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Objective:To construct a core index system of job responsibilities for specialist trauma nurses tailored to the current trauma care system in China and provide a reference for trauma centers to set up specialist trauma nurses.Methods:Literature review and group discussion were used to develop the first draft of the core index system of job responsibilities for specialist trauma nurses. The Delphi method was used to conduct two rounds of consultation among 15 experts from 7 provinces or cities in China to determine the final draft. The two rounds of expert active coefficient, expert authority coefficient ( Cr), Kendal coefficient (Kendall′s W), and average value of the importance and variation coefficient ( CV) of each indicator were calculated. Results:In both rounds of consultations, the expert active coefficient was 100%, and the Cr was 0.953. In the second round of consultation, the Kendall′s W was 0.188 ( χ2 =155.29, P<0.001), and the average value of the importance of each indicator ranged from 4.27-5.00 points with the CV of less than 0.25 points. The final index system consisted of 7 first-level indicators and 49 second-level indicators. Conclusion:The core index system of job responsibilities for specialist trauma nurses is reasonable and comprehensive, which can provide guidance for setting up positions of specialist trauma nurses in China.
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Hypoxia is an important basic feature of the solid tumor microenvironment. With the deepening of the research on the pathogenesis of renal cell carcinoma (RCC), the expression and function of hypoxia and hypoxia inducible factor (HIF) in RCC have attracted more and more attention. The hypoxia signal pathway has become a research hotspot of tumor and other diseases in recent years. This article reviews the current understanding of hypoxia signal pathway, its correlation with the occurrence and development of RCC, and the application prospect of HIF inhibitors, in order to guide the precise treatment of clinical RCC.
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Objective:To compare the effect of age and gender on mastication efficiency between healthy volunteers and dysphagic stroke survivors and to document any correlation of mastication efficiency with mandible movements.Methods:Thirty-two stroke survivors with dysphagia and 84 healthy volunteers were asked to chew two-color gum. Their chewing efficiency was indicated by the degree of color mixing after chewing (SDHue). The SDHue value was evaluated using ViewGum software. The healthy volunteers were further divided into an age 20-40 years group, a 41-60 years group and an over-60 group. The SDHue values were compared among the 3 groups. The SDHue values were correlated with clinical mandibule movement scores.Results:Among the healthy volunteers, those older than 60 years had significantly higher SDHue values on average than those between 20 and 40 years. However, no significant gender difference was observed. The dysphagic stroke survivors had, on average, significantly higher SDHue results than the healthy volunteers, and those results were positively correlated with their mandible movement scores.Conclusions:Mastication efficiency tends to be age-related but not gender-related. Among those with post-stroke dysphagia mandible movement is positively correlated with mastication efficiency.
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[Objective]:To explore the effect evaluation of discharge preparation service on elderly patients with hip fractures.Methods:Totally 80 elderly patients with hip fractures admitted to Shanghai Sixth People′s Hospital from April 2019 to October 2019 were selected as the research objects, and they were divided into intervention group and control group according to admission time, 40 patients in each group. The control group was given routine nursing care, and the intervention group was given readiness service for hospital discharge.The application effect of the scheme was evaluated by the degree of readiness for discharge and the quality of discharge guidance, Barthel index score, Harris score and incidence of complications.Results:In the intervention group,the total score of readiness for hospital discharge of patients was 83.43±8.10,the total score of the quality of discharge guidance was 151.30±16.61,while those in the control group were 77.13 ± 9.30, 141.58 ± 18.34, the differences between the two groups were statistically significant( t=3.23, 2.49, both P<0.05).In terms of the follow-up after patients were discharged for 3 months, the Harris hip score and Barthel index scores for patients with hip fracture were 82.53 ± 7.83 and 88.13 ± 3.34,while those were 76.03 ± 12.15, 86.13 ± 2.65 in the control group,the differences between the two groups were statistically significant ( t=2.84, 2.97, both P<0.05). Conclusions:The discharge preparation service can effectively improve the readiness for hospital discharge and the quality of discharge guidance. It improves the hip joint function, the quality of life of patients, and the clinical outcome of patients effectively.
