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Objective:To acquire more scientific, accurate and efficient unplanned extubation (UEX) quality management data by using information technology to directly take the quality index data of unplanned extubation from the nursing medical record system.Methods:From June 2019 to August 2019, a knowledge base of pipeline management including the name of pipeline, pipeline evaluation, pipeline care measures, and reasons for unplanned extubation of pipeline was established in Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine. Through the analysis of each node of pipeline management, pipeline management system was established. And the non-planned pipeline management data set was directly collected to the nursing quality management system for statistics and analysis, which was verified.Results:In clinical application from September 2019 to september 2020, the direct collection of unplanned extubation quality index data saved 496 hours of nursing labor costs per month, and the accuracy of direct data collection increased from 95.8% (161/168) in trial operation to 100.0% (494/494). The underreporting rate of adverse events decreased to 0. Satisfaction with the application of the quality index management system for unplanned extubation was (4.35 ± 0.73) points.Conclusions:The direct collection of quality index data for unplanned extubation improves the accuracy of the data. Nurses no longer need to report unplanned extubation incidents. The clinical nursing information system and the nursing management system are interconnected to improve the management efficiency of unplanned extubation. It is worthy of application and promotion in clinic.
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Objective@#To study the development of grip strength and its relationship with body weight, height and body composition in preschool children.@*Methods@#Data was collected from 900 children aged 3-6 years in 4 preschools in Beijing during Sept. to Oct. of 2020. A questionnaire survey (birth weight, dietary and exercise), height, weight, bioelectrical impedance analysis of body composition and dominant hand grip strength tests were conducted. Partial correlational analysis, multivariate linear regression were used for association between grip strength and body composition.@*Results@#The grip strength gradually increased with age, from (5.2±1.7) to (9.3±2.5)kg in boys ( F=57.93, P <0.01), and from (4.3±1.6) to (7.9±2.5)kg in girls ( F=48.77, P <0.01). Grip strength in boys were significant higher than that of girls ( t=6.42, P <0.01). The grip strength increased with weight status in boys ( F=5.35, P <0.01), with highest in obese group, followed by overweight and normal weight group. After adjusted for height, weight and birth weight, as well as maternal education, food consumption during the past week, grip strength in boys was positively correlated with fat free mass, upper limb muscle mass ( r=0.11, 0.09, P <0.05), and negatively correlated with body fat mass ( r=-0.18, P <0.05). Grip strength in girls was negatively correlated with body fat mass, and positively correlated with fat free mass ( r= -0.09, 0.09, P <0.05). Grip strength varied significantly by age, fat free mass and upper muscle mass in boys ( F=66.75, P < 0.01), and by age and fat free mass in girls ( F=150.81, P <0.01).@*Conclusion@#The grip strength can partially reflect changes in fat free mass for boys and girls, it also reflect changes in upper limb muscle mass for boys. Increases in fat free mass helps grip strength improvement.
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To develop a quality control checklist for the prevention and control of coronavirus disease 2019 （COVID-19） in fever clinic and isolation ward of the general hospital and to assess its application. Based on the relevant prevention and control plans and technical guidelines for COVID-19，Delphi method was used to identity items for evaluation，and a quality control checklist for the prevention and control of COVID-19 in the fever clinic and isolation ward was developed in Sir Run Run Shaw Hospital. The checklists included 8 dimensions and 32 items for fever clinic，7 dimensions and 27 items for the isolation ward. The appointed inspectors conducted daily quality control for each shift with this checklist. The expert authority coefficient was 0.88，the mean of the importance of each index in the quality control table was not less than 4.8，and the coefficient of variation was not more than 0.07. During the entire February 2020，8 problems were found and rectified on-the-spot with the application of the checklist. Quality inspection rate was 100% in both isolation wards and fever clinic. The compliance rate and accuracy rate of hand hygiene were 100%; the correct rate of wearing and removing protective equipment increased from 96% to 100%. During the same period，a total of 1915 patients were admitted to the fever clinic，including 191 suspected patients （all were isolated in the hospital，3 were confirmed）. There were no medical staff infected with COVID-19，no cross infection of patients and their families in the hospital. A quality control checklist for the prevention and control of COVID-19 has been developed and applied in the isolation wards and fever clinic，which plays an important role in preventing nosocomial infection.
