Tertiary Hospital In Shanghai Research Articles

An annotated dataset of tongue images supporting geriatric disease diagnosis.

Hospitalized geriatric patients are a highly heterogeneous group often with variable diseases and conditions. Physicians, and geriatricians especially, are devoted to seeking non-invasive testing tools to support a timely, accurate diagnosis. Chinese tongue diagnosis, mainly based on the color and texture of the tongue, offers a unique solution. To develop a non-invasive assessment tool using machine learning in supporting a timely, accurate diagnosis in the elderly, we created an annotated dataset of 15% of 688 (=100) tongue images collected from hospitalized geriatric patients in a tertiary hospital in Shanghai, China. Images were captured via a light-field camera using CIELAB color space (to simulate human visual perception) and then were manually labeled by a panel of subject matter experts after chart reviewing patients’ clinical information documented in the hospital's information system. We expect that the dataset can assist in implementing a systematic means of conducting Chinese tongue diagnosis, predicting geriatric syndromes using tongue appearance, and even developing an mHealth application to provide individualized health suggestions for the elderly.

Resilience is associated with post-stoke depression in Chinese stroke survivors: A longitudinal study

BackgroundOptimal strategies for prevention and treatment for post-stroke depression (PSD) remain unclear and a greater understanding of effect of resilience on PSD is promising. The aim was to examine the association between baseline resilience and depression at 1, 3, and 6 months after discharge, which contributes to early detection and management of PSD. MethodsA total of 217 ischemic stroke survivors were recruited in two tertiary hospitals in Shanghai, China from February 2017 to January 2018. The Chinese version of Connor-Davidson Resilience Scale (CD-RISC) was used to assess resilience at acute hospitalization. Hospital Anxiety and Depression Scale (HADS) was employed to ascertain baseline anxiety, baseline depression, and post-discharge depression. Social-demographic and disease-related information were obtained from participants’ self-report and medical records. Logistic regression analysis was used to determine which factors were independently associated with PSD. ResultsThe prevalence of depression at baseline was 21.2% and at 1, 3, and 6 months after discharge was 34.4%, 33.2%, and 29.2%, respectively. Logistics regression analyses indicated that resilience may independently predict PSD at 1 month (OR: 0.22, 95%CI: 0.097, 0.518), 3 months (OR:0.302, 95%CI: 0.151, 0.607), and 6 months (OR: 0.03, 95%CI: 0.006, 0.153) after controlling for social-demographics, disease-related characteristics, baseline anxiety, and baseline depression. LimitationsNon-multicenter survey and mild stroke severity may affect the generalization of these findings. Moreover, response bias should be acknowledged because some participants were read questionnaires out aloud. ConclusionResilience is independently associated with PSD at different timepoints. Our findings reveal the important role of resilience as a protective factor against PSD.

The Predominance of Strain Replacement Among Enterobacteriaceae Pairs With Emerging Carbapenem Resistance During Hospitalization.

Isolates of Enterobacteriaceae collected from the same patient can lose carbapenem susceptibility during antimicrobial therapy, but little attention has been given to how this conversion takes place. In the current study, we retrospectively analyzed microbiological and clinical data from patients with enterobacterial infections at a tertiary hospital in Shanghai, China. After screening 4795 patients and 7120 Enterobacteriaceae isolates over the 3-year study period, we found the change from carbapenem susceptible to carbapenem resistant in 41 pairs of isolates, of which 35 pairs (85.4%) were K. pneumoniae and 25 (61.0%) were from the same anatomic sites. Thirty-six isolate pairs showed different pulsed-field gel electrophoresis patterns between the carbapenem-susceptible and the corresponding resistant strain, and 5 pairs displayed identical pulsed-field gel electrophoresis patterns. Thirty-three (91.7%) of the 36 pairs of Enterobacteriaceae isolates were carbapenem-resistant K. pneumoniae with blaKPC-2, and 28 pairs (90.3%) of K. pneumoniae isolates had different sequence types (STs), with ST11 the most common ST found in carbapenem-resistant K. pneumoniae isolates. Forty of the 41 patients had received antimicrobial therapy such as carbapenems, cephalosporins, and fluoroquinolones, before the isolation of carbapenem-resistant Enterobacteriaceae. These results demonstrated that strain replacement is the main cause of emerging carbapenem resistance in Enterobacteriaceae during hospitalization. The loss of carbapenem susceptibility was not mainly due to in vivo development of carbapenem resistance.

