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Objective To explore the role of multi-department cooperation in the prevention and control of nosocomial infection of multi-drug-resistant bacteria(MDRO). Methods Theretrospective analysis was conducted on 1 478 inpatients before the implementation of multi-department cooperative management (January 2019 to December 2019). The implementation of multi-department cooperative management began in January 2020, including :(1) the establishment of multi-department cooperative management organization system; (2) Establish a three-level MANAGEMENT network of MDRO; (3) Multidisciplinary joint training; (4) Clinical departments shall be equipped with clinical pharmacists; (5) The hospital infection monitoring system was used to conduct real-time monitoring on the submission of microbial samples, the detection rate of MDRO, the changes of drug-resistant bacteria and the use of antibiotics; (6) Led by the department of hospital pathology and medical Service, regular joint ward rounds should be conducted in the departments and key departments with high DETECTION rate of MDRO; (7) PDCA cycle mode was adopted for quality control of all links of nosocomial infection prevention and control measures; After the implementation of multi-department cooperative management (January 2020 to December 2020), all the hospitalized patients in 1849 cases were detected and counted, and the incidence of nosocomial infection, the detection rate of MDRO, the compliance rate of hand hygiene, the implementation rate of contact isolation, and the specimen inspection rate of therapeutic use of antibiotics and the reasonable utilization rate of antibiotics were compared before and after the implementation. Results The incidence of nosocomial infection and the detection rate of MDRO were significantly lower after the implementation of multi-department cooperative management than before (χ2=46.611, χ2=16.814, P 2 = 25.357, χ2=29.227, P2=25.576, χ2=33.624, P<0.05). Conclusion The practice of multi-department cooperative management brings into full play the advantages of interdisciplinary complementarity, improves the ability of medical staff to implement the prevention and control measures for MDRO, and can effectively reduce the incidence of nosocomial infection in MDRO.
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Objective:To translate the Cardiac Symptom Survey and analyze its reliability and validity in the post-valvular heart replacement survey and to provide the basis for the clinical application of this scale.Methods:The symptoms of 233 patients after heart valve replacement were investigated in Suining Central Hospital by Chinese version of the Cardiac Symptom Survey. The reliability of the scale was evaluated by Cronbach'α coefficient and the split half coefficient, the validity of the scale was evaluated by exploratory factor analysis and content validity index.Results:The internal consistency coefficient of the Chinese version of the Cardiac Symptom Survey ranged from 0.875 to 0.968, both above 0.870.The split half coefficient was 0.699,which demonstrated better internal consistency.The content validity index of the Chinese version of the Cardiac Symptom Survey ranged from 0.84 to 1.00.Factor analysis got five factors, which explained 68.133% of the total variance.Conclusions:The Chinese version of the Cardiac Symptom Survey has good reliability and validity in the investigation of the symptoms of patients after heart valve replacement, and can be used for the investigation and management of the symptoms of patients after heart valve replacement.