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Humans , COVID-19 , Checklist , Fever , Hospitals, General , SARS-CoV-2ABSTRACT
The aim of this study was to evaluate the fatigue property
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Heart Valve Prosthesis , Heart Valves , Materials Testing , Prosthesis Design , StentsABSTRACT
In the 42 nd and 44 th workshops of CSPEN-nutritional risk-undernutrition-support-outcome-cost effectiveness ratio (NUSOC) multi-center database collaboration group, Jens Kondrup and Henrik Rasmussen described again the application of NRS 2002, the evidence-based basis of NRS 2002 development and the methodology for prospective validation of clinical effectiveness. There is no gold standard for validation. They both considered that malnutrition could be identified as a score of 3 or more for impaired nutritional status in NRS 2002. Although NRS 2002 is simple and easy to be applied, it is not comprehensive enough for malnutrition diagnosis. ASPEN and ESPEN on-line published the Global Leadership (nutritional) Initiative on Malnutrition(GLIM)diagnosis criteria in September 2018. With the gradual implementation of medicare payment based on diagnosis related groups(DRG)in China, the nutritional risk and the malnutrition diagnosis with Chinese version of ICD-10 (2016) code should be recorded in the first page of the medical records. In this terminology interpretations, the terms of nutritional risk screening(NRS 2002.01.016)and malnutrition diagnosis (GLIM-phenotypic criteria 01.028, etiologic criteria 01.029) published in Parenteral and Enteral Nutrition Terminology 2019 are discussed based on the reports given by Kondrup and Rasmussen in Beijing and Zhengzhou.
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Background:Malnutrition is common in patients with cancer, whichadversely affectsthesurvival and quality of life ofcancer patients.However, there is no national data on the prevalence of malnutrition inChinese cancer patients. Thisstudy aims to evaluate the prevalenceof malnutrition and quality of life(QOL)ofChinese patients with localregional, recurrentor metastatic cancer,to address the prognostic value of nutritional status and QOLon the survival of cancer patients in China and to validate the patient-generated subjective global assessment (PG-SGA) questionnaire in Chinese cancer patients.Methods:Thisisanobservational,multi-centered,and hospital-based prospective cohort study.We aimed to recruit 50,000 cancer patients (age 18and above)overan 8-year period.Data collection will occur within 48hrafter patientsare admitted to hospital, 30-days after hospital admission, and the follow-up will be conducted1-8years after enrolment. The primary outcomeisoverall survival, and secondaryoutcomes arelength of hospital stay and hospital costs. Factors measured are demographic characteristics, tumor characteristics, anthropometry measurements,hematological measurement, body composition, PG-SGAscores,Karnofsky performance status scores,and QLQ C30 scores. This protocol wasapproved by local ethical committees of all the participant hospitals.Conclusions: This multi-centered, large-scale, long-time follow-up prospective study will help diagnose malnutrition in cancer patients in China, and identify the related risk factors associated with the negative outcomes. The anticipated results will highlight the need for a truly scientific appraisal of nutrition therapy, and help to improve outcomes among cancer patients in China.Trial Registration: The trial has been registered with the Chinese Clinical Trial Registry, ChiCTR1800020329. Registered on 19 December 2018
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It is well known that parenteral and enteral nutrition support is helpful to improve clinical outcomes in patients with malnutrition or nutritional risk, and surgical nutrition has been used in China for 40 years. However, there is still insufficient awareness of malnutrition among clinical workers. There were different opinions from many experts after the publications of the European Society for Parenteral and Enteral Nutrition (ESPEN) consensus of malnutrition assessment 2015 and ESPEN guidelines on definitions and terminology of clinical nutrition 2017. Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition has also been published in 2018. Though it is lack of clinical validation, it is a big step forward. In order to achieve better prevention and treatment of malnutrition in clinical work, this present paper analyzes and compares the core contents of malnutrition assessment (diagnosis) in recent years, proposes current practical strategy for Chinese clinical workers, emphasizes that GLIM criteria cannot replace the three steps named "screening-assessment-intervention" .
