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Objective:To explore the effect of quality improvement based on action research study to reduce unplanned interruption during continuous renal replacement therapy.Methods:From June 2020 to December 2021, 175 patients who were treated CRRT in SICU of Beijing Chaoyang Hospital Affiliated to Capital Medical University were selected as research objects. The objects were divided into control group, observation group 1 and observation group 2 according to the time of admission. Routine nursing was used in the control group (55 cases), the first cycle of plan-action-observation-reflection according to the problems of unplanned interruption was used in the observation group 1(62 cases), the quality improvement was carried out on the basis of the first cycle, and then formulated the second cycle used in the observation group 2(58 cases). The incidence of unplanned interruption of CRRT, the duration of hemofiltration line and the ability of nurses to prevent unplanned interruption of CRRT were compared before and after implementation.Results:The baseline data of CRRT patients in the three groups were comparable ( P>0.05). After cycle quality improvement, the alarm frequencies of unplanned interruption in the observation group 1 and 2 was (8.87 ± 2.66) times and (8.07 ± 2.80) times respectively, which was significant lower than the (12.04 ± 4.23) times in the control group ( t = 3.17 and 3.97, both P<0.01). The cases of coagulation filter≥Ⅱ in the observation group 1 and 2 were 25 cases and 20 cases, which were significant lower than the 32 cases in the control group ( χ2 = 3.72, 6.38, both P<0.05). The duration of blood purification line use was (15.04 ± 7.51) h and (18.16 ± 7.67) h in the observation group 1 and 2, which were significant better than the (11.75 ± 6.84) h in the control group ( t = 3.29 and 6.41, both P<0.01). The ability of nurse to prevent unplanned interruption of CRRT in the control group, the observation group 1 and 2 were (72.62 ± 6.03), (84.77 ± 5.59) and (89.64 ± 4.54), the difference was sigaificant ( F = 146.97, P<0.001). Conclusions:The application of action research study in CRRT quality improvement could reduce the occurrence of unplanned interruption of CRRT and related complications, prolong the use time of hemofiltration line, improve the therapeutic effect of CRRT, improve the quality of nursing, and is worthy of clinical promotion.
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Objective:To explore the effect of health education based on symptom management strategy on the psychological status, self-management ability and quality of life of maintenance hemodialysis patients.Methods:A randomized controlled trial method was used. One hundred and fifty hemodialysis maintenance patients in the Blood Purification Center, Jinan People's Hospital from August 2019 to August 2020, were selected as the research subjects by convenience sampling. Patients were divided into a control group and observation group by random number table method, with 75 cases in each group. The control group was given routine health education, and the observation group was given health education based on symptom management strategies. Self-rating Anxiety Scale (SAS), self-rating Depression Scale (SDS), self-management ability scale of dialysis patients, and SF-36 quality of life scale were used to compare the improvement of negative emotion, self-management ability, and quality of life in the two groups.Results:There was no statistically significant difference between the control group and the observation group before the intervention (all P>0.05). After 3 months of intervention, the SAS and SDS scores of the patients in the observation group were (36.42 ± 4.09) and (35.74 ± 3.64) respectively, which were lower than those of the control group (46.37 ± 4.64) and (49.38 ± 2.49). The difference was statistically significant ( t=8.46, 9.42, P<0.05); the self-management score of patients in the observation group (80.11 ± 7.83) was higher than that in the control group (47.21 ± 6.62), with a statistically significant difference ( t=32.29, P<0.05); the total score of SF-36 quality of life in the observation group (594.32 ± 35.03) was higher than that in the control group (501.42 ± 32.78),with a statistically significant difference ( t=24.66, P<0.05). Conclusions:Health education based on symptom management strategy can improve the psychological status of maintenance hemodialysis patients, and has important value in improving their self-management ability and quality of life.
