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Objective To explore the effect of Plan. Do-Check-Act on homogenization of nursing processes in ICU. Methods A total of 36 nurses were selected to implement Plan. Do-Check-Act in ICU according to evidence-based medicine. Their nursing was inspected by a senior nurse. The differences of the following items before and after Plan. Do-Check-Act were compared: nursing quality comprehensive quality control index and specialized quality control index. Results After the implementation of Plan. Do-Check-Act, comprehensive quality control index of clinical nursing quality score by (89.28 ± 2.36) points up to (97.45±1.38) points, and there was significant difference(t=-7.310, P<0.01). The specialized quality control indicators including the incidence of ventilator associated pneumonia, the incidence of catheter-related bloodstream infection, the incidence of catheter-associated urinary tract infections, the incidence of accidental extubation, the incidence of pressure sores, the incidence of glycemic out of control, the incidence of sedation out of control and retention time were 26.2%(53/202), 17.8%(36/202), 18.8%(38/202), 11.9%(24/202), 2.5%(5/202), 18.3%(37/202), 15.3%(31/202), (168.0 ± 3.3) h before the implementation and 7.1%(14/196), 3.1%(6/196), 4.1%(8/196), 0.5%(1/196), 0, 3.6%(7/196), 3.1%(6/196), (96.0±4.2) h after the implementation. There were significant differences (χ2=4.913-25.907, t=66.195, all P<0.01). Conclusions The Plan. Do-Check-Act is an effective way to improve nursing quality of ICU to make it homogeneous, reduce adverse nursing and iatrogenic complications.
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Objective To study the effect of Dahuang-Mudan decoctionby retention enemafor the thepatients with acute pelvic inflammation disease (APID) and toxic heat flourishing type. Methods Ninety patients with APID (toxic heat flourishing type) were randomly divided into treatment group and control group (45 case per group). The patients in both groups were given cefamandolenafate injection and tinidazole injection;and the Dahuang-Mudan decoction by retention enema was added to the treatment group.The C-reactive protein (CRP), tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6) and clinical symptoms scores in both groups before treatment and after 2 weeks of treatment were observed. Results After treatment, CRP (3.16 ± 1.25 mg/L vs. 8.68 ± 1.45 mg/L, t=19.126), TNF-α(4.02 ± 1.06 ng/L vs. 9.64 ± 2.08 ng/L, t=15.966), IL-6 (60.34 ± 14.35 ng/L vs. 88.24 ± 12.16 ng/L, t=9.839), temperature recovery time (3.22 ± 1.13 d vs. 4.73 ± 1.36 d, t=5.638), abdominal pain disappeared time (5.26 ± 1.43 d vs. 7.45 ± 1.32 d, t=7.418), leukocyte recovery time (7.34 ± 2.06 d vs. 9.58 ± 2.26 d, t=4.834), hospital stay time (10.24 ± 3.42 d vs. 13.43 ± 4.38 d, t=3.791) in the treatment group were significantly lower than those in the control group (P<0.01). The clinical effect rate (77.27% vs. 48.84%, χ2=7.562) in the treatment group were significantly higher than that in the control group (P<0.01). Conclusions The treatment of APID (toxic heat flourishing type) with Dahuang-Mudan decoction by retention enema can reduce the inflammatory response of pelvic, promote the absorption of exudate and adhesion in pelvic.
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Objective To explore the feasibility of the double venipuncture instead of central venous catheter as a temporary vascular access in hemodialysis.Methods The upper arm below the 1/3 was tied a tourniquet,and fistula needle directly punctured the vein in the middle of the elbow.After the success of the puncture,elastic bandage was replaced by a tourniquet,and the ball movement was done by imitating the blood donation member for blood donation at hand gripping a ball or elements as the artery blood lead.Another elbow vein or lower limb saphenous vein was punctured.Thirty patients using double venipuncture dialysis or central venous catheter dialysis 2 weeks or more were randomly selected into each group,and biochemical and renal function was measured before dialysis.Results All of 1 282 patients who were newly into the blood dialysis,mature arteriovenous fistula was in 8 patients (0.6％,8/1 282),deep venipuncture to insert the central venous catheter was in 542 patients(42.3％,542/1 282),using the double venipuncture was in 732 patients (57.1％,732/1 282).The flow of blood was 180-200 ml/min,the avalible time was 1-2 months.The serum creatinine,blood urea nitrogen,calcium,phosphorus and carbon dioxide combining power had no significant difference between two groups (P ＞ 0.05).Conclusions The majority of patients with double venipuncture blood flow can satisfy the need of dialysis.Because the operation is simple,no recycling and may reduce the deep venipuncture,it is an ideal temporary vascular access.