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Objective@#To explore the correlation between PICC optimal prediction length and height, body mass index, and provide a more accurate prediction method for PICC depth management.@*Methods@#A total of 100 patients with PICC catheterization in January 2018 were selected for self-controlled study, and two different in vitro measurement methods were used for the same patient at the same time.Traditionally, the Rountree method is used to obtain the predicted length from the puncture point to the right sternoclavicular joint and back down to the third intercostal space (A). This group of methods is used only for measurement and data recording as A control.The experimental measurement method adopted the modified method, that is, the length from the puncture point to the right sternoclavicular joint, plus the predicted length based on the pre-addition of 6-10cm according to the height and body mass index (B). This group of methods was applied to the actual catheterization.The ideal length of the catheter was determined by chest radiograph after catheterization (C).The length of the catheter is predicted by traditional Rountree methods (A) 42.0 ± 2.867cm, experimentally measured (B) 40.30± 2.435cm, and idealized (C)39.81± 2.411cm.Kruskal-wallis H test and analysis of three lengths of data A, B and C were performed, and the correlation between height, body mass index and PICC catheter length was compared through multiple linear regression analysis.@*Results@#the length predicted by the experimental method was closer to the ideal length (P=0.657), and the regression model had statistical significance, F(2,97) =36.931, P<0.01, and adjusted, R2=0.421. The included height and body mass index (BMI) were statistically significant in predicting ideal catheter length (P<0.05).@*Conclusions@#The length of the catheter was predicted from the puncture point to the right sternoclavicular joint plus 6-10cm according to the height and body mass index, which was closer to the ideal length.
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Objective To explore the correlation between PICC optimal prediction length and height, body mass index, and provide a more accurate prediction method for PICC depth management. Methods A total of 100 patients with PICC catheterization in January 2018 were selected for self_controlled study, and two different in vitro measurement methods were used for the same patient at the same time.Traditionally, the Rountree method is used to obtain the predicted length from the puncture point to the right sternoclavicular joint and back down to the third intercostal space (A). This group of methods is used only for measurement and data recording as A control.The experimental measurement method adopted the modified method, that is, the length from the puncture point to the right sternoclavicular joint, plus the predicted length based on the pre_addition of 6-10cm according to the height and body mass index (B). This group of methods was applied to the actual catheterization.The ideal length of the catheter was determined by chest radiograph after catheterization (C).The length of the catheter is predicted by traditional Rountree methods (A) 42.0 ± 2.867cm, experimentally measured (B) 40.30± 2.435cm, and idealized (C)39.81± 2.411cm.Kruskal_wallis H test and analysis of three lengths of data A, B and C were performed, and the correlation between height, body mass index and PICC catheter length was compared through multiple linear regression analysis. Results the length predicted by the experimental method was closer to the ideal length (P=0.657), and the regression model had statistical significance, F(2,97)=36.931, P<0.01, and adjusted, R2=0.421. The included height and body mass index (BMI) were statistically significant in predicting ideal catheter length (P<0.05). Conclusions The length of the catheter was predicted from the puncture point to the right sternoclavicular joint plus 6-10cm according to the height and body mass index, which was closer to the ideal length.
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Objective To investigate the prevalence of nutritional risk and malnutrition in hospitalized lung cancer patients in a tertiary A hospital in Chongqing.Methods From December 2013 to July 2017,2 735 consecutive lung cancer patients were admitted to the Department of Pneumology at Daping Hospital for planned anti-cancer treatment.Patients who did not complete a nutritional status assessment and who had repeated admission wcrc excluded from the study.The demographic and tumor characteristics were investigated in the 548 lung cancer inpatients who completed the study.The nutritional risk screening 2002 (NRS 2002) was used to evaluate the nutritional risk.The individual nutritional status was also evaluated using the patient-generated subjective global assessment (PG-SGA) questionnaire,anthropometry measurements and hematological measurements.The physical status was assessed by the Karnofsky performance status (KPS).Results According to the NRS 2002 score,29.56％ (162/548) of the cancer patients had nutritional risk (score ≥3).The prevalence of nutritional risk was 17.39％,15.00％,22.00％ and 36.86％,respectively,for patients with stage Ⅰ,Ⅱ,Ⅲ and Ⅳ lung cancer.Forty-four patients (9.67％) had a body mass index＜ 18.5 kg/m2 and poor general condition,and the prevalence was 6.52％,5.00％,8.67％ and 11.22％,respectively,for stages I,Ⅱ,Ⅲ and Ⅳ.A total of 107 cases (19.53％) had impaired nutritional status (indicated by a severity score of 3 in the NRS 2002).The prevalence by different stages was 10.87％ (stage Ⅰ),5.00％ (stage Ⅱ),14.67％ (stage Ⅲ) and 25.00％ (stage Ⅳ).One hundred and twenty-five patients (22.81％) had PG-SGA scores ≥ 9,with 2.19％,2.50％,12.67％,and 33.33％ of patients in stages Ⅰ,Ⅱ,Ⅲ and Ⅳ having these high scores.The KPS scores were lower in the patients with nutritional risk and malnutrition than in the patients with a normal nutritional status.Conclusions The prevalence of nutritional risk and malnutrition in patients with lung cancer were mediom.Nutritional risk screening and nutritional status assessment should be considered at the time of admission for lung cancer patients in order to ensure better outcomes of treatment.
