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Objective:To understand the current status of the evidence-based practice program of physical restraint in ICU patients and analyze its influencing factors, formulate and implement an action plan for continuous application of the program, so as to improve the knowledge level and evidence-based nursing ability of nurses, promote the improvement of patient outcomes, and strengthen the organization′s evidence-based cultural atmosphere.Methods:This study selected the program application departments of China Japan Friendship Hospital Surgical ICU as the research object, including all nurses, patients, nursing process, department standard system, etc. To understand the status and influencing factors of the project through observation and interview methods. The "Optimized Version of Evidence-based Practice Program of Physical Restraint in ICU Patients" was formulated and implemented, and a before-and-after comparative study method was used to comprehensively evaluate the implementation effect from the level of patients, nurses and organization.Results:The implementation rate of the 7 review standards of the program application department showed a downward trend; the patient restraint rate and restraint duration increased compared with the previous period; after the implementation of the optimized version program, the implementation of each item had been improved; the physical restraint rate decreased from 34.91% (37/106) before optimization to 28.57% (8/28) ( χ 2 value was 0.40, P>0.05), and the time of physical restraint decreased from 60.93 hours before optimization to 48.09 hours after optimization ( Z value was -0.19, P>0.05). Conclusions:The continuous application of the evidence-based practice project of physical restraint in ICU patients was not very optimistic. The continuity of implementation was affected by many factors. The continuous quality improvement of this evidence-based practice project can promote the improvement of the standard of physical restraint of patients, improve the quality of life of patients, promote the improvement of nurses' knowledge level and the improvement of evidence-based nursing ability; at the same time, it created a better organization′s evidence-based cultural atmosphere.
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Objective:To explore the effect of evidence-based physical restraint practice in ICU patients based on the best evidence.Methods:Based on the previous studies of evidence- based nursing program of physical restraint in ICU patients, the nurses were trained, and the evidences were introduced into clinical application and the effect of program application on nurse level, patient level and organization system were evaluated. Results:The body restraint duration of ICU patients in the contrd group was 41 (14.25, 166.50) h, and the body restraint duration of intervention group was 37(16.75,107.50) h, the difference was statistically significant ( Z value was 1.71, P<0.05). The level of physical restraint knowledge, attitude, behavior and total scores of ICU nurses increased from (12.30±1.73), (33.69±3.80), (45.19±10.56), (91.17±13.38) before implementation to (13.37±2.07), (36.81 ±3.61), (49.17±4.98), (98.08±6.11) after implementation. The differences in attitude, behavior and total scores were statistically significant ( t values were 4.05, 0.96, 2.44, P<0.05).At the organizational system level, after the application of the program, the related procedures, norms, assessment tools, nursing record sheets, restraint tools, training materials courses and so on were improved in the department. Conclusions:By introducing the best evidence of physical restraint into clinical application, it can guide nurses to use physical restraint more scientifically and standardize physical restraint behavior.At the same time, it can reduce the use of physical constraints to a certain extent, reduce the rate of physical restraints, shorten the average length of restraint, and improve the flow system related to physical restraints, so as to provide reference for the implementation of physical restraints.
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Acute-on-chronic liver failure (ACLF) is a syndrome characterized by multiple organ failure and high short-term mortality rate, and it has always been a research hotspot in the field of severe liver diseases. Therefore, early and accurate risk stratification and timely intervention are of great significance to improve prognosis. This article summarizes the serum biomarkers identified in recent years for evaluating the prognosis of patients with ACLF, and it is pointed out that new serum biomarkers have an important guiding significance in the prognostic evaluation of ACLF patients.
