Average Hospitalization Days Research Articles

Establishment and application of early warning system for pediatric critical illness

Objective To explore the effect of early warning system in pediatric critical illness or potential critical illness. Methods The early warning system of pediatrics was established and applied to pediatric hospitalized children.A total of 568 children admitted to the hospital from August to December 2015 were selected as the research objects, and were divided into the observation group (295 cases) and the control group (273 cases) using the random number table method.The control group was treated with routine evaluation and treatment, and the observation group was treated with early warning management.The rates of unplanned admission PICU, average hospitalization days and doctors' satisfaction to nurses were compared between the two groups. Results In the observation group, the unplanned admission rate of PICU and the average length of stay were 1.69% and(4.06±1.42) days respectively, which were lower than 5.13% and (5.21±3.21) days in the control group, and the differences were statistically significant (P<0.05). Doctors' satisfaction with nurses' active observation and accurate reporting of their conditions was significantly higher than that of the control group, with statistically significant differences (P<0.05). Conclusion The establishment and application of pediatric early warning system can effectively improve the early recognition ability of medical staff for children with critical illness, timely intervention and treatment, and improve the prognosis of children. Key words: Pediatrics; Early warning system; Construction; Critical illness

Post-stroke dementia is associated with increased subsequent all-cause mortality: A population-based cohort study

Background and aimsWe aimed to determine whether patients with post-stroke dementia (PSD) have increased mortality risk in Taiwan. MethodsWe included ≥40-year-old patients who received a stroke diagnosis between 2000 and 2012 from a subset of the National Health Insurance Research Database of Taiwan. These patients were divided into PSD (International Classification of Diseases, Ninth Revision, Clinical Modification codes 290, 294.1, and 331.0) and post-stroke non-dementia (PSN) cohorts. Furthermore, we propensity score (PS) matched the PSD and PSN groups. PS was calculated through logistic regression to estimate the probability of stroke status assignment given the baseline variables, namely age, sex, and comorbidity. We calculated the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for death in the PSD and PSN cohorts after adjustments for age, sex, and comorbidities. ResultsOverall incidence density rates of death were 148.7 and 106.7 per 1,000 person-years in the PSD and PSN PS-matched cohorts, with the aHR of 1.42 (95% CI = 1.34–1.50). Average hospital days increased by 9.03 days and frequency of medical visits increased by 15.8 times per year in the PSD cohort compared with the PSN cohort. ConclusionsThe subsequent mortality rate in patients with PSD is increased compared with those without PSD. Moreover, the average hospital days and frequency of medical visit are increased in patients with PSD. Our findings provide crucial information for clinicians and the government to improve survival of patients after stroke.

Clinical analysis of 234 esophageal foreign bodies

Objective: To explore the clinical characteristics and treatment methods of esophageal foreign body. Method: The clinical data of 234 patients with esophageal foreign bodies admitted to our department from January 2015 to August 2018 were retrospectively analyzed, including course time, foreign body types, surgical methods, imaging manifestations and treatment related complications. Result: The diagnosis of esophageal foreign bodies was confirmed by esophageal CT or esophageal barium meal X-ray examination before operation in 234 patients. Course time varied from 3 hours to 7 days, and the jujube nucleus was the most common food-borne foreign body.223 patients underwent esophagoscopic exploration and foreign body removal under general intravenous anesthesia, 11 of them had no definite esophageal foreign body, 22 had esophageal perforation and periesophagitis. After removal of foreign body, the nasogastric feeding tube was inserted. About 10 days later, the nasogastric feeding tube was removed when they got healthy. Nine cases underwent cervical abscess incision and drainage under general anesthesia. The average postoperative hospital day was 11 days. Conclusion: The rigid esophagoscopy is a safe and effective method for the esophageal foreign bodies. And neck abscess incision must be necessary,when they suffered from esophageal perforation with neck abscess and other serious complications.