Study of clinically-indicated replacement of peripheral intravenous catheters in old adults

Objective To evaluate the safety of clinically-indicated replacement of peripheral intravenous catheters (PIVCs) in old adults. Methods Total of 1 627 patients with peripheral intravenous catheters in emergency wards at a tertiary hospital in shanghai were recruited. Patients were randomly divided into an experimental group (817 cases) and control group (810 cases) by random digits tale method. PIVCs in the experiment were replaced only when clinical indications appeared, while PIVCs in the control group were routinely changed every 72-96 hours. Indwelling time, complications associated with PIVCs and nurse compliance were compared after indwelling peripheral intravenous catheters. Results PIVC indwelling time was (3.43±1.36) days in the experimental group, and (3.18±1.16) days in the control group ,there was significant difference between two groups (t value was 4.07, P 0.05). The severity of phlebitis in the experiment group was higher than that in the control group, and there was significant difference between two groups (χ2 value was 20.99, P<0.05). Nurse compliance achieved in the experimental group 100.00% (817/817) was higher than that in the control group 87.65% (710/810), which showed statistically difference (χ2 value was 107.47, P<0.05). Conclusion Indwelling time in the clinically- indicated replacement group was longer than that of the routine replacement group. Peripheral intravenous catheters in old adults can be remove as clinically-indicated with a close monitoring of complications. Key words: Aged; Peripheral intravenous catheters; Clinically- indicated replacement

Risk prediction of hypertension complications based on the intelligent algorithm optimized Bayesian network

Hypertension and its related complications could be a major threat issue for cardiopathy and stroke. Effective prevention and control can decrease the incidence rate of complications in hypertension. Based on the medical data of 3062 patients with cardiovascular and cerebrovascular diseases from 2017 to 2018 in a grade-A tertiary hospital in Shanghai, the study identified the risk factors of hypertension complications by text mining. On this basis, the K2 algorithm based on the improved particle swarm optimization was proposed to optimize the structure of the Bayesian network (BN) by establishing a multi-population cooperative search mechanism. Then the optimized BN was used to analyze and predict the incidence rate of hypertension complications. Results indicate that the major indicators of accuracy, sensitivity, specificity, and AUC have been improved, and the proposed algorithm is superior to the common data mining algorithms such as the back propagation neural network and the decision tree. Through the proposed model and algorithm, the high-risk factors were identified and the occurrence probability of hypertension complications was predicted, which could provide the personalized health management guidance for hypertensive patients to prevent and control hypertension complications.

Smartphone and social media-based cardiac rehabilitation and secondary prevention in China (SMART-CR/SP): a parallel-group, single-blind, randomised controlled trial

