BACKGROUND & AIMS: :This study investigated factors causing inappropriate hospitalization from the physicians' perspectives at government, primary and military hospitals in Riyadh, Saudi Arabia. A self-administered questionnaire to 250 physicians showed that the majority were aware of inappropriate admissions. Problems with inappropriate admissions occurred more frequently at public hospitals (both government and military) than private hospitals. The reasons believed to contribute most to inappropriate admission and hospitalization were the inability of the patient's family to take care of the patient, to satisfy the patient's request, and the absence of someone to get the patient out of the hospital.

背景与目标： ：这项研究从医师的角度调查了导致沙特阿拉伯利雅得政府，基层和军事医院不适当住院的因素。一份针对250位医生的自我管理问卷表明，大多数人都知道不适当的入院治疗。与私立医院相比，公立医院（政府和军方）的不适当入院问题更常见。认为导致不适当住院和住院的最大原因是患者家属无法照顾患者，无法满足患者的要求，以及没有人将患者送出医院。

BACKGROUND & AIMS: OBJECTIVES:Acute mania is a serious medical condition that impacts men and women equally. Longtime presentation of manic symptoms is sex-dependent; however, little is known about acute symptoms of mania. The objective of this study is to track and compare acute manic symptoms for sex differences during inpatient hospitalization. METHODS:All patients with bipolar mania admitted to a large university hospital between January and October 2017 were invited to participate in this longitudinal naturalistic follow-up study. Manic (YMRS), depressive (MADRS), and psychotic (PAS) symptoms were tracked daily from admission to discharge. RESULTS:The total YMRS scores decreased significantly overtime (p < .0001) in both male (n = 34) and female (n = 23) patients (p = .7). However, male patients scored significantly higher in sexual interest (p = .01), disruptive and aggressive behavior (p = .01), and appearance (p < .001) while females had better insight into their illness (p = .01). Males and females received similar doses of lithium (p = .1), but males received significantly higher doses of valproic acid (VPA) in comparison with females (p = .003). However, plasma lithium and VPA concentrations at discharge were not significantly different between sexes. CONCLUSION:Our results show sex differences in the progression of certain domains of manic symptoms in a cohort of 23 female and 34 male patients admitted to a large academic center in Turkey. Males, in this sample, exhibited more sexual interest, disruptive and aggressive behaviors, better grooming, and less insight compared to females. While these results are concordant with our preclinical findings and with anecdotal clinical observations, replication in larger samples is needed.

背景与目标： 目的：急性躁狂症是一种严重的医学疾病，对男人和女人都有同等的影响。长时间出现的躁狂症状取决于性别。但是，对于躁狂症的急性症状知之甚少。这项研究的目的是跟踪和比较住院期间住院期间出现的急性躁狂症状的性别差异。
方法：邀请所有在2017年1月至10月间入住一家大型大学医院的躁郁症患者参加这项纵向自然随访研究。从入院到出院，每天跟踪躁狂（YMRS），抑郁（MADRS）和精神病（PAS）症状。
结果：男性（n = 34）和女性（n = 23）患者（p = .7）的总YMRS分数随着时间的推移显着降低（p <.0001）。但是，男性患者在性兴趣（p = .01），破坏性和攻击性行为（p = .01）和外表（p <.001），以及对疾病的洞察力（p = .01）方面得分明显较高，而女性。男性和女性接受相似剂量的锂（p = .1），但是男性相比女性接受了更高剂量的丙戊酸（VPA）（p = .003）。然而，两性之间的血浆锂和VPA浓度无明显差异。
结论：我们的研究结果显示，在土耳其一家大型学术中心接受治疗的23名女性和34名男性患者中，躁狂症状某些领域的进展存在性别差异。与女性相比，男性在此样本中表现出更多的性兴趣，破坏性和攻击性的行为，更好的修饰以及更少的洞察力。尽管这些结果与我们的临床前研究结果和轶事临床观察结果一致，但仍需要在较大的样品中进行复制。