Mortality and hospital readmissions in the first year of life after intra‐uterine and neonatal blood product transfusions: A population data linkage study

Blood product transfusions are a potentially life-saving therapy for fetal and neonatal anaemia, but there is limited population-based research on outcomes. We aimed to describe mortality, readmission and average hospital stay in the first year of life for infants with or without intra-uterine or neonatal blood product transfusions. Linked birth, hospital and deaths data from New South Wales, Australia (January 2002-June 2014) were used to identify singleton infants (≥23 weeks' gestation, surviving to 29 days; n = 1 089 750) with intra-uterine or neonatal transfusion or no transfusion. Rates of mortality and readmission in the first year (29-365 days) and days in hospital were calculated. Overall, 68 (0.06/1000) infants had experienced intra-uterine transfusion and 4332 (3.98/1000) neonatal transfusion. Transfusion was more common among those born at earlier gestational ages requiring invasive ventilation. Mortality, readmissions and average days in hospital were higher among transfused than non-transfused infants. Over half of infants with intra-uterine and neonatal transfusion had ≥1 readmission in the first 29-365 days (55.9 and 51.8%, respectively), and around a quarter had ≥2 (20.6 and 28.5%, respectively) compared with 15.3% with ≥1 and 3.5% with ≥2 in the non-transfused group. Infants with a history of blood product transfusion, particularly those needing a neonatal transfusion, had higher mortality and more frequent contact with the hospital system in the first year of life than those infants with no history of transfusion.

Long-term safety, efficacy, treatment satisfaction, and impact on healthcare service use of paliperidone palmitate one-month intramuscular formulation in patients with recent-onset schizophrenia in taiwan: A subgroup analysis of an asia-pacific, 18-month, phase 3b study

Objectives: In this study, the authors intended to evaluate the efficacy and safety of paliperidone palmitate 1-month injection (PP1M) in patients with recent-onset schizophrenia (SCH). Methods: A subgroup analysis was done for patients enrolled in Taiwan in an Asia-Pacific, Phase 3b study (ClinicalTrials.gov identifier NCT01051531). Patients were switched from oral antipsychotics to intramuscular PP1M. Results: We included 61 patients (age: 31.2 ± 8.8 years). The Positive and Negative Syndrome Scale scores were significantly decreased, with the largest effect size observed in positive, disorganized, and depressive factors (Cohen's d = 0.52, 0.52, and 0.79, respectively). Most symptoms stabilized within six months, whereas stabilization of functional improvement required 1–1.5 years of PP1M treatment, especially for employment/academic status. PP1M treatment was well-tolerated, with over 70% of treatment satisfaction rate, and significantly reduced the average days of hospitalization (43.3–7.1/person-years). Conclusion: Switching to PP1M improved treatment outcome and satisfaction as well as reduced healthcare service use in patients with recent-onset SCH.

Application and Reliability of Caprini Thrombus Risk Assessment Scale in Risk Assessment of Venous Thromboembolism in Acute and Severe Uygur Patients

Background: To explore the application and reliability of Caprini thromboembolism risk assessment scale in the risk assessment of venous thromboembolism in acute and severe uygur patients. Methods: 160 cases of acute and severe Uighur patients with venous thrombo embolism (VTE) that were treated in our hospital from December 2017 to December 2018 were selected as the research group. 160 cases of acute and severe uygur patients without VTE admitted to our hospital in the same period were selected as the control group. Caprini thrombus risk assessment scale and Padua thrombus risk assessment scale were used to evaluate in both groups. The general data of the two groups were compared. The results of the two groups were consistent using Caprini and Padua blood clot risk assessment scales. Clinical efficacy of two different thrombosis risk assessment scales in risk assessment of VTE. Results: Group and control group in the gender distribution, backlog of red blood cells and platelet count have no significant difference (P > 0.05), the team average age, average hospitalization days were significantly less than control group (P P P 2 = 6.956, P P (P P > 0.05). Conclusion: The sensitivity, negative predictive value and positive predictive value of Caprini thrombosis risk assessment scale in VTE risk assessment of acute and severe uygur patients are very prominent, and the clinical efficacy is better, which is worthy of application.

Effect of orthopedic surgery delay and counseling on postoperative complications and mortality rate in patients aged over 55 years in a teaching hospital.