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Objective To explore the value of ultrasound in the differential diagnosis of neonatal upper and lower gastrointestinal tract ( GIT) perforation. Methods We retrospectively reviewed the ultra-sound findings of 42 neonates of surgery-confirmed neonatal GIT perforation in our hospital from January 1, 2015 to December 31,2018. The accuracy of ultrasound for detecting GIT perforation and the ultrasound fea-tures of upper and lower GIT perforation were evaluated. Results (1)Of the 42 neonates with GIT perfora-tion,1 case didn′t undergo ultrasound,2 cases were missed,and 1 case was misdiagnosed. Thirty-eight neo-nates were diagnosed of GIT perforation by ultrasound preoperatively,with a detection rate of 92. 7%(38/41). The locations of GIT perforation were identified by ultrasound in 30 cases(78. 9%,30/38),including 11 cases of upper GIT perforation and 19 cases of lower GIT perforation. (2)A common sonographic finding of GIT perforation in 38 cases was pneumoperitoneum,which appeared as an echogenic line with posterior rever-beration artifact under diaphragm or anterior to hepatic/splenic surface and a "stratosphere" sign in M-mode sonography. Free gas changed position when the patient′s position was changed,and didn′t change due to re-spiratory change. Besides,free gas dispersed with compression on abdomen,and gathered without compres-sion. (3)Upper GIT perforation was showed that poor filling of the stomach cavity,and the abdominal free gas sharply increased. Lower GIT perforation was characterized by collapsed bowel,blurred and interrupted intestinal wall structure, and more accompanied with intestinal obstruction. ( 4 ) There was no significant difference of detection rate between ultrasound and X-ray in diagnosing GIT perforation [92. 7%(38/41) vs. 83. 3%(35/42)]( P>0. 05),whereas ultrasound more sensitive for a very small amount of free gas in the early stage of perforation. (5) Helicobacter pylori infection was found in two cases of GIT perforation. Conclusion Ultrasound can be used for differential diagnosis of upper and lower GIT perforation,and could be recommended as the first choice for detecting GIT perforation in neonatal patients.
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Objective@#To explore the value of ultrasound in the differential diagnosis of neonatal upper and lower gastrointestinal tract(GIT)perforation.@*Methods@#We retrospectively reviewed the ultrasound findings of 42 neonates of surgery-confirmed neonatal GIT perforation in our hospital from January 1, 2015 to December 31, 2018.The accuracy of ultrasound for detecting GIT perforation and the ultrasound features of upper and lower GIT perforation were evaluated.@*Results@#(1)Of the 42 neonates with GIT perforation, 1 case didn′t undergo ultrasound, 2 cases were missed, and 1 case was misdiagnosed.Thirty-eight neonates were diagnosed of GIT perforation by ultrasound preoperatively, with a detection rate of 92.7%(38/41). The locations of GIT perforation were identified by ultrasound in 30 cases(78.9%, 30/38), including 11 cases of upper GIT perforation and 19 cases of lower GIT perforation.(2)A common sonographic finding of GIT perforation in 38 cases was pneumoperitoneum, which appeared as an echogenic line with posterior reverberation artifact under diaphragm or anterior to hepatic/splenic surface and a "stratosphere" sign in M-mode sonography.Free gas changed position when the patient′s position was changed, and didn′t change due to respiratory change.Besides, free gas dispersed with compression on abdomen, and gathered without compression.(3)Upper GIT perforation was showed that poor filling of the stomach cavity, and the abdominal free gas sharply increased.Lower GIT perforation was characterized by collapsed bowel, blurred and interrupted intestinal wall structure, and more accompanied with intestinal obstruction.(4)There was no significant difference of detection rate between ultrasound and X-ray in diagnosing GIT perforation[92.7%(38/41)vs.83.3%(35/42)](P>0.05), whereas ultrasound more sensitive for a very small amount of free gas in the early stage of perforation.(5)Helicobacter pylori infection was found in two cases of GIT perforation.@*Conclusion@#Ultrasound can be used for differential diagnosis of upper and lower GIT perforation, and could be recommended as the first choice for detecting GIT perforation in neonatal patients.