Coronary heart disease is rapidly increasing in developing countries, but access to cardiac rehabilitation and secondary prevention remains low. In this study, we aimed to assess the effectiveness of a smartphone-based cardiac rehabilitation and secondary prevention programme delivered via the social media platform WeChat (SMART-CR/SP). In this parallel-group, single-blind, randomised controlled trial, we recruited patients aged 18 years or older with coronary heart disease who had received percutaneous coronary interventions from a large tertiary hospital in Shanghai, China. Participants were randomly assigned (1:1) by block randomisation to either a 2-month intensive programme followed by a 4-month step-down phase of SMART-CR/SP or to usual care. In the SMART-CR/SP group, participants received comprehensive cardiac rehabilitation and secondary prevention via WeChat. The usual care group received standard outpatient cardiology follow-up but without formal cardiac rehabilitation and secondary prevention. Assessments were done at baseline, 2 months, 6 months, and 12 months. The primary outcome was change in functional capacity from baseline, measured by 6-min walk distance, at 2 months and 6 months. Analysis was by intention to treat. Research personnel involved in assessments were blinded to group allocation. Adverse-event analysis was based on percentage of patients who discontinued the study owing to adverse events. SMART-CR/SP programme-related safety issues were also recorded. This study was registered with the Chinese Clinical Trial Registry, number ChiCTR-INR-16009598. Between Nov 17, 2016, and March 18, 2017, 312 patients (mean age 60·5 years [SD 9·2]), of whom 58 (19%) were female and 254 (81%) were male, were recruited and subsequently randomly assigned to SMART-CR/SP (n=156) or usual care (n=156). The improvement in 6-min walk distance at 2 months was significantly greater in the SMART-CR/SP group (from 489·2 m [99·4] at baseline to 539·1 m [68·0]) than in the control group (from 485·0 m [93·5] at baseline to 517·8 m [74.6]), with an adjusted mean difference of 20·64 m (95% CI 7·50-33·77; p=0·034). This improvement was maintained at 6 months (mean 6-min walk distance 543·4 m [67·5] in the SMART-CR/SP group vs 523·5 m [60·2] in the control group), with a mean between-group difference of 22·29 m (8·19-36·38; p=0·027). No adverse events or SMART-CR/SP programme-related safety issues were reported by participants during the study. SMART-CR/SP was found to be a cardiac rehabilitation and secondary prevention service model with high efficacy and accessibility and to be easy to use. These results justify the implementation of similar models of care on a broader scale. Curtin University.

An investigation of recognition and needs of policies of science and technology achievement transformation among the medical personnel in 21 tertiary hospitals in Shanghai

Objective To understand the cognition, attitudes and needs of the science and technology achievement transformation policies among the medical personnel of 21 tertiary hospitals in Shanghai. Methods Convenient sampling method was used. The self-designed questionnaires were used to survey 420 personals in 21 tertiary hospitals in Shanghai, and 411 valid questionnaires were responded with a valid rate of 97.86%. Results The cognition of science and technology achievement transformation policies of the respondents was low, and the degree of cognition was related to the professional titles (P<0.05). While the recognition degree of some policies was high; 40.47% agreed that enterprises could be the decision-maker during the transformation process; 85.99% agreed that it is OK to hire the Technology intermediary service agencies to evaluate the achievements value, confirmed that need such agencies to provide the services of information collection and screening. Conclusions More Policy publicity should be enhanced among the medical personnel, communications about their needs and suggestions on the science and technology achievement transformation should be carried out to further update related policies, as well as improve the transformation of science and technology achievements in health system. Key words: Medical personnel; Science and technology achievement transformation; Policy; Recognition; Needs

Changing etiological frequency of chronic cough in a tertiary hospital in Shanghai, China.

The frequency distributions of the etiologies of chronic cough have changed over time. This study aimed to investigate the changing etiological frequency of chronic cough in a tertiary hospital in Shanghai, China, and to explore the clinical significance. Medical records of 1,311 patients with chronic cough who visit our hospital between January 2009 and December 2016 were retrospectively reviewed. The etiologies of chronic cough were identified according to a standardized step-by-step diagnostic protocol and the changes in the etiological frequency of chronic cough over the years were using the Chi-squared (χ2) test. Cough variant asthma (CVA) (449/1,311, 34.2%), gastroesophageal reflux-related chronic cough (GERC) (374/1,311, 28.5%), upper airway cough syndrome/postnasal drip syndrome (UACS/PNDs) (241/1,311, 18.4%), atopic cough (AC) (188/1,311, 14.3%), and non-asthmatic eosinophilic bronchitis (NAEB) (147/1,311, 11.2%) were the common causes of chronic cough in descending order. The post-infectious cough (PIC) (39/1,311, 3.0%) and angiotensin-converting enzyme inhibitor (ACEI)-induced cough (25/1,311, 1.9%) were less common. During the 8-year period, the proportion of CVA (χ2=72.86, P<0.0001) and UACS/PNDs (χ2=68.80, P<0.0001) decreased, while those of NAEB (χ2=51.38, P<0.0001), GERC (χ2=55.95, P<0.0001) and AC (χ2=39.09, P<0.0001) increased. The etiological frequency of chronic cough varies over time, and it may encourage the adjustment of the current diagnostic and therapeutic strategies for chronic cough.