BACKGROUND & AIMS: :Total cholesterol to HDL cholesterol ratio (TC/HDL) is an important prognostic factor for CVD. This study used restricted cubic spline modeling to investigate the dose-response associations between TC/HDL and both CVD hospitalization and CVD rehospitalization in two independent prospective cohorts. The East Cambridgeshire and Fenland cohort includes 4,704 patients with T2D from 18 general practices in Cambridgeshire. The Randomized controlled trial of Peer Support In type 2 Diabetes cohort comprises 1,121 patients with T2D with posttrial follow-up data. TC/HDL and other demographic and clinical measurements were measured at baseline. Outcomes were CVD hospitalization over 2 years and CVD rehospitalization after 90 days of the prior CVD hospitalization. Modeling showed nonlinear relationships between TC/HDL and risks of CVD hospitalization and rehospitalization consistently in both cohorts (all P < 0.001 for linear tests). The lowest risks of CVD hospitalization and rehospitalization were consistently found for TC/HDL at 2.8 (95% CI: 2.6-3.0) in both cohorts and both overall and by gender. This is lower than the current lipid control target, 4.0 of TC/HDL. Reducing the TC/HDL target to 2.8 would include a further 33-44% patients with TC/HDL in the 2.8-4.0 range. Studies are required to assess the effectiveness and cost-effectiveness of the earlier introduction of, and more intensive, lipid-lowering treatment needed to achieve this new lower TC/HDL target.

背景与目标： ：总胆固醇与HDL胆固醇之比（TC / HDL）是CVD的重要预后因素。这项研究使用限制性三次样条曲线模型研究了两个独立的前瞻性队列中TC / HDL与CVD住院和CVD再住院之间的剂量反应关联。东剑桥郡和芬兰德队列包括来自剑桥郡18个普通科的4,704例T2D患者。同伴支持在2型糖尿病队列中的随机对照试验包括1,121例T2D患者，并提供了随访数据。 TC / HDL以及其他人口统计学和临床​​测量均在基线进行。结果是2年内进行CVD住院治疗，以及先前CVD住院90天后进行CVD再住院治疗。建模显示，在两个队列中，TC / HDL与CVD住院和再次住院的风险之间始终存在非线性关系（对于线性测试，所有P <0.001）。 TC / HDL在人群，总体和性别方面均始终为2.8（95％CI：2.6-3.0），发生CVD住院和再次住院的风险最低。这低于当前的脂质控制目标TC / HDL的4.0。将TC / HDL指标降低到2.8将进一步使TC / HDL在2.8-4.0范围内的患者占33-44％。需要进行研究以评估为实现这一新的较低TC / HDL目标而需要的早期引入和更深入的降脂治疗的有效性和成本效益。

BACKGROUND & AIMS: BACKGROUND AND OBJECTIVE:Exacerbation(s) of chronic obstructive pulmonary disease (eCOPD) entail important events describing an acute deterioration of respiratory symptoms. Changes in medication and/or hospitalization are needed to gain control over the event. However, an exacerbation leading to hospitalization is associated with a worse prognosis for the patient. The objective of this study is to explore factors that could predict the probability of an eCOPD-related hospitalization. METHODS:Data from 128 patients with COPD included in a prospective, longitudinal study were used. At baseline, physical, emotional, and social status of the patients were assessed. Moreover, hospital admission during a one year follow-up was captured. Different models were made based on univariate analysis, literature, and practice. These models were combined to come to one final overall prediction model. RESULTS:During follow-up, 31 (24.2%) participants were admitted for eCOPD. The overall model contained six significant variables: currently smoking (OR = 3.93), forced vital capacity (FVC; OR = 0.97), timed-up-and-go time (TUG-time) (OR = 14.16), knowledge (COPD knowledge questionnaire, percentage correctly answered questions (CIROPD%correct)) (<60% (OR = 1.00); 60%-75%: (OR = 0.30); >75%: (OR = 1.94), eCOPD history (OR = 9.98), and care dependency scale (CDS) total score (OR = 1.12). This model was well calibrated (goodness-of-fit test: p = 0.91) and correctly classified 79.7% of the patients. CONCLUSION:A combination of TUG-time, eCOPD-related admission(s) prior to baseline, currently smoking, FVC, CDS total score, and CIROPD%correct allows clinicians to predict the probability of an eCOPD-related hospitalization.

