ABSTRACT
Objective:To explore the clinical effect of daily target list of ICU patients with mechanical ventilation (hereinafter referred to as target list) for patients with mechanical ventilation in ICU based on multidisciplinary ward round design.Methods:A non contemporaneous controlled study with a quasi experimental design was conducted. One thousand and seventy-one patients with mechanical ventilation admitted to the comprehensive care unit of the First Affiliated Hospital of Medical College of Zhejiang University from January to December 2019 were selected as the experimental group. The target list was used to standardize the communication of multidisciplinary ward rounds and guide the clinical nursing process. Nine hundred and fifty patients with mechanical ventilation admitted from January to December 2018 were selected as the control group. Routine medical communication, ward rounds and nursing shift handover were used. The duration of mechanical ventilation and the length of stay in ICU, the utilization rate of catheter and related infection rate, the implementation rate of daily nursing measures, the incidence of nursing adverse events and the satisfaction of medical staff with multidisciplinary cooperation were compared.Results:Before the intervention, there was no significant difference in the basic data between the two groups ( P>0.05). After the intervention, the duration of mechanical ventilation and the length of stay in ICU were 4 (2, 9) h and 3 (3, 7) d in the experimental group, which were lower than those in the control group 6 (5, 35) h and 4 (3, 8) d, the differences were statistically significant ( Z=-13.76, -3.62, both P<0.01). The standard rate of sedation, the implementation rate of early activities and the implementation rate of venous thromboembolism preventive measures in the experimental group were 83.10% (4 435/5 337), 80.16% (3 155/3 936) and 93.97% (5 530/5 885) respectively, which were higher than the 81.42% (4 190/5 146), 68.83% (2 197/3 192) and 87.86% (5 839/6 646) in the control group, the differences were statistically significant( χ2=5.05, 120.93, 138.50, all P<0.05). The use rate of physical restraint, the incidence of incontinence-associated dermatitis, medical adhesive related skin injury, deep vein thrombosis and delirium in the experimental group were 39.75% (2 936/7 387), 3.64% (39/1 071), 4.11% (44/1 071), 5.23% (56/1 071), 6.54% (70/1 071), which were lower than the 43.50% (3 180/7 312), 5.90% (56/950), 8.53% (81/950), 9.26% (88/950), 12.42% (118 / 950) in the control group, the differences were statistically significant( χ2 values were 5.71-20.67, all P<0.05). The level of multidisciplinary cooperation was greatly improved, 3.83 ± 0.38 vs. 3.61 ± 0.51 ( t=-3.33, P<0.01). Conclusions:The use of target list can improve the implementation rate of treatment and nursing measures for critical patients, improve the level of multidisciplinary cooperation and team satisfaction, reduce the ICU hospitalization time, mechanical ventilation time, the incidence of nursing adverse events, and improve patient safety.
ABSTRACT
ObjectiveTo observe the effect of transcranial direct current stimulation (tDCS) on motor function of upper limbs of stroke patients with hemiplegia. MethodsFrom October, 2020 to October, 2021, 65 patients from Wuhan No.1 Hospital were randomly divided into control group (n = 32) and observation group (n = 33). All the patients received routine rehabilitation and mirror therapy, and the observation group received tDCS in addition, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Action Research Arm Test (ARAT) and modified Barthel index (MBI) before and after treatment. ResultsThe scores of FMA-UE, ARAT and MBI improved in the both groups after treatment (|t| > 10.455, Z = -2.793, P < 0.001), and all the scores were better in the observation group than in the control group (|t| > 4.152, Z = -2.045, P < 0.05). ConclusionThe combination of tDCS can effectively promote the recovery of upper limb motor function of stroke patients.
ABSTRACT
AIM To investigate the improving effects of epigallocatechin gallate (EGCG) on rat kidney injury induced by cisplatin and its mechanism of action.METHODS Fifty male SD rats (10 rats/group) were randomly divided into blank control group,kidney injury group,EGCG low-,middle-and high-dose (25,50 and 100 mg/kg) groups.The kidney injury group and the drug administration group were treated with 7.5 mg/kg cisplatin by intraperitoneal injection to build the kidney injury model,and the blank control group was intraperitoneally injected with normal saline.After fourteen days of administration,the general condition and morphological changes of kidney tissue by HE staining were observed;BUN,Cr,Cys-c contents in serum,and IL-18,KIM-1 contents in urine were detected by ELISA;MDA,GSH and T-SOD contents in renal cortex were determined by kit;Western blot method was used to determine the contents of Nrf2 protein in renal contex cytoplasm and nucleus,and the expression level of HO-1 protein.RESULTS EGCG intervention could improve the pathological structural changes of rat kidney injury induced by cisplatin,decrease kidney index,and decrease serum Cr,Cys-c contents and urine IL-18,KIM-1 contents.Moreover,renal cortex MDA concentration decreased,and renal cortex GSH concentration,T-SOD activity increased.At the same time,renal cortex cytoplasm Nrf2 content reduced,but nucleus Nrf2 and total cell HO-1 contents increased.CONCLUSION EGCG plays a role in the improvement of rat kidney injury induced by cisplatin through the activation of Nrf2/HO-1 signal pathway.