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OBJECTIVE: To assess segmental liver stiffness (LS) with MRI before and after endovascular intervention in patients with Budd-Chiari syndrome (BCS). MATERIALS AND METHODS: Twenty-three patients (13 males and 10 females; mean age, 42.6 ± 12.6 years; age range, 31–56 years) with BCS as a primary liver disease were recruited for this study. Two consecutive magnetic resonance elastography (MRE) examinations were performed before the endovascular treatment. Fifteen patients who underwent endovascular intervention treatment also had follow-up MRE scans within three days after the procedure. LS was measured in three liver segments: the right posterior, right anterior, and left medial segments. Inter-reader and inter-exam repeatability were analyzed with intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Segmental LS and clinical characteristics before and after the intervention were also compared. RESULTS: Within three days of the endovascular intervention, all three segmental LS values decreased: LS of the right posterior segment = 7.23 ± 0.88 kPa (before) vs. 4.94 ± 0.84 kPa (after), LS of the right anterior segment = 7.30 ± 1.06 kPa (before) vs. 4.77 ± 0.85 kPa (after), and LS of the left medial segment = 7.22 ± 0.87 kPa (before) vs. 4.87 ± 0.72 kPa (after) (all p = 0.001). There was a significant correlation between LS changes and venous pressure gradient changes before and after treatments (r = 0.651, p = 0.009). The clinical manifestations of all 15 patients significantly improved after therapy. The MRE repeatability was excellent, with insignificant variations (inter-reader, ICC = 0.839–0.943: inter-examination, ICC = 0.765–0.869). Bland-Altman analysis confirmed excellent agreement (limits of agreement, 13.4–19.4%). CONCLUSION: Segmental LS measured by MRE is a promising repeatable quantitative biomarker for monitoring the treatment response to minimally invasive endovascular intervention in patients with BCS.
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Female , Humans , Male , Budd-Chiari Syndrome , Elasticity Imaging Techniques , Follow-Up Studies , Liver Diseases , Liver , Magnetic Resonance Imaging , Venous PressureABSTRACT
Objective@#To investigate the status of fatigue in maintenance hemodialysis (MHD) patients, analyze the correlation between fatigue and uncertainty and hope, and establish a multiple regression model to discuss the dependence between fatigue and uncertainty and hope situation in MHD Patients.@*Methods@#A convenient sampling method was used to select 150 patients with renal failure who were treated with MHD in the hemodialysis center of a third-class general hospital in Tianjin from June to September, 2018. The demographic data and disease data of the patients were collected with self-designed general data questionnaire. The patients were assessed with Piper Fatigue Revision Scale, Disease Uncertainty Scale and Herth Hope Scale.@*Results@#The results showed that the total fatigue score of MHD patients was 4.37 ± 1.17, belonging to the moderate level, with the highest score (4.95±1.35) in behavioral dimension, and the lowest score (3.48 ± 1.37) in cognitive dimension. The results showed that the score of fatigue were different in MHD patients of different ages, marital status, educational level, work status, primary disease, and the number of complications (P<0.05). The results of correlation analysis showed that the score of fatigue in MHD patients was positively correlated with the total score of uncertainty and its dimensions (r = 0.231-0.634, P<0.05). The fatigue level of MHD patients was negatively correlated with the total score of hope and its dimensions (r=-0.608- -0.323, P<0.05). Multiple linear regression showed that the independent variables entering the regression equation included marital status, number of complications, disease uncertainty and hope level score. And the determination coefficient R2 was 0.530,the adjusted determination coefficient was 0.501, F=18.454, P=0.000, which had statistical significance.@*Conclusions@#The fatigue level of MHD patients is moderate, and the score of fatigue in behavioral dimension is the highest, which is influenced by age, marital status, education, work condition, primary disease and the number of complications. The level of fatigue in MHD patients was positively correlated with disease uncertainty and its dimensions, and negatively correlated with the level of hope and its dimensions.
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Objective To investigate the status of fatigue in maintenance hemodialysis (MHD) patients, analyze the correlation between fatigue and uncertainty and hope, and establish a multiple regression model to discuss the dependence between fatigue and uncertainty and hope situation in MHD Patients. Methods A convenient sampling method was used to select 150 patients with renal failure who were treated with MHD in the hemodialysis center of a third-class general hospital in Tianjin from June to September, 2018. The demographic data and disease data of the patients were collected with self-designed general data questionnaire. The patients were assessed with Piper Fatigue Revision Scale, Disease Uncertainty Scale and Herth Hope Scale. Results The results showed that the total fatigue score of MHD patients was 4.37 ± 1.17, belonging to the moderate level, with the highest score (4.95 ± 1.35) in behavioral dimension, and the lowest score (3.48 ± 1.37) in cognitive dimension. The results showed that the score of fatigue were different in MHD patients of different ages, marital status, educational level, work status, primary disease, and the number of complications (P＜0.05). The results of correlation analysis showed that the score of fatigue in MHD patients was positively correlated with the total score of uncertainty and its dimensions (r = 0.231-0.634, P＜0.05). The fatigue level of MHD patients was negatively correlated with the total score of hope and its dimensions (r =- 0.608- - 0.323, P＜0.05).Multiple linear regression showed that the independent variables entering the regression equation included marital status, number of complications, disease uncertainty and hope level score. And the determination coefficient R2 was 0.530,the adjusted determination coefficient was 0.501, F=18.454, P=0.000, which had statistical significance. Conclusions The fatigue level of MHD patients is moderate, and the score of fatigue in behavioral dimension is the highest, which is influenced by age, marital status, education, work condition, primary disease and the number of complications. The level of fatigue in MHD patients was positively correlated with disease uncertainty and its dimensions, and negatively correlated with the level of hope and its dimensions.