AIM:The purpose of this study was to investigate the effects of delay in the operation and counseling on postoperative complications and mortality rates in elderly patients.METHODOLOGY:The present study was a descriptive cross-sectional research. Population of this study was the entire elderly hospitalized patients who aged over 55 years for emergency orthopedic surgeries in a teaching hospital in Tehran. Surgery delays were then determined after examining the checklists, and the relationship between the variables and surgery delays, number of preoperative counseling, complications, and mortality rate was evaluated. Data were analyzed using the Mann–Whitney U-test and Pearson correlation coefficient in SPSS 18 at a 0.05 significance level.RESULTS:Overall, 89.9% of the patients had counseling. The average hospitalization days were 5 days until surgery, and the standard deviation was 0.50. The mean counseling number was 5.5. The relationship between number of counseling and surgical delays was significant. Delay in surgery in this age group, mortality, and the chances of death have become 2.7 times more than who had not a surgical delay. No significant relationship was observed between surgery delay and the incidence of Deep Venous Thrombosis (P = 0.102), postoperative sepsis and Myocardial Infarction (P = 0.337), embolism (P = 0.505), and postoperative Cerebrovascular Accident (P = 0.153).CONCLUSIONS:The delay in surgery in the elderly causes an increase in mortality. Considering the findings of this study and the importance of emergency orthopedic surgeries in the elderly, to reduce the surgical delays and the mortality rate in the elderly, the establishment of a surgical team for elderly patients in hospitals is recommended.

Clinical study on surgical treatment of lower extremity chronic ischemia caused by arteriosclerosis obliterans of lower extremity-analysis of 4 602 cases

Objective The incidence of chronic lower limb ischemia caused by arteriosclerotic obliteration of lower extremities is increasing recent years and there is a high risk of amputation and mortality. This study was to find out the changes in a single center for 16 years. Methods A retrospective analysis of the data of patients in single-center vascular surgery in the past 16 years was carried out. The patients with chronic lower limb ischemia caused by lower limb arteriosclerosis obliterans were screened out, and the data of operation information, amputation, length of stay and hospitalization expenses during hospitalization were collected. Results A total of 4 602 patients were included, of whom 57.39% were diabetic. It was found that the number of patients admitted, the number of endovascular treatment, the average cost of hospitalization increased year by year, and the average length of hospitalization decreased year by year. The amputation rate decreased from 8.12% (from 2002 to 2007) to 0.92% (from 2008 to 2017) (P<0.01). The average days of hospitalization decreased from 28.20 days (from 2002 to 2007) to 11.65 days (from 2008 to 2017) (P<0.01). The average hospitalization cost rose from 54 466.94 yuan (from 2002 to 2007) to 73 685.22 yuan (from 2008-2017) (P<0.01). There was no significant difference in amputation rate, hospitalization days and hospitalization costs between diabetic group and non-diabetic group. In diabetic subgroup, amputation rate decreased from 8.83% (between 2002 and 2007) to 1.05% (between 2008 and 2017) (P<0.01). The average hospitalization days decreased from 30.12 days (between 2002 and 2007) to 12.60 days (between 2008 and 2017) (P<0.01). The average cost of hospitalization rose from 58 530.94 yuan (between 2002 and 2007) to 74 433.75 yuan (between 2008 and 2017) (P<0.01). Conclusions From 2002 to 2017, the number of patients with chronic lower limb ischemia increased gradually, and so as the number of endovascular treatment. While the amputation rate and average hospitalization time decreased, and the average hospitalization cost increased. The same trend was observed in the diabetic subgroup. The significant decrease in amputation rate may be related to the development of endovascular therapy and angiogenesis therapy. Key words: Arteriosclerosis obliterans/CO; Lower extremity/BS; Ischemia/ET; Diabetes mellitus; Amputation

Trends in Urodynamic Procedures, Surgical Procedures, and Overall Health Resource Utilization in the Adult Taiwanese Population With Urinary Incontinence: A Secondary Data Analysis.

