ABSTRACT
Objective:To apply the best evidence of evidence-based volume management in patients with chronic heart failure to clinical practice and evaluate its effect.Methods:From February 2018 to May 2019, according to the clinical evidence practice application mode of Joanna Briggs Institute (JBI), and the best evidence obtained in the previous study, we constructed audit indicators. And then perfomed clinical audits for the patients with chronic heart failure in the department of cardiology of Shandong Provincial Hospital affiliated to Shandong First Medical University. The obstacle factors were analyzed, and the action strategies were formulated. The cognition of the medical staff on the volume management, and the fasting body mass monitoring rate, the volume management target compliance rate, the time to dry body mass, average hospitalization day of the patients′, number of negative events related to volume management were compared before and after the application of the best evidence.Results:After the implementation of the reform, Indicator 8-14 and Indicator 20 of the 20 audit indicators implementation rate had been improved, and the difference was statistically significant ( χ 2 values were 6.668-97.000, P<0.05); the volume management target compliance rate increased from (34.24±30.33)% to (61.28±16.10)%, the difference was statistically significant ( t value was 30.21, P<0.001); the time to dry body mass decreased from (10.89±3.46) days to (5.48±1.58) days, the difference was statistically significant ( t value was 13.97, P<0.001); compared with the negative events related to the access control, the number of acute left heart failure cases decreased from 7 to 2 ( χ2 value was 4.194, P=0.041). Conclusion:Evidence-based volume management of patients with chronic heart failure can improve clinical nursing practice, shorten the time for patients to reach dry body mass, and reduce the average hospitalization day. Quality review still needs to continue to improve the quality of nursing.
ABSTRACT
Objective To investigate the status of knowledge,attitude and behavior of schistosomiasis control of rural resi-dents in Wanjiang River region after a flood,so as to provide the reference for targeted health education. Methods The multi-stage sampling was applied to select the respondents in rural residents in Wanjiang River region,and the self-designed question-naire was used to investigate the current situation of knowledge,attitude and behavior of schistosomiasis prevention and control of the rural residents. Results The total awareness rate of knowledge about the prevention and control of schistosomiasis was 47.92%. The age,education,family income,relatives and friends with medical background,and health education significantly influenced the awareness rate(χ2=12.76,89.19,18.19,50.83 and 92.60 respectively,all P<0.05). The accuracy rates of at-titude and behavior in schistosomiasis control were 62.89%and 52.37%respectively. Conclusion The awareness rate of knowl-edge about the prevention and control of schistosomiasis,and the accuracy rates of attitude and behavior in schistosomiasis con-trol of the rural residents in Wanjiang River region are all inefficient,and therefore,the targeted health education should be strengthened to decrease the risk of schistosomiasis transmission.
ABSTRACT
Objective To understand the status of stroke patients' perceived control and healthrelated quality of life,and to analyze the effect of perceived control on stroke patients' depression and health-related quality of life.Methods By convenience sampling,264 stroke patients were chosen to complete the questionnaire survey,Perceived Control Questionnaire,Hamilton Depression Scale and ShortForm Health Survey Scale-2.Results The score of patient's perceived control and health-related quality of life were (18.21±2.74),(46.62±11.56) points respectively.The perceived control had a negative correlation with the depression (r=-0.32,P ＜ 0.05),had a weak positive correlation with the body health (r=0.05,P ＜0.05),and had a positive correlation with the mental health of health-related quality of life (r=0.29,P ＜0.05),depression was negatively correlated with health-related quality of life of the body health,mental health (r=-0.26,-0.28,P ＜ 0.05).Conclusions Medical personal should improve the level of stroke patients' perceived control through various methods,to reduce depression and improve health related quality of life.
ABSTRACT
Objective To understand the status of colleague support and colleague solidarity of nurses,and explore the relationship between colleague support and colleague solidarity.Methods A total of 231 nurses from Zhengzhou City were chosen using convenience sampling method to complete the questionnaire survey about colleague support and colleague sohdarity.Results The nurses' colleague support scored (76.34±2.75) totally and colleague solidarity scored (64.63±4.25) totally.In dimensions of nurses' perception of colleague support,head nurse support,support result,cooperation,sympathy establishment,awareness increasing were positively correlated with emotional unity dimension of colleague solidarity (r=0.32,0.26,0.27,0.30,0.28,all P＜ 0.05);head nurse support,support result,cooperation,awareness increasing,goal setting,action projects were positively correlated with academic unity dimension of colleague solidarity (r=0.30,0.28,0.25,0.29,0.27,0.26,all P ＜ 0.05);head nurse support,support result,cooperation,awareness increasing,action projects and process management were negatively correlated with negative views of colleague solidarity (r=-0.31,-0.27,-0.30,-0.23,-0.24,-0.27,all P ＜ 0.05).Conclusions Improving the nurse colleague-peer support can improve degree of colleague solidarity.
