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Objective:Based on the real-world clinical data of hospital electronic medical records, to analyze the length of stay and healthcare costs associated with in-hospital falls and fall injuries in hospitals.Methods:Based on the electronic medical record system of the First Affiliated Hospital of Nanjing Medical University, a retrospective cohort study was conducted on patients admitted to these departments reported falls in nursing management information system from January 2017 to December 2019. A total of 38 481 patients from 74 units were enrolled in this study. The patients′ characteristics, falls, falls injury, and explore the length of hospital stay and bottom-up direct cost were analyzed.Results:A total of 243 cases (0.6%) fell and 154 cases (63.4%) were injured by falls from January 2017 to December 2019. Compared with non-fallers, the median length of stay of patients with falls was 19 days, which was significantly increased compared with 7 days of patients without falls ( Z=-15.18, P<0.05). The median hospitalization cost of patients with falls was 39 000 yuan, which was significantly higher than 16 300 yuan of patients without falls ( Z=-11.47, P<0.01). There was no statistical difference between non-injuried fallers and injuried fallers for length of stay and healthcare costs ( Z=-0.92, -0.64, P>0.05). Linear regression model analysis showed that gender, age, comorbidity, inpatient department unit, reason of hospitalization were significantly correlated with inpatient cost and length of stay ( F=280.05, 217.31, all P<0.05). Conclusions:Patients who have an in-hospital fall have significantly longer hospital stays and higher direct costs, mainly can be attributed to the fall itself, not the injury. Our findings have important financial implications for real world in light of optimal intervention strategies, resource allocation and economic evaluation of fall prevention.
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Objective:To design and develop an unplanned extubation clinical decision support system, aiming to provide a reference for nurses' clinical decision-making.Methods:Through literature review and expert consultation, the knowledge base of the clinical decision support system for unplanned extubation was constructed, and the system function and interface were designed.Results:The authoritative coefficients of the two rounds of expert consultation were 0.853 and 0.867, respectively, and the Kendall ′s W were 0.458 and 0.492, respectively. The final built knowledge base included catheter evaluation module, unplanned extubation evaluation module, and knowledge reasoning rule module. At present, the knowledge base had sorted out 48 first-level items, 9 second-level items, 72 third-level items in the catheter evaluation module, and 5 first-level items, 12 second-level items, and 73 third-level items in the unplanned extubation evaluation module. Entry, 40 knowledge reasoning rules. Conclusions:The clinical decision-making system for unplanned extubation has changed the implementation of unplanned extubation risk early warning, optimized the management process, and realized the interaction of the hospital system. It can conduct dynamic unplanned extubation risk assessment based on individualization and assist nurses Make clinical decisions and promote the safety of nursing management.
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Objective:To evaluate and summarize the best evidence of health workers respiratory protection during aerosol-generating procedures in patients with acute respiratory infectious diseases.Methods:We searched EBM Guidelines, Essential Evidence Plus, Dynamed, UpToDate, JBI, BMJ, Clinical Key, Cochrane Library, NICE, AARC, PubMed, EMbase, CKNI, Wanfang to collect related literature including guidelines,evidence summary, recommended practices, standards, consensus and systematic reviews.Results:A total of 20 articles were included, including 10 guidelines, 1 consensus, 2 standards, 2 evidence summaries, and 5 systematic reviews. 24 best evidences including aerosol-generating procedures, training of protective equipment using, principles of protective equipment using, protective equipment using, aerosol operating environment control and medical staff self-monitoring were summarized.Conclusion:The study integrated the best evidence of healthcare workers respiratory protection during aerosol-generating procedures in patients with acute respiratory infectious disease. It is recommended to combine the current status of institutional protection resources and clinical practice experience to promote the conversion of the best evidence to clinical practice.
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Objective:To provide reference for the development of a more intelligent and systematic nursing clinical decision support system based on the concept of precision nursing and data sharing, the nursing plan module of clinical decision support system.Methods:An evidence-based knowledge base was constructed based on the nursing process and the standardized nursing terminologies; the nursing plan module was designed according to clinical needs, and the logical reasoning rules were formulated from the generation, sequencing and stopping of nursing problems, objectives, measures and activities, and finally the nursing plan module of clinical decision support system was formed.Results:The nursing plan module of clinical decision support system included the basic information of patients, positive evaluation items and weight values, nursing problems, objectives, measures and activities, etc. the module could automatically deduce the nursing plan according to the patient's individual characteristic index (positive evaluation item), and sort the nursing problems and corresponding measures and activities according to the generation time, weight value and correlation degree. It could automatically distinguish nursing problems, goals, measures and the time of activity stop, and realize intelligent decision-making.Conclusion:The interface of nursing plan module of this system is clear and logical reasoning rules are rigorous. It breaks through the bottleneck of nursing decision-making based on personal professional knowledge and experience in clinical situation for a long time, which can ensure the homogeneity of nursing plan and improve the correctness of decision-making.
