ABSTRACT
Objective@#To explore the influence of cluster nursing intervention on inadequate drainage in vacuum sealing drainage (VSD) for inpatients in burn unit.@*Methods@#From October to December 2016, 60 patients, aged (43.6±2.8) years admitted to our department, receiving VSD treatment and conforming to the inclusion criteria, were included in the routine nursing group, and among the patients, 37 cases were male and 23 cases were female. From May to July 2017, 58 patients, aged (44.2±3.2) years admitted to our department, receiving VSD treatment and conforming to the inclusion criteria, were included in the cluster nursing group, and among the patients, 36 cases were male and 22 cases were female. The patients′ medical records were retrospectively analyzed. After VSD treatment, patients in routine nursing group received routine nursing, and patients in cluster nursing group received cluster nursing. A cluster intervention group was formed and headed by a chief surgeon. The cluster nursing plan was formulated and implemented strictly from the following six aspects of material preparation, negative pressure value control and negative pressure mode setting, drainage tube nursing, semi-permeable membrane reinforcement, standardizing changing process and timing of drainage capsule, and health education. During VSD treatment, the incidence of inadequate drainage, reasons of inadequate drainage and the occurrences, occurrences of inadequate drainage of wounds in different types and sites, and satisfaction of patients in two groups were observed and calculated. The patient satisfaction items included procedure of drainage capsule replacement, the method of tube fixation, the content and form of health education. Data were processed with independent sample t test and chi-square test.@*Results@#(1) During VSD treatment, the incidence of inadequate drainage of patients in routine nursing group was 43.33% (130/300), which was significantly higher than 17.24% (50/290) in cluster nursing group (χ2=43.350, P<0.01). (2) During VSD treatment, the incidences of inadequate drainage caused by blockage of drainage tube due to scabbing of drainage, low negative pressure, air leakage of semi-permeable membrane, improper changing process of drainage capsule, shedding, compression, reversal of drainage tube of patients in cluster nursing group were 7.93% (23/290), 4.48% (13/290), 1.72% (5/290), 1.03% (3/290), and 2.07% (6/290), respectively, significantly lower than 16.67% (50/300), 11.67% (35/300), 4.33% (13/300), 4.00% (12/300), and 6.67% (20/300) in routine nursing group (χ2=10.379, 22.951, 4.832, 7.840, 7.399, P<0.05 or P<0.01). (3) During VSD treatment, the incidences of inadequate drainage of burn wounds, trauma wounds, pressure ulcer, venous ulcer in lower limbs, and diabetic foot of patients in cluster nursing group were significantly lower than those in routine nursing group (χ2=17.835, 6.809, 9.478, 4.939, 8.631, P<0.05 or P<0.01). During VSD treatment, the incidences of inadequate drainage of wounds in different types of patients in the same group were close (χ2=0.434, 0.057, P>0.05). (4) During VSD treatment, the incidences of inadequate drainage of wounds in limbs, trunk, buttocks, and sacrococcyx of patients in cluster nursing group were significantly lower than those in routine nursing group (χ2=31.892, 9.588, 4.939, 4.549, P<0.05 or P<0.01). During VSD treatment, the incidences of inadequate drainage of wounds in different wound sites of patients in the same group were close (χ2=0.071, 0.069, P>0.05). (5) The satisfaction scores in changing process of drainage capsule, method of tube fixation, content and form of health education of patients in cluster nursing group after VSD treatment were significantly higher than those in routine nursing group (t=5.166, 4.471, 7.958, 8.975, P<0.01).@*Conclusions@#Cluster nursing intervention on patients receiving VSD treatment could reduce the incidences of inadequate drainage of wounds in different types and sites caused by various reasons. It also can improve patient satisfaction.