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Objective:To explore the effect of the pharyngeal pressure feedback training on pharyngeal constriction in persons with swallowing disorders caused by brainstem lesions.Methods:Twenty patients with disordered swallowing caused by a brainstem lesion were randomly divided into a control group and an intervention group, each of 10. Both groups received routine swallowing training including oral sensorimotor training, neuromuscular stimulation and balloon catheter dilation, while the intervention group was additionally provided with two weeks of pharyngeal pressure feedback training. Before and after the treatment, both groups were evaluated in terms of the peak pressure of superior and inferior pharyngeal constriction, endoscopically and also using the functional oral intake scale.Results:There was no significant difference between the two groups in any measure before the intervention. Afterward, both groups had improved significantly by all of the measurements, but the average peak upper pharyngeal pressure, the average intake scale score and the endoscopy results of the intervention group were all significantly better than the control group′s averages.Conclusions:Pharyngeal pressure feedback training can significantly relieve swallowing disorders caused by brainstem lesions.
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Objective:To observe any effect of intermittent theta burst stimulation (iTBS) of the prefrontal lobe on dysphagia and impaired cognition, and to explore the neural mechanisms involved.Methods:Twenty-eight patients with dysphagia and mild cognitive impairment were randomly divided into an iTBS group of 16 and a control group of 11. The iTBS group received 20 minutes of iTBS (2 seconds on and 8 seconds off) of the right dorsal lateral prefrontal cortex (DLPFC) once daily for 2 weeks, with the intensity at 80% of the resting movement threshold of the right abductor pollicis brevis, while the control group was given sham iTBS. Before and after the treatment, both groups′ cognitive functioning was evaluated using the Montreal Cognitive Assessment Scale (MoCA), a trial marking test, a digit span test and a Stroop color word test. Video-fluoroscopy was used to record oral transmission times (OTTs), hyoid bone anterior displacement and hyoid bone upward displacement during swallowing. Resting-state functional magnetic resonance imaging measured the amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo) and functional connectivity in the patients′ brains.Results:Before the treatment there was no significant difference in the average indices of cognition or swallowing function between the 2 groups. Afterward the average MoCA score had increased significantly in both groups, with the improvement in the iTBS group significantly greater than that of the controls. Average OTT had shortened significantly in both groups, with significantly greater improvement in the iTBS group. The magnetic resonance imaging showed that after iTBS treatment, local excitation indicators and functional connections in several brain regions had changed. ALFF and ReHo in the right anterior cuneus had increased, ReHo in the left middle temporal gyrus, the orbital region of the left inferior frontal gyrus and the left middle cingulate gyrus had decreased, and functional connectivity in the right DLPFC, the bilateral cuneus and the right middle cingulate gyrus had increased.Conclusions:Two weeks of intermittent TBS of the right DLPFC can improve the swallowing and cognition of persons with dysphagia. Functional reorganization of brain networks may be one of the neural mechanisms involved.
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Objective:To explore the effect of swallowing different viscosities and volumes on the swallowing of dysphagic stroke survivors, and also penetration and aspiration.Methods:A total of 59 stroke survivors with dysphagia were evaluated using videofluoroscopy while completing the Chinese version of the volume viscosity swallow test. They were required to swallow 3, 5 and 10ml of food of medium, low, zero and high viscosity. Modified barium swallowing impairment profiles (MBSImPs) and the Rosenbek penetration aspiration scale were used for quantitative analysis.Results:Tongue control, initiation of the pharyngeal swallow and larynx closure showed the worst performance when swallowing zero-viscosity food. Oral residue performance was poor when swallowing large volumes and pharyngeal peristalsis was poor with small volumes. The risk of penetration and aspiration was greater with low-viscosity, large-volume swallowing tasks. There was a significant positive correlation between the penetration aspiration grade and total pharyngeal score. Larynx closure was especially strongly correlated with the penetration aspiration grade.Conclusions:The characteristics of physiological swallowing are closely related to the viscosity and volume of the material being swallowed. The risk of penetration and aspiration is greater with large volumes of low-viscosity food.