The prevalence and incidence of the main risk factors for urinary incontinence (UI) have both increased over time. In addition, official statistics indicate that Taiwan is on course to evolve from an aging society into an aged society within the next decade. However, most of the studies in the literature that address the natural history of UI target Western and other non-Asian populations. Taiwan lacks knowledge of the natural history of UI. The aims of this research were to study the trends in the use of urodynamic and surgical procedures for various subtypes of UI and to investigate the relationship between UI and healthcare resource utilization. The data on 1 million, randomly selected people who were enrolled in the Taiwan National Health Insurance program between 2000 and 2008 were extracted from the Longitudinal Health Insurance Database. The population and all procedures were identified based on the International Classification of Disease, Ninth Revision, Clinical Modification codes. Annual incidence of UI was calculated on an annual basis, and trend analysis was performed using logistic regression models. The association between UI and healthcare utilization was examined using generalized linear models in a gamma distribution with a log link function. Overall, the trend in the annual incidence for all types of UI increased significantly (p < .01). Significantly increasing trends in the use of urodynamic procedures over time were observed for mixed and other types of UI (p < .01). In addition, a significantly increasing trend was observed in the annual rates of surgical procedures that were received by patients with urge or stress UI (p < .05). Patients with UI showed significantly higher healthcare resource utilization, including number of ambulatory visits, number of hospitalizations, average ambulatory care expenditures, and average days of hospitalization, than those without UI. However, limited information is available on the conservative treatment of UI in the database. UI symptoms may lead to increased healthcare resource utilization in patients with UI.

The evidence-based practice of bowel preparation by transrectal prostate biopsy

Objective To formulate and standardized the procedure of bowl preparation before transrectal ultrasound-guided prostate biopsy. Methods The standardized transrectal ultrasound-guided prostate biopsy flowchart were formulated based on the best evidences and recommendations. One hundred and forty patients selected with suspected of prostate cancer and scheduled for transrectal ultrasound-guided prostate biopsy was equally assigned to two groups, the control group was given routine hospital practice before biopsy, and the observation group followed the formulated flowchart. Monitoring two groups for complications, time cost for bowl preparation, medical billing and the average day of hospitalization. Results The incidence of complications and the number of hospitalization days between two groups were comparable, the observation group in bowl preparation time was (3.75±0.78) min, the control group in bowl preparation time was (11.88±1.93) min, the difference of two groups showed statistical significance (t=15.643, P<0.01). The observation group in medical bill was ¥(81.62±15.62), the control group in medical bill was ¥(427.78±76.87), the difference of two groups showed statistical significance (t=-36.964, P<0.01). Conclusions Application of evidence-based practice to formalize bowl preparation and antibiotic use in transrectal ultrasound-guided prostate biopsy patient can facilitate the clinical nurses to provide homogenized care to prostate biopsy patients as well as improve the efficiency of nursing work. Key words: Transrectal ultrasound guided prostate biopsy; Bowel preparation; Evidence-based practice

The integration of urban and rural medical insurance to reduce the rural medical burden in China: a case study of a county in Baoji City

BackgroundIn 2003, the Chinese government launched the New Rural Cooperative medical System(NRCMS) for its rural population. In 2007, the Urban Resident Basic Medical Insurance Scheme(URBMS) was inaugurated, which aimed to cover all urban residents who are out of the labor market. However, the accessibility and fairness of the healthcare service have hindered the progress of universal healthcare. At the beginning of 2010, the Integration of Urban and Rural Medical Insurance Scheme(IURMIS) was implemented to bridge the gap in medical care between urban and rural areas. The main objective of this study is to determine the extent to which the IURMIS has been successful.MethodsThe statistical software packages SPSS 19.0 and STATA 12.0 were used for all analyses, and P < 0.05 was set as the required level of significance. Data were collected from outpatients from 2009 (July to December, n = 20,459) through 2011 (n = 65,258 in 2010, n = 59,036 in 2011) and from inpatients in 2011 (n = 3662). Due to the enormous amount of data and the short time span, most of our analysis was descriptive. However, regression discontinuity (RD) and the chi-squared (χ2) test were used to compare the ratios of medical expenses before and after the IURMIS.ResultsIn the RD analysis, there was a downward trend in the mean medical expense (Coef. = − 0.66, P < 0.001), and rural outpatients flowed to township hospitals and village clinics after the implementation of the IURMIS (Coef. = − 0.45, P < 0.001). However, compensation expenses showed an upward trend (Coef. = 11.59, P < 0.001). In the analysis of inpatient expenses, the average expenses (CNY 2067) and hospitalization days (10.0) for all the hospitals were less than those in the Chinese Fourth National Health Services Survey (CNY 3412 and 10.3, respectively).ConclusionsRural residents’ healthcare options and quality were improved and medical expenses were significantly reduced after implementation of the scheme. These results provide an evidence-based reference for improving the integration of the urban and rural medical security systems throughout China.

