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2021 ◽  
Author(s):  
Yunlong Zhu ◽  
Na Li ◽  
Zhiliu Peng ◽  
Mingxing Wu ◽  
Haobo Huang ◽  
...  

Abstract Background:Discharged heart failure (HF) patients might still have lung congestion (PC) expressed by residual lung ultrasound B-lines (LU-BL). Detection efficacy for PC is suboptimal with widely used imaging modalities, like x-ray or echocardiography, while lung ultrasound (LU) can sufficiently detect PC by visualizing LU-BL. In this trial, we sought to evaluate the impact of residual LU-BL at discharge and other clinical indexes on rehospitalization due to HF and all-cause mortality (composite primary outcome) up to 1 year post discharge in HF patients. The impact of intensive HF therapy post discharge on outcome up to 1 year after discharge will also be investigated for discharged HF patients with evidence of PC.Aim: IMP-OUTCOME is a prospective, single-center, observational cohort study, which is designed to investigate whether residual LU-BL at discharge is one of the independent determinants of poor outcome in discharged HF patients and if intensive HF therapy (adding SGLT2 inhibitor and more frequent follow up including LU-BL assessment) post discharge could improve the outcome of discharged HF patients with residual LU-BL up to 1 year after discharge.Methods and results: After receiving the standardized treatment of HF according to current guidelines, 233 discharged HF patients will be grouped into < 3 LU-BL and ≥ 3 LU-BL groups according to LU measurement within 48 hours before discharge. Patients in the ≥ 3 LU-BL group will be further divided into the conventional HF therapy group and the intensive HF therapy group at 1:1 ratio. Intensive HF therapy group will be treated with an SGLT2 inhibitor, if not contraindicated, beyond other HF medications and monitored by HF nurses and cardiologists at 1-month interval by clinical visit. Patient-relates basic clinical data including sex, age, blood chemistry, imaging examination, drug utilization, and so on will be obtained and analyzed. Following discharge from the hospital, patients in the LU-BL<3 group and conventional HF therapy group will be followed up at 1 month, 3 months, 6 months, post discharge by clinical visit or telephone call, by clinical visit at 12 months post discharge. LU-BL will be assessed monthly post discharge in the intensive HF therapy group, and at 12 months post discharge for patients in the conventional HF therapy group and LU-BL<3 group. Echocardiography examination will be performed for all patients at 12 months post discharge. The primary endpoint is the composite of re-hospitalization for worsening HF and all-cause death during follow-up. Secondary endpoints include the change in the Duke Activity Status Index (DASI), NT-pro BNP value and 6-min walk distance at each follow up, EF and number of LU-BL at 12 months post discharge. Conclusion: This trial will explore the potential impact of residual B-lines on the outcome of discharged HF patients and the impact of intensive HF management on the outcome of discharged HF patients with residual LU-BL up to 1 year after discharge.Trial Registration ClinicalTrials.gov; NCT05035459. Registration date, 2021/09/02, “prospectively registered”.


2021 ◽  
Author(s):  
Xiangshu Dong ◽  
Baodan Liu ◽  
Xiang Xiao ◽  
Huawei Han

Abstract Background With the integration of urban and rural health insurance, the demand for health services from rural residents increases rapidly, which in turn, bring heavier workload for doctors from county public hospitals (CPHs). Meanwhile, township healthcare centers (THCs) are required to provide more additional public health services under the integration of public health and primary care, which also brings challenges for its doctors’ workload. As a result, Chinese rural doctors from both CPHs and THCs have to cope with heavier workload that may have an adverse effect on their job satisfaction. This study sought to investigate the association between the workload and their job satisfaction during the new healthcare reform in China. Methods A cross-sectional survey using mixed methods targeting Chinese rural doctors from both CPHs and THCs in three provinces of Gansu (the west province of China), Shanxi (the middle province of China), and Shandong (the east province of China) was conducted. Correlation analyses of three dimensions of workload and job satisfaction were performed. The association between workload and job satisfaction was estimated using discrete choice regression and the detail parts of workload were analyzed using qualitative data collected from interviews with some agency administrators and representatives from the respondents. Results Of the 849 rural doctors enrolled, 52.18% thought that the proportion of time spent on non-medical activities (PT) was too high; 78% reported that they worked more than 8 hours in a working day; up to 40% of rural doctors from county public hospitals (CPHs) reported unaffordable clinical visit number per day (CV), which was significantly higher than that from township healthcare centers (THCs). Both of the proportion of time on non-medical issues and working hours (WH) were significantly and negatively associated with the job satisfaction of rural doctors. However, the effects of clinical visit number were mixed, with a significantly negative association with the job satisfaction of doctors from CPHs rather than from THCs. Qualitative analysis indicated that non-medical activities constituted the main source of Chinese rural doctors workload, in terms of a performance assessment criteria for doctors from CPHs and public health services for doctors from THCs. Conclusion The workload, dominated by non-medical activities, working hour and clinical visit number, are non-negligible factors that negatively associated with Chinese rural doctors’ job satisfaction in the healthcare reform setting. The growing number of patients towards CPHs and the additional public health service imposed on the THC doctors were the main source for the workload that worsened rural doctors’ job satisfaction. Policy makers should consider some feasible measures to reduce non-medical activities for rural doctors so that they could dedicated their limited energy and time to the medical service.