SMARTphone and Social Media-Based Cardiac Rehabilitation and Secondary Prevention in China (SMART-CR/SP): A Randomised Controlled Trial

Background: Coronary heart disease (CHD) is rapidly increasing in developing countries, but access to cardiac rehabilitation and secondary prevention (CR/SP) remains low. We assessed the effectiveness of SMARTphone and WeChat-based CR/SP (SMART-CR/SP) in the first randomised controlled trial (RCT) of a dedicated social media-based CR/SP program for patients with CHD. Methods: In this parallel-group, single-blind, RCT, CHD patients from a large tertiary hospital in Shanghai, China were randomised (1:1) to an eight-week 'intensive', followed by a 16-week 'step down' program of SMART-CR/SP, or usual care. Assessments were conducted at baseline, eight and 24 weeks. The primary outcome was functional capacity measured by six-minute walk test distance (6MWTD). Secondary outcomes included CHD knowledge, and risk factor control. Analysis was by intention-to-treat. Findings: Between November 17, 2016 and March 18, 2017, 312 patients (mean age, 60.5 [SD 9.2] years, 81.4% male) were randomised to SMART-CR/SP (n=156) or usual care (n=156). The mean increase in 6MWTD was greater at both eight (46.5 vs. 20.9 m; 95% CI 9.6 to 41.5; p=0.002) and 24 weeks (54.2 vs. 26.2 m; 95% CI 10.9 to 44.9; p=0.001) in the SMART-CR/SP group versus controls. The SMART-CR/SP group had a better knowledge of CHD score at eight (17.9 vs. 13.8; 95% CI 2.84 to 5.44; p<0.001) and 24 weeks (17.9 vs. 13.7; 95% CI 2.91 to 5.51; p<0.001), and adherence to core cardioprotective medications at eight (OR 1.95, 95% CI 1.23 to 3.07; p=0.004) and 24 weeks (OR 1.82, 95% CI 1.11 to 2.97; p=0.017). Systolic blood pressure (123.2 vs. 131.8 mm Hg; 95% CI -16.4 to -0.9; p=0.029) and resting heart rate (69.3 vs. 75.4 bpm; 95% CI -11.9 to 0.3; p=0.039) were improved following 24 weeks of SMART-CR/SP, but not control. Interpretation: SMART-CR/SP provided an effective CR/SP service model that was low cost and easy to access. These results justify implementation of similar models of care on a broader scale. Trial Registration: Trial registration was with http://www.chictr.org.cn (ChiCTR-INR-16009598). Funding Statement: PhD scholarship from Curtin University (TD). Other expenses were met by research funds held by AM/BKT at Curtin University. Blood pressure monitors were donated by Sky Innovation Technology Ltd. Declaration of Interests: The blood pressure monitors used in the study were donated by Sky Innovation Technology Ltd. TD received a PhD research scholarship from Curtin University. All other authors declare no competing interests. Ethics Approval Statement: The Human Research Ethics Committee of Fudan University Zhongshan Hospital granted the primary ethics approval for the trial (B2016-058) with reciprocal approval provided by the Curtin University Human Research Ethics Office (HRE2016-0120).

Resource allocation for chronic diseases based on a patient willingness survey.