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Objective@#To evaluate the motility of the esophagus while swallowing of brainstem stroke survivors.@*Methods@#Eighteen patients and 10 healthy subjects were included in the study. There was no significant difference in average age, gender, weight or body mass index between the two groups. All underwent high-resolution esophageal manometry to assess esophageal motility while swallowing, and they were rated using the version 3.0 of the Chicago classification.@*Results@#Fourteen of the 18 stroke survivors displayed abnormal esophageal dynamics (77.8%), compared with only 10.0% of the healthy control group, but that difference was not statistically significant. The typical abnormalities were a lack of contraction, high pressure contractile esophagus, gastroesophageal junction outflow obstruction and/or distal esophageal spasm. Compared with the control group, the average resting pressure of the patients′ upper esophageal sphincters (UESs) was significantly lower, while the UES residual pressure and integrated relaxation pressure of their lower esophageal sphincters (LESs) were higher and the average UES relaxation time was significantly shorter. No significant differences were found in the LES resting pressures, distal contractile integrals or the distal latency between the two groups.@*Conclusions@#Abnormal esophageal motility is highly prevalent in brainstem stroke survivors and due attention should be paid to it. High-resolution manometry can be used to assess this condition.
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Objective:To explore the value of flexible endoscopic evaluation of swallowing (FEES) in guiding the decannulation of neurological disease patients with dysphagia after a tracheotomy.Methods:The FEES results of 188 neurological disease patients with dysphagia who had undergone a tracheotomy were analyzed retrospectively. The utility of FEES evaluation indexes (including glottis activity, the classification of pharyngeal secretions and residues as well as penetration-aspiration grade) for predicting the success of decannulation was explored.Results:One hundred and nine of the patients (the success group) were decannulated successfully and 79 (the failure group) were not, a success rate of 57%. The abnormal glottis activity rate among the failure group was 55%, significantly higher than among the success group (21%). The pharyngeal secretion classifications and penetration-aspiration grades among the success group were also significantly lower than among the failure group, on average. The average course of recovery from the tracheotomy was 184 days in the success group, significantly shorter than that of the failure group (292 days). No significant differences in residues were observed.Conclusion:The glottis activity, secretions and intake aspiration evaluated using FEES are of great value for guiding the decannulation of neurological disease patients with dysphagia after a tracheotomy.
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Objective:To investigate the effectiveness of basic swallowing training for tracheotomy patients using a speech valve after severe cranial injury.Methods:Thirty brain injury patients were randomly divided into a control group and an observation group, each of 15. In addition to conventional drug therapy, those in the control group were given basic swallowing training, while those in the observation group received the same swallowing training wearing a speech valve. The basic swallowing training included ice stimulation, tongue movement training and cough training twice a day, five days a week, for four weeks. The patients in the observation group were also trained to wear a speech valve on the same schedule. The subjects′ swallowing function was evaluated laryngoscopically using Saito′s dysphagia rating scale and the Rosenbek leakage aspiration rating scale before and after the 4 weeks of treatment.Results:Significant improvement was observed in both groups, with significantly greater improvement in the observation group, on average.Conclusions:Basic swallowing training when wearing a speech valve can improve the swallowing function of patients with severe brain injury after a tracheotomy and reduce aspiration during swallowing.
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Objective:To evaluate the motility of the esophagus while swallowing of brainstem stroke survivors.Methods:Eighteen patients and 10 healthy subjects were included in the study. There was no significant difference in average age, gender, weight or body mass index between the two groups. All underwent high-resolution esophageal manometry to assess esophageal motility while swallowing, and they were rated using the version 3.0 of the Chicago classification.Results:Fourteen of the 18 stroke survivors displayed abnormal esophageal dynamics (77.8%), compared with only 10.0% of the healthy control group, but that difference was not statistically significant. The typical abnormalities were a lack of contraction, high pressure contractile esophagus, gastroesophageal junction outflow obstruction and/or distal esophageal spasm. Compared with the control group, the average resting pressure of the patients′ upper esophageal sphincters (UESs) was significantly lower, while the UES residual pressure and integrated relaxation pressure of their lower esophageal sphincters (LESs) were higher and the average UES relaxation time was significantly shorter. No significant differences were found in the LES resting pressures, distal contractile integrals or the distal latency between the two groups.Conclusions:Abnormal esophageal motility is highly prevalent in brainstem stroke survivors and due attention should be paid to it. High-resolution manometry can be used to assess this condition.
