ABSTRACT
Objective:To study the application of the best evidence of dysphagia recognition in acute stroke patients.Methods:The study was performed guided by JBI evidence-based continuous quality improvement pattern, including evidence acquisition, baseline audit, evidence implementation and re-audit. Data were collected by using field observation, questionnaire survey and review of nursing records. 80 patients and 18 nurses were recruited in the study. Barriers to evidence implementation and available solutions were analyzed. Before and after the application of evidence, the compliance of audit criterion, screening rate of swallowing disorder, screening accuracy, screening record rate and knowledge of nurses were compared.Results:Before and after the implementation of evidence, the compliance of all audit criterion was 0-33.3% and 95.0%-100.0%, and had a significant difference ( P<0.05). The dysphagia recognition knowledge score was improved from 40-80(60.56±10.69) to 60-100 (82.78±10.18) and had a significant difference ( t value was -6.39, P<0.05). The screening rate for dysphagia increased from 7.5% to 95.0%, with statistically significant difference ( χ2 value was 119.10, P<0.05). The screening accuracy was 100%, and the screening record rate was 97.4%, only 4 of the 24 patients at risk of dysphagia developed pulmonary infection. Conclusion:The application of the best evidence of dysphagia recognition in acute stroke patients can improve the nurses′ ability of dysphagia screening and improve nursing practice in dysphagia management.
ABSTRACT
Objective To observe the clinical effect of gifitinib combined with hydroxylcamptothecin pericardial perfusion in the treatment of patients with advanced non-small cell lung cancer(NSCLC) with pericardial effusion. Methods From January 2016 to September 2017,eighty-four cases of late NSCLC with pericardial effusion treated in the People′s Hospital of Jiaozhou were randomly divided into two groups according to the digital table,with 42 cases in each group.The control group was treated with gefitinib,and the observation group was treated with hydroxylcampto-thecin on the basis of the control group.The curative effect was evaluated after two courses of treatment in the two groups,and the clinical efficacy and adverse reactions were observed.Results The effective rates of the control group and the observation group were 47.6% (20/42) and 66.7% (28/42),respectively.The effective rate of the observa-tion group was significantly higher than that of the control group(χ2 =4.525,P<0.05).The effective rate of pericar-dial effusion was 33.3% (14/42) in the control group and 69.1% (29/42) in the observation group,the difference between the two groups was statistically significant( χ2 =10.720,P <0.05).There was no ststistically significant difference in the incidence rate of adverse reactions between the two groups during treatment(P<0.05).Conclusion Combination of gefitinib and hydroxylcamptothecin pericardial perfusion in the treatment of NSCLC with pericardial effusion has good tolerance and good safety for the patients.
ABSTRACT
OBJECTIVE:To promote the safe use of Heparin sodium injection for children. METHODS:According to litera-ture retrieve,questionnaire survey and field investigation,Health care failure mode and effect analysis method(HFMEA)was ad-opted to search for the failure modes of Heparin sodium injection for children,and preventive strategies were established and imple-mented based on these failure modes. Its effects were evaluated by comparing the error rate and risk priority number rating (RPN value)before and after the implementation. RESULTS:Totally 5 risk points of Heparin sodium injection requiring immediate inter-vention were obtained from RPN value,including wrong dose of Heparin sodium injection in prescribing,pharmacists'unclearness for the calculation method of the dose of Heparin sodium injection in dispensing,and nurses'no performing of double check sys-tem before infusion in administration,etc. After implementing related countermeasures,related error of Heparin sodium injection was decreased from 8 cases to 1 case,and error rate was declined from 3.76% to 0.51%(P<0.01). The RPN values of 5 failure modes were decreased from 112.08,91.56,115.78,94.52,99.23 to 28.02,23.91,27.71,23.63,20.55,respectively. CONCLU-SIONS:HFMEA can prospectively conduct systematical analysis for Heparin sodium injection for children. Implementing related countermeasures based on the current situation of our hospital can reduce the related error of Heparin sodium injection and promote the medication safety of children.