In China, patients with chronic diseases have complete freedom to choose the medical institutions at which they are treated, which has resulted in wasted medical resources and increased medical expenses. The purpose of this study is to determine the effective mechanisms to incentivise patients with chronic diseases to obtain referrals from community health centres to tertiary hospitals and estimate the funds that could be saved using various mechanisms. Questionnaire research, expert consultations, and data simulation were applied. We surveyed 1824 outpatients at nine tertiary hospitals in Shanghai, and the results showed that the proportion of patients willing to obtain referrals was 48.4%. By increasing the registration fee, reducing the payment ratio of medical insurance, publicising, and rating the quality of community health centres, up to 51.3%, 50.6%, and 65.41% patients with chronic diseases indicated that they would obtain referrals, respectively. According to the 2015 Shanghai outpatient database, the funding that could be saved through these three mechanisms would be 361.67, 356.73, and 461.14 million yuan, respectively. We conclude that referral of patients with chronic diseases could reduce medical expenses and save medical insurance funds. Nevertheless, no single measure can effectively change patient habits. Comprehensive measures need to be applied to guide patient referral actively.

Practical exploration of clinical research unit platform construction and management mode based on research-oriented hospitals: The case study of a tertiary hospital in Shanghai

Objective To summarize the practical experiences of Clinical Research Unit (CRU) platform established by Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, provide reference for domestic institutions that have prepared or to prepare to establish CRU platform. Methods Oriented by demand, this platform has set up six modules including project management module, methodology support module, data management module, quality risk management module, project transformation module and training and international exchange module. Besides, it also establishes and improves the corresponding module system, quality assurance, technical support and information data platform system. Results With this platform, the enthusiasm of departments to carry out clinical research has been continuously enhanced, the talent pool of clinical research has been expanded; the awareness of clinical research cooperation has been improved and the international cooperation fields have been further extended; the number of clinical research projects and funding have increased rapidly. Conclusions CRU Platform in Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine provides all-dimensional technical support and whole-process informatization management to improve clinical research quality and efficiency. While learning from the advanced international concepts, we still need to explore and improve the platform construction and management mode in line with general research-oriented hospitals in China, further to enhance the academic research internationally. Key words: Clinical Research Unit; Platform construction; Management mode

Identifying patterns of occupational stress trajectories among newly graduated nurses: A longitudinal study

BackgroundNewly graduated nurses have comparatively high levels of occupational stress. Previous studies have evaluated stress across this population as a whole; however, little is known about potentially different occupational stress responses among new nurses and the impact of demographic and work-related characteristics on occupational stress responses. ObjectivesTo determine differences in occupational stress levels of newly graduated nurses at different time points during the first 3 years of practice; to identify potential subgroups of nurses who perceive different occupational stress levels over time; and to evaluate differences in identified subgroups based on demographic and work-related characteristics. DesignAn observational longitudinal study. SettingsFour tertiary hospitals in Shanghai were selected randomly using a computer-generated random number table. ParticipantsAll 343 newly graduated nurses employed in the selected hospitals were invited to participate. The inclusion criteria were (1) newly graduated without nursing experience, excluding nursing internship; (2) current employment in in-patient departments/ICU/operation room; and (3) consented to participate. A total of 152 participants met criteria and completed all four points of data collection. MethodsParticipants completed an annual paper survey. Occupational stress levels were measured using the Job Stress Scale for Newly Graduated Nurses. Occupational stress scores at different time points were compared using latent growth modeling. Group-based trajectory modeling was performed to identify subgroups of occupational stress trajectory. ANOVA and Fisher’s exact test were conducted to examine the differences of demographic characteristics between classes. ResultsThe entire sample of newly graduated nurses experienced a significant decrease in occupational stress during the first three years. The best-fitting group-based trajectory model described three distinctive trajectories: low occupational stress (19.1% of sample); medium occupational stress (67.1%) and high occupational stress (13.8%). The low occupational stress subgroup had a higher proportion of nurses from Shanghai, and the majority were employed as contact- based nurses. In comparison, the high occupational stress subgroup had the largest proportion of nurses from other provinces (outside of Shanghai), almost half of participants were employed as “bianzhi” nurses, and the majority reported to be assigned preceptor by shift. ConclusionsNewly graduated nurses perceived occupational stress differently over time. Identified subgroups with different demographic characteristics have significantly different perceptions of occupational stress over the first three years of practice and future intervention programs such as peer-support programs or a standardized preceptorship should be tailored to meet the unique needs of these different subgroups.