Effect of " hospital informationized blood glucose management" on perioperative diabetic patients

Objective To explore the effect of hospital informationized blood glucose on perioperative diabetic patients. Methods Three hundred patients with type 2 diabetes mellitus, who underwent selective operations from orthopedics, general surgery, urological surgery, and thoracic surgery were divided into two groups: 150 cases of blood glucose information management group and 150 cases of traditional blood glucose monitoring and management group. The blood glucose on target rate, percent of hypoglycemic events, percent of hyperglycemic events, the blood glucose level on the first postoperative day, the average hospitalization day, perioperative infection rate were evaluated for efficacy. Results The blood glucose on target rate in informationized blood glucose management group was significantly higher than that of the control group [(52.52 ± 18.31)% vs (14.88±8.39)%, P 0.05). Conclusion The hospital informationized blood glucose is simple and practical, which may significantly improve the rate of blood glucose control in each period, reduce the average hospitalization day, and decrease perioperative infection tendency. (Chin J Endocrinol Metab, 2018, 34: 768-772) Key words: Informationized blood glucose management; Perioperative period; Diabetes mellitus

Mobile health applications in self-management of patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis of their efficacy

BackgroundMobile health applications are increasingly used in patients with Chronic Obstructive Pulmonary Disease (COPD) to improve their self-management, nonetheless, without firm evidence of their efficacy. This meta-analysis was aimed to assess the efficacy of mobile health applications in supporting self-management as an intervention to reduce hospital admission rates and average days of hospitalization, etc.MethodsPubMed, Web of Science (SCI), Cochrane Library, and Embase were searched for relevant articles published before November 14th, 2017. A total of 6 reports with randomized controlled trials (RCTs) were finally included in this meta-analysis.ResultsPatients using mobile phone applications may have a lower risk for hospital admissions than those in the usual care group (risk ratio (RR) = 0.73, 95% CI [0.52, 1.04]). However, there was no significant difference in reducing the average days of hospitalization.ConclusionSelf-management with mobile phone applications could reduce hospital admissions of patients with COPD.

Influence of postoperative infection on hospitalization day and medical costs of patients with nervous system tumor

Objective: To investigate the influence of postoperative infection on average hospitalization days and medical costs in patients with nervous system tumor. Methods: The tumor patients treated in neurosurgery ward from July 1, 2015 to June 30, 2017 were included in the study. The patients with and without postoperative infections were divided into a case group and a control group, respectively (1 ∶ 1 ratio), matched by admission time (±3 months), age (±5 years) and surgical site. Average hospitalization days and medical costs between the two groups were analyzed. Results: The incidence of postoperative infection was 5.66%, the surgical site infection and lower respiratory tract infection accounted for 54.72% and 31.32% of the total, respectively. The median of hospitalization days in the case group was 20.5, 8.5 days longer than that in the control group (Z=-10.618, P<0.001). The median of total medical costs in the case group was 91 573.42 yuan, higher than that of the control group by 30 518.17 yuan (Z=-9.988, P<0.001). The average costs of surgical and lower respiratory tract infection were 84 888.50 yuan and 110 442.64 yuan, respectively. Among them, surgical site infection or lower respiratory tract infection caused the extra cost of 23 627.49 yuan (Z=-6.627, P<0.001) and 43 631.36 yuan (Z=-4.954, P<0.001), respectively. Conclusions: Postoperative infection greatly increased the patient's financial burden, prolonged the hospitalization duration and resulted in unnecessary use of health resources. It is necessary to pay close attention to postoperative infection.

