ObjectiveTo explore the diagnostic efficacy of Geriatric Nutritional Risk Index (GNRI) in malnutrition of elderly patients with chronic obstructive pulmonary disease (COPD) in outpatient department. MethodsOne hundred and five elderly outpatients with COPD were enrolled in the study, and their nutritional screening was carried out. The clinical and laboratory parameters of patients in the normal nutrition group (high GNRI group) and malnutrition group (low GNRI group) were compared, and the correlation analysis was conducted. The diagnostic efficacy of GNRI was evaluated based on the malnutrition universal screening tool (MUST). ResultsThe prevalence of malnutrition was high in COPD elderly outpatients. The prevalence of malnutrition in group D was 61.8%. There were significant differences between the two groups in body mass index, serum albumin, FEV1 percentage in the predicted value, 6-minute walk distance, and the number of acute exacerbations in the past year. GNRI was significantly related to the above parameters. The sensitivity, specificity and accuracy of GNRI were 81.8%, 83.6% and 82.9%, using MUST as the standard. ConclusionGNRI can be used for nutritional screening of COPD patients in elderly outpatients, which is simple, convenient and relatively accurate, and can be popularized in other medical institutions.
Osteosarcopenia (OS), which has become a global public health problem, is a geriatric syndrome in which sarcopenia and osteoporosis co-exist, leading to falls, fractures, and even varying degrees of disability in the elderly. The Dietary Inflammatory Index (DII) is a tool to measure the overall level of dietary inflammation in an individual, and the DII score is closely associated with the development of OS. This article reviews the basic concepts of DII and OS and their interrelationships, focusing on the associations between diet, inflammation, DII and OS, with the aim of providing a reference for dietary interventions in the prevention and control of OS patients.
Objective To explore the effect and evaluation criterion of the transplantation of autologous peripheral blood stem cells(PBSC)for blood flow remodeling in the critical limb ischemia (CLI).MethodsThirty six patients with 39 limbs suffered from CLI at Yunnan Provincial Center of Vascular Surgery and Department of Vascular Surgery of The First Affiliated Hospital of China Medical University from March 2003 to January 2007 were included in this study.These patients were divided into two groups. One groupconsisted of 20 cases in all 22 limbs used the transplantation of autologous PBSC,and another group included 16 cases in all 17 limbs were not use this technique.Multifunction monitoring device,dopplor ultrasound monitoring device,per cutem oxygen partial pressure monitoring device and digital subtraction angiography were used to measure effect degree of limbs regional blood flow from cutaneous covering,blood vessel and blood on the preoperative and postoperative days and the follow-up time was six months.ResultsThe effect indexes of limbs regional blood flow of the case by transplantation of autologous PBSC was as follows:skin temperature index(STI)was(1.5±0.3) ℃， per cutem oxygen partial pressure monitoring device(TcPO2)was(36.6±9.3)mm Hg,ankle-brachium index(ABI)was0.7±0.1,photoplethysmograpy index(PPGI) was0.8±0.1,saturation of blood oxygen(SaO2)was(78.3±15.9)%,digital subtraction angiography score was1.5±0.3,the rate of limbs salvage was 82%,the distance of intermittent claudication was(150.3±41.1)meters,and the change of index was consistent with ameliorative tendency of symptom(0.415＜r＜0.592, P＜0.05).ConclusionThe transplantation of autologous PBSC can promote blood flowremodeling in limbs ischemia,and the effect indexes of limbs regional blood flow can objectively reflect the degree of blood flow remodeling.
Objective
To explore the risk factors of perioperative insomnia in young patients with breast masses undergoing ambulatory Mammotome (MMT) minimally invasive surgery.
Methods
A total of 166 young female patients who were ≤40 years old, diagnosed with breast masses, undergoing ambulatory MMT between June and December 2016 in West China Hospital of Sichuan University were included in this study. Questionnaire survey and data about general condition, preoperative and postoperative Insomnia Severity Index (ISI), Hospital Anxiety and Depression Scale, and postoperative pain Visual Analogue Scale were collected in the enrolled population. Univariate analysis was used to screen the factors that might cause insomnia, and then multiple logistic regression analysis was performed to identify possible risk factors of insomnia.