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In order to improve the clinical outcomes and promote the development of enhanced recovery after surgery(ERAS),a full-time specialized role of nurse navigator(NN) was established in Department of Surgery in February,2016. Clinical pathway for ERAS was designed,and role functions,core competencies and responsibilities of NN were formulated. According to the functions and the working frame,NN connected and coordinated teamwork activities,monitored the implementation of ERAS during the overall process. After implementation,the NN had dealt with 10 unusual incidents,the execution efficiency of the 14(82.4%) measurements were 100%,1 measurement was 97%,2 measurements were 94.1%,and 33 patients and 42 medical staff thought highly of the NN. This practice effectively promoted the development of ERAS team and specialist nurse role in our hospital.
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Intestinal motility disorders,one of the common complications of critically ill patients,can be caused by a variety of diseases.It was reported that intestinal motility disorders could be improved by modulating the micro-ecological environment in the distal digestive cavity and by reducing the bacterial toxins,and thereby it provides a new reference strategy for the treatment of intestinal motility disorders.Dictary fiber has physiological functions such as accelerating colonic transition,regulating the intestinal microflora and protecting the intestinal mucosal barrier.Clinically,dietary fiber is used as an adjuvant therapy of intestinal motility disorders widely in critical illness,inflammatory bowel disease and diabetes.In order to explore the relationship between the application of dietary fiber and the improvement of intestinal motility disorders,we retrieved the Chinese and English databases and summarized sone recent literatures for providing new ideas for the prevention and treatment of intestinal motility disorders.
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Nutritional support therapy includes three main components:nutritional screening,nutritional assessment,and nutritional intervention.It is important to emphasize that nutritional screening and nutritional assessment are two different concepts and definitions,which are often confusing for many physicians,nurses,and dietitians.In this review,we present an overview on the main concepts about nutritional screening and nutritional assessment,highlight their features and complementarity,and discuss the future perspectives in the clinical practice.
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The information system of 301 Hospital One-Card service, was designed to enable outpatients to register online via mobile ends, pay in real-time, and hierarchical examination-diagnosis among other services. As the hospital HIS system cannot link to the Internet directly, the system could make use of the Internet application front end of China′s financial platform, and such means of 2D-barcodes and APP. This innovation could improve outpatient experience, keep confidential of medical information and patients′privacy, and change on-site registration to appointment in advance.
