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Objective To explore the effectiveness of Team Strategies & Tools to Enhance Performance and Patient Safety (TeamSTEPPS) in reducing hyperphosphatemia of outpatients on maintenance hemodialysis.Methods A total of 56 outpatients on hemodialysis received traditional dietary management from April to June,2016 were as control group,and 60 patients from October to December,2016 with TeamSTEPPS implemented in hyperphosphatemic dietary management were as observation group.The difference of the incidence rate of hyperphosphatemia and hypoproteinemia,grasp of knowledge of hyperphosphatemic dietary management were compared between two groups and medical staffs.Results The incidence rate of hyperphosphatemia were dropped from 60.7％(34/56) in control group to 41.7％(25/60) in observation group,difference between two groups had statistical significance(x2=4.20,P=0.036).The hypoproteinemia had no statistical difference between two group(x2=2.72,P=0.102),but still dropped from 39.3％ (22/56) in control group to 25.0％ (15/60) in observation group.Grasp of knowledge of hyperphosphatemic dietary management were rised from (75.1±5.1) points and (69.7 ±6.4)points in control group and medical staffs to (88.4±2.6) points and (80.1±6.5) points in observation group and medical staffs respectively,and there were significant differences(t=15.82,-8.84,P=0.00).Conclusions The application of TeamSTEPPS for hyperphosphatemic dietary management in outpatients on maintenance hemodialysis can effectively decrease the incidence of the hyperphosphatemia.
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Objective To explore the relationship between the CT phenotypes of the inner ear and pathogenic mutations of SLC26A4,and analyze the feasibility of using the method of gene sequence analysis to help CT examination in diagnosing part of patients related to vestibular aqueduct malformation with sensorineural hearing loss.Methods A retrospective review of CT findings relating to 2 705 cases of outpatients was carried out.The inner ear malformations diagnosed by CT were classified according to the methods proposed by Sennaroglu 2010.The DNA sequence of SLC26A4 was analyzed in those patients to explore the relationship between the CT phenotypes and the pathogenic mutations of SLC26A4.Results A total of 826 cases of the inner ear malformations were found in 2 705 cases of patients with sensorineural hearing loss by CT examination.The 446 cases of cochlear malformation consisted of the follow types:5 cases of Michel deformity,12 cases of cochlear aplasia,6 cases of common cavity deformity,34 cases of cochlear hypoplasia (CH-Ⅰ type was 9 cases,CH-Ⅱ type was 8 cases and CH-Ⅲ type was 17 cases),389 cases of cochlear incomplete partition (22 cases of IP-Ⅰ type,352 cases of IP-Ⅱ type,15 cases of IP-Ⅲ type).The 380 cases of non-cochlea malformation consisted of the follow types:340 cases of large vestibular aqueduct,40 cases of simple vestibular/semicircular canal/internal auditory canal malformation,and 1 879 normal cases.The DNA sequence results revealed that 517 cases carried pathogenic mutations (B i-allelic mutations) of SLC26A4,among which 164 cases were homozygous and 353 cases were compound heterozygous.Pathogenic mutations of SLC26A4 detected 100 ％ (517/517) in the group related to vestibular aqueduct malformation and the positive rate was 74.71 ％ (517/692).Conclusion The results suggested that pathogenic mutations of SLC26A4 were closely related to the CT phenotypes of vestibular aqueduct malformation.An analysis of SLC26A4 can help CT examination to diagnose part of patients related to vestibular aqueduct malformation with sensorineural hearing loss.
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Objective To investigate the clinical effect of a new type of disposable heparin freedialysis tube in uremic patients without heparin dialysis. Methods A total of 110 patients withoutheparin dialysis were divided into control group and observation group by random digits table method with55 cases each. Based on the same pre dialysis and dialysis for heparin saline flushing of discontinuoussaline on the control group using the traditional dialysis pipe for hemodialysis without heparin, theobservation group used disposable non heparin dialysis pipe for hemodialysis without heparin. The numberof patients with venous catheter blockage, blood loss and completion of dialysis time in two groups wasrecorded. Results The number of patients with venous catheter blockage, blood loss and completion ofdialysis time was 6, 6, 47 cases in control group and 0, 0, 54 cases in observation group. The differences were statistically significant (χ2=4.407, 4.407, 4.356, P<0.05). Conclusions The new disposableheparin free dialysis tube can reduce the loss of blood and prolong the treatment time, and the operation issimple, safe and effective, and has good application value and application prospect.
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Objective To design and investigate the clinical effects of parallel double venous pots hemodialysis tubing set in patients with heparin-free hemodialysis.Methods Totally 120 patients who received hemodialysis therapy in our hospital from May,2014 to June,2016 were randomly divided into the experimental group (n=60) and the control group(n=60) via random number table.The experimental group received self-designed parallel double venous pots dialysis tubing set,while the control group received the normal dialysis tubing set.The number of preventive replacement of dialyzer and tubing set during heparin-free dialysis,the number of discarded tubing set due to coagulation and the time frame for the first tubing set were recoded from two groups.Results There were statistically significant differences in the number of discarded tubing set due to coagulation and the time frame for the first tubing between two groups(P＜0.05).Conclusion Parallel double venous pots dialysis tubing set can reduce the number of discarded tubing set due to coagulation,prolong the time frame for the first tubing.