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Objective To investigate the effect of Danhong injection combined with edaravone in the treatment of patients with acute cerebral infarction,and its influence on cytokines,cerebral hemodynamics and vascular endothelial function.Methods From March 2018 to March 2019,142 patients with acute cerebral infarction treated in the People's Hospital of Yuhuan were randomly divided into treatment group and control group according to the digital table,with 71 cases in each group.The treatment group was treated with Danhong injection combined with edaravone,while the control group was only treated with edaravone.Both two groups were treated for 2 weeks.The therapeutic effects,changes of cytokines,cerebral hemodynamics,vascular endothelial function,activity of daily living index(Barthel index) and neurological deficit score(NIHSS score) before and after treatment were compared between the two groups.Results The total effective rate of the treatment group was 90.14％ (64/71),which was higher than 74.65％ (53/71) of the control group,the difference was statistically significant(x2 =5.874,P ＜ 0.05).After treatment,the serum levels of CRP [(5.43 ± 1.20) mg/L] and IL-6 [(32.15 ± 7.39) ng/L] in the treatment group were lower than those in the control group [(9.38 ± 1.74) mg/L and (67.43 ± 10.29) ng/L] (t =15.747,23.465,all P ＜0.05).After treatment,the Vp [(69.83 ± 3.24) v ·-1 · s-1] and Vm [(35.24 ± 2.10) v ·-1 · s-1] in the treatment group were higher than those in the control group [(63.81 ± 2.68) v ·-1 · s-1 and (32.18 ± 1.73) v ·-1s-1],while the PI in the treatment group [(0.72 ± 0.04)] was lower than that in the control group [(0.83 ±0.07)],the differences were statistically significant (t =12.064,9.477,11.497,all P ＜ 0.05).After treatment,the serum level of ET-1 [(60.17 ± 5.46) mg/L] in the treatment group was lower than that in the control group[(73.21 ±6.78)mg/L],while the NO level in the treatment group[(72.15 ±7.39) ng/L] was higher than that in the control group [(61.43 ± 10.29) ng/L],the differences were statistically significant (t =12.622,7.130,all P ＜0.05).After treatment,the Barthel index score of the treatment group [(68.93 ± 7.83) points] was higher than that of the control group [(54.57 ± 7.38)points],while the NIHSS score of the treatment group [(9.34 ± 1.97)points] was lower than that of the control group [(14.54 ± 2.89) points],the differences were statistically significant (t =11.246,12.528,all P ＜ 0.05).Conclusion Danhong injection combined with edaravone in the treatment of acute cerebral infarction is effective,which can alleviate inflammation and improve cerebral hemodynamics and vascular endothelial dysfunction.
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Objective:To standard the behavior of clinical physical restraint and reduce the rate of physical restraint.Methods:Evidence-based method was used to screen the clinical practice guide of physical restraint, and the recommendations were integrated and the clinical applicability was evaluated. The nursing scheme of physical restraint evidence-based practice for ICU patients was constructed through group discussion, and 12 experts were consulted by Delphi method for 2 rounds of correspondence.Results:Included 2 high quality guidelines, integrated the recommendations and evaluated the clinical applicability, and then summarized them into 11 recommendations on three major topics: practical recommendation, educational recommendation and organizational recommendation. Constructed nursing programs including physical restraint implementation process, treatment relationship, physical restraint evaluation, physical restraint dynamic monitoring, restraint substitution method and so on. The enthusiasm of experts was 100%, the authority coefficient was 0.87. The expert acceptance rate was 0.75-1, and the coefficient of variation of expert letter was 0.14-0.26.Conclusions:The construction process of evidence-based nursing scheme for ICU patients with physical restraint is rigorous and the results are reliable, which can be used to guide and standardize the implementation and nursing of physical restraint for ICU patients in clinic.
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OBJECTIVE@#To investigate the phylogenetics and prevalence of bloodstream infections with ST131, the antimicrobial resistance profiles of the pathogens, and the clinical features.@*METHODS@#Non-duplicate isolates were collected from 144 patients with bloodstream infections in our hospital between January and December, 2016.The phylogenetic groups of the isolates were analyzed using multiplex PCR, and O serotyping of ST131 strains was performed by allele-specific PCR.The clinical characteristics of the 144 patients were analyzed to define the differences in the clinical features between patients with ST131 infection and those with non-ST131 infection.Antibiotic susceptibility of the isolates was determined using the Vitek 2 compact system.@*RESULTS@#The phylogenetic group analysis showed a domination by group B2 (41.0%[59/144]), followed by group F, group B1 and group E, which accounted for 16.7%(24/144), 13.9%(20/144), and 13.2% (19/144), respectively.Nine strains (6.3%) of were identified to be ST131 strains, among which 8 were O25b-B2-ST131 strains and 1 was O16-B2-ST131 strain.Of the 9 cases of ST131 infection, 7(77.8%) were found to occur in a nosocomial setting.The demographic characteristics and clinical features of the ST131-infected patients were similar to those of non-ST131-infected patients.ST131 strains were sensitive to piperacillin/tazobactam, imipenem, ertapenem, and amikacin, but showed high resistance rates to cefazolin, ceftriaxone, ciprofloxacin, levofloxacin, gentamicin, and trimethoprim/ sulfamethoxazole (all over 50%).The positivity rate of ESBLs in the ST131 strains was 77.8%, and the multidrug resistance rate reached 88.9%, which was higher than that of non-ST131 isolates, but the difference was not statistically significant.@*CONCLUSIONS@#The most common phylogenetic groups of isolates from patients with bloodstream infections are group B2 and F, and the positivity rate of ST131 is low.We for the first time detected O16-ST131 in patients with blood-borne infections in China.The clinical features of ST131-infected patients are similar to those of non-ST131-infected patients.The positivity rate of ESBLs and the multidrug resistance rate are high in ST131 strains, which may raise concerns in the future.