背景与目标： 背景与目的：慢性阻塞性肺疾病（eCOPD）的恶化会引起描述呼吸道症状急性恶化的重要事件。需要改变用药和/或住院治疗以控制事件。然而，导致住院的恶化与患者预后较差有关。这项研究的目的是探讨可以预测eCOPD相关住院的可能性的因素。
方法：采用一项前瞻性，纵向研究中的128例COPD患者的数据。在基线时，评估患者的身体，情绪和社会状况。此外，在一年的随访期间还记录了入院情况。基于单变量分析，文献和实践建立了不同的模型。将这些模型组合起来，得出一个最终的整体预测模型。
结果：在随访期间，有31名（24.2％）参与者被录入了eCOPD。总体模型包含六个重要变量：当前吸烟（OR = 3.93），强制肺活量（FVC； OR = 0.97），定时走走时间（TUG时间）（OR = 14.16），知识（COPD知识）问卷，正确回答问题的百分比（CIROPD％正确））（<60％（OR = 1.00）; 60％-75％：（OR = 0.30）;> 75％：（OR = 1.94），eCOPD历史记录（OR = 9.98） ）和护理依赖性量表（CDS）的总评分（OR = 1.12），该模型已经过很好的校准（拟合优度检验：p = 0.91），并正确分类了79.7％的患者。
结论：TUG时间，基线之前的eCOPD相关入院，当前吸烟，FVC，CDS总分和CIROPD％correct的组合使临床医生可以预测eCOPD相关住院的可能性。

BACKGROUND & AIMS: :The purpose of the current study was to examine the role and activities of family caregivers for older relatives during hospitalization. The Family Care Actions Index was completed by 293 family caregivers of hospitalized older adults. Results indicated that the scope of caregiving activities extended beyond providing care to the patient and included working together with the health care team. Activities requiring interaction with providers, such as care coordination, planning, evaluation, and oversight, were frequently performed by family caregivers. Family caregivers are assuming a greater role during the hospital stay of older relatives. Partnering with family caregivers provides hospital staff an opportunity to improve care, outcomes, and satisfaction. [Journal of Gerontological Nursing, 46(3), 45-50.].

背景与目标： ：本研究的目的是检查住院期间年老亲戚的家庭看护人的作用和活动。 293名住院老年人的家庭护理人员完成了家庭护理行动指数。结果表明，护理活动的范围超出了为患者提供护理的范围，还包括与医疗团队一起工作。家庭护理人员经常进行需要与提供者互动的活动，例如护理协调，计划，评估和监督。家庭护理人员在老年亲戚住院期间扮演着更重要的角色。与家庭护理人员的合作为医院工作人员提供了改善护理，改善结局和满意度的机会。 [老年护理杂志，46（3），45-50。]。

BACKGROUND & AIMS: OBJECTIVE:To establish the direct costs of the process of diagnosing lung cancer in 2003. As a secondary objective, the cost of admissions defined as inappropriate was evaluated. MATERIAL AND METHODS:A prospective cohort study of lung cancer cases diagnosed in 2003 was performed. Diagnosis was based on cytohistology or clinical and radiological criteria. The total cost was determined according to Decree 222/2003, governing Galician health service rates. A distinction was drawn between hospitalized patients and outpatients, and between small cell and non-small cell carcinomas. Inappropriate admissions were analyzed in accordance with the criteria established by our study team, and the savings that would have been made had these patients been treated as outpatients were calculated. The statistical analyses were performed using SPSS version 10.0. RESULTS:A total of 160 patients were diagnosed with lung cancer; 76 (47.5%) of these were outpatients, and the remaining 84 (52.5%) were hospitalized patients. Admissions were considered inappropriate in 27 cases. Of the total of 160 patients, 108 were diagnosed as having non-small cell carcinomas, and 38 as having small cell carcinomas; the remaining 14 patients were diagnosed on the basis of clinical-radiological criteria. Total cost was 742,847 Euro(mean, 4643 Euro; 95% confidence interval, 4049-5236 Euro), composed of 552,614 Euro(mean, 6579 Euro) for admitted patients, and 190,233 Euro(mean, 2503 Euro) for outpatients. Mean cost was 3692 Euro for the small cell carcinomas, and 5070 Euro for the non-small cell carcinomas. Comparing limited and extensive small cell carcinomas, the mean cost for the former was significantly lower than for the latter (1894 Euro compared to 4098 Euro); there was also a lower mean cost for early compared to advanced stages of non-small cell carcinomas (3660 Euro compared to 5494 Euro). The savings to be made from unnecessary admissions were calculated at 120,258 Euro. CONCLUSIONS:The mean cost for outpatient lung cancer treatment was 62% lower than for hospitalization. Non-small cell carcinomas were more costly on average than small cell carcinomas, and advanced stages of the small cell carcinomas involved a higher average cost than the initial stages of the disease. For our series, the savings to be made from unnecessary admissions were calculated at 120,258 Euro.