The Surgeon ◽  
2021 ◽  
Author(s):  
Stephen Keelan ◽  
Niamh Foley ◽  
Donagh Healy ◽  
Elrasheid Kheirelseid ◽  
Seamus McHugh ◽  
...  

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yanshi Liu ◽  
Jialin Liu ◽  
Maimaiaili Yushan ◽  
Zhenhui Liu ◽  
Tao Zhang ◽  
...  

Abstract Background The hexapod external fixator (HEF) is increasingly used for high-energy tibial shaft fracture care as more general orthopedic surgeons are gaining expertise of this versatile device. The purpose of this study was to evaluate the clinical effectiveness of the HEF for definitive management in patients with high-energy tibial shaft fractures. Methods The study was conducted on 34 patients with tibial shaft fractures who were admitted or referred to our institution and consented to HEF treatment from Jan 2016 to June 2019, including 27 males and 7 females with a mean age of 39 years (range 18 to 65 years). Patients' clinical and radiological data, and the final clinical outcomes at a minimum of 12 months follow-up were collected and retrospectively analyzed. All complications were documented according to Paley’s classification. The clinical outcomes were evaluated using the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit. Results All patients remained in the HEF for a mean of 26 weeks (range 15 to 52 weeks) and acquired complete bone union. The satisfactory alignment was achieved in all patients, and all the patients were able to perform daily activities with no difficulty at the last clinical visit. Complications included pin tract infection (44%), delayed union (6%), nonunion (3%), and joint stiffness (3%). The ASAMI bony result was excellent in 31 patients and good in 3. The ASAMI functional result was excellent in 27 patients, good in 6, and fair in 1. Conclusions Definitive management using the hexapod external fixator is an alternative and effective method for high-energy tibial shaft fractures, including technical advantages of early trauma-control, the versatility of achieving excellent alignment, and the continuity of device until bone union.


2021 ◽  
Author(s):  
Yanshi Liu ◽  
Jialin Liu ◽  
Maimaiaili Yushan ◽  
Zhenhui Liu ◽  
Tao Zhang ◽  
...  

Abstract Background: The Taylor spatial frame (TSF) is increasingly used for acute tibial shaft fracture care as more general orthopedic surgeons are gaining expertise of this versatile device. The purpose of this study was to evaluate the clinical effectiveness of the TSF for fracture reduction and definitive management in patients with acute tibial shaft fractures.Methods: The study was conducted on 34 patients with acute tibial shaft fractures who were admitted or referred to our institution and consented to TSF treatment from Jan 2016 to June 2019, including 27males and 7 females with a mean age of 39 years (range 18 to 65 years). Patients' clinical and radiological data, and the final clinical outcomes at a minimum of 12 months follow-up were collected and retrospectively analyzed. All complications were documented according to Paley’s classification. The clinical outcomes were evaluated using the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.Results: All patients remained in the TSF for a mean of 26 weeks (range 15 to 52 weeks) and acquired complete bone union. The satisfactory alignment was achieved in all patients, and all the patients were able to perform daily activities with no difficulty at the last clinical visit. Complications included pin tract infection (44%), delayed union (6%), nonunion (3%), and joint stiffness (3%). The ASAMI bony result was excellent in 31 patients and good in 3. The ASAMI functional result was excellent in 27 patients, good in 6, and fair in 1. Conclusions: Fracture reduction and definitive management using the Taylor spatial frame is an alternative and effective method for acute tibial shaft fractures, including technical advantages of early trauma-control, ease of soft tissue care, the versatility of achieving excellent alignment, and the continuity of device until bone union.


Thorax ◽  
2021 ◽  
Vol 76 (3) ◽  
pp. 228-238
Author(s):  
Judith Garcia-Aymerich ◽  
Milo A Puhan ◽  
Solange Corriol-Rohou ◽  
Corina de Jong ◽  
Heleen Demeyer ◽  
...  