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Objective To study sensorineural hearing loss classification and incidence of inner ear malformations based on the image of high-resolution computed tomography.Methods The investigation took the form of a retrospective review of CT findings relating to the 5 398 ears of outpatients in the general PLA hospital in the last 10 years.The inner ear malformations diagnosed by CT were classified according to the methods proposed by Sennaroglu's 2010.Results A total of 1 640 ears of inner ear malformations were found in 5 398 ears with sensorineural hearing loss by CT examination.The incidence of the inner ear malformation was 30.38% (1 640/5 398).The epidemiological information of 1 660 ears of inner ear malformation according to Sennaroglu's classification was as follows: cochlea information was 53.66%(880/1 640)and non-cochlea information was 46.34%(760/1 640)of the group.Eight hundred and eighty ears of cochlea malformation consisted of these types: 5 ear of Michel deformity, 23 cochlea of aplasia, 6 common cavity deformity, 69 cochlea of hypoplasia with 19 CH-I , 16 CH-II, and 34 CH-III, 777 cochlea incomplete partition with 44 IP-I , 703 IP-II and 30 IP-III.Seven hundred and sixty ears of non-cochlea malformation consisted of 680 large vestibular aqueducts, 80 simple vestibular/ semicircular canal/ internal auditory canal malformations.IP-II type and large vestibular aqueduct were related to the vestibular aqueduct malformation, making up 84.33%(1 383/1 640)ears of the whole malformation group.Conclusion The results suggest that 30.38% inner ear malformation can be found in ears with sensorineural hearing loss,higher than reported based on the image of high-resolution computed tomography.Sennaroglu's 2010 classifications have instructive significance in investigating the status of inner ear malformations.
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Teamwork impacts the effectiveness of care, patient safety and clinical outcomes, and team training has been identified as a strategy for enhancing teamwork, reducing medical errors and building a culture of safety in healthcare. The paper reviewed the concept, construct, training model, measures and implementation in healthcare of team strategies and tools to enhance performance and patient safety (TeamSTEPPS) which was the most widely applied team training strategy, in order to provide reference for the healthcare in China.
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Objective To evaluate the efficacy of modified arytenoid adduction in the management of patients with unilateral vocal fold paralysis(UVFP).Methods A retrospective review was performed on 22 patients who underwent modified arytenoid adduction for UVFP between February 2001 and December 2007.Pre-,and 3 months postoperative aspiration,perceptual(GRBAS),acoustic data(fundamental frequency,F_0,fundamental frequency perturbation,jitter,amplitude perturbation,shimmer,normalized noise energy,NNE)and aerodynamic(maximal phonatory time,MPT,mean airflow rate,MFR)were analyzed statistically.Results The ratings of postoperative aspiration were significantly decreased than that of the preoperation(P<0.0001).There was a significant decrease in GRBAS scales postoperatively versus preoperatively(P<0.0001).The mean values of voice acoustics parameters (F_0,jitter,shimmer,NNE)were significantly decreased,the maximum phonation time were significantly longer,and the mean airflow rate were significantly decreased after operation than that of the preoperation(P<0.001).Conclusion Modified arytenoid adduction is an effective medialization technique that can restore satisfactory speech and prevent aspiration in patients with UVFP.
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OBJECTIVE To study the therapeutic effect of arytenoid within-shift combining with recurrentlaryngeal nerve (RLN) anastomosis to ansa cervicalis for patients with long-term unilateral vocal cord paralysis (UVCP) . METHODS Twelve patients with traumatic RLNs paralysis were studied. The courses of injury varied from 3 to 22 years. RLN was anastomosed to ansa cervicalis and arytenoid was within-shifted on ipsilateral side in all patients. Therapeutic efficacy was evaluated by laryngoscope, strobe-laryngoscope, voice evaluation, voice acoustics parameter analysis, and laryngeal electromyography (LEMG) . RESULTS The voice was improved in all cases after arytenoid within-shift immediately. The mean values of voice acoustics parameters (jitter, shimmer, NNE) were significantly smaller and maximum phonation time (MPT) were significantly longer after operation compared with those of before treatment. Laryngoscope showed that arytenoid was significantly within-shifted. The glottic posterior chink vanished in 9 cases and reduced in 3 cases. The voice resumed normal, obviously improved, improved and no improved were found in 9、 3、0、0 cases respectively 12 months after operation. The mass and tension of all treated vocal cords may become the same as the contralateral normal vocal cords, thus resuming symmetric vibration of the vocal cords. The reinnervation of the RLNs were approved by LEMG in these patients whose RLNs were restored. CONCLUSION Arytenoid within-shift combining with RLN anastomosis to ansa cervical can restored normal voice in patients with long-term UVCP.