ABSTRACT
This study aimed to explore key quality control factors that affected the prognosis of intensive care unit (ICU) patients in Chinese mainland over six years (2015-2020). The data for this study were from 31 provincial and municipal hospitals (3425 hospital ICUs) and included 2 110 685 ICU patients, for a total of 27 607 376 ICU hospitalization days. We found that 15 initially established quality control indicators were good predictors of patient prognosis, including percentage of ICU patients out of all inpatients (%), percentage of ICU bed occupancy of total inpatient bed occupancy (%), percentage of all ICU inpatients with an APACHE II score ⩾15 (%), three-hour (surviving sepsis campaign) SSC bundle compliance (%), six-hour SSC bundle compliance (%), rate of microbe detection before antibiotics (%), percentage of drug deep venous thrombosis (DVT) prophylaxis (%), percentage of unplanned endotracheal extubations (%), percentage of patients reintubated within 48 hours (%), unplanned transfers to the ICU (%), 48-h ICU readmission rate (%), ventilator associated pneumonia (VAP) (per 1000 ventilator days), catheter related blood stream infection (CRBSI) (per 1000 catheter days), catheter-associated urinary tract infections (CAUTI) (per 1000 catheter days), in-hospital mortality (%). When exploratory factor analysis was applied, the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation: nosocomial infection management (21.35%), compliance with the Surviving Sepsis Campaign guidelines (17.97%), ICU resources (17.46%), airway management (15.53%), prevention of deep-vein thrombosis (14.07%), and severity of patient condition (13.61%). Based on the different weights of the core elements associated with the 15 indicators, we developed an integrated quality scoring system defined as F score=21.35%xnosocomial infection management + 17.97%xcompliance with SSC guidelines + 17.46%×ICU resources + 15.53%×airway management + 14.07%×DVT prevention + 13.61%×severity of patient condition. This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.
Subject(s)
Humans , China/epidemiology , Cross Infection/epidemiology , Intensive Care Units/statistics & numerical data , Quality Control , Quality Indicators, Health Care/statistics & numerical data , Sepsis/therapy , East Asian People/statistics & numerical dataABSTRACT
This study aimed to explore key quality control factors that affected the prognosis of intensive care unit (ICU) patients in Chinese mainland over six years (2015-2020). The data for this study were from 31 provincial and municipal hospitals (3425 hospital ICUs) and included 2 110 685 ICU patients, for a total of 27 607 376 ICU hospitalization days. We found that 15 initially established quality control indicators were good predictors of patient prognosis, including percentage of ICU patients out of all inpatients (%), percentage of ICU bed occupancy of total inpatient bed occupancy (%), percentage of all ICU inpatients with an APACHE II score ⩾15 (%), three-hour (surviving sepsis campaign) SSC bundle compliance (%), six-hour SSC bundle compliance (%), rate of microbe detection before antibiotics (%), percentage of drug deep venous thrombosis (DVT) prophylaxis (%), percentage of unplanned endotracheal extubations (%), percentage of patients reintubated within 48 hours (%), unplanned transfers to the ICU (%), 48-h ICU readmission rate (%), ventilator associated pneumonia (VAP) (per 1000 ventilator days), catheter related blood stream infection (CRBSI) (per 1000 catheter days), catheter-associated urinary tract infections (CAUTI) (per 1000 catheter days), in-hospital mortality (%). When exploratory factor analysis was applied, the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation: nosocomial infection management (21.35%), compliance with the Surviving Sepsis Campaign guidelines (17.97%), ICU resources (17.46%), airway management (15.53%), prevention of deep-vein thrombosis (14.07%), and severity of patient condition (13.61%). Based on the different weights of the core elements associated with the 15 indicators, we developed an integrated quality scoring system defined as F score=21.35%xnosocomial infection management + 17.97%xcompliance with SSC guidelines + 17.46%×ICU resources + 15.53%×airway management + 14.07%×DVT prevention + 13.61%×severity of patient condition. This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.
