolled 949 adult patients with laboratory-confirmed COVID-19 admitted to Tongji Hospital in Wuhan between January 28 and February 12, 2020. Demographic, clinical and laboratory data were collected and analyzed. A multivariable Cox proportional hazard regression analysis was performed to calculate hazard ratios and 95% confidence interval for assessing the risk factors for 30-day mortality.Results:The 30-day mortality was 11.8% (112 of 949 patients). Forty-nine point nine percent (474) patients had one or more comorbidities, with hypertension being the most common (359 [37.8%] patients), followed by diabetes (169 [17.8%] patients) and coronary heart disease (89 [9.4%] patients). Age above 50 years, respiratory rate above 30 beats per minute, white blood cell count of more than10 × 109/L, neutrophil count of more than 7 × 109/L, lymphocyte count of less than 0.8 × 109/L, platelet count of less than 100 × 109/L, lactate dehydrogenase of more than 400 U/L and high-sensitivity C-reactive protein of more than 50 mg/L were independent risk factors associated with 30-day mortality in patients with COVID-19. A predictive CAPRL score was proposed integrating independent risk factors. The 30-day mortality were 0% (0 of 156), 1.8% (8 of 434), 12.9% (26 of 201), 43.0% (55 of 128), and 76.7% (23 of 30) for patients with 0, 1, 2, 3, ≥4 points, respectively.Conclusions:We designed an easy-to-use clinically predictive tool for assessing 30-day mortality risk of COVID-19. It can accurately stratify hospitalized patients with COVID-19 into relevant risk categories and could provide guidance to make further clinical decisions. © 2021 The Chinese Medical Association, Published by Wolters Kluwer Health, Inc.
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Purpose The disruption of routine treatment, including the interruption of medication, might be deteriorating chronic conditions during disasters such as the COVID-19 epidemic. This study aims to assess the effectiveness of patient-centered measures for patients with chronic diseases during the COVID-19 epidemic. Method This was a cross-sectional study to analyze the effectiveness of chronic disease prescriptions issued by hospital-based clinicians, prescription refilling rate, the utilization rate of reservation for picking-up medicine, and the rate of returning to the hospital for refilling prescriptions as scheduled at a tertiary care hospital in Taiwan by using chi-square test. The enrolled outpatients received managed care from January to June of 2019 and 2020. The SAS (v8.2) statistical software was used for analysis. Results The percentage of chronic disease prescriptions issued by physicians out of a total number of outpatient visits increased to 66.0% significantly, and the rate of patients who returned to the hospital to refill chronic disease prescriptions decreased to 52.4%. The utilization rate of reservation service for prescription refills increased significantly from 3.9% to 10.5%. There is a significant difference in age groups and specialties visited by patients who made prescription refill reservations. The top five specialties are cardiovascular medicine, metabolic diseases, and endocrinology, neurology, urology, orthopedics, and rehabilitation. The specialties with the highest increase in reservation rate are psychiatry, gastroenterology, gynecology and pediatrics, and rheumatology. Discussion Most of the chronic disease continuous prescription users are the elderly, but the elderly are at high risk of severe COVID-19. Adopted patient-centered measures for preparedness to go out with medication such as outdoor drug dispensing counters, walk or drive-through pharmacies and online reservations for prescription refilling were effective, which can help elderly with the stable chronic disease obtain medication on schedule and reduce the risk of coronavirus exposure. National Health Insurance Administration should add the prescription refilling records to health insurance cards for further evaluating medicine adherence when prescriptions are revised. © 2022, Gerontechnology. All Rights Reserved.
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Objective: To observe the application effects of a standard communication system-based continuous home remote visit mode in the management of visits to severely burned patients in the post-pandemic era of coronavirus disease 2019 (hereinafter referred to as post-pandemic era). Methods: A retrospective cohort study was conducted. A total of 69 severely burned patients who met the inclusion criteria and were admitted to the First Affiliated Hospital of Army Medical University (the Third Military Medical University) from February to December, 2020 and their 69 family members were recruited into this study. According to the difference of visit model, 33 severely burned patients who were admitted into burn intensive care unit (BICU) from February to June, 2020 and received completely restricted visits according to the requirements for epidemic prevention and control and their corresponding 33 family members were included into conventional visit group; 36 severely burned patients who were admitted into BICU from July to December, 2020 and received the standard communication system-based continuous home remote visits and their 36 corresponding family members were recruited into remote visit group. The family members in conventional visit group could only communicate with the primary nurses by telephone, while the patients and family members in remote visit group could communicate with the primary nurses, responsible doctors, rehabilitation therapists, and nutrition therapists through WeChat video call. The survey results of general information questionnaire and Hamilton Anxiety Scale (HAMA) scores of two groups of patients and their family members at BICU admission of patients, HAMA scores of the two groups of patients and their family members in the second week of BICU admission and at discharge from BICU of patients, the scores of the Visiting Effect Evaluation Scale of the two groups of patients and their family members and the scores of Chinese version of Critical Care Family Satisfaction Survey (C-CCFSS) of the two groups of family members at discharge from BICU, and the scores of Satisfaction Survey