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Objective To probe into the lower limb pad with the functions of fracture-reduction and bed-belts using for the pre-operation patients of tibiofibular fracture. Methods A total of 60 tibiofibular fracturewere selected by using random number table method.and they were divided into experimental group and control group, 30 cases in each. The experimental group used the lower limb pad with the functions of fracture-reduction and bed-belts,and the control group used the common trapezoid lower limb pad;compareing the incidence of nursing adverse events in two group in one week,the skin condition around the fracture,the swelling, the comfort, the adjusting times of bone traction,and VAS. Results In the experimental group, the frequency of low-limb mat movement/calves falling and the frequency of the doctor adjusting the displacement of fractured ends were 0.00 (0.00-0.00) and 0.00 (0.00-0.00), respectively. Besides, corresponding frequency was 2.00 (0.00-4.00) and 2.00 (0.00-4.50) in the control group, the differences were statistically significant between groups (Z=-3.907,-3.248, P=0.009, 0.012). Furthermore, there was an obvious difference in the skin condition around the fracture between groups (χ2=16.525, P=0.001). Statistical difference was also found in the comparison of patient comfort score between groups (χ2=13.416, P=0.001). VAS score results showed that the score was (5.15 ± 1.451) points and (6.65 ± 2.45) points on the first day after traction in the experimental group and the control group, respectively, and the difference was statistically significant (t=-3.201, P<0.05). On the third day after traction, statistical difference was also found that the VAS score was (4.29 ± 1.66) points in the experimental group and (5.55±1.89) points in the control group (t=-2.964, P<0.05). However, no obvious statistical difference was observed between the experimental group and the control group on the fifth day [(3.22±1.32) points vs. (3.45±1.45) points, t=-1.538, P>0.05] and seventh day after traction [(3.25±1.13) points vs. (3.35±1.24) points, t=-1.177, P>0.05]. Conclusion The lower limb pad with the functions of fracture-reduction and bed-belts is able to maintain the best traction performance in tibiofibular fracture patients with skeletal traction through the calcaneum, which has significant efficacy in decreasing the incidence of low-limb mat movement/calves falling during preoperative traction, improving the comfort degree of patients, alleviating doctors′ workload, maintaining effective restoration, producing sustained detumescence, and reducing preoperative waiting time, etc.
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Objective To study the prevalence situation of chronic diseases among teachers from some middle and primary schools in Chongqing City.Methods The physical examination data of 6969 teachers in 52 middle and primary schools in a district of Chongqing major city were collected.The survey data of overweight,obesity,hyperlipidemia,osteoporosis,fatty liver and hyperuricemia were statistically analyzed.Results The total morbidity rates of overweight,obesity,hyperlipidemia,osteoporosis,fatty liver and hyperuricemia were 31.3 ％,7.5 ％,35.1％,34.7 ％,22.4 ％ and 22.2 ％ respectively.The incidence rates of above diseases had difference among the age periods of ≤44 year old,＞44 ＜60 years old and ≥60 year old (P＜0.05).The incidence rate was significantly increased with age increase (P＜0.05).The incidence rate of osteoporosis in females was higher than that in males(P＜ 0.01);while the incidence rate of fatty liver and hyperuricemia in males were higher that in females (P＜0.01).Conclusion The incidence of chronic diseases among teachers in middle and primary schools is worth attention.Therefore it is necessary to carry out the health education aiming at the teacher population characteristics,strengthen their heath management and behavior intervention for increasing their health level.
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Objective To probe into the lower limb pad with the functions of fracture-reduction and bed-belts using for the pre-operation patients of tibiofibular fracture. Methods A total of 60 tibiofibular fracturewere selected by using random number table method.and they were divided into experimental group and control group, 30 cases in each. The experimental group used the lower limb pad with the functions of fracture-reduction and bed-belts,and the control group used the common trapezoid lower limb pad;compareing the incidence of nursing adverse events in two group in one week,the skin condition around the fracture,the swelling, the comfort, the adjusting times of bone traction,and VAS. Results In the experimental group, the frequency of low-limb mat movement/calves falling and the frequency of the doctor adjusting the displacement of fractured ends were 0.00 (0.00-0.00) and 0.00 (0.00-0.00), respectively. Besides, corresponding frequency was 2.00 (0.00-4.00) and 2.00 (0.00-4.50) in the control group, the differences were statistically significant between groups (Z=-3.907,-3.248, P=0.009, 0.012). Furthermore, there was an obvious difference in the skin condition around the fracture between groups (χ2=16.525, P=0.001). Statistical difference was also found in the comparison of patient comfort score between groups (χ2=13.416, P=0.001). VAS score results showed that the score was (5.15 ± 1.451) points and (6.65 ± 2.45) points on the first day after traction in the experimental group and the control group, respectively, and the difference was statistically significant (t=-3.201, P<0.05). On the third day after traction, statistical difference was also found that the VAS score was (4.29 ± 1.66) points in the experimental group and (5.55±1.89) points in the control group (t=-2.964, P<0.05). However, no obvious statistical difference was observed between the experimental group and the control group on the fifth day [(3.22±1.32) points vs. (3.45±1.45) points, t=-1.538, P>0.05] and seventh day after traction [(3.25±1.13) points vs. (3.35±1.24) points, t=-1.177, P>0.05]. Conclusion The lower limb pad with the functions of fracture-reduction and bed-belts is able to maintain the best traction performance in tibiofibular fracture patients with skeletal traction through the calcaneum, which has significant efficacy in decreasing the incidence of low-limb mat movement/calves falling during preoperative traction, improving the comfort degree of patients, alleviating doctors′ workload, maintaining effective restoration, producing sustained detumescence, and reducing preoperative waiting time, etc.
