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Management of suicide attempts in Italy and Sweden - A comparison of services offered to consecutive samples of suicide attempters

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GENERAL HOSPITAL PSYCHIATRY 2000年第6期22卷 432-436页

作者： Runeson, B Scocco, P DeLeo, D Meneghel, G Wasserman, D Karolinska Inst St Gorans Hosp Dept Clin Neurosci Sect Psychiat S-11281 Stockholm Sweden Univ Padua Dept Neurol & Psychiat Sci WHO Collaborating Ctr Res & Training Suicide Prev Padua Italy Griffith Univ Brisbane Qld 4111 Australia Karolinska Inst Natl Inst Psychosocial Med Natl Swedish Ctr Suicide Res & Prevent Mental Ill Stockholm Sweden Karolinska Inst WHO Collaborating Ctr Stockholm Sweden

The aim of the study was to compare the management of suicide attempts by patients in Sweden and Italy with a view to providing a perspective on differences in treatment. Two consecutive samples of suicide attempters from Huddinge (n=97) and Padua (n=100) were studied in trans of sociodemographic characteristics previous care, referral, medical and psychiatric care, hospitalization, aftercare and short-term compliance. In Italian somatic management of acute suicidal crises, there are more physicians specializing in anesthesia or internal medicine working in ambulances and emergency wards, and there is a heavier emphasis on somatic care. Swedish management procedures seem to entail more medical examinations and biohumoral tests. Moreover, the procedures at the Swedish hospital give priority to early psychiatric intervention, and admission to psychiatric inpatient care is more frequent. However, it is not normal practice in emergency psychiatric care at either of the centers for specialists to serve in the immediate liaison consultation. There are differences in assessment and treatment between the two countries that may provide a perspective on their procedures, implying that current procedures for managing patients belonging to groups identified as "high-risk" in terms of suicide may be modified. (C) 2000 Elsevier Science Inc.

关键词：出院后医疗/组织和管理急诊室精神病/组织和管理住院/统计学和数值数据意大利精神卫生服务/组织和管理病人依从/心理学病人依从/统计学和数值数据精神病学/组织和管理卫生保健质量转诊和会诊/组织和管理社会经济因素自杀未遂/预防和控制自杀未遂/心理学自杀未遂/统计学和数值数据瑞典青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Management of fever without source in infants and children

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ANNALS OF EMERGENCY MEDICINE 2000年第6期36卷 602-614页

作者： Baraff, LJ Univ Calif Los Angeles Ctr Emergency Med Dept Pediatr & Emergency Med Los Angeles CA 90024 USA

Twenty percent of febrile children have fever without an apparent source of infection after history and physical examination. Of these, a small proportion may have an occult bacterial infection, including bacteremia, urinary tract infection (UTI), occult pneumonia, or, rarely, early bacterial meningitis. Febrile infants and young children have, by tradition, been arbitrarily assigned to different management strategies by age group: neonates (birth to 28 days), young infants (29 to 90 days), and older infants and young children (3 to 36 months). Infants younger than 3 months are often managed by using low-risk criteria, such as the Rochester Criteria or Philadelphia Criteria. The purpose of these criteria is to reduce the number of infants hospitalized unnecessarily and to identify infants who may be managed as outpatients by using clinical and laboratory criteria. In children with fever without source (FWS), occult UTIs occur in 3% to 4% of boys younger than 1 year and 8% to 9% of girls younger than 2 years of age. Most UTIs in boys occur in those who are uncircumcised. Occult pneumococcal bacteremia occurs in approximately 3% of children younger than 3 years with FWS with a temperature of 39.0 degreesC (102.2 degreesF) or greater and in approximately 10% of children with FWS with a temperature of 39.5 degreesC (103.1 degreesF) or greater and a WBC count of 15,000/mm(3) or greater. The risk of a child with occult pneumococcal bacteremia later having meningitis is approximately 3%. The new conjugate pneumo coccal vaccine (7 serogroups) has an efficacy of 90% for reducing invasive infections of Streptococcus pneumoniae. The widespread use of this vaccine will make the use of WBC counts and blood cultures and empiric antibiotic treatment of children with FWS who have received this vaccine obsolete.

