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Objective:To assess the nosocomial infection risk events of neonatology experienced by a hospital, for identifying those events deserving high priority in infection prevention and control and critical rooms of improvement, hence minimizing such risks of the hospital.Methods:The hazard vulnerability analysis was called into play, along with literature review and clinical practices, while the hazard vulnerability analysis team of neonatology of the hospital preliminarily screened the indexes in brainstorming method. Then the individual indexes from such screening evaluated by means of questionnaires, and the risk evaluation index system for neonatal infection prevention and control was formed in combination with the risk value evaluation table of Kaiser model. On such basis, an evaluation questionnaire for the prevention and control was developed.In May 2020, the team members scored the possibility and severity of these risk indexes in the form of questionnaire, calculated the hazard risk value, and divided the risk zones by matrix analysis.Results:The risk assessment index system of neonatology was composed of 11 management indexes, 20 implementation indexes and 7 outcome indexes. The top 5 indexes of hazard risk value were: incorrect hand hygiene method(39.20%), inadequate cleaning and disinfection of environmental object surface(39.04%), the formula was not used immediately when ready(38.19%), nosocomial infection outbreak(38.02%), and low hand hygiene compliance(37.99%). The indexes with high severity and low readiness include three indexes related to formula feeding and three indexes related to cleaning and disinfection of object surface. The matrix analysis results showed that there were 9 indexes in the high-risk zone, 7 indexes in the medium risk zone and 22 in the low-risk zone.Conclusions:This study identified risk management events in hospital infection management in neonatology by means of hazard vulnerability analysis. The neonatology administrators are recommended to prioritize indexes in the high risk zone, make a root cause analysis of those indexes of high risk value and low readiness and take intervention measures in time, hence reducing the incidence of nosocomial infection and avoiding the outbreak of nosocomial infection.
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Objective:To investigate the relationship between excessive daytime sleepiness and freezing of gait in Parkinson′s disease (PD).Methods:A total of 136 participants with PD were consecutively recruited between August 2017 and January 2018 at the Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The patients were divided into freezers with 50 patients and nonfreezers with 86 patients. The clinical characteristics of freezers and nonfreezers in PD patients were assessed. In the longitudinal study, a cohort of nonfreezers with 86 patients at baseline clinical visit for a maximum of 18 months were prospectively followed. The patients were divided into the excessive daytime sleepiness group ( n=14) and the non-excessive daytime sleepiness group ( n=72). Then a Cox regression analysis was performed to further investigate the relationship between excessive daytime sleepiness and freezing of gait in PD, and explore risk factors for freezing of gait. Results:The freezers had significantly worse sleep compared with the nonfreezers. The proportion of patients with excessive daytime sleepiness in freezers was higher than nonfreezers [40% (20/50) vs 16% (14/86), χ2=9.49, P=0.002]. The proportion of freezers in the patients with excessive daytime sleepiness was significantly higher than that in the patients without excessive daytime sleepiness [59% (20/34) vs 29% (30/102), χ2 =9.49, P=0.002]. During a maximum of 18-month follow-up, freezing of gait incidence (6/7) in the excessive daytime sleepiness group was significantly higher than that in the non-excessive daytime sleepiness group [21% (8/39) , χ2 =9.04, P=0.003]. Excessive daytime sleepiness ( HR=8.03, 95% CI 2.58-24.99, P<0.01) and high L-dopa equivalent daily dose ( HR=5.92, 95% CI 1.95-17.93, P=0.002) were significantly associated with an increased hazard of freezing of gait. Conclusion:Excessive daytime sleepiness and high L-dopa equivalent daily dose may be risk factors for the development of freezing of gait in PD in the future.
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Objective@#To explore the effect of optimizing the green channel intravenous thrombolysis process and nursing intervention in the treatment of acute cerebral infarction.@*Methods@#Forty-five patients with acute cerebral infarction admitted to emergency department of Beijing Tiantan Hospital Affiliated to Capital Medical University in 2018 were selected as observation group, and 45 patients with cerebral infarction admitted in 2017 were selected as control group, and treated with traditional process and nursing intervention. Door to needle time (DNT), hospitalization time, Emergency bed turnover rate and National Institute of Health Stroke Scale (NIHSS) scores before and after thrombolysis were compared between the two groups.@*Results@#The DNT time, hospitalization time and emergency bed turnover rate in the control group were (82.82±9.73) min, (11.31±2.96) days and 22.07(1 280/58), respectively, while those in the observation group were (37.62±8.40) min, (7.33±1.16) days and 31.93(1 852/58), respectively. There were significant differences between the two groups (t=25.526, 8.926, χ2=10.526, P < 0.01 or 0.05). There was no significant difference in NIHSS scores between the two groups at admission (P > 0.05); the NIHSS score of the observation group at discharge was 3.13±2.00, which was significantly lower than that of the control group (7.33 ± 1.95), and the difference was statistically significant (t=8.469, P < 0.05).@*Conclusion@#The cure rate of patients with acute cerebral infarction is closely related to the timeliness of treatment. The establishment of fast green channel can not miss the best opportunity for patients, but also help to promote the recovery of nerve function, so as to achieve the effect of improving the cure rate of patients.