BackgroundThe Daily-PROactive and Clinical visit-PROactive Physical Activity (D-PPAC and C-PPAC) instruments in chronic obstructive pulmonary disease (COPD) combines questionnaire with activity monitor data to measure patients’ experience of physical activity. Their amount, difficulty and total scores range from 0 (worst) to 100 (best) but require further psychometric evaluation.ObjectiveTo test reliability, validity and responsiveness, and to define minimal important difference (MID), of the D-PPAC and C-PPAC instruments, in a large population of patients with stable COPD from diverse severities, settings and countries.MethodsWe used data from seven randomised controlled trials to evaluate D-PPAC and C-PPAC internal consistency and construct validity by sex, age groups, COPD severity, country and language as well as responsiveness to interventions, ability to detect change and MID.ResultsWe included 1324 patients (mean (SD) age 66 (8) years, forced expiratory volume in 1 s 55 (17)% predicted). Scores covered almost the full range from 0 to 100, showed strong internal consistency after stratification and correlated as a priori hypothesised with dyspnoea, health-related quality of life and exercise capacity. Difficulty scores improved after pharmacological treatment and pulmonary rehabilitation, while amount scores improved after behavioural physical activity interventions. All scores were responsive to changes in self-reported physical activity experience (both worsening and improvement) and to the occurrence of COPD exacerbations during follow-up. The MID was estimated to 6 for amount and difficulty scores and 4 for total score.ConclusionsThe D-PPAC and C-PPAC instruments are reliable and valid across diverse COPD populations and responsive to pharmacological and non-pharmacological interventions and changes in clinically relevant variables.


2021 ◽  
Author(s):  
Rosana Poggio ◽  
Goodarz Danaei ◽  
Laura Gutierrez ◽  
Ana Cavallo ◽  
María Lopez ◽  
...  

Abstract Background The effective management of cardiovascular (CVD) prevention among the uninsured population in Argentina is low since less than 30% of the individuals with predicted 10-year CVD risk ≥10% attend a clinical visit for CVD risk factors control in the primary care clinics (PCCs). Methods We conducted a non-controlled feasibility study using a mixed methods approach to evaluate acceptability, adoption and fidelity of a multi-component intervention implemented in the public healthcare system. The eligibility criteria were being uninsured, age ≥ 40 years, residence in the PCC´s catchment area and 10-year CVD risk ≥ 10%. The multi-component intervention addressed (1) system barriers through task shifting among the PCC´s staff, protected medical appointments slots and a new CVD form and (2) Provider barriers through training for primary care physicians and CHW and individual barriers through a home-based intervention delivered by community health workers (CHWs).Results A total of 185 participants were included in the study. Of the total number of the eligible participants, 82.2% of eligible participants attended to at least one clinical visit for risk factor control. Physicians intensified drug treatment in 77% of participants with BP ≥140/90 mmHg and 79.5% of participants with diabetes, increased the proportion of participants treated according to GCP from 21% to 32.6% in hypertensive participants, 7.4% to 33.3% in high CVD risk and 1.4% to 8.7% in very high CVD risk groups. Mean systolic and diastolic blood pressure were lower at the end of follow up (156.9 to 145.4 mmHg and 92.9 to 88.9 mmHg, respectively) and control of hypertension (BP<140/90 mmHg) increased from 20.3% to 35.5%.Conclusion The proposed CHWs-led intervention was feasible and well accepted in improving the detection and treatment of risk factors in the uninsured and poor population with moderate or high CVD risk at the primary care setting in Argentina. Task sharing activities with CHWs not only stimulated teamwork among PCC staff, but it also improved quality of care. This study showed that community health workers could have a more active role in the detection and clinical management of CVD risk factors in low-income communities.


2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Gianni Lazzarin ◽  
Marino Di Furia ◽  
Lucia Romano ◽  
Alessandra Di Sibio ◽  
Carla Di Giacomo ◽  
...  

Objectives. The prevalence of morbid obesity has dramatically increased over the last several decades worldwide, currently reaching epidemic proportions. Gastric leak (GL) remains the potentially fatal main complication after sleeve gastrectomy (SG) for morbid obesity. To our knowledge, there are no standardized guidelines for GL treatment after laparoscopic sleeve gastrectomy (LSG) yet. The aim of this study was to represent our institutional preliminary experience using the endoscopic double-pigtail catheter (EDPC) as the method of internal drainage and propose it as first-line treatment in case of GL after LSG. Methods. One hundred and seventeen patients were admitted to our surgical department and underwent laparoscopic sleeve gastrectomy (LSG) for morbid obesity from March 2014 to June 2019. In 5 patients (4.3%) of our series, GL occurred as a complication of LSG. EPDC was the stand-alone procedure of internal drainage and GL first-line treatment. The internal pig tail was endoscopically removed from 30th to 40th POD in all cases. Results. Present data (clinical, biochemical, and instrumental tests) showed a complete resolution of GL, with promotion of a pseudodiverticula and complete re-epithelialization of leak. Follow-up was more strict than usual (clinical visit and biochemical test on 7th, 14th, and 21st day after discharge; a CT scan with gastrografin on 30th day from discharge if clinical visit and exams were normal). Conclusion. This was a preliminary retrospective observational study, conducted on 5 patients affected by GL as a complication of LSG for morbid obesity. EDPC maintains the safety, efficacy, and nonexpensive characteristic and may be proposed as better first-line treatment in case of GL after bariatric surgery.


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