关键词：年龄分布算法门诊医疗/统计学和数值数据菌血症/并发症菌血症/流行病学发热原因不明/流行病学发热原因不明/病因学发热原因不明/治疗住院/统计学和数值数据发病率肺炎/并发症肺炎/流行病学预后危险因素性别分布泌尿道感染/并发症泌尿道感染/流行病学儿童儿童学龄前女(雌)性人类婴儿婴儿新生男(雄)性

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Reduction in the need for hospitalization for recurrent ischemic events and bleeding with clopidogrel instead of aspirin

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AMERICAN HEART JOURNAL 2000年第1期140卷 67-73页

作者： Bhatt, DL Hirsch, AT Ringleb, PA Hacke, W Topol, EJ Cleveland Clin Fdn Dept Cardiol Cleveland OH 44195 USA Univ Minnesota Sch Med Vasc Med Program Minneapolis MN 55455 USA Heidelberg Univ Sch Med Dept Neurol Heidelberg Germany

Background Repeat hospitalizations of patients with atherosclerosis represent a considerable burden on the health care system. We sought to determine whether clopidogrel compared with aspirin decreases the need for rehospitalization for ischemia and bleeding. Methods and Results The Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial was a randomized, blinded, multicenter, trial of 19,185 patients with atherosclerotic disease manifested as recent ischemic stroke or myocardial infarction or symptomatic peripheral arterial disease. Without any double-counting of events, the number of rehospitalizations for ischemic events (defined as angina, transient ischemic attack, or limb ischemia) or bleeding events was determined for the entire cohort. There was a significant reduction in the total number of rehospitalizations for ischemic events or bleeding with clopidogrel use compared with aspirin (1502 vs 1673;P = .010) over an average of 1.6 years of treatment. This reduction in rehospitalization was consistent across individual outcomes of angina, transient ischemic attack, limb ischemia, and bleeding. Compared with aspirin, clopidogrel also resulted in a 7.9% relative risk reduction in a combined end point of vascular death, stroke, myocardial infarction, or rehospitalization for ischemic events or bleeding (15.1% to 13.7% at 1 year;P = .011). Adjusting for baseline prognostic variables, clopidogrel therapy was an independent predictor for reduction of vascular death, stroke, myocardial infarction, or rehospitalization for ischemic events or bleeding (P = .009). Conclusions Treatment with clopidogrel results in a significant decrease in the need for rehospitalization for ischemic events or bleeding compared with aspirin. This meaningful end point tracks well with other, more traditional measures of outcome and has incremental value beyond such end points.

关键词：阿司匹林/投药和剂量脑缺血/药物疗法脑缺血/病因学脑缺血/死亡率死亡原因置信区间双盲法出血/药物疗法出血/死亡率住院/统计学和数值数据发病率缺血/药物疗法缺血/病因学缺血/死亡率多元分析心肌梗死/并发症心肌梗死/药物疗法心肌梗死/死亡率外周血管疾病/并发症外周血管疾病/药物疗法外周血管疾病/死亡率血小板聚集抑制剂/投药和剂量概率预后比例危险度模型复发/预防和控制危险性评估存活率分析噻氯匹定/投药和剂量噻氯匹定/类似物和衍生物女(雌)性人类男(雄)性中年人

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Hospital admissions for rotavirus infection in the Netherlands

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CLINICAL INFECTIOUS DISEASES 2000年第3期31卷 698-704页

作者： de Wit, MAS Koopmans, MPG van der Blij, JF van Duynhoven, YTHP Natl Inst Publ Hlth & Environm Dept Infect Dis Epidemiol NL-3720 BA Bilthoven Netherlands Natl Inst Publ Hlth & Environm Res Lab Infect Dis NL-3720 BA Bilthoven Netherlands Med Ctr Alkmaar Netherlands

The development of a vaccine against rotavirus (RV) infection has necessitated the estimation of the number of hospitalizations for RV infection in the Netherlands. During 1998, pediatricians have reported all hospitalizations with RV infection and supplied information on the duration of admission, clinical picture, indication for admission, and treatment. Also, data from the National Disease Registry on hospitalizations for gastroenteritis (International Classification of Disease codes 006.6. 006.8, 009, and 558.9) and laboratory surveillance data for 1996-1998 were combined in a Linear regression model to indirectly estimate the incidence and proportion of hospitalizations attributable to RV infection. The direct estimate of admissions for RV infection in children aged <5 years was 0.9 per 1000, and the indirect estimate was 2.7 per 1000 in 1998 (1996, 3.4;1997, 1,6). The proportion of hospitalizations for gastroenteritis attributable to RV ranged from 32% in 1997 to 58% in 1996.