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Objective Based on the three-dimensional quality structure model,to construct the nursing quality evaluation index system for acute leukemia,in order to provide references for clinical evaluation of quality of nursing care for acute leukemia.Methods Based on the theory of Donabedian's structure-process-outcome quality structure model,through literature search,semi-structured interview,expert meeting,expert consultation and analytic hierarchy process,the quality evaluation index system and index weight for acute leukemia were determined.Results After two rounds of expert consultation,questionnaire response rates were 94.74％,100％;expert authority coefficients were 0.848,0.854;Kendall coordination coefficients were 0.273,0.420,and P values were all less than 0.01.The final index system consisted of 3 first-level indicators,8 second-level indicators,and 24 third-level indicators (3 structure indicators,7 process indicators,14 outcome indicators).Each of third-level indicators contained index names,calculation methods,and data collection methods.Conclusion The process of construction of nursing quality evaluation index system for acute leukemia is scientific,the contents are reasonable,which can reflect nursing characteristics of acute leukemia.
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Objective To identify the nursing interventions and activities for hemiplegic patients in various functions suffered from stroke,and guide clinical practice.Methods Review rehabilitation of evidence-based clinical practice and literature of hemiplegic patients,stroke patients in different functional states were continuously cared and recorded by a researcher.Nursing program was identified according to patients' functions and the sixth edition of Nursing Interventions Classification,8 experts were consulted by a questionnaire survey,which was based on the initial screened nursing interventions and activities,30 nurses and 41 experts were consulted then.Results The established nursing program included 20 interventions and 307 activities.80％-100％ nurses' opinions culminated in consensus on the selected interventions.The selected activities scored 4.00-5.00 in average,with the coefficient of variations ranging from 0.00 to 0.25.Conclusions The established nursing program is convenient to communication and could be a tool to guide the clinical nursing practice.
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Objective To build the index about the training effect of oncology specialist nurse and test the reliability and validity.Methods By consulting literature and the methods of Delphi,which was consulted by the 9 experts and the two rounds of 35 experts,the original index was estabhshed.The correlation coefficient and validity of the index was evaluated.Results A total of the index was consist of 106 first-l,second-land third-llevel items.Questionnaire recovery rate was 100％ (35/35).The level of authority was 0.816.Expert opinion concentration in various purposes mean variation coefficient was less than 0.244 2.The coordination level of expertise was 0.302.The overall reliability Cronbach α was 0.963.Adopting the method of double variable Spearman calculated the correlation coefficient was above 0.428.Cronbach a of second-and third-level indexes were 0.512-0.895.The second-land third-level indexes correlation coefficient were 0.428-0.931.Conclusions The index about the training effect of oncology specialist nurse has the high authority and representative.The reliability and validity of the index are better,which can be used to evaluate the efficacy of the evaluation about the training of oncology specialist nurse.
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Objective To investigate the effect and mechanism of S100A16 in the course of 3T3-L1 preadipocytes differentiation.MethodsA recombinant virus vector overexpressing S100A16 ( PLJM1-S100A16-GFP) was constructed and transfected into 3T3-L1 preadipocytes.The expression of S100A16 in the course of 3T3-L1 preadipocytes differentiated into adipocytes was detected by Western blot.The lipid droplets were observed by oil-red O staining and triglycercide (TG) content was measured by the TG measure kit.Levels of adipogenesis-associated genes such as PPARγ,CCAAT/enhancer binding protein ( C/EBP-α),lipoprotein lipase ( LPL),fatty acid synthase ( FAS),adipocyte fatty acid binding protein( aP2 ) were measured by realtime PCR and Western blot.The interaction between S100A16 and p53 was detected by immunoprecipitation.Results3T3-L1 cell line overexpressing S100A16was successfully contructed.It was found that the expression of S100A16 was increased during 3T3-L1 adipocytes differentiation.Overexpression of S100A16 stimulated 3T3-L1 preadipocytes differentiation and increased the accumulation of triglycerides in adipocytes (P＜ 0.01 ),along with the up-regulation of adipocyte differentiationassociated gene expressions including PPARγ,C/EBP-α,LPL,aP2,and FAS ( P ＜ 0.05 or P ＜ 0.01 ).Immunoprecipitation analysis revealed that S100A16 interacted with tumor suppressor protein p53,also a known inhibitor of adipogenesis.ConclusionS100A16 stimulates 3T3-LI preadipocytes differentiation via inhibiting p53activity.