Results
In the 166 young female patients, the mean age was (30.90±5.96) years, and the mean perioperative ISI score was 8.83±4.97. Slight insomnia was found in 39.7% (66/166) of the patients, moderate insomnia was found in 12.7% (21/166), and severe insomnia was found in 2.4% (4/166). The results of multiple logistic regression suggested that the number of breast masses [taking the number=1 as the reference, when the number=4, odds ratio (OR)=2.269, 95% confidence interval (CI) (1.917, 13.818), P=0.001; when the number>4,OR=9.359, 95%CI (4.507, 19.433), P<0.001] and the maximum diameter of breast masses [taking 1–10 mm as the reference, when the maximum diameter was 26–30 mm,OR=6.989, 95%CI (1.488, 32.785), P=0.014; when the maximum diameter >30 mm, OR=17.290, 95%CI (4.664, 64.071), P<0.001] were independent risk factors of the severity of perioperative insomnia in these young women.
Conclusion
It is recommended that psychological nursing and comprehensive admission education should be enhanced for young patients who have >3 breast masses or the diameter of the mass is >25 mm, aiming to improve the postoperative recovery of patients with high risk of insomnia.
OBJECTIVE In order to inquire the methods of thumb reconstruction by transferring the index finger with incomplete conditions of nerve or blood vessels. METHODS From April 1987 to October 1997, 6 cases were treated by 3 kinds of operative methods according to the damage type of thumb and complications injures of the rest of hand: 1. transferring the index finger with pedicle without proximal phalanx, 2. transferring the index finger with palmar nerve and blood vessels, and dorsal skin pedicle, 3. transferring the index finger with compound pedicle. RESULTS All 6 cases of thumb reconstruction were successful. Followed up 6 months to 2 years, the pinching and gribing functions in 6 cases were completely recovered, and the sensation were partly recovered. CONCLUSION The operative method of thumb reconstruction had following advantages: Simple operation, high survival rate and certain function recovery. It can enlarge the indications of thumb reconstruction.
Objectives
To construct patient trust evaluation index system based on the background of hierarchical medical system, and to provide reference for the evaluation of the degree of patient trust on medical institutions and offer guidence to the implementation and further improvement of the hierarchical medical policy in China.
Methods
Based on literature review, the modified Delphi method was used to carry out 2 rounds of expert consultations from 11 experts in different fields to determine the indicators of patient trust evaluation index system.
Results
Questionnaire recovery rates of 2 rounds were 100.00% and 90.91%, the expert authority coefficient was greater than 0.75, the coefficient of variation of each index was less than 0.25, and the coordination coefficient of experts in the total index were 0.236 and 0.424 (P<0.001). Patient trust evaluation index system was preliminary constructed including medical environment, service trust, technical skills, pharmaceutical and equipment, the overall trust 5 first-level indexes and 20 level two indexes.
Conclusions
The patient trust evaluation index system can be used to evaluate patients' trust in different levels of medical institutions under the hierarchical medical system.
ObjectiveTo evaluate the effectiveness of the upper limb free flap for repair of severe contracture of thumb web, and one stage reconstruction of the index finger abduction. MethodsBetween March 2007 and June 2011, 16 cases of severe contracture of thumb web and index finger abduction dysfunction were treated. There were 14 males and 2 females with an average age of 29 years (range, 16-42 years). All injuries were caused by machine crush. The time between injury and admission was 6-24 months (mean, 10 months). The angle of thumb web was 10-25° (mean, 20°), and the width of thumb web was 15-24 mm (mean, 22 mm). After scar relax of the thumb web, the defect size ranged from 6 cm × 4 cm to 8 cm × 6 cm; the upper limb free flap from 7 cm × 5 cm to 9 cm × 7 cm was used to repair the defect, index finger abduction was simultaneously reconstructed by extensor indicis proprius tendon transfer. The donor site was repaired with skin grafting. ResultsAll the flaps and skin graftings survived after operation and incisions healed by first intention. Fourteen patients were followed up 6-12 months (mean, 9 months). The flap appearance was satisfactory. The two-point discrimination was 6-9 mm (mean, 7 mm) after 6 months. The angle of thumb web was 85-90° (mean, 88°). The width of thumb web was 34-52 mm (mean, 40 mm). The abduction and opposing functions of thumb and abduction function of index finger were both recovered. Conclusion A combination of the upper limb free flap for severe contracture of thumb web and one stage reconstruction of the index finger abduction for index finger abduction dysfunction can achieve good results in function and appearance.