ABSTRACT
Objective@#To describe the status of non-steroidal anti-inflammatory drugs (NSAIDs) use in areas with a high incidence of upper gastrointestinal cancer in China. @*Methods@#This study was based on the National Key Research and Development Program of "National Precision Medicine Cohort of Esophageal Cancer" and "Study on Identification and Prevention of High-risk Populations of Gastrointestinal Malignancies (Esophageal cancer, Gastric cancer and Colorectal cancer)" . From January 2017 to August 2018, 212 villages or communities with a high incidence of esophageal cancer or gastric cancer were selected from 12 regions in 6 provinces. A total of 35 910 residents aged between 40 and 69 years old who met the inclusion criteria and signed the informed consent were investigated and enrolled in this study. The use of NSAIDs, demographic characteristics, health-related habits, height, weight, and blood pressure were collected by the questionnaire and physical examination. The status of main NSAIDs (aspirin, acetaminophen and ibuprofen) use with the difference varying in genders, age groups and regions were analyzed by using χ2 test and Cochran-Armitage trend analysis method. @*Results@#Of 35 910 subjects, the mean age was (54.6±7.1) years old and males accounted for 43.42% (15 591). The overall prevalence of NSAIDs intake was 4.56% (1 638), but it significantly varied in different provinces (P<0.001). The overall prevalence of NSAIDs intake was 4.87% (1 750) in females, which was significantly higher than that in males 4.24% (1 524) (P<0.001). The prevalence of NSAIDs intake increased with age (P for trend <0.001). As the frequency of NSAIDs intake increased, the incidence of gastrointestinal symptoms, gastrointestinal ulcers and black stools increased (P for trend <0.05 for all). @*Conclusion@#The use of NSAIDs is prevalent in some areas with a high incidence of upper gastrointestinal cancer in China. The increased use of NSAIDs may lead to more adverse effects related to the gastrointestinal tract.
ABSTRACT
Objective: To analyze the trend of lung cancer incidence rate among rural residents in Feicheng city between the years 2000 and 2012,and predict the incidence rate between the years 2013 and 2018,and subsequently provide baseline data for lung can-cer control and prevention.Methods:With the cancer registration data in Feicheng rural areas,the time trend of lung cancer inci-dence rate and the annual percentage change(APC)were calculated by the Joinpoint model,while the incidence of lung cancer from 2013 to 2018 were predicted by the ARIMA(p,d,q)model.Results:A total of 3,908 new cases of lung cancer were diagnosed be-tween 2000 to 2012.The incidence rate was 40.77/105,the age-specific cancer incidence rate in the Chinese population(ASRC)and world population(ASRW)were 32.95/105 and 32.97/105,respectively.The incidence was 2.14 times higher among males than females (P<0.001).The incidence of lung cancer which apparently rose from 25.13/105to 64.92/105 with an APC value of 9.74%(P<0.001),was increasing every year.The change in the trend of lung cancer with respect to age could be divided into three segments,the incidence rate in the 0 to 59 years group showed a rapid upward trend(APC=113.38,P<0.001),which was lower in the 60 to 79 years group (APC=20.39,P<0.05)and began to decline in the 80 years or older group(APC=-21.20,P>0.05).The incidence of lung cancer was also observed to be increasing yearly from 2013 to 2018,and with an average annual growth rate of 4.92%,was predicted to reach 87.92/105 in 2018.Conclusions:The occurrence of lung cancer was closely related to population aging,unhealthy habits,and environmental risk factors.Due to the increasing aging population,the incidence of lung cancer will continue to increase.In order to formulate specif-ic strategies,the control and prevention of lung cancer must be based on its incidence features.
ABSTRACT
Objective@#To investigate the trend of esophageal and stomach cancer incidence and mortality in Feicheng during 2000 to 2013, and to evaluate the effects of the national project of screening for upper digestive tract cancers from 2006 to 2015 in Feicheng.@*Methods@#We collected 26 569 cases, which were coded of C15 and C16 in the 10th edition of international classification of diseases (ICD) during the period of 2000-2013. The data came from cancer registration system of Feicheng, Shandong Province, China. These cases already covered 21 679 882 person-year. The annual percent change (APC) of incidence and mortalit were analyzed. The risk factors of upper gastrointestinal cancer were investigated and evaluated for people aging 40-69 in three street offices and eleven townships of Feicheng, and endoscopic screening was conducted among people who was in high risk. The corresponding data were used to analyze the early detection project of upper gastrointestinal cancer screening and early diagnosis, with the index of detection rate, early diagnosis rate, early treatment rate and other indicators.@*Result@#There were 26 569 new cases of esophageal cancer and gastric cancer occurred in Feicheng from 2000 to 2013. The incidence of esophageal cancer gradually increased since 2000 with 76.06 per 100 000 people (575/756 005) and reached the peak in 2010 with incidence rate of 118.76 per 100 000 people (852/717 429), with the annual percent change at about 4.3% (95%CI: 2.7%-5.9%) and showed a downward trend after then but has no significance, with APC about-7.1% (95%CI:-15.8%-2.5%). The incidence of gastric cancer was increased from 2000 with an incidence rate of 37.70 per 100 000 people (285/756 005) to 2013 with an incidence rate of 54.59 per 100 000 (538/985 512), with an annual percent change of about 3.3% (95%CI: 2.1%-4.5%). Esophageal cancer and gastric cancer mortality showed a relatively stable trend during 2000 to 2013, esophageal cancer with APC about 0.1% (95%CI: -1.3%-1.5%) and stomach cancer with APC about 0.8% (95%CI: -0.5%-2.0%). From 2006 to 2015, 58 579 residents aged 40-69 years old participated cancer screening project covered 206 105 populations in Feicheng. There were 1 124 invasive cancers and in situ cases from upper digestive tract were detected, with the detective rate at 1.92%. Among those cases, 941 cases were in early stage with the early diagnosis rate of 83.72%, and about 88.97% of detected patients received appropriate treatment after diagnosis.@*Conclusion@#The incidence of esophageal cancer and gastric cancer with a very high level of incidence and mortality, this made the prevention and control situation was still very serious. The project of cancer screening, early diagnosis and treatment on upper digestive tract cancers in Feicheng plays a positive role on cancer control.