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Objective@#To analyze the decannulation difficult reason and the application of multidisciplinary cooperation of 1 case of premature neonate with leg vein organic compound formation.@*Methods@#Through the PICC decannulation difficult reason analysis and processing, drawing tube under multidisciplinary cooperation comprehensive intervention.@*Results@#Children managed to root out PICC under digital subtraction angiography (DSA), but organic compound in the popliteal vein remained. No organic compound falling off and blood clots occurrd after 6-month follow-up.@*Conclusion@#For neonatal PICC decannulation difficult, we can give appropriate postures, wet hot compress, local massage method, as well as ultrasound for confirmation of presence of thrombus when necessary, such as machine compound and fibrin sheath formation. Application of multidisciplinary cooperation can improve the success rate of minimally invasive decannulation. According to the cause of decannulation difficult and take effective preventive measures is the key point of PICC catheter nursing.
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Objective To analyze the decannulation difficult reason and the application of multidisciplinary cooperation of 1 case of premature neonate with leg vein organic compound formation. Methods Through the PICC decannulation difficult reason analysis and processing, drawing tube under multidisciplinary cooperation comprehensive intervention. Results Children managed to root out PICC under digital subtraction angiography (DSA), but organic compound in the popliteal vein remained. No organic compound falling off and blood clots occurrd after 6-month follow-up. Conclusion For neonatal PICC decannulation difficult, we can give appropriate postures, wet hot compress, local massage method, as well as ultrasound for confirmation of presence of thrombus when necessary, such as machine compound and fibrin sheath formation. Application of multidisciplinary cooperation can improve the success rate of minimally invasive decannulation. According to the cause of decannulation difficult and take effective preventive measures is the key point of PICC catheter nursing.
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OBJECTIVE@#To delineate laboratory and clinical characteristics of a case with chronic myelogenous leukemia (CML) and co-occurrence of t(9;22)(q34;q11) and t(8;21)(q22;q22).@*METHODS@#The patient was subjected to cytogenetic, molecular, morphological and immunophenotypic analyses.@*RESULTS@#Cytogenetic analysis revealed presence of t(8;21)(q22;q22) in addition to t(9;22)(q34;q11) in the patient. Chimeric BCR/ABL and AML1/ETO genes were detected by fluorescence in situ hybridization (FISH). Transcripts of BCR/ABL210 and AML1/ETO fusion genes were detected by relative quantity PCR. Morphological study suggested that the patient was at the chronic phase of CML. No significant immunophenotypic abnormality was detected by flow cytometry.@*CONCLUSION@#Co-occurrence of t(8;21)(q22;q22) and t(9;22)(q34;q11) is rare in CML. Only 5 similar cases have been described previously. This case suggested that chromosomal alterations may precede morphological, flow cytometric and clinical changes and accelerate progression of the disease.
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Humans , Chromosome Aberrations , Chromosomes, Human , Fusion Proteins, bcr-abl , In Situ Hybridization, Fluorescence , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Genetics , Translocation, GeneticABSTRACT
BACKGROUND:Long-term use of corticosteroids (hereinafter referred to as hormone) after renal transplantation could obviously lead to adverse reactions. Immunosuppressive regimen with less and no hormone has been a hot focus in the study of renal transplantation al over the world. However, reduction or withdrawal of hormones has a certain risk. At present, there is no unified scheme. Because urine protein can be immediately detected after tubular injury, to monitor urine protein can find the renal dysfunction after transplantation in recipients undergoing renal transplantation, which can gain time for clinical therapy. OBJECTIVE:To discuss the influence of hormone (prednisone) removal on the occurrence of urine protein in recipients undergoing renal transplantation. METHODS:A total of 35 recipients undergoing renal transplantation after removal of prednisone received immunosuppressive regimen of cyclosporine A or tacrolimus+mycophenolate mofetil bivalent. Initial dose of prednisone was 30 mg/d, and then gradual y reduced by 5 mg per week, and withdrawn at 1 month after renal transplantation. There were 16 cases in cyclosporine A group and 19 cases in tacrolimus group. Urine protein was measured and quantified at 3, 6, 12 and 24 months after renal transplantation and 3, 6 and 12 months after addition of prednisone in both groups. Simultaneously, serum creatinine, fasting glucose, body mass increases, the rate of acute rejection, infection, patient/graft survival at 2 years after renal transplantation and urine protein at 24 hours before and after adding hormone were recorded. RESULTS AND CONCLUSION:For the two groups, urineα1-microglobulin started to rise after 6 months of removal of prednisone. Urinary microalbumin, urinaryα1-microglobulin, and urinary transferrin ascended obviously at 12 months. Urinary protein was positive in five cases of cyclosporine A group and in three cases of tacrolimus group. At 24 months, urinary microalbumin, urinaryα1-microglobulin, urinary transferrin and urinary IgG ascended obviously. Urinary protein was positive in cyclosporine A group with 11 cases and in tacrolimus group with 10 cases. 24-hour urinary protein quantity was more than 1 g in every case. On this base, we made the patients to take more prednisone for 6 months, so urineα1-microglobulin and urinary microalbumin began to descend. Each group had one case of positive urinary protein turning to negative. Twelve months after the adjustment of the prednisone, urinary microalbumin, urinaryα1-microglobulin, and urinary transferrin descended respectively. Positive urinary protein turned into negative:in cyclosporine A group with two cases and in tacrolimus group with three cases. 24-hour urinary protein quantity was around 0.7 g. Two years after renal transplantation, serum creatinine and acute rejection rates were higher in the cyclosporine A group than in the tacrolimus group (P<0.05). No significant difference in fasting glucose, body mass increase, infections, and patient/graft survival was detectable between both groups. Results suggested that removal of prednisone greatly affected urine protein in recipients undergoing renal transplantation. In particular, at 2 years after renal transplantation, urinary microalbumin, urinaryα1-microglobulin, urinary transferrin and urinary IgG ascended obviously, and the security needs further research.