背景与目标： 目的：确定2003年肺癌诊断过程的直接费用。作为次要目标，评估了被定义为不合适的入院费用。
材料与方法：对2003年确诊的肺癌病例进行了一项前瞻性队列研究。诊断基于细胞组织学或临床和放射学标准。总费用是根据有关加利西亚卫生服务费率的第222/2003号法令确定的。在住院患者和门诊患者之间以及小细胞癌和非小细胞癌之间进行了区分。根据我们研究小组确定的标准对不适当的入院进行了分析，并计算了将这些患者作为门诊患者所能节省的费用。使用SPSS 10.0版进行统计分析。
结果：总共160例患者被诊断出患有肺癌；其中76（47.5％）位为门诊病人，其余84位（52.5％）为住院病人。 27例入院被认为是不适当的。在160例患者中，有108例被诊断为非小细胞癌，38例为小细胞癌。其余14例患者是根据临床放射学标准诊断的。总费用为742,847欧元（平均，4643欧元； 95％置信区间，4049-5236欧元），其中入院患者为552,614欧元（平均，6579欧元），门诊为190,233欧元（平均，2503欧元）。小细胞癌的平均成本为3692欧元，非小细胞癌的平均成本为5070欧元。比较有限和广泛的小细胞癌，前者的平均成本明显低于后者（1894欧元对4098欧元）；与晚期非小细胞癌相比，早期的平均费用也较低（3660欧元对5494欧元）。通过不必要的录取可节省的费用为120,258欧元。
结论：门诊肺癌治疗的平均费用比住院低62％。非小细胞癌平均比小细胞癌昂贵，并且小细胞癌的晚期阶段比疾病初始阶段的平均成本更高。对于我们的系列课程，不必要的入学节省了120,258欧元。

BACKGROUND & AIMS: BACKGROUND:Previous studies have examined the association between proton pump inhibitor (PPI) use and the risk of Clostridium difficile-associated disease (CDAD), with conflicting results. Whether outpatient PPI use influences the risk of hospital admission for CDAD among older patients who have recently been treated with antibiotics is unknown. METHODS:We conducted a population-based, nested case-control study of linked health care databases in Ontario, Canada, from 1 April 2002 through 31 March 2005. We identified patients aged > or = 66 years who were hospitalized for CDAD within 60 days of receiving outpatient antibiotic therapy. Each case patient with CDAD was matched with 10 control subjects on the basis of age, sex, and details of antibiotic use (antibiotic class, timing, and number of antibiotics used). PPI use by case patients and control subjects was categorized as current (within 90 days), recent (91-180 days), or remote (181-365 days). We used conditional logistic regression to estimate the odds ratio for the association between outpatient PPI use and risk of hospitalization for CDAD. RESULTS:We identified 1389 case patients and 12,303 matched control subjects. Case patients were no more likely than control subjects to have received a PPI in the preceding 90 days (adjusted odds ratio, 0.9; 95% confidence interval, 0.8-1.1). Similarly, we found no association between hospitalization for CDAD and more remote use of PPIs. CONCLUSIONS:Among community-dwelling older patients, PPI use is not a risk factor for hospitalization with CDAD.