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Objective To analyze the effectiveness and safety of percutaneous screw fixation assisted by an orthopedic robot for treatment of pelvic and acetabular fractures.Methods Fifteen patients with fresh closed pelvic or acetabular fracture were hospitalized from September to December 2017 at Department of Orthopaedics,Foshan Hospital of Traditional Chinese Medicine.They were 10 men and 5 women,from 22 to 69 years of age (average,65.2 years).There were 9 pelvic fractures (5 cases of Tile type B and 4 ones of Tile type C) and 6 acetabular fractures (3 anterior column fractures,2 posterior column fractures and one transverse fracture).All patients underwent percutaneous transpedicular screw fixation with the assistance of an orthopaedic robot.Fluoroscopic frequency,number of guide needle adjustment and deviation between initial planning and the final screw position were recorded intraoperatively.Postoperative CT was performed to evaluate screw positions and incidence of adverse events.Functional recovery in the patients was evaluated in regular follow-ups.Results A total of 26 screws were implanted in the operation.The fluoroscopic frequency ranged from 12 to 49 times,with a mean value of 17.3 times per screw;the number of needle adjustment ranged from 0 to 2 times(mean,0.3 times);the deviation of the actual path from its initial planning ranged from 0.82 to 1.42 mm (mean,1.06 mm).No surgery-related neurovascular injury occurred in any patient.Postoperative CT examination revealed that no screws cut out of cortical bone,yielding a 100％ rate of excellent and good screw positions.Two patients were lost to the follow-up,and the remaining 13 patients were followed up for 12 to 14 months (mean,12.6 months).Their Majeed functional scores at the final follow-up averaged 88.6 points (from 68 to 96 points).No neurological symptoms were observed during follow-up.Conclusion Since percutaneous screw fixation assisted by an orthopaedic robot is accurate and safe and needs less fluoroscopic frequency,it will became a major minimally invasive surgical technique for pelvic and acetabular fractures.
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Objective To establish normative data for the fetal cisterna magna septa (CMS) at various gestational age,and to evaluate its clinical significance.Methods A total of consecutive fetal between 14 and 40 gestational week(GW) were included in this prospective study.The length and width of CMS were measured by two-dimensional ultrasonography.Regression analysis was used to study the relationship between the width and length of the fetal cisterna magna septa and gestational age.Twenty-five case of fetuses with the absence of CMS and 12 case of fetuses with the enlargement of CMS were retrospectively analyzed in the past six years in our hospital.Results ①The fetal CMS length and width increased gradually between 14 and 22 GW,then plateaued between 23 GW and 36 GW,and decreased after 37 GW.This ultrasonographic pattern was in agreement with normal development of rhombencephalon.②The absence of CMS in the fetuses were common in Dandy-Walker syndrome,holoprosencephaly,severe hydrocephalus,neural tube defects,rhombencephalon synapsis and Arnold-Chiari malformation.The enlargement of CMS in the fetuses may be shown in physiologic enlargement of posterior fossa.ConclusionsCMS is a potential new marker for normal development of rhombencephalon.The enlargement and absence of CMS are related to various malformations of central neural system,especially in the abnormalities of posterior fossa.
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Objective To evaluate the pattern of development of fetal cerebral sulei by prenatal ultrasound and its clinical significance. Methods Sixty hundred and ninety-two fetuses at age from 17 to 40 weeks were observed for the development and depth of cerebral sulci (parietal-occipital sulcus, calcarine suleus, central sulcus, eingulate sulcus, cingulate gyrus, and sylvian fissure) by transabdominal ultrasonography. Results Parietal-occipital sulcus,calcarine sulcus,and sylvian fissure were visible at about 19 weeks of gestation, central sulcus was at about 25 weeks, cingulate sulcus and cingulate gyrus were at about 26 weeks. One case of them was considered as cerebral sulei growth retardation due to the signs of invisible parietal-occipital sulcus and sylvian fissure at 24 weeks of gestation. Two cases were considered as cerebral sulci growth retardation due to the signs of invisible parietal occipital sulcus and central sulcus and the shallow blunt shape of sylvian fissure at 29 weeks of gestation. There were positive correlations between the depths of fetal cerebral sulci and gestational weeks, and negative correlations between their relative depths and gestational weeks(all P <0.05), Conclusions Transabdominal ultrasonography can be use to observe the development of fetal cerebral sulci (parietal-occipital sulcus, calcarine sulcus, central sulcus, eingulate sulcus,cingulate gyrus,and sylvian fissure). The depth of cerebral sulci is relative to gestational weeks,and would be considered for prenatal assessment of cerebral sulci maldevelopment, such as cerebral sulci growth retardation and lissencephalia.