ABSTRACT
Objective To explore the effects of early active mobilization on hand function after zone 5 flexor tendon and ulnar nerve repair.Methods Fifty-five patients who had received primary repair in zone 5 of a flexor tendon and the ulnar nerve were randomly divided into an observation group (26 cases, 88 digits) and a control group (27 cases, 91 digits).Both groups were given routine treatment after the operation, and started to do active and passive exercise 4 weeks later.The observation group was additionally forced to do active range of motion exercise training starting 8 days after the operation.Twelve weeks after the operation, the hand function of both groups was assessed using the total active motion (TAM) scoring system of the American Society for Surgery of the Hand, peripheral nerve function evaluation and the disabilities of arm-shoulder-hand (DASH) scale.Results At the end of the treatment, the average TAM score of the observation group was significantly better than that of the control group.The average active movement range of the wrist in palm flexion, dorsal extension, ulnar deviation and in radial deviation were all significantly better than in the control group.Grip strength, overall hand function and DASH score were also significantly better on average.Conclusion Early active mobilization following flexor tendon and ulnar nerve repair can effectively promote the recovery of hand function.
ABSTRACT
@#Objective To investigate the impact of chronic disease self-management on motor function, activities of daily living, quality of life, and depression of patients in poststroke rehabilitation in community. Methods 120 stroke patients living in Gangdu community, Wuhan city were selected and randomly divided into self-management group (n=60) and control group (n=60). The control group experienced home rehabilitation and functional training by themselves, meanwhile they were asked to have regular outpatient referral and do the followup clinic when feeling indisposed. Self-management mode was used in the self-management group instructed by the professor and under the rehabilitation assessment by community doctors, therapist and family members. Also group separated instruction, individualized rehabilitation plan, home visit processes and patients' group activity had been organized. They were evaluated with Fugl-Meyer Assessment (FMA), modified Barthel Index (MBI), Hamilton Depression Rating Scale (HAMD) and the World Health Organization Quality of Life (WHOQOL-100) before and 6 months after intervention. Results There were no difference in FMA upper and lower limbs scores as well as the MBI score, HAMD score and WHOQOL-100 score before intervention (P>0.05). The FMA upper and lower limbs score, MBI score and WHOQOL- 100 score significantly improved in the self-management group and were better than in the control group 6 months after intervention (P<0.05). The control group also improved in the above items, however, the differences were not statistically significant (P>0.05). HAMD score significantly reduced in the self-management group and less than in the control group 6 months after intervention (P<0.05). The control group also reduced in the above scores, however, the differences were not statistically significant (P>0.05). Conclusion Chronic disease self-management for stroke patients in community can significantly improve their motor function, activities of daily living and quality of life, and reduce depression caused by stroke.
ABSTRACT
Objective To explore the effectiveness of visual feedback in retraining upper limb function after stroke.Methods Sixty-one hemiplegic stroke patients were randomly assigned to a treatment group (31 cases)which received motion training using visual feedback in addition to routine neurodevelopment treatment and a motor relearning program,and a control group (30 cases) which received only the neurodevelopment treatment and a motor relearning program.The Fugl-Meyer assessment (FMA) and the modified Ashworth scale (MAS) were used for as-sessment before treatment and after 4 weeks of treatment.Results After 4 weeks of treatment,the FMA and MAS scores of both groups had improved significantly,as had the strength of the forearm flexors.The improvements were significantly greater in the treatment group than in the control group.Conclusion Motion training with visual feed-back can alleviate upper limb spasticity after stroke significantly better than routine rehabilitation alone.
ABSTRACT
Objective To develop the Assessment Scale for Patient Safety Culture in ICU and do psychometric test.Methods The Assessment Scale for Patient Safety Culture in ICU was developed based on literature review,qualitative interview,and two-round Delphi consultation.The reliability and validity were tested among 235 chnical nurses and doctors in ICU.Results A 45-item questionnaire was originally developed and eleven of them were deleted after subjective screening,project analysis and exploratory factor analysis.Seven factors were extracted with cumulative contribution rate of 59.347％.The scale of total Cronbach's alpha coefficient was 0.909; the split half reliability was 0.832.Each dimension of Cronbach's alpha coefficient was between 0.481～0.909,and the split half reliability was 0.481～0.866.All had significance in statistics above.Conclusions The Assessment Scale for Patient Safety Culture in ICU has good reliability and validity,which can be used to evaluate the ICU patient safety culture atmosphere domestically.
