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In order to provide efficient medical care to atrial fibrillation patients in the community, the Huamu Community Health Service Center in association with its medical consortium, Renji Hospital have developed a novel atrial fibrillation management system. With the collaboration of general practitioners and specialist team from the tertiary hospital, a special clinic for atrial fibrillation has been set up in the community health service center, which is based on the internet technology and the medical consortium platform. This article introduces the development of this novel system and the initial outcome of the measures, to provide a reference for the management of atrial fibrillation patients in the community.
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BACKGROUNDIncreasing attention has been paid to cardiac involvement in patients with coronavirus disease 2019 (COVID-19). Yet, scarce information is available regarding the morphological and functional features of cardiac impairments in these patients. METHODSWe conducted a prospective and serial echocardiographic study to investigate the structural and functional cardiac changes among COVID-19 patients admitted to the intensive care unit (ICU). From January 21 to April 8, 2020, a total of 51 ICU patients (31 critically ill and 20 severely ill) with confirmed COVID-19 were monitored by serial transthoracic echocardiography examinations. Outcomes were followed up until April 8, 2020. RESULTSOf 51 ICU patients, 33 (64.7%) had cardiovascular comorbidities. Elevations of levels of cardiac biomarkers including high-sensitivity cardiac troponin-I (hs-cTnI) and brain natriuretic peptide were observed in 62.7% and 86.3% of patients, respectively. Forty-two (82.3%) had at least one left-heart and/or right-heart echocardiographic abnormality. The overall median left ventricular ejection fraction (LVEF) was 65.0% (IQR 58.0-69.0%), with most (44/86.3%) having preserved LVEF. Sixteen patients (31.4%) had increased pulmonary artery systolic pressure, and 14 (27.5%) had right-ventricle (RV) enlargement. During the study period, 12 (23.5%) patients died. LVEF was comparable between survivors and non-survivors, while non-survivors had more often pulmonary hypertension (58.3% vs. 23.1%; P=0.028) and RV enlargement (58.3% vs. 17.9%, P=0.011). Kaplan-Meier analysis demonstrated similar survival curves between patients with vs. without echocardiographic left-heart abnormalities (P=0.450 by log-rank test), while right-heart abnormalities had adverse impact on mortality (P=0.012 by log-rank test). CONCLUSIONSTypical cardiac abnormality in ICU patients with COVID-19 was right-heart dysfunction with preserved LVEF. Echocardiographic right-heart dysfunction was associated with disease severity and increased mortality in patients affected by COVID-19. CLINICAL TRIAL REGISTRATIONUnique identifier: NCT04352842.
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Objective: To evaluate the risk factors of hypercoagulability in the patients with chronic kidney disease (CKD) by thrombelastograph.Methods:According to the maximal elasticity of thrombus(MA),221 patients with chronic kidney disease under-going thromboelastography were divided into two groups: low coagulation group (MA<69mm, n=139) and high coagulation group (MA≥69mm,n=82). The basic conditions of the two groups were analyzed respectively, including gender, age, height, weight, concomitant diseases such as diabetes mellitus,hyperlipidemia and nephrotic syndrome,medication situation such as recombinant hu-man erythropoietin,anti-platelet drugs and hormones,renal function such as CKD1-3 stages and CKD4-5 stages,clotting parameter re-sponse time(R value),clotting time(K value),angle α,maximum thrombus(MA)and the other coagulation-related indicators such as platelet PLT,and binary logistic regression was used to analyze the risk factors causing hypercoagulability. Results:There were no significant differences in age,gender,height and weight etc(P>0.05)while there were significant differences in concomitant diseases, drug use,renal function, coagulation indicators including thrombus elasticity and blood index between the groups (P<0.05). The risk factors of hypercoagulation mainly included disease factors (diabetes OR 1.895,95% CI 1.082-3.318, nephrotic syndrome OR 2.501,95% CI 1.429-4.379,CKD4-5 stage OR 1.989,95% CI 1.136-3.483),and drug factors(recombinant human erythropoietin rHuEPO)(OR 2.254,95% CI 1.207-4.208). Conclusion: In the patients with CKD, diabetes mellitus, nephrotic syndrome and CKD4-5 stages increase the hypercoagulability of patients,and rHuEPO also increases the risk of hypercoagulability in the patients with renal anemia.
