ABSTRACT
Objective To investigate the predictors of early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke and its impact on short-term outcomes. Methods From January 2017 to April 2019, patients with acute ischemic stroke treated with intravenous thrombolysis in the Second Affiliated Hospital of Xuzhou Medical University were enrolled retrospectively. END was defined as the National Institutes of Health Stroke Scale (NIHSS) score within 7 days after admission increased by ≥2 compared with the baseline. The short-term outcomes were evaluated by the modified Rankin Scale at discharge. 0-2 was defined as good outcomes and 3-6 was defined as poor outcomes. Multivariate logistic regression analysis was used to determine the independent predictors of END and their correlation with short-term outcomes. Results A total of 199 patients with acute ischemic stroke received intravenous thrombolysis were enrolled. The median age was 68 years (interquartile range: 62- 76 years), 69 were women (34. 7％), and the baseline median NIHSS score was 6 (interquartile range: 3- 12). END occurred in 35 patients (17. 6％). Symptom progression occurred mainly 2 days after admission (31 patients, 88. 6％). Most of the causes of END were ischemic progression or recurrence (28 patients, 80. 0％). The univariate analysis showed that fasting blood glucose and symptomatic intracranial hemorrhage were associated with END (all P < 0. 05). However, multivariate logistic regression analysis did not find independent predictors of END. Excluding 12 patients with missing short-term outcome data, a total of 187 patients were included in the short-term outcome analysis. Among them, 110 patients had good outcomes and 77 had poor outcomes. Univariate analysis showed that ischemic heart disease, atrial fibrillation, mild stroke, etiological classification, baseline NIHSS score, absolute lymphocyte count, fasting blood sugar, neutrophil/lymphocyte ratio, whether to receive interventional therapy, and END were correlated with short-term outcomes (all P < 0. 05 ). Multivariate logistic regression analysis indicated that high baseline NIHSS score (odds ratio 1. 350, 95％ confidence interval 1. 182-1. 541; P < 0. 001) and END (odds ratio 32. 540, 95％ confidence interval 6. 149- 172. 21; P < 0. 001 ) were the independent risk factors for short-term poor outcomes. Conclusions END still occurs in some patients after intravenous thrombolysis for acute ischemic stroke, and END is an independent risk factor for short-term poor outcomes.
ABSTRACT
Objective To improve the quality of teaching, conduct the examination mode reform of the course Fundamental Nursing among undergraduate students, and explore a reasonable and fair appraisal mechanism. Methods Taking a class of 2013 consisting of 160 undergraduates majored in nursing as an experimental group, reform the content, method and evaluation method and implement them in the fundamentals of nursing examination. In addition, compile a self- made questionnaire to investigate the feedback effect of carrying out the assessment model. Meanwhile, take 151 nursing undergraduates in grade 2012 as a historical control group, and conduct the statistical analysis with the overall rating scores of the experimental group. Results After the reform was carried out, 91.82 percent (146/159) of the students holded the view that it was necessary to reform, 86.16 percent (137/159) were satisfied with the evaluation reform, 84.91 percent (135/159) agreed on the spreading of the reformed examination pattern to other courses, and percentage of students′passing the exam reached 98.75 percent (158/160). The difference of the course assessment overall achievement between the experimental group and control group, was statistically significant (Z=-2.62, P < 0.01). Conclusions The reform of the examination mode will achieve the harmonious unification of teaching, learning, exam, improve the quality of teaching and promote the realization of the talent training goal.