关键词：儿童住院/统计学和数值数据交叉感染/病毒学胃肠炎/流行病学胃肠炎/病毒学住院/统计学和数值数据发病率实验室医院/统计学和数值数据线性模型荷兰/流行病学病人出院/统计学和数值数据人群监测/方法轮状病毒感染/流行病学轮状病毒感染/病毒学时间因素儿童学龄前女(雌)性人类婴儿婴儿新生男(雄)性

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Clinical predictors of morbidity and mortality in patients with myocardial infarction or revascularization who underwent cardiac rehabilitation, and importance of diabetes mellitus and exercise capacity

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第3期85卷 344-349页

作者： Yu, CM Lau, CP Cheung, BMY Fong, YM Ho, YY Lam, KB Li, LSW Univ Hong Kong Queen Mary Hosp Div Cardiol Dept Med Hong Kong Peoples R China Univ Hong Kong Tung Wah Hosp Dept Med Hong Kong Peoples R China

This investigation was a prospective, follow-up study to assess whether baseline clinical and investigational parameters were predictors of cardiovascular morbidity and mortality in patients enrolled into the cardiac rehabilitation program. A cohort of 418 patients (70% were men) with coronary heart disease was followed up 3.2 +/- 1.1 years. Two hundred twenty-seven of them (54%) had a recent myocardial infarction (MI), with a thrombolytic rare of 54%. Percutaneous transluminal coronary angioplasty (PTCA) was performed in 45% of patients. The covariates assessed include age, gender, smoking habit, body mass index, the presence of hypertension or diabetes mellitus, exercise habit, site and severity of MI, status of thrombolytic therapy, peak creatine phosphokinase, plasma lipid profiles, ejection fraction, PTCA performed, number of diseased coronary arteries, and exercise capacity. Low-density lipoprotein cholesterol decreased significantly (3.2 +/- 1.0 vs 2.7 +/- 0.7 mmol/L, p <0.001). The cumulative mortality was 13%. In a univariate model, the parameters that significantly predict mortality included older age, diabetes, low exercise capacity (less than or equal to 4 metabolic equivalents) 3-vessel disease, those without PTCA performed, and a low ejection fraction. In the Cox proportional-hazards model analysis, the independent factors were coexisting diabetes (chi-square 6.1, p = 0.01) and a low metabolic equivalent (chi-square 6.5, p = 0.01). One hundred six patients were rehospitalized for nonfatal cardiovascular events that included unstable angina (48%), heart failure (21%), acute MI (6%), symptomatic arrhythmia (6%), and severe hypertension (1%). Factors that independently predicted rehospitalization were low exercise capacity (p = 0.02) and the presence of diabetes (chi-square 4.8, p = 0.03). Diabetes was also associated with more episodes of hospital admission (2.3 +/- 2.1 vs 1.6 +/- 1.4, p = 0.04) and a longer cumulative hospital stay (25.5 +/- 34.6 vs 11.

关键词：队列研究糖尿病并发症无病生存运动(Exercise) 随访研究香港/流行病学住院/统计学和数值数据年患病率心肌梗死/并发症心肌梗死/死亡率心肌梗死/康复比例危险度模型前瞻性研究危险因素女(雌)性人类男(雄)性中年人

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Complementary therapy use: a survey of community- and hospital-based patients with advanced cancer

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PALLIATIVE MEDICINE 2000年第5期14卷 432-434页

作者： Oneschuk, D Hanson, J Bruera, E Grey Nuns Community Hosp Reg Palliat Care Program Edmonton AB T6L 5X8 Canada Cross Canc Inst Edmonton AB T6G 1Z2 Canada Univ Texas MD Anderson Canc Ctr Houston TX 77030 USA

Presents the results of a face-to-face survey dealing with complementary therapy use in consecutive advanced cancer patients in the community and in a tertiary palliative care unit. Use of complementary therapies; Reasons for use; Cost of the therapies; Presence of beneficial effects; Influence of involvement with health-care providers.

关键词：社区卫生服务/组织和管理补充疗法/利用住院/统计学和数值数据肿瘤/治疗姑息疗法/方法问卷调查老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Evaluation of chest pain suspicious for acute coronary syndrome: Use of an accelerated diagnostic protocol in a chest pain evaluation unit

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第5A期85卷 40B-48B页

作者： Kirk, JD Diercks, DB Turnipseed, SD Amsterdam, EA Univ Calif Davis Med Ctr Sch Med Dept Internal MedDiv Emergency MedPSSB Sacramento CA 95817 USA Univ Calif Davis Sch Med Dept Internal Med Div Cardiovasc Med Sacramento CA 95817 USA