ABSTRACT
Objective:To explore value of 256-slice spiral CT pulmonary artery angiography (CTPA)evaluating right heart function in patients with acute pulmonary embolism (APE).Methods:According to death risk assessment of APE patients, a total of 67 APE patients were divided into high risk APE group (n=41)and non-high risk APE group (n=35).CTPA was used to analyze and compare CTPA obstructive index and right heart function indexes between two groups.Correlations among CTPA obstructive index and right heart function indexes were also analyzed.Results:Compared with non-high risk APE group,there were significant rise in CTPA constructive index [8.58% vs.24.69%],percentages of straight or left protruded ventricular septum (31.46% vs.73.17%)and bronchial artery dilation (5.71% vs.24.69%);Except the supe- rior vena cava diameter,the rest right heart function parameters had difference significance in two groups,P<0.05 or<0.01. Spearman correlation analysis indicated that CTPA obstructive index was significant positively correlated with right ventricular maximal short axis (RVMSA),RV:LV,diameters of main pulmonary artery,superior vena cava and azygos (r=0.684~0.954),and significant inversely correlated with LVMSA (r=-0.786),P<0.01 all.ROC curve analysis indicated that AUCs of CTPA RV:LV (0.949)was the biggest diagnosing APE severity.Conclusion:Right heart func- tion indexes measured by multi-detector CT are accurate and practical indexes evaluating APE severity,and it possesses im- portant significance.
ABSTRACT
<p><b>OBJECTIVE</b>To understand the distribution of esophageal squamous cell cancer and precursor lesions in high-risk areas of China, and to provide evidence for determining the reference ranges of detection rates in high-risk areas.</p><p><b>METHODS</b>Endoscopy with Lugol's iodine staining was performed on 15 709 local residents aged 40 to 69 years old in Linzhou of Henan province and Feicheng of Shandong province from 2005-2009. 35 cases without accurate pathology diagnosis and 11 cases with vital disease before screening were excluded. 15 663 subjects were enrolled in this study. Compliance was calculated by the percentage of the people who had endoscopic screening among the target population. Chi-square test and trend chi-square test were used to compare the distribution differences in age, gender and areas of esophageal squamous cell cancer and precancer. 95% CI of the detection rates was then employed to represent the reference ranges of esophageal squamous cell cancer and precursor lesions.</p><p><b>RESULTS</b>The compliance rate of screening endoscopy of this study was 49.36% (15 709/31 826) of all, and female's compliance (54.05%, 8 447/15 628) was much higher than that of male (44.83%, 7 262/16 198) (χ(2) = 88.14, P < 0.001). The detection rates of basal cell hyperplasia, low grade intraepithelial neoplasia, high grade intraepithelial neoplasia and esophageal squamous cell cancer of males were 4.17% (302/7 246), 17.22% (1 248/7 246), 1.67% (121/7 246), 0.83% (60/7 246), and were higher than that of females (3.45% (290/8 417), 14.82% (1 247/8 417), 1.41% (119/8 417), 0.48% (40/8 417), respectively). Except for high-grade intraepithelial neoplasia, the detection rates of male were higher than that of female (P values were 0.018, < 0.001, 0.960, 0.006). The detection rates of all grades of precursor lesions increased with age rising (all P values < 0.001), among which the detection rates of the mentioned four lesions for 40-44 years old were 2.69% (94/3 500), 8.11% (284/3 500), 0.40% (14/3 500), 0.14% (5/3 500), and that of 65-69 years old were 5.46% (46/843), 23.25% (196/843), 3.68% (31/843), 2.14% (18/843). The proportion of esophageal precursor lesion of Linzhou were higher than that of Feicheng observably except for esophageal squamous cell cancer (P values were < 0.001, < 0.001, < 0.001, 0.437). The detection rates of the four lesions of Linzhou and Feicheng were 4.90% (504/10 287), 17.37% (1 787/10 287), 1.79% (184/1 0287), 0.60% (62/10 287) and 1.64% (88/5 376), 13.17% (708/5 376), 1.04% (56/5 376), 0.71% (38/5 376). The 95% CI of detection rates of various lesions were, 3.78% (3.48%-4.08%) for basal cell hyperplasia, 15.93% (15.37%-16.50%) for low-grade intraepithelial neoplasia, 12.31% (11.79%-12.82%) for mild dysplasia and 3.62% (3.33%-3.91%) for moderate hyperplasia, 1.53% (1.34%-1.72%) for high-grade intraepithelial neoplasia and 0.64% (0.51%-0.76%) for esophageal squamous cell cancer, respectively.