Objective?To study the improved index finger dorsal island flap for primary repair of thumb tip injury.?Methods?Between January 2009 and February 2010, 23 patients with thumb tip injury were treated. There were 17 males and 6 females, aged 21-47 years (mean, 27.5 years). The causes of injury were mechanical injury in 18 cases and heavy crushing injury in 5 cases. The time from injury to operation was 2.5-5.0 hours (mean, 3.5 hours). The defect locations included ulnar palmar defect in 5 cases, dorsal foot defect in 6 cases, radial palmar defect in 8 cases, and radial dorsal defect in 4 cases. All patients complicated by exposure of the thumb distal phalanx. The wound area varied from 2.1 cm × 1.8 cm to 2.8 cm × 2.5 cm. According to distal soft tissue defect of thumb, a modified index finger dorsal island flap was designed, key point of which was moved forward, and defects were repaired with the flaps. The size of flap was 2.3 cm × 2.0 cm to 3.0 cm × 2.7 cm. The donor sites were repaired with skin graft.?Results?All the flaps and grafts survived after operation and the wounds healed by first intention. All patients were followed up 6-12 months with an average of 6.4 months. The appearance and texture of the flaps were excellent. At last follow-up, the sensation of the flaps recovered to S3+ in 18 cases, to S3 in 2 cases, and to S2 in 3 cases. The two-point discrimination was 3-4 mm. Thumb opposition function was normal without contracture at the first web space. The skin graft at the donor site survived completely, and the metacarpophalangeal joint at donor site had the flexion and extension function.?Conclusion?Using a modified index finger dorsal island flap for primary repair thumb tip injury is a simple operation, which has good blood supply and high survival rate. When the pedicle flap rotation point is moved forward 10 mm or more, it can meet the needs of repairing thumb tip defect.
ObjectivesTo understand the quantitative measurement tools for active aging and compare the index construction, applicability and application of different tools domestically and abroad, so as to provide a scientific basis for the formulation and improvement of localized measurement tools for active aging.MethodsWe performed electronical searches on PubMed, Web of Science, Elsevier, CNKI, WanFang Data, VIP, and websites of WHO, European Commission, United Nations Economic Commission for Europe from April 2002 to November 2019. Two reviewers independently screened literature and extracted data according to inclusion and exclusion criteria, and conducted a qualitative analysis and comparison of the obtained measurement tools.ResultsA total of 36 researches were included, which involved 9 original active aging quantitative measurement tools. Specifically, 3 were from Thailand, 2 were from China, 1 was from the European Union, Russia, Australia and Finland, respectively. There were 2 to 3 dimensions of the tools, 3 to 10 items of primary measurement targets, and 11 to 177 items of measurement indicators. The construction of the dimension and first-level measurement goals were mainly based on the three pillars of health, participation, and security which composed WHO’s policy framework. The indicators of tools had measured the health, participation, and security targets except for the AAQ-CHN (2012) and AAL-Thai (2016) tools. Five age-specific indicators of the use of electronic information technology equipment, voluntary services, participation in political activities, access to health care services, and lifelong learning habits appeared in the EU tool. The AAI-EU's empirical applications and related 20 studies had been published mainly in Europe, Asia, and the Americas. AAI-Thai (2006) and AAI-Thai (2014) were used in empirical researches in Asia and China, respectively, and the 3rd and 4th studies were published.ConclusionsThe indicators' design of AAI-EU (2012) has the most contemporary characteristics, the most confirmatory research and widest application. The development of Chinese localized quantitative measurement tools should take advantage of the EU and other representative measurement tools.
To achieve policy goals of new medical reform, a control line of drug proportion was delimited for hospitals by the Department of National Administration. However, to formulate criteria of drug proportion in a scientific and rational approach has been a challenge, which plagued numerous medical workers. This study aims to analyze the baseline data of drug proportion and its impact factors in clinical departments, and quality control charts are applied to explore an estimating method and process for rationally formulating an index criterion of pharmaceutical management, so as to provide a reference for hospital management practice.