Management of patients presenting to the emergency department with chest pain suggestive of acute myocardial infarction (AMI) remains a continuing challenge, A low threshold far admission has been traditional because of concern for patient welfare and the litigation potential associated with the inadvertent discharge of patients with ischemic events. Because of this approach, < 30% of patients admitted for chest pain ultimately are found to have an acute coronary syndrome. To reduce unnecessary admissions, maintain patient safety, and enhance cost-effectiveness, innovative strategies have been applied to the management of patients with chest pain, It is now recognized that a tow-risk group can be identified by the clinical presentation and initial electrocardiogram. Chest-pain centers have been developed to provide further risk stratification and systematic management of these patients, We employ an accelerated diagnostic protocol based on immediate exercise treadmill testing to evaluate low-risk patients, Moderate-risk patients are assessed over a 6-hour observation period with serial electrocardiagrams and evaluation of cardiac-injury markers. Patients with positive evaluations are admitted, Those with negative results undergo either exercise echocardiography or rest myocardial perfusion Imaging utilizing technetium-99m sestamibi. Patients with positive functional tests are admitted, Those with negative studies are discharged with outpatient followup. These strategies have provided a safe and accurate means of patient disposition from the emergency department with the potential for vital cost savings. (C)2000 by Excerpta Medica, Inc.

关键词：算法胸痛/血液胸痛/诊断胸痛/超声检查冠心病/血液冠心病/诊断冠心病/超声检查肌酸激酶/血液诊断鉴别心电描记术急诊室医院/组织和管理运动试验住院/统计学和数值数据试验预期值危险因素肌钙蛋白/血液人类

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Hospitalization in ICD recipients

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EUROPEAN HEART JOURNAL 2000年第14期21卷 1123-1124页

作者： Capucci, A Osped Civile Piacenza Piacenza Italy

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Containment of heart failure hospitalizations and cost by angiotensin-converting enzyme inhibitor dosage optimization

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第5期86卷 519-523页

作者： Luzier, AB Forrest, A Feuerstein, SG Schentag, JJ Izzo, JL SUNY Buffalo Dept Pharm Practice Buffalo NY 14260 USA SUNY Buffalo Dept Med Buffalo NY 14260 USA Millard Fillmore Hosp Kaleida Hlth Clin Pharmacokinet Lab Buffalo NY 14209 USA

Using our model relating angiotensin-converting enzyme (ACE) inhibitor dosing and outcomes in heart failure (HF), we designed a prospective intervention trial for patients with systolic dysfunction. A clinical pharmacist initiated or titrated ACE inhibitor therapy or adjusted other medications within an HF management program based on Agency for Healthcare Policy and Research guidelines, Entry into the protocol required the approval of the attending physician. All patients received dietary, nursing, rehabilitation, social service, and clinical pharmacy consultations. Treatment conformed to Agency for Healthcare Policy and Research guidelines in 25% of patients (group A). Suboptimal therapy (75% of patients) was usually due to failure to administer an ACE inhibitor (48%) or inadequate dosing of an ACE inhibitor (46%). In 62% of suboptimal cases, the attending physician agreed to follow the clinical pharmacist's recommendations (group B). Patients of physicians who declined pharmacist intervention served as a negative control (group C). On admission, mean enalapril-equivalent daisy doses in groups A, B, and C were 30, 4, and 6 mg, respectively, and at discharge, 36, 18, and 6 mg, respectively. At 180 days, rehospitalization frequency and total charges were lower in groups A (31% and $5,600) and B (35% and $3,800) than in group C (63% [p <0.004] and $9,800 [p <0.04]). Thus, optimization of ACE inhibitor doses by a clinical pharmacist can greatly improve rehospitalization rates and significantly lower cost of core in an HF management program. (C) 2000 by Excerpta Medica, Inc.

关键词：血管紧张素转换酶抑制药/投药和剂量费用控制心力衰竭/药物疗法心力衰竭/经济学住院/经济学住院/统计学和数值数据药理学临床前瞻性研究人类

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Low nutrient intake contributes to adverse clinical outcomes in hospitalized elderly patients

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NUTRITION REVIEWS 2000年第7期58卷 214-217页

作者： Hall, K Whiting, SJ Comfort, B Univ Saskatchewan Coll Pharm & Nutr Saskatoon SK S7N 5C9 Canada

A prospective cohort study on hospitalized elderly patients revealed that inadequate nutrient intake during hospitalization was associated with adverse clinical outcomes and increased morbidity. Because this occurred in patients who were initially assessed as being in good health, it emphasizes the need for continuous nutritional surveillance of hospitalized elderly patients.

关键词：队列研究进食/生理学住院/统计学和数值数据普查营养评价营养障碍/并发症营养障碍/诊断营养障碍/经济学营养状况/生理学老年人女(雌)性人类男(雄)性

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