背景与目标： 背景：以前的研究已经检查了质子泵抑制剂（PPI）的使用与艰难梭菌相关疾病（CDAD）风险之间的关联，但结果却相矛盾。在最近接受抗生素治疗的老年患者中，门诊使用PPI是否会影响CDAD入院的风险。
方法：从2002年4月1日至2005年3月31日，我们在加拿大安大略省的相关医疗数据库中进行了一项基于人群的嵌套病例对照研究。我们确定了60天内≥66岁的CDAD住院患者。门诊抗生素治疗的情况。根据年龄，性别和抗生素使用的详细信息（抗生素类别，使用时间和使用的抗生素数量），将每例CDAD患者与10名对照受试者进行匹配。病例患者和对照对象使用PPI分为当前（90天之内），近期（91-180天）或远程（181-365天）。我们使用条件逻辑回归来估计门诊PPI使用与CDAD住院风险之间关联的优势比。
结果：我们确定了1389例患者和12303例匹配的对照对象。在过去90天内，病例患者与对照组相比，接受PPI的可能性更大（调整后的优势比为0.9； 95％置信区间为0.8-1.1）。同样，我们发现CDAD的住院治疗与PPI的更远程使用之间没有关联。
结论：在社区居住的老年患者中，使用PPI并不是CDAD住院的危险因素。

BACKGROUND & AIMS: OBJECTIVE:Acute hospitalization of older patients may be associated with loss of muscle strength and functional performance. The aim of this study was to investigate the effect of acute hospitalization as a result of medical disease on muscle strength and functional performance in older medical patients. DESIGN:Isometric knee-extension strength; handgrip strength; and functional performance, that is, the Timed Up and Go test, were assessed at admission, at discharge, and 30 days after discharge. Twenty-four-hour mobility was measured during hospitalization. RESULTS:The mean (SD) age was 82.7 (8.2) years, and the median length of stay was 7.5 days (interquartile range, 4.25-11). Knee-extension strength did not change over time (1.0 [N·m]/kg, 1.1 [N·m]/kg, and 1.1 [N·m]/kg, P = 0.138), as did handgrip strength (24.2 kg, 23.3 kg, and 23.5 kg, P = 0.265). The Timed Up and Go test improved during hospitalization, from 17.3 secs at admission to 13.3 secs at discharge (P = 0.003), but with no improvement at the 30-day follow-up (12.4 secs, P = 0.064). The median times spent in lying, sitting, and standing/walking were 17.4 hrs per day, 4.8 hrs per day, and 0.8 hrs per day, respectively. CONCLUSIONS:Muscle strength did not change during hospitalization and 30 days after discharge in the acutely admitted older medical patients. Despite a low level of mobility during hospitalization, functional performance improved significantly during hospitalization, without further improvement.

背景与目标： 目的：老年患者的急性住院可能与肌肉力量和功能下降有关。这项研究的目的是调查由于医学疾病而导致的急性住院对老年医学患者肌肉力量和功能表现的影响。
设计：等距膝盖伸展力量；握力；在入院时，出院时和出院后30天评估其功能和性能，即“定时起跑”测试。住院期间测量二十四小时的流动性。
结果：平均（SD）年龄为82.7（8.2）岁，中位住院时间为7.5天（四分位间距为4.25-11）。伸膝力没有随时间变化（1.0 [N·m] /kg、1.1 [N·m] / kg和1.1 [N·m] / kg，P = 0.138），握力也没有变化（24.2 kg ，23.3公斤和23.5公斤，P = 0.265）。住院期间的定时出诊测试从入院时的17.3秒提高到出院时的13.3秒（P = 0.003），但在30天的随访中没有改善（12.4秒，P = 0.064）。躺，坐和站立/行走所花费的中位数时间分别为每天17.4小时，每天4.8小时和每天0.8小时。
结论：急性入院的老年医学患者在住院期间和出院后30天肌肉力量没有改变。尽管住院期间的活动程度较低，但住院期间的功能性能仍得到了显着改善，而没有进一步改善。