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Objective To study the prevalence situation of chronic diseases among teachers from some middle and primary schools in Chongqing City.Methods The physical examination data of 6969 teachers in 52 middle and primary schools in a district of Chongqing major city were collected.The survey data of overweight,obesity,hyperlipidemia,osteoporosis,fatty liver and hyperuricemia were statistically analyzed.Results The total morbidity rates of overweight,obesity,hyperlipidemia,osteoporosis,fatty liver and hyperuricemia were 31.3 ％,7.5 ％,35.1％,34.7 ％,22.4 ％ and 22.2 ％ respectively.The incidence rates of above diseases had difference among the age periods of ≤44 year old,＞44 ＜60 years old and ≥60 year old (P＜0.05).The incidence rate was significantly increased with age increase (P＜0.05).The incidence rate of osteoporosis in females was higher than that in males(P＜ 0.01);while the incidence rate of fatty liver and hyperuricemia in males were higher that in females (P＜0.01).Conclusion The incidence of chronic diseases among teachers in middle and primary schools is worth attention.Therefore it is necessary to carry out the health education aiming at the teacher population characteristics,strengthen their heath management and behavior intervention for increasing their health level.
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Objective To observe the effect of reteplase on the thromboelastogram tracing of patients experiencing acute is-chemic stroke(AIS).Methods Selected 43 AIS inpatients in the Third People’s Hospital of Liaocheng from October,2013 to August,2015,who received reteplase less than 4.5 hours after the onset of syndrome of AIS.Blood samples were obtained before reteplase administration and at 0.5,1,2 and 4 hours after reteplase administration and measured by thromboelastogra-phy.Results The parameters R,K,Angle and MA of the thromboelastogram had changed after beginning administration of reteplase.The R value at 0.5 h after thrombolysis was significantly higher than that before thrombliysis,however,the R Value at 1h after thrombolysis was the most highest,and the K value.At 0.5 h after thrombolysis was the highest.At 0.5 h after thrombolysis MA and Angle values were the lowest,the differences were statistically significant (P<0.001).Conclu-sion The study suggests that the thromboelastogram is an useful tool for determining changes in the coagulation system of patients receiving reteplase.
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Aim To observe the analgesic effect of oxymatrine(OMT)and its mechanism.Methods A peripheral mononeuropathy was produced in adult mice by placing loosely constrictive ligatures around the common sciatic nerve.The antinociceptive effects of the OMT were assessed in mechanical allodynia and cold allodynia tests.The CAMKII inhibitor KN-93 and AIP were adopted to investigate the influence of OMT on the analgesic effect and analyze its analgesic mecha-nisms.Western blot was used to evaluate the expres-sions of tCaMKII and pCaMKII protein.Results The intraperitoneal administration of OMT (1 60,80 mg· kg -1 )increased the paw withdrawal threshold in the mechanical allodynia test (P <0.05 ),OMT (1 60, 80,40 mg·kg -1 ,ip)remarkably decreased the paw lifts in the cold allodynia test (P <0.05).Ith KN-93 (1 .25 μg/site),AIP (0.02 μg/site)significantly en-hanced the analgesic effect of OMT (35 mg·kg -1 ) (P <0.01 ).Protein expression of pCaMKII was de-creased by OMT(1 60 mg·kg -1 ).Conclusion OMT has significant protective effects on chronic constriction injury(CCI)in mice,and the effective mechanism of OMT inhibits the expression of CaMKII receptor.