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Objective To study the relationship between the medial artery calcification and expression of core-binding factor alpha 1 (Cbf α-1) and collagen Ⅱ (Col Ⅱ) in chronic kidney disease (CKD) stage 5 patients.Methods Pieces of radial arteries were taken from 40 patients with CKD stage 5 during internal arteriovenous fistula operation.Ten patients with subtotal gastrectomy and normal renal function were chosen as control.The vessels were examined for calcification by von Kossa stain and for the presence of Cbfα-1 and Col Ⅱ by immunohistochemistry.According to von Kossa stain,CKD stage 5 patients were divided into no calcification group,mild-moderate calcification group and severe calcification group.Other related factors including serum calcium,phosphate,intact parathyroid hormone (iPTH),C-reactive protein (CRP),triglyceride(TG),cholesterol(TC) and lowdensity lipoproteins(LDL) were also detected.Results Seventeen (42.5％) of CKD Stage 5 patients showed vascular calcification,while calcification was not found in controls.Most calcification occurred in medial layer.Positive immunohistochemical staining of core-binding factor and Col Ⅱ was found in the smooth muscular cell plasma of medial layer in the vessels with calcification.However,above positive staining was also observed in 78.3％ of no calcification group.But there was little staining in control group.Positive staining score of Cbfα-1 and Col Ⅱ in severe calcification group was significantly higher than that in no calcification group.Same findings were obtained in mild-moderate calcification group,but the difference between them was not statistically significant.CRP and Ca × P were positively correlated with staining score of Cbfα-1 and Col Ⅱ.Serum phosphate was positively correlated with Cbfα-1 (r=0.786,P＜0.01) and Col Ⅱ (r=0.785,P＜0.01) respectively.Conclusions 42.5％ of CKD stage 5 patients in our group shows vascular calcification,which occurrs mainly in medial layer.High expression of Cbfα-1 and Col Ⅱ can be observed in vascular calcification of radial arteries,which is earlier than vascular histological changes.Cbfα-1 and Col Ⅱ may be involved in the development of vascular calcification.
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@#Objective To investigate the correlation of the expressions of P170,topoisomerase Ⅱ(TOPⅡ)and the proliferation in gliomas.Methods Ki-67 was used as the marker of the proliferation in gliomas.The expressions of P170,TOPⅡ and Ki-67 were tested by S-P immunohistochemical technique using monoclonal antibody to their protein in 54 cases of low-grade gliomas(WHO Ⅰ～Ⅱ grade)and 54 cases of high-grade gliomas(WHO Ⅲ～Ⅳ grade),analysis of the clinical and follow-up were performed.Results The expressions of P170,TOPⅡ and Ki-67 had significant differences between low-grade and high-grade gliomas(P<0.01).Correlation analysis showed that the expression of P170 was negatively related with Ki-67(r=-0.276,P=0.019);the expression of TOPⅡ was positively related with Ki-67(r= 0.637,P<0.001);there was no correlation between the expressions of P170 and TOPⅡ.Conclusion The expressions of P170 and TOPⅡ are associated with the malignant prognosis in gliomas.
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<p><b>OBJECTIVE</b>To investigate the histological typing and differentiation as well as clinical manifestation and prognosis in pineal parenchymal tumors (PPTs).</p><p><b>METHODS</b>The histological typing of 21 PPTs were made by using HE staining. Synaptophysin (Syn), neuron special enolase (NSE), neurofilament (NF), neuroblastoma (NB), glial fibrillary acid protein (GFAP), cytokeratin (CK), desmin (Des) were detected in 20 cases with SP immunohistochemical staining methods. Analysis of the clinical data and follow-up were performed.</p><p><b>RESULTS</b>9 pineocytomas, 4 pineoblastomas, 8 pineal parenchymal tumors of intermediate differentiation were found in 21 PPTs. Immunoreactivity to Syn, NSE, NF, GFAP, NB were in 20, 20, 14, 15, 2, while Des and CK were negative in all cases.</p><p><b>CONCLUSIONS</b>Pineal parenchymal tumors of intermediate differentiation were characterized by a distinctly biphasic pattern, including areas of pineocytoma and pineoblastoma, or with intermediate differentiation and transitional feature. PPTs expressed neuronic differentiation. Death rate of PPTs were higher inside 1 year after the operation.</p>