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Objective To analyze the effect of ultrasound-guided glucocorticoid injection on different pathologies of the shoulder retrospectively.Methods Clinical data were collected describing 75 patients with shoulder pain who received ultrasound-guided glucocorticoid injection and finished 3 month follow-ups in the rehabilitation clinic of the Third Affiliated Hospital of Sun Yat-sen University between April and September of 2017.The patients were divided into three groups based on their different injection sites:group 1 was injected at the subacromial bursa alone,group 2 was injected at both the subacromial bursa and the coracoid bursa,while group 3 was injected at the subacromial bursa and the long head of the tendon sheath of the biceps brachii.A shoulder pain and disability index (SPADI) was used to quantify the pain and disability of each patient before and after the injection.Results Significant improvement was observed in the average pain and disability scores of all groups at 1 week,1 month and 3 months after the injection.Moreover,significant and continuous improvement was observed in the average pain and disability scores of groups 1 and 3,as well as the average disability score of group 2 from right after the injection until the last follow-up.However,no significant differences were found in the average pain score between one and three months after the injection.There was no significant difference among the 3 groups in the average pain and disability scores before and immediately after the injection.Conclusion Ultrasound-guided glucocorticoid injection is effective and persistent for treating shoulder pain with different pathologies.
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Objective@#To compare a new agar thickener with xanthan gum as a thickener in treating dysphagia patients with nasopharyngeal carcinoma after radiotherapy.@*Methods@#Twenty nasopharyngeal carcinoma patients with dysphagia after radiotherapy were asked to swallow moderately and extremely thick liquids thickened with the agar and xanthan gum, and their swallowing was recorded with a videofluoroscope.@*Results@#The average pharyngeal constriction ratio when swallowing agar thickener was significantly lower than when swallowing the traditional thickener. The average oral transit time, the initiation of pharyngeal swallowing were both significantly quicker. There was no significant difference in the average penetration aspiration scale scores between the two thickeners. In the subjective evaluation, the agar thickener was adjudged smoother and with better residual mouthfeel than the xanthan gum, but the scent of the xanthan gum was preferred.@*Conclusion@#The new agar thickener is smooth and not sticky. It produces faster transport with less oropharyngeal residue. It can be widely used among nasopharyngeal carcinoma patients with dysphagia after radiotherapy.
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Objective@#To explore the value of videofluoroscopy in assessing the capsule swallowing ability of stroke survivors.@*Methods@#Twenty-seven stroke survivors with functional oral intake scale ratings of 4-7 with no aspiration were selected as a patient group, while 16 healthy subjects were chosen as a control group. All swallowed capsules filled with barium sulfate with water while being monitored videofluoroscopically. The success rate of capsule swallowing was recorded along with oral transit time, stage transition time (STT), pharyngeal transition time, the upper esophageal sphincter (UES) opening time, delay time (DT), superior hyoid bone movement, anterior hyoid bone movement and UES opening diameter for each swallowing.@*Results@#The swallowing success ratio was 78.3% in the patient group, significantly lower than in the control group. Swallowing failures manifested as hindered transport and retention of the capsule in the oral or pharyngeal cavity. Significant differences were found in STT and DT between the two groups.@*Conclusion@#Even if eating and swallowing ability recover somewhat after a stroke, survivors still have difficulty swallowing oral medication. Clinical assessment for ability to take oral medication is crucial and videofluoroscopy can be one useful tool.
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Objective To explore the value of videofluoroscopy in assessing the capsule swallowing ability of stroke survivors. Methods Twenty-seven stroke survivors with functional oral intake scale ratings of 4-7 with no aspiration were selected as a patient group, while 16 healthy subjects were chosen as a control group. All swallowed capsules filled with barium sulfate with water while being monitored videofluoroscopically. The success rate of capsule swallowing was recorded along with oral transit time, stage transition time ( STT) , pharyngeal transition time, the up-per esophageal sphincter ( UES) opening time, delay time ( DT) , superior hyoid bone movement, anterior hyoid bone movement and UES opening diameter for each swallowing. Results The swallowing success ratio was 78.3％ in the patient group, significantly lower than in the control group. Swallowing failures manifested as hindered transport and retention of the capsule in the oral or pharyngeal cavity. Significant differences were found in STT and DT between the two groups. Conclusion Even if eating and swallowing ability recover somewhat after a stroke, survivors still have difficulty swallowing oral medication. Clinical assessment for ability to take oral medication is crucial and videofluoros-copy can be one useful tool.