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Humans , Anti-Bacterial Agents , Therapeutic Uses , Bacteremia , Drug Therapy , Epidemiology , Microbiology , China , Drug Resistance, Bacterial , Escherichia coli , Classification , Genetics , Escherichia coli Infections , Drug Therapy , Epidemiology , Microbiology , Genotype , Microbial Sensitivity Tests , Molecular Epidemiology , Phylogeny , Species SpecificityABSTRACT
Objective To understand the distribution and antimicrobial resistance of pathogenic bacteria isolated from patients in the department of infectious diseases in Xiangya Hospital.Methods The distribution and antimicrobial susceptibility testing results of pathogenic bacteria isolated from patients in this department in 2011 -2015 were analyzed retrospectively.Results A total of 560 strains were isolated during 5 years,of which gram-posi-tive bacteria and gram-negative bacteria accounted for 44.1 % (n =247)and 55.9%(n =313)respectively.69.8%(81/116)of coagulase-negative staphylococcus and 24.3%(9/37)of Staphylococcus aureus were methicillin-resistant (MRCNS,MRSA)respectively.Enterococcus was highly susceptible to vancomycin,linezolid,and phosphonomy-cin (>81 %).Enterobacteriaceae remained highly susceptible to carbapenems (88.9%-100.0%),and was suscep-tible to amikacin,cefoperazone/sulbactam,and piperacillin/tazobactam (>84%).Acinetobacter baumannii was the major isolated multidrug-resistant organism (MDRO),isolation rate of imipenem-resistant Acinetobacter baumannii increased from 50.0% in 2011 to 77.8% in 2015,its resistance rate to imipenem was 64.9%.Conclusion The majority of clinically isolated pathogenic bacteria from this department is gram-negative bacilli,and detection rate of MDROs showed an upward trend;antimicrobial agents should be chosen according to distribution and antimicrobial resistance of pathogenic bacteria.
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Objective To investigate the distribution and change in antimicrobial resistance of pathogens causing blood-stream infection,so as to provide reference for rational antimicrobial use.Methods The isolation and antimicrobial resistance of major pathogens from blood culture specimens from a tertiary first-class hospital in 2012-2015 were analyzed statistically.Results A total of 4 780 isolates were detected,the top five species were Escherichia coli (n = 1 008, 21.09%),Klebsiella pneumoniae (n = 624,13.05%),Acinetobacter baumannii (n = 452,9.46%),Staphylococcus aureus (n=437,9.14%),and Pseudomonas aeruginosa (n=247,5.17%).The percentage of gram-negative bacilli, gram-positive cocci,fungi,and others were 62.05%,29.31%,7.76%,and 0.88% respectively.The resistance rates of Klebsiella pneumoniae to ertapenem and imipenem increased from 4.50% in 2012 to 46.79% and 33.94% in 2015(both P<0.01).The resistance rates of Acinetobacter baumannii to cefepime,ceftazidime,tobramycin,gentamicin,and imipenem were 86.50%,80.56%,78.10%,79.87%,and 84.29% respectively;resistance rates to amikacin in 2012-2015 were 0, 10.22%,39.85%,and 21.30% respectively(P<0.01);resistance rates to minocycline in four years were 0-7.52% (P<0.01 ).Conclusion The main pathogens causing bloodstream infection are gram-negative bacilli,Acinetobacter baumannii is highly resistant to cephalosporins and carbapenems,resistance rates of Klebsiella pneumoniae to carbapenems increased rapidly.Broad-spectrum antimicrobial agents must be used cautiously to reduce the selective pressure of antimicrobial agents.