ABSTRACT
Objective To investigate the occupational musculoskeletal injury of nurses in a thirdgrade and A-level general hospital in Zhengzhou,and analyze the relationship between occupational musculoskeletal injury and presenteeism.Methods 460 nurses were surveyed with questionnaires by convenience sampling,including nurses' demographic data,Nordic Standardized Questionnaires and Work Limitations Questionnaire.Results The annual incidence rate of OMSI in nursing staff was 82.38％.The parts of body which had high annual incidence rate of nurses' OMSI were lower back,neck and shoulder.The rates of presenteeism for no OMSI,one part OMSI and two or more parts OMSI were 35.14％,52.60％ and 59.68％.The scores of work efficiency decrease were (2.02±1.26),(4.67±2.53),(7.31±3.42).Conclusions Nurses' occupational musculoskeletal injury can result in presenteeism.The more serious occupational musculoskeletal injury is,the higher incidence rate of presenteeism,the more critical the presenteeism is.
ABSTRACT
Objective In this study,we investigate the influence on nurses professional ability by the hierarchical level training under the advanced mode.Methods By referring to advanced mode of clinical expertise,combined with impacts including the ability of nurses,seniority factors,professional titles and educational background,1 527 nurses of our hospital were divided into five ranks (including nine grades).We developed training plan,training forms and training purposes aiming at all level of training objectives.In addition,we developed a training effect questionnaire and promotion criteria.All the nurses must be evaluated and compared with the traditional nursing mode,which contained 1 486 nurses as the control.Results Within two years after the start of the experiment in the observation group,1 106 nurses had been promoted.Compared with the traditional platform-based training model,nursing assessment indicators were significantly improved by the hierarchical level of training.Quality control of care services was significantly improved and the score of patient satisfaction was significantly increased.Nurses acceptance of tiered training was improved compared to the control group,published research papers were significantly increased.Conclusions Detailed training on the layer classification of the nurses can improve the ability of nurses including specialist knowledge,interpersonal communication and humanistic care,teaching,scientific research,management and other professional skills,so as to improve nursing quality and work efficiency.
ABSTRACT
Objective To explore the effects of family empowerment model on medication adherence in youth patient with cerebral infarction.Methods By convenience sampling,a questionnaire survey was conducted among 84 patients and families of neurology department in a third-grade and a-level general hospital in Zhengzhou.The patients and families were randomly divided into the control group and the intervention group,each group consisted of 42 patients and families.Patients and families in the control group got routine health education,but patients and families in the intervention group were intervened under family empowerment.The medication adherence of the patients were compared between the two groups before and after health education.Results The medication adherence in both groups were higher after health education than that before health education,the diffidence in the comparison of medication adherence was statistically significant between the two groups after health education.Conclusions The family empowerment model can improve the medication adherence in youth patient with cerebral infarction.
ABSTRACT
Objective To investigate the job burnout status of nurses in a third-grade and A-level general hospital in Zhengzhou,and analyze the relationship between job burnout and presenteeism.Methods 300 nurses were surveyed with questionnaires by convenience sampling,including nurses' demographic data,Nurse Job Burnout Scale and Work Limitations Questionnaire.Results The scores in three dimensions of job burnout of nurses were respectively EE (25.92±11.56) points,DP (10.63±6.82) points,and PA(26.30±9.11) points.The job burnout rate in nurses was 76.2％,the rates of low,moderate,and high degree of burnout were respectively 30.4％,28.7％,and 17.4％.The scores of presenteeism for low,moderate,and high degree of work limitations were respectively (2.29±1.60)points,(5.90±3.03)points,(7.89±3.12)points.Conclusions Nurses' burnout can results in presenteeism.The more serious job burnout is,the more critical the presenteeism is.
ABSTRACT
Objective To investigate the expression of Golgi phosphoprotein 3 (GOLPH3) at protein and mRNA levels in serous epitheial ovarian carcinoma and its significance.Methods The expression of GOLPH3 at protein and mRNA levels were evaluaed by Western blot and Real time RT-PCR,respectively,in 42 cases of serous epithelium ovarian carcinoma,14 cases of benign serous ovarian tumors and 7 cases of normal ovarian epithelium tissues.Results GOLPH3 mRNA was significantly higher from 2.97 to 7.04 fold in ovarian serous cystadenocarcinoma tissues compared with ovarian serous carcinoma tissues (P ＜ 0.05).There was no positive expression of GOLPH3 protein in normal ovarian epithelium tissues.GOLPH3 protein positive expression rate was higher in ovarian serous cystadenocarcinoma (73.81 ％) than that in ovarian serous carcinoma (35.71％) (P ＜ 0.01).GOLPH3 protein was correlated with the pathologic differentiation (P =0.019),the FIGO stage (P =0.042),and lymphatic metastasis (P =0.000),but was not associated with age (P =0,881).The positive rate and overexpression of GOLPH3 in poor differentiated grade group were higher than that in well and middle differentiated grade group (P ＜ 0.05).Conclusions GOLPH3 may play an important role on the development of ovarian serous cystadenocarcinoma,and may be a potential target of gene therapy.