ABSTRACT
Objective To analyze and study the implication of dynamic changes in plasma CD62P among patients with obstructive jaundice and cholecystolithiasis.Methods A total of 58 patients diagnosed with choledocholithiasis and jaundice were included in the obstructive jaundice group,and 50 patients were in the cholecystolithiasis group.Peripheral venous blood was collected on preoperative day 3,on opera-tive day,and on postoperative days 3,6,9,12,15,18,and 21 in two groups,and the concentrations of plasma CD62P were measured by ELISA.Comparison of continuous data between the two groups was made by t test.Results The concentrations of plasma CD62P from preop-erative day 3 to postoperative day 18 were significantly higher in the obstructive jaundice group than in the cholecystolithiasis group (P<0.01 across all time points).In the cholecystolithiasis group,the concentrations of plasma CD62P significantly increased on operative day, and the increase continued and reached the peak on postoperative day 3,then followed by a decrease down to the preoperative level on post-operative day 9.In the obstructive jaundice group,the concentrations of plasma CD62P reached the peak on postoperative day 9,followed by a gradual decrease down to the preoperative level on postoperative day 18 and to an even lower level (preoperative level of patients with cho-lecystolithiasis)on postoperative day 21.Conclusion Extrahepatic biliary obstruction may lead to endothelial cell injury and platelet acti-vation,the condition of which is improved with the relief of obstruction.The surgery for obstructive jaundice may lead to much more endothe-lial cell injury and higher platelet activation than that for cholecystolithiasis.
ABSTRACT
Objective To study the expression and significance of nuclear factor-kappa B(NF-κB)and proliferating cell nuclear antigen(PCNA)in uterine cervix cancer tissues.Methods The expression of NF-κB p65 and PCNA in the uterine cervix cancer tissues(n=45)and normal cervix tissues(n=30)were detected by immunohisto chemistry method.Results The expression rate of NF-κB p65 and PCNA in the uterine cervix cancer tissues were significantly higher than that in normal cervix tissues(P＜0.05).The expression of NF-κB p65 and PCNA in stage Ⅰ b,Ⅱa were significantly higher than that in stageⅠ a(P＜0.05),they were significantly higher in poorly differentiated than those in moderately differentiated,well-differentiated(P ＜ 0.05),they were significantly higher in existing lymphnode metastasis than those in non-existing lymphnode metastasis(P ＜0.05);and the expression of NF-κB p65 was positively related to PCNA in uterine cervix cancer tissues(r=0.705,P＜0.05).Conclusion The invasion,infestation and metastasis maybe dosely related to NF-κB and PCNA.
ABSTRACT
Objective To explore the expression of cyclooxygenase-2(COX-2) in non-small cell lung cancer (NSCLC) and its relationship with NSCLC development. Methods Expression of COX-2 protein was detected in 45 eases of NSCLC tissues and 45 cases of paracaneerous tissues by immunohistochemistry assay. Results Expression of COX-2 was detected in a significantly greater proportion of NSCLC tissues(64.4 % ) than that of paracancerous tissues(31.1% )(P＜0.05 );expression of COX-2 in different gender, age and tissue differentiation was no significant difference(P＞0.05);expression of COX-2 in adenocarcinoma was obviously higher than that in squamous carcinoma(P＜0.05);expression of COX-2 in the diameter of carcinoma tissue above 3cm was significantly higher than that below 3cm(P＜0.05) ;expression of COX-2 in carcinoma tissue existing lymphnode metastasis was obviously higher than that in non-existing lymphnode metastasis( P＜0.05 );expression of COX-2 in stage Ⅲ+Ⅳ of TNM was significantly higher than stage Ⅰ + Ⅱ of TNM(P＜0.05 ). Conclusion COX-2 was involved in occurrance and development process of lung cancer.
ABSTRACT
To evaluate the effect of mobilization of peripheral blood stem cells (PBSC) with high dose cyclophosphamide combination chemotherapy and G-CSF in breast cancer patients, a new mobilization protocol was designed on the basis of standard combination chemotherapy regimen, in which the dose of cyclophosphamide was raised to 2 to 4 times, and G-CSF began to be used at the dose of 150 micro g twice everyday when white blood cell (WBC) decreased below 1.0 x 10(9)/L. PBSC collection was performed while WBC increased over 5.0 x 10(9)/L during bone marrow recovering. The PBSC mobilization protocol was completed in 10 patients, the median nadir of WBC was 0.8 (0.4 - 1.0) x 10(9)/L, the median time of PBSC collection was 2 (2 - 4), the median number of collected CD34(+) cells was 6.43 (1.99 - 8.75) x 10(6)/kg. The results showed that the protocol, high dose cyclophosphamide combination chemotherapy, was an optimal PBSC mobilization regimen in breast cancer patients.