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Objective To investigate the current status of self-efficacy and care ability among stroke patients′ family caregivers and explore the correlation between them. Method A total of 79 stroke patients and family caregivers were engaged in the investigation by demographical data questionnaires, general self-efficacy scale and questionnaire for assessing the comprehensive care-giving ability of stroke caregivers. Results The score on self-efficacy of the family caregiver was (27.16 ± 5.64) and the total score on care ability was (90.01 ± 16.57). There was a positive correlation between self-efficacy and care ability of family caregivers(P<0.05). Conclusions The self-efficacy and care ability of stroke patient′s family caregivers are at middle level. Their self-efficacy is positively correlated with their care ability. The nurses can improve the ability of daily caring of family caregivers by enhancing their self-efficacy.
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Objective To understand clinical distribution and antimicrobial resistance of clinically isolated Serratia marcescens(S .marcescens ),and provide basis for rational use of antimicrobial agents,as well as prevention and control of infection.Methods 427 S .marcescens strains isolated between January 1 ,2012 and December 31 ,2015 were analyzed,antimicrobial susceptibility testing were performed by disk diffusion method.Results 427 S . marcescens strains were mainly from respiratory tract (70.26%),among which the majority were from sputum (64.87%).S .marcescens were primarily from intensive care unit(ICU,19.44%),department of integrated tradi-tional Chinese and Western medicine(15.46%)as well as rehabilitation department (13.58%).The resistance rates of S .marcescens to cefoperazone/sulbactam,ertapenem,cefepime,ceftazidime,amikacin,imipenem,levofloxacin, and piperacillin/tazobactam were all<10%;resistance rates to ciprofloxacin,gentamicin,tobramycin,ceftriaxone, sulfamethoxazole/trimethoprim (SMZ/TMP),and aztreonam were 10%-30%.Difference in the resistance rates of S .marcescens to cefoperazone/sulbactam,ciprofloxacin,ceftriaxone,amikacin,aztreonam,and SMZ/TMP dur-ing 4 years were statistically significant (P <0.05).In 2012-2013,resistance rates of S .marcescens to cefopera-zone/sulbactam,ciprofloxacin,ceftriaxone,aztreonam,and SMZ/TMP increased obviously,then resistance rates tend to be stable,while resistance rates to cefoperazone/sulbactam decreased.Conclusion Susceptibility of S.marcescens to most antimicrobial agents are high,but resistance had increasing tendency;susceptible rates of S .marcescens to ertapenem,ceftazidime,levofloxacin,and piperacillin/tazobactam are all high,and can be used as the empirical medication for the treatment of related infection.
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Objective To analyze strains of Proteus mirabilis (P .mirabilis )and Proteus vulgaris (P .vulgaris ) isolated in a hospital,detect resistance to commonly used antimicrobial agents,and provide reference for rational ap-plication of antimicrobial agents in clinic.Methods 172 P .mirabilis isolates and 68 P .vulgaris isolates isolated between January 1 ,2011 and June 30,2013 were analyzed,antimicrobial resistance susceptibility testing were per-formed by disk diffusion method,data were analyzed with WHONET 5.4 software.Results P .mirabilis strains were mainly isolated from wound secretion(26.74%),sputum(22.68%)and urine(18.61 %),P .vulgaris were mainly from wound secretion(48.53%),urine(17.65%)and sputum(11 .77%).The resistance rates of P .mirabilis to ampicillin and trimethoprim/sulfamethoxazole were both>45.00%;the resistance rates of P .vulgaris to cefazo-lin and trimethoprim/sulfamethoxazole was 86.76% and 41 .18% respectively;the resistance rates of P .mirabilis and P .vulgaris to piperacillin/tazobactam,cefotaxime,ceftazidime,cefepime,carbapenems (ertapenem and mero-penem)and amikacin were all <20.00%.Conclusion The resistance rates of P .mirabilis and P .vulgaris to pip-eracillin/tazobactam,cefotaxime,ceftazidime,cefepime,ertapenem,meropenem and amikacin are all high,and can be used as the empirical medication for the treatment of related infection.