Do free thyroxine levels influence the relationship between maternal serum ferritin and gestational diabetes mellitus in early pregnancy?

PurposeThe objective of this study was to estimate the combined effect of serum ferritin (SF) concentration and free thyroxine (fT4) levels on the risk of gestational diabetes mellitus (GDM). MethodsWomen presented for antenatal care at a tertiary hospital in Shanghai, China were included in this study from December 2012 to March 2014. Women were divided into six groups according to the SF and fT4 level. Multiple logistical regression model was used to estimate odds ratio (OR) among different groups. Relative excess risk of interaction (RERI), the attributable proportion (AP) of the interaction and the synergy index (SI) were applied to evaluate the additive interaction of SF concentration and fT4 level. ResultsA total of 6542 qualifying pregnant women were included in this study. We observed that a high SF concentration in early pregnancy was related to an increased risk of GDM (OR = 1.21, 95%CI: 1.02–1.43); while a low fT4 level was not (OR = 1.18, 95%CI: 0.89–1.58). There is no addictive interaction between SF and fT4 level on the presence of GDM. ConclusionsThe study suggests that only high serum ferritin concentration is associated with an increased risk of GDM in early pregnancy. The level of fT4 in early pregnancy might have no effect on the association between high SF and risk of GDM.

Inappropriate admissions of the cardiology and orthopedics departments of a tertiary hospital in Shanghai, China.

ObjectivesAdmission rates have increased in China, despite the fact that accessibility to primary care is improving. Hospital care could be cost-inefficient, and little is currently known about the appropriateness of admissions to tertiary hospitals in China. This study aims to measure the extent of inappropriate admissions in the cardiology and orthopedics departments of a tertiary hospital in Shanghai, to explore the factors associated with inappropriateness for each department, and to identify the causes of inappropriate admissions.MethodsThe records of inpatients discharged on randomly sampled two days each week during March 2013 to February 2014 from the two departments were extracted. Two reviewers were recruited to assess the records according to the Chinese version of the Appropriateness Evaluation Protocol (C-AEP). Demographic, socio-economic, and other admissions-related variables were collected. Logistic regression analysis was adopted to determine the associated factors of inappropriateness.Results35.0% (N = 120) of the 343 admissions and 38.7% (N = 179) of the 463 admissions of the cardiology and orthopedics departments were not justified by the C-AEP, respectively. Age (OR = 0.717), self-pay (OR = 3.752), admission via outpatient sector (OR = 5.332), and readmission (OR = 2.501) were identified as factors affecting the appropriateness of admissions in the cardiology department. Age (OR = 0.930), self-pay (OR = 2.597), admission during 12:00–17:59 (OR = 3.211), and admission via outpatient sector (OR = 7.060) were determined to be associated with appropriateness of admission in the orthopedics department. The main reason for inappropriateness was premature admission for both departments.ConclusionsThe magnitude of inappropriate admissions was considerable in the departments. To improve appropriateness, the results suggest that further interventions should be focused on both external and internal factors.