and Evaluation Scale During Hospitalization of patients within the first week after the discharge of patients from BICU were compared. Data were statistically analyzed with chi-square test, Fisher's exact probability test, and Mann-Whitney U test. Results: In remote visit group, there were 29 males and 7 females in patients, aged 48 (34, 53) years, and 15 males and 21 females in family members, aged 45 (30, 48) years. In conventional visit group, there were 24 males and 9 females in patients, aged 49 (38, 54) years, and 9 males and 24 females in family members, aged 44 (35, 48) years. At BICU admission of patients, the HAMA scores of the two groups of patients and family members were both similar (P>0.05). The total HAMA scores of patients and family members in remote visit group were significantly lower than those in conventional visit group in the second week when the patients were admitted to BICU (Z=-3.195, -3.018, P<0.01) and discharged from BICU (Z=-2.118, -2.380, P<0.05). At discharge from BICU of patients, the scores of each dimension in Visiting Effect Evaluation Scale of the patients in the two groups were similar (P>0.05); while scores of 3 dimensions including patient safety information, diagnosis and treatment quality information, and psychological support information in Visiting Effect Evaluation Scale of family members in remote visit group were significantly higher than those in conventional visit group (Z=-2.372, -2.209, -2.174, P<0.05), and only the scores of visit perception of family members were close to those in conventional visit group (P>0.05). At discharge from BICU of patients, the C-CCFSS scores of the family members in remote visit group was 99 (98, 108), which were significantly higher than 98 (97, 100) in conventional visit group (Z=-2.545, P<0.05). Within the first week after the discharge of patients from BICU, the scores of Satisfaction Survey and Evaluation Scale During Hospitalization of patients in remote visit group were 99 (98, 100), which were significantly higher than 96 (94, 98) in conventional visit group (Z=-5.213, P<0.01). Conclusions: In the management of visits to severely burned patients in the post-pandemic era, application of the standard communication system-based continuous home remote visit mode can improve the visit effect and satisfaction, and effectively alleviate the anxiety of patients and their family members.
Subject(s)
COVID-19 , Pandemics , Communication , Female , Humans , Male , Retrospective Studies , SARS-CoV-2ABSTRACT
The 2019 novel coronavirus (2019-nCoV) is extremely infectious and the human population globally is generally susceptible to it. Its spread poses a serious threat to public health. Analyzing the epidemiological and clinical characteristics of patients with coronavirus disease 2019 (COVID-19) can more fully demonstrate its characteristics and evolution, and provide effective scientific strategies for preventing and controlling the epidemic. In this study, nucleic acid detection was performed on 228 suspected COVID-19 cases in Ningbo City from January 2020 to August 2020. The RNA of the virus was extracted by the nano magnetic bead method and was detected by real-time fluorescent quantitative PCR. Patients whose test results were positive were considered as research subjects. Clinical data of the patients were collected through a medical record system and the epidemiology and characteristics of COVID-19 were analyzed. Among the 228 suspected cases, 108 patients had a positive nucleic acid test result. The 108 confirmed patients were selected as research subjects, including 9 patients with mild symptoms, 85 patients with common symptoms, and 14 patients with severe symptoms. The age range of the patients was 17-82 years. Overall, 35 patients (32.40%) had complications. The median incubation period for patients was 7.5 days. Seventy patients (64.81%) had a contact history with a diseased individual. In terms of the clinical symptoms of the patients, the following symptoms were identified: fever in 92, cough in 62, fatigue in 34, sputum expectoration in 32, dry cough in 22, sore throat in 19, diarrhea in 8, headache in 8, shortness of breath in 7, nasal congestion in 5, and muscle ache in 5 cases. The results of chest CT imaging showed that 96 patients (88.89%) exhibited bilateral or unilateral pneumonia lesions of varying degrees, manifested as bilateral or unilateral lung patches, cloudy floccules, patches with an increased density shadow. The CT images of 12 patients (11.11%) showed no obvious abnormalities, while 24 cases (22.22%) had absolute white blood cell count of <4x10(9)/L, while 1 case had one of >10x10(9)/L. The absolute neutrophil count in 10 patients (9.26%) increased (>6.3x10(9/)L). The absolute lymphocyte count in 49 patients (45.37%) decreased (<1.1x10(9)/L). The hemoglobin, hematocrit, and platelet levels of the vast majority of patients were normal, while a few were low or high. Fifty-eight patients (53.70%) had elevated C-reactive protein (>10 mg/L);14 (12.96%) had elevated D-dimer (>256 mu g/L);14 (12.96%) had high levels of alanine aminotransferase (>40 U/L);9 (8.33%) had increased aspartate aminotransferase (>40 U/L);while 32 (29.6%) had increased lactate dehydrogenase (>250 U/L). COVID-19 in Ningbo is mainly transmitted in clusters, and elderly patients are more likely to develop severe symptoms. There is no significant difference in clinical characteristics between patients with severe conditions and those with mild and common ones.
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The prevention and control of coronavirus disease 2019 (COVID-19) has already entered a key period. The patients treated in the burn and wound care ward are susceptible to viral infection because of disease, age and other factors, so it is very important to manage the burn and wound care ward during the prevention and control of COVID-19 pandemic. In this paper, combining with the key clinical problems of prevention and control in hospital during the epidemic period of COVID-19 infection, medical evidence, and clinical and management experience, the authors formulate prevention and control management strategy of the author's unit in order to provide reference for prevention and control of burn and wound care ward.