ABSTRACT
Objective:To explore the scheme of assigning rational scores to the Modified Pediatric Nutritional Risk Screening Tool for children with cerebral palsy(CP) at different Gross Motor Function Classification System(GMFCS) levels.Methods:The clinical data of 360 children with CP hospitalized in the Department of Children′s Rehabilitation, the Third Affiliated Hospital of Zhengzhou University from January to October 2019 were analyzed retrospectively.All the CP children at different GMFCS levels who met the inclusion criteria were subject to nutrition screening and assessment by using the Modified Pediatric Nutritional Risk Screening Tool and the Subjective Global Nutritional Assessment(SGNA) scale.The distribution of malnutrition rates assessed by the SGNA scale among the children at different GMFCS levels was examined.Data between groups were compared by the χ2 test.Children at different GMFCS levels were divided into different subgroups according to the statistical difference.Then, 0 or 1 score was assigned to the Modified Pediatric Nutritional Risk Screening Tool in different subgroups, and different combinations were formed.The nutritional risk screening results of different combinations were evaluated by using the SGNA scale assessment results as a reference. Results:In children with CP, the risk detection rate and incidence rate of malnutrition were 58.1%(209/360) and 36.9%(133/360), respectively.There was no significant difference in the incidence rate of malnutrition between GMFCS Ⅱ and GMFCS Ⅲ, as well as between GMFCS Ⅳ and GMFCS Ⅴ(all P>0.05). Therefore, children with CP were divided into 3 subgroups, namely, group Ⅰ, group Ⅱ to Ⅲ, and group Ⅳ to Ⅴ.Different CP disease scores were given to the Modified Pediatric Nutritional Risk Screening Tool in 3 subgroups, forming 3 different protocols[protocol 1 (0, 0, 1 point); protocol 2(0, 1, 1 point); current protocol (1, 1, 1 point)]. Taking the SGNA scale assessment results as a reference, the sensitivity of protocol 1, protocol 2 and current protocol were 85.7%, 92.5%, and 93.2% respectively.The specificity protocol 1, protocol 2 and current protocol were 81.1%, 78.0%, and 62.6%, respectively.And the Youden indexes of above three protocols were 0.668, 0.705, and 0.558, respectively.The Youden index of protocol 2 was relatively high. Conclusions:The Modified Pediatric Nutritional Risk Screening Tool can effectively identify the risk of malnutrition in children with CP.The scheme of assigning 0 points to children with GMFCS grade Ⅰ and 1 point to children with GMFCS grade Ⅱ to Ⅴ is more reasonable.
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Objective To observe the effect of team-based continuous nursing on improving the life function of children with cerebral palsy. Methods From March 2014 to March 2016, 35 children aged 18-36 months with cerebral palsy were selected as the experimental group;35 matched patients with the same age, same gender, same Gross Motor Function Classification System (GMFCS) and functionally similar were selected as the control group by matching design. Among them, 32 cases were followed up in the experimental group while 30 cases in the control group. In the control group, routine discharge education was adopted, but the experimental group was treated by team-based continuous nursing. The ability of daily living was evaluated by the Pediatric Evaluation of Disability Inventory (PEDI). Neuropsychological development was evaluated by the Gesell Development Scale and Body balance was evaluated by the Berg Balance Function Scale after discharge and also after 6 months follow-up. Results After the intervention for 6 months, the functional skill and assisting assistance of PEDI was (77.56 ± 23.58), (38.78 ± 13.96) points in the experimental group, and (65.12 ± 24.23), (30.35 ± 12.78) points in the control groups, there were significant differences between two groups(t=2.0485, 2.4750, P0.05) , but the experimental group was higher than the control group. The scores of Berg Balance Function Scale was(33.20 ± 4.12) points in the experimental group, and (29.67 ± 4.98) points in the control group, there were significant differences between two groups (t = 3.0488, P<0.05). Conclusions To improve the life function of children with cerebral palsy, the implementation of the team-based continuous nursing had a significant effect.
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Objective To evaluate the clinical applied value of spiral CT during arterial portography(SCTAP)in evaluating the surgical resectabitity of the hepatocellular carcinoma(HCC).Methods 23 patients with focal hepatic lesions (including HCC 21 cases) were examed with SCTAP,convenient CT and DSA.The difference and the sensitivity in detecting the number of lesions by these three examied methods were comparatively analysed.Results SCTAP had significant difference in comparision with convenient CT and DSA (?0.05) when the lesions were more than 30.0 mm in diameter.21 cases of HCC hepatic metastatic lesions were not found by SCTAP in 9 cases,they chosen the surgical treatment,and 12 cases underwent the interventional trans-catheter artenial chamical embolism(TACE),because of hepatic metastasis showed by SCTAP.Conclusion SCTAP is of high sensitivity in showing small hepatocellular carcinoma and small liver metastatic lesion in comparision with convenient CT and DSA,and it is of great clinical applied value in judging the patients with HCC whether can be or not be treated by surgery.