BACKGROUND & AIMS: Aim:Inflammation-based Glasgow Prognostic Scores (GPS) have been reported to predict the prognosis of patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). The goal of this study was to investigate whether three kinds of GPSs can effectively predict major cardiovascular adverse events (MACEs) in STEMI or non-ST-segment elevation myocardial infarction (NSTEMI) patients undergoing PPCI, elective PCI (EPCI) or conservative drug therapy during hospitalization. Methods:In this retrospective cohort study, patients with acute myocardial infarction (AMI) were divided into 0, 1 or 2 score according to the GPSs. Logistic regression and receiver operating characteristic (ROC) curve analysis were performed to assess the predictive value of GPSs for MACE and all-cause mortality during hospitalization. Three kinds of GPSs, Inflammation-based Glasgow Prognostic Score (GPS), modified GPS (MGPS) and high-sensitivity CRP-modified GPS (HS-MGPS) and Global Registry of Acute Coronary Events (GRACE) score were applied in this study. Results:A total of 188 patients were enrolled. The ROC curve with MACE showed that the AUC of GPS (0.820 (95% confidence interval (CI) [0.754-0.885]), P < 0.001) was larger than that of MGPS (0.789 (95% CI [0.715-0.863]), P < 0.001), HS-MGPS (0.787 (95% CI [0.717-0.856]), P < 0.001) and GRACE score (0.743 (95% CI [0.672-0.814]), P < 0.001). The ROC curve with all-cause mortality showed that the AUC of GPS (0.696 (95% CI [0.561-0.831]), P = 0.005) was similar to the HS-MGPS (0.698 (95% CI [0.569-0.826]), P = 0.005) and higher than the MGPS (0.668 (95% CI [0.525-0.812]), P = 0.016), but lower than the GRACE score (0.812 (95% CI [0.734-0.889]), P < 0.001). Multivariate logistic regression analysis showed that the GPS was an independent risk factor for the incidence of MACE during hospitalization. Compared with the odds ratio (OR) value for a GPS of 0, the OR for a GPS of 1 was 7.173 (95% CI [2.425-21.216]), P < 0.001), and that for a GPS of 2 was 18.636 (95% CI [5.813-59.746]), P < 0.001), but not an independent risk factor for all-cause mortality (P = 0.302). GRACE score was an independent risk factor for MACE (1.019 (95% CI [1.004-1.035]), P = 0.015) and all-cause mortality (1.040 (95% CI [1.017-1.064]), P = 0.001). In the subgroups classified according to the type of AMI, the presence of disease interference GPSs and the type of PCI, the ability of GPS to predict the occurrence of MACE seemed to be greater than that of MGPS and HS-MGPS. Conclusion:The GPS has a good predictive value for the occurrence of MACE during hospitalization in patients with AMI, regardless of STEMI or NSTEMI, the choice of PCI mode and the presence or absence of diseases that interfere with GPS. However, GPS is less predictive of all-cause mortality during hospitalization than GRACE score, which may be due to the interference of patients with other diseases.