Resilience and Its Predictors Among Chinese Liver Cancer Patients Undergoing Transarterial Chemoembolization

Although resilience has many positive effects on cancer patients, little is known about the level of resilience and its predictors in Chinese liver cancer patients undergoing transarterial chemoembolization (TACE). The aims of this study were to evaluate resilience level and identify its predictors among Chinese liver cancer patients undergoing TACE. Two hundred fifty-one patients were recruited from a tertiary hospital in Shanghai, China. According to Kumpfer's resilience framework, participants were assessed with Connor-Davidson Resilience Scale, Demographic and Disease-Related Information, Family Apgar Scale, Social Support Rating Scale, Herth Hope Index, General Self-efficacy Scale, and Simplified Coping Style Questionnaire. Multiple regression analysis was conducted to find predictors of resilience. The average score for Connor-Davidson Resilience Scale was 70.33 (11.70). Multiple regression identified that educational level, time span since diagnosis, family function, social support, hope, self-efficacy, and positive coping strategies predicted higher resilience, whereas metastasis predicted lower resilience. These predictors accounted for 61.8% of the total variance in resilience. Resilience in liver cancer patients undergoing TACE needs to be further improved, which was positively predicted by educational level, time span since diagnosis, family function, social support, hope, self-efficacy, and positive coping strategies, but was negatively predicted by metastasis. Hope had the largest influence on resilience. Interventions aimed to improve hope are crucial to patients' resilience. Additional attention should be given to patients who had lower educational level or had metastasis. Family-centered interventions and strategies used to strengthen self-efficacy and positive coping strategies are also important in improving patients' resilience.

The clinical and laboratory features of neurosyphilis in HIV-infected patients: A retrospective study in 92 patients.

Neurosyphilis (NS) is an important component of central nervous system diseases among HIV-infected patients. However, its characteristics are not very clear. A retrospective analysis of clinical and laboratory findings was performed in 92 NS patients with HIV infection from a tertiary hospital in Shanghai, China. The patients had a median age of 38 years and a median CD4 count of 198 cells/μL. In all, 44.6% (41/92) were diagnosed as asymptomatic NS (ANS), 23.9% (22/92) as syphilitic meningitis, 17.4% (16/92) as cerebrovascular NS, and 14.1% (13/92) as parenchymal syphilis. A quarter of patients (23/92) complicated with ocular syphilis (OS), 60.9% (14/23) of which were ANS. The serum tolulized red unheated serum test (TRUST) titers were ≤1:8 in 15 patients (16.3%), 1:16–1:128 in 51 patients (55.4%), and ≥1:256 in 26 patients (28.3%). Sixty-nine patients (75.0%) had both cerebrospinal fluid (CSF) TRUST and Treponema pallidum particle assay reactive. CSF pleocytosis and protein elevation were found in 58.7% and 53.3% of patients, respectively. Syphilitic meningitis was more likely to present with CSF pleocytosis than ANS (P = .001), cerebrovascular NS (P < .001), and parenchymal NS (P < .001). The proportion of patients with CSF elevated protein was lower in ANS group than that in syphilitic meningitis (P = .003), cerebrovascular NS (P = .001), and parenchymal NS groups (P = .025), and was higher in sero-TRUST titers ≤1:8 group than that in 1:16–1:128 (P = .01) and 1:256–1:1024 groups (P = .005).This study revealed that ANS was the most common clinical type of NS in HIV-infected patients, which should be considered in HIV and syphilis co-infection patients without neurologic symptoms, especially in those with OS. Different patterns of NS might have different CSF features which may also vary with sero-TRUST titers.

Diagnosis related group grouping study of senile cataract patients based on E-CHAID algorithm.

To figure out the contributed factors of the hospitalization expenses of senile cataract patients (HECP) and build up an area-specified senile cataract diagnosis related group (DRG) of Shanghai thereby formulating the reference range of HECP and providing scientific basis for the fair use and supervision of the health care insurance fund. The data was collected from the first page of the medical records of 22 097 hospitalized patients from tertiary hospitals in Shanghai from 2010 to 2012 whose major diagnosis were senile cataract. Firstly, we analyzed the influence factors of HECP using univariate and multivariate analysis. DRG grouping was conducted according to the exhaustive Chi-squared automatic interaction detector (E-CHAID) model, using HECP as target variable. Finally we evaluated the grouping results using non-parametric test such as Kruskal-Wallis H test, RIV, CV, etc. The 6 DRGs were established as well as criterion of HECP, using age, sex, type of surgery and whether complications/comorbidities occurred as the key variables of classification node of senile cataract cases. The grouping of senile cataract cases based on E-CHAID algorithm is reasonable. And the criterion of HECP based on DRG can provide a feasible way of management in the fair use and supervision of medical insurance fund.

