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Objective:To analyze the influential factors of hypothermia in congenital heart disease (CHD) after cardiopulmonary bypass (CPB) rewarming using the decision tree model, thus providing theoretical basis for medical staff.Methods:A total of 711 CHD children who underwent surgery in the Shanghai Children′s Medical Center from January 1, 2019 to April 30, 2019 were retrospectively analyzed.A decision tree model was established to predict the risk factors for hypothermia in CHD children following CPB.Results:The decision tree model showed that CPB program, preoperative nutrition score and body surface area were the high-risk factors for hypothermia in CHD children after CPB rewarming.The accuracy, sensitivity, specificity of the decision tree model were 86.45%, 77.14% and 90.97%, respectively, and the area under the receiver operating characteristic curve was 0.851(95% CI: 0.798-0.904). Conclusions:Decision tree model has a high application value in predicting hypothermia in CHD children following CPB.It contributes to identify the influential factors of hypothermia, and provides references for performing preventive treatment and nursing measures to control the risk of hypothermia.
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Objective@#To translate the Children′s International Mucositis Evaluation Scale (ChIMES) into Chinese and evaluate its psychometric charateristics in pediatric patients with acute leukemia.@*Methods@#After translation and cognitive debriefing interviews, convenience sampling was used to recruit 105 pediatric patients with acute leukemia in a Shanghai AAA pediatric hospital.@*Results@#The known-group validity was great, and criterion validity was 0.947. Through EFA, the Chinese version of ChIMES included two dimensions which accounted for 75.270% of the accumulated variance, and each item had high factor loading quantity (>0.5). Cronbach alpha was 0.826 and the split-half reliability was 0.590. Relevance between each item and total score was good, with Pearson correlation coefficient 0.424-0.900.@*Conclusion@#The Chinese version of ChIMES has been proved valid and reliable and can be practically and feasibly used in the future.
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Objective:To translate the Children ′s International Mucositis Evaluation Scale (ChIMES) into Chinese and evaluate its psychometric charateristics in pediatric patients with acute leukemia. Methods:After translation and cognitive debriefing interviews, convenience sampling was used to recruit 105 pediatric patients with acute leukemia in a Shanghai AAA pediatric hospital.Results:The known-group validity was great, and criterion validity was 0.947. Through EFA, the Chinese version of ChIMES included two dimensions which accounted for 75.270% of the accumulated variance, and each item had high factor loading quantity (>0.5). Cronbach alpha was 0.826 and the split-half reliability was 0.590. Relevance between each item and total score was good, with Pearson correlation coefficient 0.424-0.900.Conclusion:The Chinese version of ChIMES has been proved valid and reliable and can be practically and feasibly used in the future.
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Objective To investigate the use of smartphone applications in the adherence with inhaled glucocortiocoids (ICS) therapy in asthma children. Methods Sixty-six asthma children and their caregivers in Shanghai Childrren's Medical center from July 2016 to February 2017 were recruited in this study using convenience sampling . All participants were randomly allocated to intervention and control groups. All participants were given routine education and technical guidance on inhalation. In addition all participants had the same chips attached to their regular nebulizers. The APP was installed on each caregivers' smartphone in the intervention group. Key modules of mobile applications include real-time monitoring of medication and health education. The ICS adherence rates were recorded by the chips and were monitored monthly by researcher. The frequency of asthma exacerbations, emergency department visits and hospital admissions in intervention group was collected by smartphone APP every 3 months. the frequency of asthma exacerbations, emergency department visits and hospital admissions in control group was investigated by researcher every 3 month. Results After 6 months follow up, although ICS compliance decreased in both groups. The first month's adherence in the intervention group was 98(97.0, 100.0)％, in the sixth month's was 96(92.0, 100.0)％. The first month's adherence in the control group was 93(68.5,100.0)％, in the sixth month's was 28(0, 55.5)％. The difference in adherence between the two groups was significant (Z=2.664, 4.318, P<0.01). The decline trend of the control group was significantly greater than that of the intervention group (F=25.097, P<0.01). The compliance of the control group was less than 60％from the third month and below 30％by the sixth month, below the average ICS compliance of 30％ to 60％ in China. Though the ICS compliance of intervention group was declining, the ICS compliance was more than 90％ and higher than the mean compliance in our country. No significant differences were found in the frequency of asthma exacerbations, emergency department visits and hospital admissions between the intervention and control group (χ2=3.043, 1.065, 1.015, P>0.05). But the frequency of asthma exacerbations, emergency department visits and hospital admissions of two times or more intervention group was lower than that in the control group. Conclusions Smartphone APP significantly improved the compliance of children with asthma aged 0 month to 3years old.
