ABSTRACT
Objective@#To investigate the efficacy and safety of percutaneous lauromacrogol injection (PLI) in treatment of cystic or predominantly cystic thyroid nodules.@*Methods@#A total of 114 cystic thyroid nodules and 61 predominantly cystic thyroid nodules with pain or uncomfort or aesthetic complaints were offered PLI. Therapeutic success rates and side effects were evaluated. From October 2012 to December 2015,114 patients with cystic thyroid nodules and 61 with predominantly cystic thyroid nodules with pain or uncomfortable or aesthetic complaints at the outpatient clinic of the First Affiliated Hospital of Wenzhou Medical University were offered percutaneous lauromacrogol sclerotherapy. Cytological results were benign. This study was a prospective trial. Ultrasonography sound examination was performed in all patients before treatment. The baseline data of all the patients and the data of the patients examined at the follow-up of 1, 3, 6 and 12 months were analyzed. Therapeutic success rate (nodule volume reduction >50%) and safety were observed. The data of nodule volume reduction ratio and the function of thyroid were normal distribution and analyzed by Mann-Whitney test and t test. The data of nodule volume, symptoms score and cosmetic score were skewed distribution, which were indicated with median and analyzed by nonparamentic test.@*Results@#The mean volume of the cystic thyroid nodules was reduced from 12.5 cm3 before PLI to 0.2 cm3 at 12 months after PLI (χ2=266.175, P<0.001), with a therapeutic success rate of 100%, and the mean volume of the predominantly cystic thyroid nodules was reduced from 10.5 cm3 before PLI to 2.0 cm3 at 12 months after PLI (χ2=203.122, P<0.001) with a therapeutic success rate of 93.4%(57/61). Pressure symptom score and cosmetic grade were significantly improved at 12 months after PLI in patients with cystic or predominantly cystic thyroid nodules. Pressure symptom score and cosmetic grade in patients with cystic thyroid nodules were Z=-6.126 and Z=-13.735, respectively; pressure symptom score and cosmetic grade in patients with predominantly cystic thyroid nodules were Z=-3.126 and Z=-7.212, respectively (all P<0.001) . There no significant difference in the thyroid functions before and after PLI in two groups of patients (all P>0.05) . The side effects of PLI were mild.@*Conclusion@#PLI is a safe and effective alternative to treat benign cystic or predominantly cystic thyroid nodules.
ABSTRACT
Objective To evaluate the effect of psychosocial nursing intervention on the analgesic efficacy of labour analgesia in parturients.Methods A total of 160 parturients,aged 18-35 yr,with a singleton fetus in vertex presentation at 38-41 week gestation,who required labor analgesia voluntarily,were divided into 2 groups (n =80 each) using a random number table:control group (group C) and psychosocial nursing intervention group (group Ⅰ).The epidural catheter was placed at L2.3 interspace when the cervical dilation was 3 cm,and 0.1％ ropivacaine 12 ml was injected.And then patient-controlled epidural analgesia (PCEA) was performed.The solution for PCEA contained 0.1％ ropivacaine and hydromorphone hydrochlorid 2.5 μg/ml (diluted to 160 ml in 0.9％ normal saline).The catheter was connected to a PCEA pump programmed to deliver 6 ml with a lockout interval of 12 min,background infusion at 0.1 ml/h and limit dose of 30 ml/h.After the initial administration of ropivacaine,parturients were only informed of the usages and notice items of the PCEA pump in group C,and in addition psychological nursing intervention was carried out,and the peak effect of drugs and principle of PCEA pump were also introduced in group Ⅰ.The intensity of pain was assessed using visual analogue scale score before labour analgesia and at 15,30,60,120,180 and 240 min after labour analgesia.The development of adverse reactions such as lower extremity numbness,motor nerve block,nausea and vomiting,pruritus,urinary retention and hypotension after labour analgesia was recorded.Parturient's satisfaction with labour analgesia was evaluated at 24 h after the end of delivery,and the rate of satisfactory analgesia was calculated.Results Compared with group C,visual analogue scale scores were significantly decreased at 60,120,180 and 240 min after labour analgesia,and the rate of satisfactory analgesia was increased in group Ⅰ (P＜0.05).One patient developed motor nerve block at 30 min after labour analgesia in group C,and no patient developed motor nerve block after labour analgesia in group Ⅰ.No adverse reactions such as lower extremity numbness,nausea and vomiting,pruritus,urinary retention or hypotension were found in the two groups.Conclusion Psychosocial nursing intervention can raise the analgesic efficacy of labour analgesia in parturients.
ABSTRACT
Objective To identify and investigate the cause of the unacceptable bacteria level inside the lumen of fiberendoscope during monitoring so as to increase the pass rate of its cleaning and disinfection. Methods A failure mode effect analysis of the cause was done and the workflow was thereafter improved. Meanwhile, pre and post bacteriological monitor was applied to the fiberendoscope lumen samples. Results The number of scrubbing times while manual cleaning affected the monitoring results. The scrubbing times was amended and the pass rate increased from 84.15% to 98.65%. The results were significantly different The failure mode risk index of endoscope cleaning and disinfection was calculated, and the highest two items were: The number of scrubbing times the operators execute RPN=640, the method of lumen cleaning RPN=480. These were the key factors of qualification of monitoring. Conclusions After the amendment, no less than 5 times' scrubbing was required and the bacteriological monitoring method was used to analyze the effects,thereafter the pass rate of lumen bacteria monitoring can be increased significantly.