ABSTRACT
Objective To investigate the impact of chronic disease self-management on motor function, activities of daily living, quality of life, and depression of patients in poststroke rehabilitation in community. Methods 120 stroke patients living in Gangdu community, Wu-han city were selected and randomly divided into self-management group (n=60) and control group (n=60). The control group experienced home rehabilitation and functional training by themselves, meanwhile they were asked to have regular outpatient referral and do the follow-up clinic when feeling indisposed. Self-management mode was used in the self-management group instructed by the professor and under the rehabilitation assessment by community doctors, therapist and family members. Also group separated instruction, individualized rehabilita-tion plan, home visit processes and patients' group activity had been organized. They were evaluated with Fugl-Meyer Assessment (FMA), modified Barthel Index (MBI), Hamilton Depression Rating Scale (HAMD) and the World Health Organization Quality of Life (WHOQOL-100) before and 6 months after intervention. Results There were no difference in FMA upper and lower limbs scores as well as the MBI score, HAMD score and WHOQOL-100 score before intervention (P>0.05). The FMA upper and lower limbs score, MBI score and WHO-QOL-100 score significantly improved in the self-management group and were better than in the control group 6 months after intervention (P0.05). HAMD score significantly reduced in the self-management group and less than in the control group 6 months after intervention (P0.05). Conclusion Chronic disease self-management for stroke patients in community can significantly improve their motor function, activities of daily living and quality of life, and reduce depression caused by stroke.
ABSTRACT
Objective This paper summarizes the safety management of 13 ARDS patients resulting from influenza A (H7N9) virus infection with daily awakening during analgesia and sedation treatment.Methods Safety management was given to 13 ARDS patients with influenza A (H7N9) virus infection during analgesia and sedation treatment.Results No serious complications or adverse events occurred during interruption period of analgesia and sedation.Conclusions To give safety management of daily awakening to patients with influenza A (H7N9) virus infection during analgesia and sedation treatment can increase treatment effect and facilitate early recovery of patients.
ABSTRACT
Objective To evaluate the effects of exercise therapy for patients with difficult weaning using mechanical ventilation.Methods A total of 63 patients with difficult weaning using mechanical ventilation were randomly divided into the experimental group(33 cases) and the control group(30 cases).The patients in the control group received routine respiratory care,however,the patients in the experimental group received gradual and individualized exercise therapy according to patients' condition and physical strength.The items such as the tidal volume,respiratory rate,PaO2/FiO2 were compared between two groups.Results Compared with the control group,the tidal volume,respiratory rate,PaO2/FiO2 and the score of APACHE Ⅱ were better in the experimental group on the 21th and 28th day after mechanical ventilation,the heart rate was better in the experimental group on the 28th day after mechanical ventilation.In addition,the duration of mechanical ventilation and ICU hospitalization was shorter in the experimental group.But the rate of complications showed no significant difference.Conclusions Exercise therapy has a positive effect on patients with difficult weaning using mechanical ventilation.
ABSTRACT
BACKGROUND:Self-made Distraction Reduction Fixation System is characterized by Distraction Reduction Fixation functions,which can completely fuse to the design of steel plate,and by no need to provide many surgical instruments,by reduction of bleeding and trauma.OBJECTIVE:To test changes in the stiffness of porcine short spinal segments in integrity and following destabilizing and internal fixation of the Distraction Reduction Fixation System.DESIGN,TIME AND SETTING:The control observation experiment was performed at the Laboratory of Biodynamics,Institute of Onhopedics,General Hospital of Chinese PLA from December 2004 to December 2005.MATERIALS:Twelve fresh porcine lumbar spines(T11-S2 segments)were bought from a market.Upper and lower segments were crossed and inserted with Kirschner wire to make porcine spine samples of the L1-7 segments.METHODS:Stiffness of intact samples was recorded during forward-bending,backward-bending,lateral-bending and axial rotation.Intervertebral discs,facet ioints,anterior and posterior longitudinal ligaments were removed to loose the spine.Stifrness of each motion was measured.Stiffness tests were repeated again after internal fixation on short segments using Distraction Reduction Fixation System.MAIN OUTCOME MEASURES:Stiffness in the intact,unstable and internal fixed spines during each motion.RESULTS:The stiffness iu unstable porcine spine were significantly lower than those in intact porcine spine(P<0.05),but the stiffness after internal fixation was significantly higher than in unstable porcine spine(P<0.05).No significant difference was detected in stifiness during forward-bending,lateral-bending and axial rotation(P>0.05)except that it was significantly higher during backward.bending after internal fixation compared with the intaet spine(P<0.05).CONCLUSION:Biodynamics confirms that the stiffness in short-segment fixation porcine after using Distraction Reduction Fixation System is markedly increased than in unstable porcine spine,except during backward-bending,which is comparable with that in intact porcine spine.
ABSTRACT
Objective To analyze the status of Leishmania infantum asymptomatic infection in human population of a Kala-azar endemic area in Wenxian County,Gansu Province,and to evaluate the tests used.Methods Blood samples were tested by PCR using two pairs of primers,RV1-RV2 and K13A-K13B,for detecting Leishmania-specific DNA.ELISA and rK39-dipstick were used to detect Leishmania-specific antibodies.Results The positive rate of PCR,ELISA and rK39-dipstick was 30.9%(83/269),24.2%(65/269) and 0(0/269) respectively.Conclusion The prevalence of asymptomatic infection of L.infantum in humans is high in the area.PCR test based on RV1-RV2 and K13A-K13B primer pairs is a sensitive and specific method for detecting the asymptomatic infection.