背景与目标： 目的：已经报道了基于炎症的格拉斯哥预后评分（GPS）可预测接受原发性经皮冠状动脉介入治疗（PPCI）的急性ST段抬高型心肌梗死（STEMI）患者的预后。这项研究的目的是调查三种GPS是否可以有效预测接受PPCI，选择性PCI（EPCI）或保守药物治疗的STEMI或非ST段抬高型心肌梗死（NSTEMI）患者的主要心血管不良事件（MACE）在住院期间。
方法：在这项回顾性队列研究中，根据GPS将急性心肌梗塞（AMI）患者分为0、1或2分。进行逻辑回归和接收者操作特征（ROC）曲线分析，以评估GPS对住院期间MACE和全因死亡率的预测价值。本研究采用了三种GPS，即基于炎症的格拉斯哥预后评分（GPS），改良的GPS（MGPS）和高敏CRP改良的GPS（HS-MGPS）以及急性冠脉事件全球登记表（GRACE）评分。
结果：共纳入188例患者。具有MACE的ROC曲线显示GPS的AUC（0.820（95％置信区间（CI）[0.754-0.885]，P <0.001））大于MGPS（0.789（95％CI [0.715-0.863]） ，P <0.001），HS-MGPS（0.787（95％CI [0.717-0.856]，P <0.001）和GRACE评分（0.743（95％CI [0.672-0.814]），P <0.001）。具有全因死亡率的ROC曲线显示GPS的AUC（0.696（95％CI [0.561-0.831]，P = 0.005）与HS-MGPS（0.698（95％CI [0.569-0.826]）相似，P = 0.005）且高于MGPS（0.668（95％CI [0.525-0.812]，P = 0.016），但低于GRACE评分（0.812（95％CI [0.734-0.889]），P <0.001 ）。多元逻辑回归分析表明，GPS是住院期间发生MACE的独立危险因素。与GPS值为0的优势比（OR）相比，GPS值为1的OR为7.173（95％CI [2.425-21.216]，P <0.001），而GPS值为2的OR为18.636（95％CI [2.425-21.216]，P <0.001）。 95％CI [5.813-59.746]，P <0.001），但不是全因死亡率的独立危险因素（P = 0.302）。 GRACE评分是MACE（1.019（95％CI [1.004-1.035]，P = 0.015）和全因死亡率（1.040（95％CI [1.017-1.064]），P = 0.001）的独立危险因素。在根据AMI类型，疾病干扰GPS的存在和PCI类型进行分类的亚组中，GPS预测MACE发生的能力似乎大于MGPS和HS-MGPS。
结论：无论STEMI或NSTEMI，PCI模式的选择以及是否存在干扰GPS的疾病，GPS对AMI患者住院期间发生MACE均具有良好的预测价值。但是，与GRACE评分相比，GPS不能更好地预测住院期间的全因死亡率，这可能是由于其他疾病患者的干扰所致。

BACKGROUND & AIMS: OBJECTIVE:This study aimed to identify the 10 most frequent pediatric orthopaedic injuries requiring hospitalization in the United States, the major causes of these injuries, and their economic burden to health care cost. METHODS:The 2006 Kids' Inpatient Database (KID) (age range, 0-20 years) was used to determine the 10 most frequent pediatric orthopaedic injuries requiring hospitalization. The injuries were identified by ICD-9-CM codes 800.0-999.9 and external cause of injury codes (E-codes). Discharges were weighted to produce national estimates according to average age at admission, hospital charges, and length of stay. RESULTS:The 2 populations accounting for the highest total hospitalization charges (USD) for pediatric orthopaedic injury were young children with femur fractures (11 years of age, 20%, $32 441 per visit) and adolescents with vertebral fractures (17 years of age, 8%, $53 992 per visit). But the most common injuries requiring hospitalization were femur (11 years of age; 20%) and humerus (8 years of age; 18%) fractures. The most costly injuries, vertebral and pelvic injuries, were largely related to motor vehicle accidents (11.7% and 14.4%, respectively). In contrast, humerus and radius fractures had a high rate of playground-related injuries (21.9% and 11.3%, respectively). None of the causes accounted for more than 25% of the total incidence for the 10 most common injuries identified in this study. CONCLUSIONS:Identification of the patients responsible for the majority of the hospitalization charges for pediatric injuries will enable institutions to better plan their budgets on the basis of the local incidence.

背景与目标： 目的：本研究旨在确定在美国需要住院的十种最常见的小儿骨科损伤，这些损伤的主要原因以及它们对医疗保健成本的经济负担。
方法：使用2006年儿童住院数据库（KID）（年龄范围0-20岁）确定需要住院的10例最常见的小儿骨科损伤。伤害由ICD-9-CM代码800.0-999.9和外部伤害原因代码（E代码）标识。根据入院时的平均年龄，住院费用和住院时间，对出院时间进行加权以得出全国估计。
结果：儿童骨科损伤总住院费（USD）最高的2个人群是股骨骨折的幼儿（11岁，20％，每次就诊$ 32 441）和青少年的椎骨骨折（17岁， 8％，每次访问$ 53 992）。但是最需要住院的伤害是股骨（11岁； 20％）和肱骨（8岁； 18％）骨折。损失最大的是椎骨和骨盆损伤，主要与机动车事故有关（分别为11.7％和14.4％）。相比之下，肱骨和radius骨骨折的操场相关伤害发生率较高（分别为21.9％和11.3％）。在本研究中确定的10种最常见伤害中，没有一种原因占总发病率的25％以上。
结论：确定负责小儿伤害的大部分住院费用的患者，将使各机构可以根据当地发生率更好地计划预算。