Changes in antimicrobial susceptibility of commonly clinically significant isolates before and after the interventions on surgical prophylactic antibiotics (SPAs) in Shanghai.

Surveillances and interventions on antibiotics use have been suggested to improve serious drug-resistance worldwide. Since 2007, our hospital have proposed many measures for regulating surgical prophylactic antibiotics (carbapenems, third gen. cephalosporins, vancomycin, etc.) prescribing practices, like formulary restriction or replacement for surgical prophylactic antibiotics and timely feedback. To assess the impacts on drug-resistance after interventions, we enrolled infected patients in 2006 (pre-intervention period) and 2014 (post-intervention period) in a tertiary hospital in Shanghai. Proportions of targeted pathogens were analyzed: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), imipenem-resistant Escherichia coli (IREC), imipenem-resistant Klebsiella pneumoniae (IRKP), imipenem-resistant Acinetobacter baumannii (IRAB) and imipenem-resistant Pseudomonas aeruginosa (IRPA) isolates. Rates of them were estimated and compared between Surgical Department, ICU and Internal Department during two periods. The total proportions of targeted isolates in Surgical Department (62.44%, 2006; 64.09%, 2014) were more than those in ICU (46.13%, 2006; 50.99%, 2014) and in Internal Department (44.54%, 2006; 51.20%, 2014). Only MRSA has decreased significantly (80.48%, 2006; 55.97%, 2014) (p < 0.0001). The percentages of VRE and IREC in 3 departments were all <15%, and the slightest change were also both observed in Surgical Department (VRE: 0.76%, 2006; 2.03%, 2014) (IREC: 2.69%, 2006; 2.63%, 2014). The interventions on surgical prophylactic antibiotics can be effective for improving resistance; antimicrobial stewardship must be combined with infection control practices.

Patient preference and choice of healthcare providers in Shanghai, China: a cross-sectional study

ObjectivesThis study aimed to assess patients’ healthcare-seeking preferences in mild, chronic, and serious illness; identify influential factors; and examine the reasons underlying patients’ healthcare-seeking preference.DesignA retrospective study.SettingThe study was conducted...

Inappropriate hospital days of a tertiary hospital in Shanghai, China

This study aims to evaluate the prevalence of inappropriate hospital stays in a tertiary hospital in Shanghai, identify the causes for the inappropriateness and analyze the predictors. A retrospective review of medical records. The cardiology and the orthopedics departments of a tertiary hospital in Shanghai, China. About 806 patients discharged from the cardiology or the orthopedics department of a tertiary hospital from March 2013 to February 2014. Two reviewers audited 8396 hospital days of the cardiology department (n = 3606) and the orthopedics department (n = 4790) by adopting the Chinese Version of the Appropriateness Evaluation Protocol. Univariate and multivariate analysis were adopted to identify the predictors of higher levels of inappropriateness produced by internal causes. The prevalence of inappropriate hospital days. It was found that 910 (25.2%) and 1940 (40.5%) hospital days were judged to be inappropriate in the cardiology and the orthopedics departments, respectively; and 753 (20.9%) and 1585 (33.1%) of these inappropriate hospital days were due to internal reasons, respectively. Awaiting tests, surgery or discharge were determined to constitute the main causes of inappropriateness for both departments. The predictors of higher levels of inappropriateness in the cardiology department were younger age, self-pay, outpatient admission and inappropriate admission. Self-pay, surgical and/or first-time admission patients exhibited the highest levels of inappropriateness in the orthopedics department. The rates of inappropriateness in the involved departments were relatively high. Further interventions should be designed and implemented, accordingly.