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Objective To determine the effectiveness of an oral care protocol on prevention and treatment of chemotherapy-induced oral mucositis in patients with hematological neoplasms. Methods Totally 106 patients with hematological neoplasms undergoing therapies from March to October 2017 were enrolled. Patients who were included from March to June 2017 constituted the control group, others from July to October constituted the intervention group. Patients in control group received the regular care, while patients in intervention group received a 3-week period oral care protocol. The oral health status of the patients was recorded and compared between the two groups. Results On the 7th,14th, 21th day after chemotherapy, the oral mucositis level of I degree,Ⅱdegree,Ⅲdegree andⅣdegree of the intervention group were 11, 13, 17, 1 cases, 28, 16, 0, 0 cases, 9, 3, 0, 0 cases, which were lower than the control group whose degrees were 24, 18, 10, 2 cases, 21, 13, 12, 0 cases, 13, 9, 8, 0 cases, respectively. The difference between the two groups was statistically significant (Z=-2.177,-2.504,-2.113, P<0.05). On the 3th, 7th, 14th and 21th day after chemotherapy, the oral pain scores reported by patients in the intervention group were 2.00(2.50), 3.00(2.75), 2.50(2.00), 0.00 (1.00), which were lower than the control group whose scores, in contrast, were 3.00(4.00), 5.00(3.25), 5.50 (4.00), 2.00(3.25). The difference between the two groups was statistically significant (Z=-2.587,-3.326,-4.925,-3.217, P <0.05). The positive rate of microbial examination in the intervention group was 14.6％(7/48), which was lower than 36.2％(21/58) in the control group. The difference between the two groups was statistically significant(χ2=6.318, P<0.05). Conclusions The oral care protocol established and implemented based on evidence could effectively decrease the incidence of chemotherapy-induced oral mucositis, ease oral pain and reduce inflammation for patients with hematological neoplasms.
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Objective To identify the core interventions preliminarily performed by pediatric nurses for hospitalized children. Methods Based on Nursing Interventions Classification (NIC), the data of survey related to the factors of representation and frequency derived from the definition of Core Nursing Interventions were collected from 59 pediatric senior nurses above the 3rd clinical ladder, working in one of Shanghai university affiliated and tertiary children hospitals. The data was analyzed by L type of Metric Diagram. The intervention with product of two factors above 12 was selected as the core intervention. Results A total of 109 interventions were selected as core interventions on pediatric nursing from 497 interventions of NIC. The top 3 domains in quantity of interventions were physiological complex domain (36 items), physiological basic domain (26 items) and health system domain (19 items). The domain with the highest score (16.79 ± 3.42) was safety domain, followed by physiological complex domain (16.19 ± 2.98), while domain with the lowest score (13.62±2.05) was family domain. Conclusions The initial and systematic pediatric nursing core interventions were identified based on NIC and definition of core intervention. Part of core interventions reflects the characteristics of pediatric nursing practice, but more is requested to reflect the pediatric-specific care related to family-center and age-appropriated concepts. Some of inefficient interventions remind nursing administers further reflect thinking, especially on human resource management.
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Objective To explore the relationship between the genetic polymorphism and serum concentration of mannan binding lectin (MBL)and the clinical manifestation of the hand-foot-mouth disease (HFMD) children infection by human enterovirus 71 (HEV71).Methods One hundred and thirty-eight children diagnosed as HFMD infected by HEV71 (including 80 mild cases and 58 severe cases) and 40 healthy,symptom-free children were investigated.The concentrations of serum MBL were measured in 40 healthy controls,80 mild HFMD cases and 56 severe HFMD cases at both acute and convalescent phases by a sandwich enzyme immunoassay with a human MBL ELISA kit.And the genomic DNA of all cases were extracted from blood according to standard phenol-chloroform procedure.Six SNPs in the MBL gene(-550G/C,-221G/C and +4C/T of the promoter,CGT52TGT,GGC54GAC,and GGA57GAA of the exon 1) were analyzed by a sequencing-based typing method.Results The MBL serum level of the severe HFMD circulatory respiratory failure group in acute phase was significantly increased compared with severe HFMD encephalitis group,the mild cases and the control,but in the convalescence phase it significantly decreased compared with them.The frequencis of type B/B mutation (+230 of the exon 1),type P/P mutation (+4C/T of the promoter),and type H/H mutation (-550G/C of the promoter) were a significant difference among mild group,severe group and the control(P=0.006,0.043,0.028,respectively).The frequencies of LYPB/LYPB genotype and HYPA/HYPA genotype were a significant difference among mild group,severe groupand the control (P=0.028,0.014,respectively).Conclusion Low MBL protein level as a result genetic polymorphism seems to be correlative with clinical manifestation of HFMD disease.The MBL gene mutation and low MBI.protein level may be used as one of the evaluation method of HFMD severeity.
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Objective To investigate the clinical value of urinary retinol binding protein(RBP) and N-acetyl-β-glucosaminidase(NAG) for evaluating renal function in preterm neonate.Methods 89 neonates in our NICU were selected,divided into three groups:the asphyxial preterm group (18 cases),the no-asphxial preterm group (25 cases),and the control group (46 term infants without asphyxia).All objects were detected the urinary RBP,NAG and creatinine(Cr).The levels of RBP/Cr and NAG/Cr and blood urea nitrogen(BUN),Cr were observed within 48h after birth after birth.The fluctuations of urinary RBP/Cr and NAG/Cr in no-asphxial preterm group also were observed in 0~48h,~96h,~168h after birth respectively.Results The urinary RBP/Cr levels in asphyxial preterm group [(0.951±0.629)g/mol] were higher than those in no-asphxial preterm group[(0.389±0.281)g/mol] and the control group[(0.119±0.081)g/mol](P0.05).The levels of serum Cr and BUN were no significant difference in the three groups(P>0.05).The urinary RBP/Cr level had non-linear correlation with either postnatal or gestational age in no-asphyxial preterm group.While the urinary NAG/Cr levels negative correlated with the gestational age(r=-0.625,P<0.05).And the correlation between the urinary NAG/Cr and postnatal age was postive(P<0.05).Conclusion The determination of urinary NAG/Cr and RBP/Cr provides a sensitive and reliable method to evaluate the renal function of neonates,especially in preterm infants.The RBP/Cr is affected by asphyxia more than NAG/Cr,which is rather correlated with gestational age.