BACKGROUND & AIMS: OBJECTIVES:To quantify the prevalence of frailty in adults of all ages undergoing chronic hemodialysis, its relationship to comorbidity and disability, and its association with adverse outcomes of mortality and hospitalization. DESIGN:Prospective cohort study. SETTING:Single hemodialysis center in Baltimore, Maryland. PARTICIPANTS:One hundred forty-six individuals undergoing hemodialysis enrolled between January 2009 and March 2010 and followed through August 2012. MEASUREMENTS:Frailty, comorbidity, and disability on enrollment in the study and subsequent mortality and hospitalizations. RESULTS:At enrollment, 50.0% of older (≥ 65) and 35.4% of younger (<65) individuals undergoing hemodialysis were frail; 35.9% and 29.3%, respectively, were intermediately frail. Three-year mortality was 16.2% for nonfrail, 34.4% for intermediately frail, and 40.2% for frail participants. Intermediate frailty and frailty were associated with a 2.7 times (95% confidence interval (CI) = 1.02-7.07, P = .046) and 2.6 times (95% CI = 1.04-6.49, P = .04) greater risk of death independent of age, sex, comorbidity, and disability. In the year after enrollment, median number of hospitalizations was 1 (interquartile range 0-3). The proportion with two or more hospitalizations was 28.2% for nonfrail, 25.5% for intermediately frail, and 42.6% for frail participants. Although intermediate frailty was not associated with number of hospitalizations (relative risk = 0.76, 95% CI = 0.49-1.16, P = .21), frailty was associated with 1.4 times (95% CI = 1.00-2.03, P = .049) more hospitalizations independent of age, sex, comorbidity, and disability. The association between frailty and mortality (interaction P = .64) and hospitalizations (P = .14) did not differ between older and younger participants. CONCLUSIONS:Adults of all ages undergoing hemodialysis have a high prevalence of frailty, more than five times as high as community-dwelling older adults. In this population, regardless of age, frailty is a strong, independent predictor of mortality and number of hospitalizations.

背景与目标： 目的：定量分析接受慢性血液透析的所有年龄段成年人的脆弱程度，其与合并症和残疾的关系以及与死亡率和住院不良后果的关系。
设计：前瞻性队列研究。
单位：马里兰州巴尔的摩的单一血液透析中心。
参加者：2009年1月至2010年3月至2012年8月，共有146名接受血液透析的患者入选。
测量：参加研究时的虚弱，合并症和残疾以及随后的死亡率和住院治疗。
结果：入组时，接受血液透析的年龄较大（≥65岁）的个体为50.0％，较年轻（<65岁）为35.4％；中度脆弱的分别为35.9％和29.3％。非脆弱人群的三年死亡率为16.2％，中度脆弱人群为34.4％，脆弱人群为40.2％。中度虚弱和虚弱与死亡无关的危险性分别高2.7倍（95％置信区间（CI）= 1.02-7.07，P = .046）和2.6倍（95％CI = 1.04-6.49，P = .04）年龄，性别，合并症和残疾。入选后的一年中，住院的中位数为1（四分位间距为0-3）。两次以上住院的比例为：非体弱者为28.2％，中度体弱者为25.5％，体弱者为42.6％。尽管中度虚弱与住院人数无关（相对危险度= 0.76，95％CI = 0.49-1.16，P = 0.21），虚弱率却是1.4倍（95％CI = 1.00-2.03，P = .049）与年龄，性别，合并症和残疾无关的住院人数增加。衰老和死亡率（互动性P = .64）与住院治疗（P = .14）之间的关联在年龄较大和较年轻的参与者之间没有差异。
结论：接受血液透析的所有年龄段的成年人的身体虚弱率很高，是居住社区的老年人的五倍以上。在这个人群中，无论年龄大小，衰弱都是死亡率和住院次数的有力，独立的预测指标。