Application of early enteral nutrition combined with supplementary parenteral nutrition in acute ischemic stroke elderly patients with mechanical embolectomy

Objective To explore the effects of early enteral nutrition (EEN) combined with supplementary parenteral nutrition (SPN) in acute ischemic stroke elderly patients after mechanical embolectomy. Methods From October 2015 to June 2017, we retrospectively collected 35 acute ischemic stroke elderly patients treated with nutritional support after mechanical embolectomy. All of the patients were divided into alone EEN group (n=9) and EEN+SPN group (n=26) according to whether to accept SPN or not. We analyzed the clinical data and curative effects, and summarized nutritional monitoring indexes such as the hemoglobin (HGB) , total protein (TP) , total lymphocyte count (TLC) , serum albumin (ALB) before and one, two weeks after surgery and compared the incidence of complications such as pulmonary infection, diarrhea, gastrointestinal hemorrhage as well as average hospital day, hospitalization expenses, outcome of disease. Results There were 24 patients who were cured and discharged from hospital and two patients who were fatal in EEN+SPN group. There were 9 patients who were cured and discharged from hospital. There was no significant difference in HGB, TP, TLC, ALB between two groups before and after surgery (P>0.05) . The difference in ALB of EEN group two weeks after surgery was significant which was compared with that before surgery (P 0.05) . There was no significant difference in average hospital day and hospitalization expenses between EEN+SPN group [ (22.94±12.91) d, (12.53±4.98) ten thousand yuan, respectively]and EEN group (P>0.05) . Conclusions The application of alone EEN in acute ischemic stroke elderly patients after mechanical embolectomy may easily cause that the level of ALB decreases. The EEN+SPN may be applied according to patient's condition so as to prevent hypoproteinemia and improve the nutritional state. Key words: Aged; Stroke; Enteral nutrition; Supplementary parenteral nutrition; Mechanical embolectomy

To study the clinical pathway of enhanced recovery after surgery in patients undergoing laparoscopic hysterectomy

Objective To investigate the effect of clinical pathway of enhanced recovery after surgery in patients undergoing laparoscopic hysterectomy. Methods All patients with uterine fibroids, uterine adenomyosis, cervical lesions and endometrial lesions were selected in Qinghai Provincial Traffic Hospital during the period of January 2015 to December 2016. Among them, 108 cases undergoing laparoscopic hysterectomy were analyzed and enrolled in the study. They were randomly divided into two groups. The observation group was treated with clinical pathway of enhanced recovery, while the control group received routine clinical pathway. The general situation, clinical pathway related indicators were recorded and compared between the two groups. Results The average age, BMI, abdominal surgery history and disease composition of the two groups were not statistically significant (P>0.05). The exhaust time [(19.5±5.6)h vs (24.2±7.5)h], activity time [(17.2±7.5)h vs (26.4±5.3)h], indwelling catheter time [(18.1±3.9)h vs (30.5±4.7)h], average hospitalization days [(5.2±1.1)days vs (6.3±1.7)days] and hospitalization expenses [(13 688.2±709.6)yuan vs (15 793.4±1 021.3)yuan] of the observation group were less than those of the control group, with statistically significance difference (P<0.05). Conclusions Clinical pathway of enhanced recovery after surgery can speed up the rehabilitation of laparoscopic hysterectomy, improve the patient′s medical experience and shorten the average length of stay. Key words: Hysterectomy; Laparoscopy; Rehabilitation; Critical pathways

Effects of blood conservation management on rapid rehabilitation in patients undergoing total hip replacement