ABSTRACT
ObjectiveTo evaluatethe microbial spectrum and clinical characteristics of microbiological diagnosed bloodstream infections ( BSI ) with identified infective sources. Methods The hospitalized patients microbiologically diagnosed as BSI with identified infective sources were included in this study from January 2008 to December 2009.Data were collected retrospectively and analyzed by software SPSS 17.0.ResultsIn this 2-year study,301 strains of microbes were isolated from 249 patients.There were 205 ( 82.33％ ) patients with monomicrobial BSI,while the other 44 ( 17.67％ ) patients with polymicrobial BSI.The most common identified source of bloodstream infections was lower respiratory tract infection (125,41.5％ ),followed by intraabdominal infection (55,18.3％ ) and intravascular devices related infection (54,17.9％ ).The four most common isolated pathogens were Acinetobacter species (60,19.9％ ),Escherichia coli (50,16.6％ ),Pseudomonas species (35,11.6％ ) and Staphylococcus Aureus (34,11.3％ ).Eighty-eight (35.3％) patients died during hospitalization due to all causes,out of which 62(24.9％ ) patients died owing to BSI.The patients with BSI originated from lower respiratory tract had a higher crude in-hospital case-fatality ratio than those with BSI originated from other resources ( OR =2.186 ; 95％ CI 1.260-3.792; x2 =7.879,P =0.005). In the multivariate regression,age ≥ 65,invasive mechanical ventilation, reservation of central line and polymicrobial BSI during hospitalization were independent risk factors of death due to all causes. Conclusions Lower respiratory tract is the most common originated source of BSI with microbiological identified sources. Gram-negative bacillus taking advantage,the microbial spectrum of BSI with identified sources in our study is different from those reported before both in primary and secondary BSI.The patients with BSI originated from respiratory tract have a higher crude in-hospital case-fatality ratio.
ABSTRACT
Objective To report the clinical characteristics of prosthetic valve endocarditis (PVE).Methods All 25 cases of definite PVE (Duke criteria) diagnosed at our hospital between January 1992 to December 2008 were retrospectively analyzed. Among them, 7 cases were pathologically confirmed and the others were clinically confirmed with either 2 major criteria or 1 major and ≥3 minor criteria. Their clinical characteristics, underlying heart diseases, previous heart operations, presenting manifestations, causative microbes, echocardiographic findings and prognosis, were studied. Results (1) Although most cases underwent valve transplantations for underlying heart diseases of rheumatic heart diseases and congenital heart diseases, 10 patients were complicated with infectious endocarditis (IE) prior to the operations, 4 of them were PVE. (2) Eleven of them developed PVE within 2 months postoperatively. Fever (100%),major vessel embolism (48%), and anemia (36%) were the most frequently manifestations. Fourteen cases (56%) had positive culture results with 15 causative pathogens, including 5 coagulase-negative Staphylococcus (CNS, 3 were methicillin-resistant coagulase-negative Staphylococcus, MRSCoN), 4 fungi, 2Enterococcus faecalis, 2 Burkholderia cepacia, 1 Stenotrophomonasmal-tophilia, and 1 Streptococcus.(3)Prosthetic valve vegetations, periannular leakage, regurgitation, were the main echocardiographic findings.Transesophageal echocardiography (TEE) revealed 13 PVE who had no positive findings on previous transthoracic echocardiography (TTE). (4) Eighteen PVE (72%) developed peri-annular complications (12 leakage, 3 dehiscence, 2 abscesses, 1 fistula), major vessel embolism, congestive heart failure (16%) were frequently observed, 9 of the 17 patients died in hospital, in spite of intensive managements.Conclusions PVE has a high mortality and is a severe complication for patients who underwent heart surgery. Its causative pathogen spectrum is quite different from that of native valve endocarditis. TTE is not sensitive for some PVE cases.