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Objective: To investigate the application value of thrombelastography(TEG) in coagulation monitoring for ACS patients.Methods: Totally 255 ACS patients were selected with coagulation monitoring by TEG.The patients were divided into none ST-segment elevation myocardial infarction (NSTEMI) group and ST-segment elevation myocardial infarction (STEMI) group.The clotting characteristics in different types of ACS patients were compared and analyzed.Results: The ACS patients had higher intensity of thrombosis (MA) and Angle value.D-dimer and MA were significantly different between NSTEMI group and STEMI group(P＜0.01).The drug utilization in STEMI group was closer to the requirements of the guidelines.Conclusion: TEG shows high application value in coagulation monitoring for ACS patients.MA value and Angle value are more sensitive in evaluating hypercoaguable state.
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Delphi method is a kind of forecasting method with several rounds of consultation with experts. It has three major characteristics including anonymity,information feedback and statistical analysis of results. With the continuous development of the method,its application fields is widened from the initial development of sociology to clinical medicine,psychology,nursing and so on. Since pharmacy and clinical medicine is inseparable,Delphi method used in pharmacy field has become the new direction of pharmaceutical research,and it can provide a new method for the pharmaceutical regulations,medical risk assessment and development of clinical pharmacy. In the paper,the application of Delphi method in the field of pharmacy was summarized in order to provide new ideas for the development of pharmacy.
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Objects To investigate the correlation of the single nucleotide polymorphism ( SNP) of clopidogrel related gene CYP2C19, ABCB1, PON1 to the occurrence of clopidogrel resistance ( CR) and TEG among patients after percutaneous coronary intervention.Methods A total of 299 patients after PCI were enrolled from April 2015 to December 2015.It genotyped the CYP2C19(rs4244285,rs4986893)ABCB1 ( rs1045642 ) and PON1 ( rs662 ) gene, measured clopidogrel response by TEG.Accordingly, all the enrolled 299 patients were then divided into CR group (n=17) +non-CR (NCR) group (n=282) or CLR group (n=54) +non-CR (NCR) group (n=245) by TEG(%).All the patients were divided into EM、IM and PM group by CYP2C19 genotype.The age of patient in CR (71.1 ±11.1) years old is higher than NCR (65.02 ±10.51) years old (t=2.559, P0.05).There was no significant difference between CR(χ2 =0.175,P=0.916) CLR(χ2 =1.589,P=0.452)and the level of TEG(ADP) (Z=-0.030,P=0.976) in PON1(rs662) polymorphism.There was no significant difference between CR(χ2 =1.722,P=0.423) CLR(χ2 =0.176,P=0.916) and the level of TEG(ADP) (Z=-0.331,P=0.741) in ABCB1(rs1045642) polymorphism.Conclusions CYP2C19 PM is associated with decreased of TEG(ADP).It is considered that no correlation exists between ABCB1(rs1045642) and PON1(rs662) polymorphism and clopidogrel resistance in patients with coronary heart diseases.The loss of function of ABCB1 ( rs1045642 ) and PON1 ( rs662 ) is not associated with decreased of TEG(ADP) in CYP2C19 PM patients.
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OBJECTIVE:To evaluate the prophylactic use of antibiotics in perioperative period in our hospital. METHODS:The prophylactic use of antibiotics in 841 patients in our hospital in the first 3 months was analyzed statistically. RESULTS:841 patients have used antibiotics,and 74.04% of those patients with typeⅠ incision operation used antibiotics for 3 to 7 days. Cephalosporins and Fluoroquinolones were predominantly used for prophylactic purpose. Irrational use of antibiotics was seen in 714 cases. CONCLUSION:The prophylactic use of antibiotics in our hospital is far from rational,thus it is necessary to put "Guideline on Clinical Use of Antimicrobials" into practice.