Objective To explore the effects of blood conservation management on rapid rehabilitation in patients with total hip replacement. Methods A total of 120 patients who have undergone primary unilateral total hip replacement from November 2016 to June 2017 in the People's Hospital of Guangxi Zhuang Autonomous Region were selected and randomly divided into experimental group and control group, with 60 cases in each group. The patients in the control group were given hemostatic drugs and routine nursing care during perioperative period. The experimental group was treated with rapid rehabilitation nursing during perioperative period under blood protection management, including the protection of core body temperature, blood dilution, hemostatic, autotransfusion, controlled hypotension, iron drugs. The intraoperative blood transfusion rate, blood loss, postoperative drainage, the removal time of drainage tube and the average length of hospitalization were compared between two groups. Results The blood transfusion rate of the experimental group was 3.33%, and that of the control group was 26.67%, with statistical significance (χ2=12.810, P<0.01) . In the experimental group, the amount of intraoperative blood loss was (240.86±65.78) ml, postoperative drainage (433.95±72.26) ml, the removal time of drainage tube was (36.2±6.5) h and the average hospitalization day was (6.9±2.1) , which were all lower than those of the control group [ (320.32±70.48) ml, (511.71±85.66) ml, (50.4±2.8) h, (8.1±3.4) d], and the differences were statistically significant (t=-3.659, 3.800, -2.860, 3.800; P<0.01) . Conclusions The application of rapid rehabilitation surgery blood protection management in patients with total hip replacement during the perioperative period is significant, which is beneficial to the early rehabilitation of patients, and opens a new concept for the rapid rehabilitation of joint replacement surgery. Key words: Arthroplasty, replacement, hip; Perioperative nursing; Rapid rehabilitation surgery; Blood management

S56. PHOENIX GROUP, A PROJECT TO PREVENT RELAPSES IN SCHIZOPHRENIA

BackgroundSchizophrenia is a syndrome of variable and highly disruptive psychopathology that infers emotion, perception, and several aspects of behavior. Relapses caused by noncompliance are common and may lead to hospitalizations. In many ways they increase social disability and health care costs.The project’s philosophy was based on the motivation of the patients to continue their treatment, improve their quality of life, and reduce disease relapses, which in turn reduces public health care costs.MethodsWe enrolled 10 schizophrenia and schizoaffective patients with a poor treatment adhesion in a pilot group. All the patients were at the acute psychosis ward. The patient’s average hospitalization days were 180 days/year, and they were highly noncompliant with the open ward treatment accompanied with assertive community treatment model. Seven patients had depot injections and three patients had oral antipsychotic medication.During the hospital treatment the patients started in a group, which continued after the discharge. Weekly group meetings with different activities were organized at the hospital by the ward personnel. The doctor, nurses, a psychologist and an occupational therapist participated the group with different combinations and in a nonhierarchical manner. Psychoeducation was used to increase the knowledge and coping with the disorder. Functional group activities like cooking, arts and visits to different places were organized.The clinical parameters including the work status, relapse rates and hospitalization days were evaluated at every 6-months during 18 months. For the clinical measurements we used the Brief Psychiatric Rating Scale (BPRS) and 15D Health Related Quality of Life instrument.ResultsAt 18 months follow-up, eight of 10 group members had not needed hospitalization at all, one needed hospitalization of 15 days and another 20 days. Both of them were in voluntary treatment. During the pilot stage, two patients got jobs.At five year follow-up, five of 10 initial patients were full-time employed persons. None have needed hospitalization after 18 months.DiscussionThe intensive group focused on noncompliant patients, organized by the hospital ward, where these patients had been recurrently treated, improved substantially the patients’ commitment to the treatment and decreased rehospitalizations. The non-hierarchical group operating in the interface of the hospital and open ward was able to cause a significant reduction of general health costs and an improvement in the quality of life of these patients. They were reintegrated into society, and the stigma and marginalization associated with psychoses decreased while the self-esteem improved. The patients were able to create friendships with others in the same situations. They helped one another, and thus also improved their own self-help capacity. These elements prevent social isolation, treatment nonadherence and functional deterioration, which also would be a risk for increased violence and suicide.The group meetings began during the hospital treatment, and the patients intensively continued in the familial group after the discharge. However, the goal for these patients is gradually to leave the group and attend other open-ward, occupational and social activities.ConclusionsThrough psycho-educational interventions combined with pharmacological and psychological treatments, Phoenix group, a patient orientated, peer supporting and hospital wall-breaking method obtains results clearly observable that we can warmly recommend.