ABSTRACT
Objective To investigate the clinical characteristics of tuberculosis (TB) first presenting as fever of unknown origin (FUO). Methods The clinical data of 100 cases of FUO, diagnosed as TB finally, among in-patients in Peking Union Medical College Hospital were analyzed retrospectively.Results ( 1 ) Sites of TB: there were 39 patients with merely pulmonary TB, 28 patients with merely extrapulmonary TB, and 33 patients with both pulmonary and extrapulmonary TB. (2) Clinical manifestations: depending on the different sites of tuberculous lesion, the clinical symptoms varied accordingly. The common laboratory findings included anemia, hypoalbuminemia, elevation of the level of ESR and C-reactive protein (CRP). (3) Methods for diagnosis: 34 cases were diagnosed by sputum smearor cultivation-positive for acid-fast bacilli; 8 cases by histopathology; 49 cases by clinical diagnosis of TB with an effective anti-TB therapy; and 9 cases by effective diagnostic anti-TB therapy. (4) Responses to treatment: among 73 cases with complete follow-up data, only 2 cases (2. 7% ) died and the other cases were cured or alleviated. Fifty-five cases (77.5%) showed marked efficacy after less than 4 weeks of regular anti-TB therapy, 37 cases ( 52. 1% ) suffered adverse effects of anti-TB agents, and all of them had improved after modifying anti-TB therapy and supporting treatment. Conclusions The diagnosis of TB that presents as FUO is quite difficult, and the median interval time for making diagnosis is 14 weeks (3-77weeks). Investigating clinical manifestations comprehensively, reviewing radiology data carefully, and eliciting microbiological and pathologic evidence of TB, are extremely important for making the correct diagnosis. In some cases, a therapeatic trial of anti-TB therapy is necessary.
ABSTRACT
Objective To investigate the prevalence of primary HIV-1 genotype drug-resistance and viral subtype from 237 treatment-naive patients in China.nethods CD4+ T cell counts,plasma HIV-1 viral load and HIV-1 gene sequencing in total 237 treatment-naive patients enrolled from 20 provinces/regions were detected for the evaluation of primary HIV genotypic drug-resistance.Results The survey of 237 treatment-naive patients from muhicenter areas including Henan Province,Yunan Province,and Shanghai showed that 9 subtypes of HIV-1 strains were finally identified.Most of patients were infected before 2003.Only 3 cases had genotypic mutations associated resistance to antiretroviral drugs,with high resistance to nucleoside reverse transcriptase inhibitors(NRTIs),moderate resistance to protease inhibitors(PIs)and high resistance to non-nucleoside reverse transcriptase inhibitors(NNRTIs).respectively.The prevalence of primary genotypic drug resistance was 1.3%(3/237)in this study.Conclusions The rate of HIV-1 primary genotypic drug-resistance is still relatively low in treatment-naive HIV/AIDS patients while 9 subtypes of HIV-1 strain was diseovered.
ABSTRACT
<p><b>OBJECTIVE</b>To study the alteration of peripheral lymphocyte subsets in severe acute respiratory syndrome (SARS) patients and to help improve the early diagnosis of the disease.</p><p><b>METHODS</b>Anti-coagulating blood samples from 98 SARS patients in the acute phase, 56 normal healthy blood donors, and from patients infected by HIV, CMV and EBV were collected. The T lymphocyte subsets were counted by flow cytometry using fluorescence-labeled specific monoclonal antibodies.</p><p><b>RESULTS</b>A significant decrease was observed in all SARS patients in their peripheral CD4(+) and CD8(+) T lymphocyte absolute counts [256 (104) x 10(6)/L and 256 (117) x 10(6)/L, respectively], which were also lower than those of the patients infected with HIV, CMV and EBV. All patients infected with HIV, CMV and EBV had significantly higher CD8(+) T lymphocyte counts in comparison with normal controls.</p><p><b>CONCLUSIONS</b>Decrease of both CD4(+) and CD8(+) T lymphocytes of patients is related to onset of SARS. T lymphocyte subset analysis would help improve the early diagnosis of the disease.</p>
Subject(s)
Adult , Female , Humans , Male , CD4-Positive T-Lymphocytes , Cell Biology , CD8-Positive T-Lymphocytes , Cell Biology , Leukocyte Count , Severe Acute Respiratory Syndrome , DiagnosisABSTRACT
Objective] To investigate the clinical features of amebic liver abscess, the causes of misdignosis and the effect of medical and surgical therapy on patient′s prognosis. [Methods] The clinical features of 36 patients with amebic liver abscess admitted from 1982 to 1997 in our hospital were retrospectively reviewed. [Results] The major clinical manifestations were: abdominal pain (86 1%), fever (86 1%),hepatomegaly with tenderness (83 3%) and right intercostal tenderness(58 3%). Leukocytosis was observed in 61 1%, and increased of ESR in 88 5% (23/28). Serologies against Entamoeba histolytica were noted in 92 6%. Ultrasonography showed single lesions in 75% and right\|lobe involvement in 75%. All patients were treated with metronidazole and 27 patients received treatment with needle aspiration or draining at the same time. After treatment, 10 patients were cured, 25 patients were improved significantly and effective rate was 97 2%. One patient died of hepatic failure. [Conclusion] Medical therapy alone was excellent for small abscesses, while percutaneous needle aspiration or draining was a successful approach in patients with large abscesses.