</p><p><b>CONCLUSION</b>Up to 21.88% residents that were asymptomatic were suffered from esophageal squamous cancer or precursor lesions in high-risk areas in China. The distribution of esophageal squamous cell cancer and precursor lesions was closely related to the gender and the age, which suggested that males were supposed to be paid more attention to.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Age Distribution , Carcinoma, Squamous Cell , Epidemiology , China , Epidemiology , Endoscopy , Esophageal Neoplasms , Epidemiology , Iodides , Precancerous Conditions , Epidemiology , Sex DistributionABSTRACT
Objective To analyze the application value of multislice spiral CT in diagnosis of children malformation of large blood vessels outside the heart.Methods The diagnosis results were compared between echocardiography and multislice spiral CT in 110 children with congenital heart disease,and the children had been confirmed by operation.Congenital heart disease was divided three kinds according to the region:heart,connections between heart and large blood vessels and large blood vessels outside the heart.Results One hundred and ten children with congenital heart disease were selected,and they had 366 malformations.The accuracy rates of echocardiography and multislice spiral CT were 90.7％ (332/366) and 95.6％ (350/366) respectively,and there was no statistical difference (x2 =3.284,P =0.070).In 366 malformations,160 malformations were in heart region.The accuracy rates of echocardiography and multislice spiral CT were 98.1％ (157/160) and 97.5％ (156/160) respectively,and there was no statistical difference (x2 =0.776,P =0.378).There were 55 malformations in connections between heart and large blood vessels.The accuracy rates of echocardiography and multislice spiral CT were 94.5％ (52/55) and 100.0％ (55/55) respectively,and there was no statistical difference (x2 =3.083,P =0.243).There were 151 malformations in large blood vessels outside the heart.The accuracy rates of echocardiography and multislice spiral CT were 81.5％(123/151) and 92.1％ (139/151) respectively,and there was statistical difference (x2 =7.377,P =0.01).Conclusion Multisltce spiral CT has great application value in diagnosis of children congenital heart disease,especially in malformation of large blood vessels outside the heart.
ABSTRACT
<p><b>OBJECTIVE</b>To estimate the cost-effectiveness of esophageal cancer endoscopic screening once-in-a-lifetime and to predict the optimal screening age for people in high-risk areas of rural China.</p><p><b>METHODS</b>A Markov model was constructed to predict and compare the effect of four esophageal cancer endoscopic screening modalities which varied with different screening ages. Long-term epidemiological effectiveness and cost-effectiveness were predicted by simulation of the model.</p><p><b>RESULTS</b>Compared with the control group, strategies starting at 40, 45, 50 and 55 year-old had saved life-years of 629.51, 769.88, 738.98 and 533.21 years per 100 000 people, respectively, of which the strategy starting at 45 year-old saved the maximum life years. All strategies were cost-effective and starting at 40 year-old cost the most per life-year saved. Among all alternatives, strategies starting age at 45 year-old and 50 year-old were incremental cost-effective, and the incremental cost-effective ratios were 34 962.87 and 3 346.43 RMB per life year saved, respectively.</p><p><b>CONCLUSIONS</b>The strategy starting at 40 year-old implemented at present and other strategies were cost-effective in high-risk areas of rural China. However, the 45-year-old group is more aligned with the principle of cost-effectiveness. Considering the cost-effectiveness of different strategies and social economic status, 45 year-old is regarded as the optimal starting age of esophageal cancer once-in-a-lifetime endoscopic screening and is recommended in areas lacking health resources. The strategy of starting age at 40 year-old which could obtain better screening effects would be preferable in wealthy regions.</p>