Multicenter retrospectie analysis on clinical characteristics and pharmaceutical therapy of elderly Patients with chronic heart failure

Objective: To investigate the clinical characteristics and pharmaceutical therapy of elderly patients with chronic heart failure (CHF). Methods: Using the multi-center retrospective cross-sectional survey, we analyzed 1 799 hospitalized patients with CHF as the main cause and NYHA heart function classification Ⅱ-Ⅳ from nine tertiary hospitals of Tianjin during March 2014 to February 2016. According to age, we divided them into non- elderly group(age<65 years), normal elderly group (age ≥65-79 years), and the old elderly group(age≥80 years). We analyzed the clinical characteristics and pharmaceutical therapy of different age groups of CHF patients. Results: One thousand seven hundred and ninety-nine patients with CHF, mean age (70±13) years old. Elderly patients over 65 accounted for 69.87%; men accounted for 61.53%; the average hospitalization days were 11.33 days, hospitalization days of the old elderly group were significantly prolonged to 13.26 days(P<0.05). With increasing age, the proportion of men, NYHA Ⅱ and HFrEF patients gradually decreased, the proportion of women, NYHA Ⅳ and HFpEF patients gradually increased(all P<0.05). The distribution of HFmrEF in different age groups was not statistically significant(P>0.05), accounting for one third. Etiology and comorbidities: the first eight diseases were coronary heart disease, hypertension, hyperlipidemia, diabetes, pulmonary infection, cerebrovascular disease, renal dysfunction and atrial fibrillation. The ratios of old elderly group with pulmonary infection, cerebrovascular disease, renal dysfunction and atrial fibrillation were significantly higher than the non-elderly group( all P<0.05). The numbers of comorbidity in old elderly group and the normal elderly group were higher than the non-elderly group, respectively 3.74, 3.37 and 2.82(all P<0.05). The application rate of β-blockers and ACEIs in non-elderly group was higher than the other groups (P<0.05). The application rate of ARBs, digitalis, energy metabolites and nitrates in the normal elderly group and the old elderly age group was higher than the non-elderly group (P<0.05). Conclusions: With increasing age, the proportion of men and HFrEF patients with CHF gradually decrease, the proportion of women and HFpEF patients with CHF gradually increase, the proportion of old elderly men and women tend to be equal, HFmrEF maintains the proportion of about 1/3, no change with age. The elderly patients with CHF have more comorbidity, worse heart function, and more serious heart failure.The overall application of anti-HF drugs in elderly CHF patients needs to be improved.

Practice and discussion on prevention and treatment of venous thrombosis based on multidisciplinary integration

Objective To evaluate the effective e measures of the prevention and treatment of venous thrombosis in hospital and evaluate the effect of antibolt work in patients with multidisciplinary cooperation. Methods Compare the level of venous thromboembolism (VTE) incidence, average hospital day, patient satisfaction and the level of knowledge of medical staff in the high risk department of VTE. Results After intervention in high-risk departments staff VTE related knowledge level improved, 2013 high-risk departments medical staff about the basic knowledge, risk assessment, VTE prevention knowledge of three dimensional awareness were 34.7% (26/75), 49.3% (37/75), 32.0% (24/75), respectively, 2016 were 56.0% (42/75), 69.3% (52/75), 90.7% (68/75), respectively, two groups compare the difference was statistically significant (χ2= 6.887, 6.217, 54.423, P < 0.01 or 0.05). Reduced incidence of VTE 2 groups, 2013 annual incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) were 31.7% (38/120), 11.7% (14/120), respectively, in 2016 the annual incidence of DVT and PE were 14.2% (17/120), 4.2% (5/120), respectively, two groups compare the difference was statistically significant (χ2=10.402, 4.630, P<0.01 or 0.05). VTE in 2016 patients with high-risk departments the average hospitalization time significantly below 2013, 2013 was (18.3±3.5) days while 2016 was (12.7±2.9)days, two groups compare the difference was statistically significant (t= 13.496, P < 0.01). In 2016, the satisfaction rate of patients with VTE was higher than that in 2013, 77.5% (93/120) in 2013, 90.8% (109/120) in 2016, and the difference between the two groups was statistically significant (χ2=8.004, P=0.005). Conclusion The prevention and control of venous thrombosis based on multi-disciplinary integration is effective in preventing the occurrence of thrombosis in hospitalized patients and is worthy of clinical promotion. Key words: Venous thromboembolism; Multidisciplinary; Cooperation between doctor and nurse; Prophylaxis