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ObjectiveTo explore the obstacles and causes of communication and cooperation among doctors, nurses and rehabilitation therapists in a stroke rehabilitation team. MethodsFrom July to October, 2022, twelve rehabilitation evaluation meetings were observed using ethnographic research, based on Shared Mental Model theory. Semi-structured interviews were held with five doctors, ten nurses and four rehabilitation therapists. ResultsFour themes and nine sub-themes were presented, namely equipment (poor interoperability of information system, limited knowledge of rehabilitation equipment for doctors and nurses), task (members were under time pressure to attend meeting, imperfect inter-discipline communication system), team interaction (insufficient information sharing, unfamiliar with roles/responsibilities, misunderstanding between specialties) and team member (less participation of nurses, limited multidisciplinary knowledge). ConclusionThe communication and cooperation among stroke rehabilitation team members is limited by many factors, such as equipment, task, team interaction and team members. It is suggested to improve interoperability of information systems, create a supportive environment, know each other's roles/responsibilities, strengthen interdisciplinary crossover, pay attention to and support the cultivation of nurses' ability, to promote efficient communication and cooperation among team members.
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Objective To investigate the value of abdominal aortic balloon combined homeostasis in the cesarean section with invasive completeplacenta previa. Methods Data of 47 cases of completeplacenta previa with placenta accrete from March 2007 to August 2018 were analyzed retrospectively. Seventeen cases (study group) were treated with abdominal aortic balloon combined homeostasis before cesarean, and 30 cases (control group) did not receive balloon occlusion. The operation time, intra-operative blood loss, intra-operative blood transfusion volume, disseminated or diffuse intravascular coagulation (DIC) rate, hysterectomy rate and post operative complications, time of postoperative hospital stay were compared. Also, the blood coagulation parameters 24 h after operation, including activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer werecompared between the two groups. Results Significant difference was observed in the blood loss [1 000 (800—2 000) ml vs. 2 200 (1 000-4 100) ml, Z=-2.272, P=0.023] and blood transfusion volume [400 (0-2 450) ml vs. 2 460 (200-4 460) ml, Z =- 2.02, P = 0.03], 16 cases of the study group still bled after releasing the balloon.Fifteen cases of them received uterine artery ligation. Bleeding stopped after uterine balloon compression in 1 case. Eleven cases of the 15 cases received uterine balloon compression at the same time. One case of 28 weeks gestation underwent subtotal hysterectomy due to hemorrhagic shock combined with DIC caused by placenta accretion of the bladder. While in control group, 7 cases underwent total hysterectomy because hemorrhagic shock combined with DIC and 3 cases underwent subtotal hysterectomy due to heavy bleeding, and there was statistical significance between two groups [1/17 vs. 33.3%(10/30), P=0.039]. Conclusions Temporary balloon occlusion of the abdominal aorta combined with conventional homeostasis can reduce blood loss, blood transfusion and hysterectomy rate in the cesarean section complicated with invasive complete placenta previa.
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@#Objective To investigate the features of eating difficulties in acute stroke patients, and its related factors. Methods From April to June, 2016, 192 stroke patients within 30 days were conveniently sampled, and investigated with a questionnaire about eating difficulties. Results The total rate of eating difficulties was 66.67% (including 15 nasal feeding patients). Among the 177 patients with oral feeding, the incidence of eating difficulties was 113, including 66 with feeding difficulties, 28 with dysphagia, and 91 with loss of energy and appetite, while there were 19 patients reporting all the problems above. The incidence of eating difficulties was various with the National Institutes of Health Stroke Scale (NIHSS) scores, Drinking Test scores, aphasia, prosopoplegia, stay in bed, eating assistance, activities of daily living (ADL) score, and oral health score (P<0.05). Myodynamia of upper limbs and ages also related with eating difficulties (P<0.05). The nutrition score of patients with eating difficulties was lower than those patients without eating difficulties. NIHSS score, eating assistance, ADL score, oral health score were the independent factors related with eating difficulties through multiple linear regression.Conclusion Eating difficulties are common in acute stroke patients, not only from dysphagia, but also about feeding difficulties and loss of energy and appetite. High NIHSS score, eating assistance, lower ADL score, bad oral health condition are the related factors of eating difficult, which may result in nutrition problems.
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Objective To explore the types, clinical pathologic and immunohistochemical features of spindle cell tumors of the uterine and broad ligament. Methods Clinical pathological files of spindle cell tumors in the uterine and broad ligament from 2007.12 to 2015.12 were reviewed. Results The primary sites of the 145 cases was cervical in 11 cases (7.58%), uterine body in 119 cases (82.07%), the broad ligament in 12 cases (8.28%), and uterine or cervix and the abdominal wall in 3 case (2.07%). Histopathological types of the 145 cases was smooth muscle origin in 126 cases (86.90%), of which 120 cases had benign leiomyoma, 3 cases had uncertain malignant potential and 3 cases had leiomyosarcoma;endometrial stromal origin in 15 cases (10.34%), including endometrial stromal nodule (5 cases), endometrial stromal sarcoma (10 cases); endometrial stromal- variant (3 cases, 2.07%), including endometrial stromal nodule associated with smooth muscle differentiation (2 cases), endometrial stromal sarcoma associated with smooth muscle differentiation (1 case); gastrointestinal stromal tumor (1 case, 0.68%). Conclusions Origin of spindle cell tumors of the uterine and broad ligament is mainly smooth muscle, endometrial stromal origin, and endometrial stromal tumor variants, and gastrointestinal stromal tumors in rare cases. We need to combine the clinical site, pathological morphology and immunohistochemistry for diagnosis and differential diagnosis.
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The measurement of pressure between tongue and the hard palate during swallowing is an evaluation method which is non-invasive and accurately quantitative. This article reviewed the measurement of tongue pressure, the changes of pressure in different poses, bolus types and people, as well as the prediction of dysphagia according to tongue pressure.
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@#The measurement of pressure between tongue and the hard palate during swallowing is an evaluation method which is noninvasive and accurately quantitative. This article reviewed the measurement of tongue pressure, the changes of pressure in different poses,bolus types and people, as well as the prediction of dysphagia according to tongue pressure.
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@#Objective To explore the relationship between quality of life and coping style of nurse. Methods 203 nurses were surveyedwith the World Health Organization Quality of Life-100 (WHOQOL-100) and simplified coping style questionnaire through conveniencesampling in rehabilitation hospital. Results and Conclusion Self-evaluations of nurses were significantly higher than ordinary people (P<0.01) in domains of psychological, independent, social relationship, spiritual pillar and personal beliefs, but lower in physical domain (P<0.01). Positive coping style was adopted by most of nurses. The coping style related with their physical status.
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@# Objective To investigate the acquaintance of secondary spinal cord injury (sSCI) of patients and medical workers. Methods 260 patients with sSCI, 145 nurses and 45 doctors were surveyed by questionnaire on the principle of convenience sampling. Results 20% patients knew about sSCI before injured, 41.5% patients took site protection; 90% nurses and 100% doctors knew about sSCI. Conclusion Related knowledge should be publicized to decrease the rate of sSCI and raise people' consciousness, and medical workers should be strengthened health education.