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Objective To investigate the clinical value of 2 dimension late Gadolinium enhancement MRI (LGE-MRI) technique for the evaluation of atrial myocardial fibrosis in patients with atrial fibrillation. Methods Forty-nine cases of atrial fibrillation in our hospital from March 2015 to December 2016 were retrospectively collected. The LGE-MR was acquired by the Siemens 3.0 T MR machine before the catheter ablation.The findings of LGE-MR were evaluated by two experienced doctors. The left atrium(LA)were manually segmented into 8 regions in axial view.All patients were classified into 4 stages based on the extent of enhancement, stage 0: absence of enhancement, stage Ⅰ: enhancement appeared in minimal two consecutive slices in single region,stageⅡ:enhancement in two regions,stageⅢ:enhancement in three or more regions. All electroanatomic maps were obtained after electrical conversion during catheter ablation. The Kappa test was used to assess the consistency of LGE-MRI left atrial myocardial fibrosis and CARTO system of the left atrial endocardial voltage reconstruction. Results Forty-nine cases of atrial fibrillation with LGE-MRI and CARTO were included. There were 17 cases of atrial fibrosis stage 0,10 cases of stageⅠ,11 cases of stageⅡ,11 cases of stageⅢaccording to LGE-MRI findings;There were 17 cases of atrial fibrosis stage 0,19 cases of stageⅠ,12 cases of stageⅡ,11 cases of stage Ⅲ with reference to CARTO findings. The diagnostic accuracy of the LGE-MRI atrial fibrosis was 81.6%(40/49),of which the correlation was good(Kappa= 0.751,P<0.001). Conclusions LGE-MRI can accurately assess the degree of left atrial myocardial fibrosis in patients with atrial fibrillation,help to select the proper candidate and strategy in catheter ablation.
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Nursing risk management is an important part of nursing management and of great significance to improve patient safety and nursing quality. This article summarized systematically current studies and effects of nursing risk management in ICU. Besides, this paper provided strategies about nursing risk management of ICU combined with the development of foreign nursing risk management so as to provide nursing risk early warning,avoid nursing risk and decrease the incidences of nursing risks and accidents.
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Objective To investigate the status of undergraduates′ sub-health and explore the relationship between personality traits and sub-health and the mediating role of self-harmony. Methods A total of 196 undergraduate nursing students in Tianjin University of Traditional Chinese Medicine were investigated by Sub-health Self-rating Scale (SSS), Self Consistency and Congruence Scale (SCCS) and Eysenck Personality Questionnaire Short Scale. Results The the total scores of the undergraduate nursing students′personality traits, self-harmony and sub-health were 22.71±4.90, 102.74±14.41, 182.54± 31.76. The neuroticism and extroversion of personality traits were significantly correlated with self-harmony and sub-health (P<0.01). Neuroticism had a significant prediction on self-harmony (β=0.37, P<0.01) and sub-health (β=-0.64, P<0.01), after controlling self-harmony, the prediction on sub-health was reduced, but still significant (β=-0.56, P<0.01);extroversion had a significant prediction on self-harmony (β=-0.27, P<0.01) and sub-health (β=0.54, P<0.01), after controlling self-harmony, the prediction on sub-health was reduced, but still significant (β=0.46, P < 0.01). Conclusions The sub-health status of undergraduate nursing students was not optimistic. Nursing students′ personality traits of psychoticism, extroversion, which directly impact on the health status, and through self-harmony indirectly affect their health level, self-harmony played a intermediary role between personality traits and sub-health.
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Objective To explore the effect of gender on the concentration of D-dimer between the healthy and the patients with aortic dissection.Methods From January 2015 to January 2016,53 patients with aortic dissection were treated in a hospital and 50 patients of health control group were matched by age,Sysmex CS5100 was used to detect the concentration of D-dimer in the selected population,and the results were analyzed statistically.Results In the same age group,the concentration of D-dimer in healthy control group female was higher than that in male,difference was statistically significant (t=5.357,P<0.05);The concentration of D-dimer in male patients with aortic dissection group was higher than that of female patients,difference was statistically significant(t=-2.041,P<0.05).The concentration of D-dimer in patients with aortic dissection group was higher than that of the healthy control group,difference was statistically significant(t=5.757,P<0.05).Conclusion The concentration of D-dimer between healthy adults and patients with aortic dissection exist gender differences,and it has a certain correlation.