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Objective To compare a new agar thickener with xanthan gum as a thickener in treating dyspha-gia patients with nasopharyngeal carcinoma after radiotherapy. Methods Twenty nasopharyngeal carcinoma patients with dysphagia after radiotherapy were asked to swallow moderately and extremely thick liquids thickened with the agar and xanthan gum, and their swallowing was recorded with a videofluoroscope. Results The average pharyngeal con-striction ratio when swallowing agar thickener was significantly lower than when swallowing the traditional thickener. The average oral transit time, the initiation of pharyngeal swallowing were both significantly quicker. There was no sig-nificant difference in the average penetration aspiration scale scores between the two thickeners. In the subjective eval-uation, the agar thickener was adjudged smoother and with better residual mouthfeel than the xanthan gum, but the scent of the xanthan gum was preferred. Conclusion The new agar thickener is smooth and not sticky. It produces faster transport with less oropharyngeal residue. It can be widely used among nasopharyngeal carcinoma patients with dysphagia after radiotherapy.
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Objective To investigate the current status and influencing factors of compassion fatigue in clinical nurses,and to provide theoretical references for prevention of nurse burnout and promotion of nurse retention.Methods Totally 992 clinical nurses from ten tertiary hospitals were enrolled through random cluster sampling to complete general information questionnaire,the Professional Quality of Life Scale (Pro-QOL-V),the Resilience Scale for Adults(RSA) and the Jefferson Scale of Empathy·Health Professionals(JSE-HP).Results The prevalence of moderate and high risk of secondary stress and burnout were 71.1％,73.2％,respectively;clinical nurses with work experience of 6 to 10 years presented the highest level of burnout(P＜0.01);lower empathy and resilience,as well as adverse work environment were risk factors of compassion fatigue.Multiple regression analysis showed that the influencing factors of nurse burnout were compassion satisfaction,secondary stress,resilience,workload,recognition,empathy,and payment,which explained 70.5％ of the total variance.Conclusion Secondary stress,burnout and compassion satisfaction in clinical nurses are influenced by nurses' empathy,resilience and work environment,and nursing administrators should pay attention to receiving recognition as positive predictors of burnout,except for workload and payment.
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Objective To evaluate the value of DTI in mild articular cartilage injury in patellofemoral joint.Methods The DTI and arthroscopy data of 82 patients wih routine MRI diagnosed as mild articular cartilage injury were analyzed retrospectively.According to the results of arthroscopy,40 cases of mild articular cartilage injury with Outerbridge classification Ⅰ or Ⅱ were divided into experimental group,and 33 cases with normal patellofemoral articular cartilage were divided into control group.There were 8 articular cartilage injury patients with Outerbridge classification Ⅲ or Ⅳ in patello-femoral join were excluded.The DTI data were analyzed compared with arthroscopy.Results Arthroscopy detected 62 lesions of cartilage injury in experimental group.Totally 49 lesions (49/62,79.03 ％) were detected by ADC pseudocolor image and 51 lesions (51/62,82.25 ％) were detected by FA pseudocolor image.The DTI pseudocolor images of articular cartilage injury showed uneven levels.The red or pink levels can been observed.Compared with the control group,ADC value increased and FA value decreased significantly in experimental group (both P＜0.05).Conclusion DTI can clearly display and detect mild articular cartilage injury in patellofemoral joint,which provide valuable information for early cartilaginous injury.
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Objective To explorer the effectiveness of game-based surface electromyographic biofeedback training (GBsEMGBF) on dysphagic brainstem injury patients.Methods Thirty-six brainstem injury dysphagic patients were randomly and evenly divided into a treatment group and a control group,both of 18,by using a random number table.Both groups were given conventional swallowing rehabilitation including oral sensory and motor training,Mendelsohn swallowing training and balloon dilatation of the cricopharyngeal muscle.The treatment group was additionally provided with GBsEMGBF training.All the treatments were provided 5 times per week for 5 weeks.Both groups were assessed using the functional oral intake scale (FOIS),penetration-aspiration scale (PAS),hyoid anterior movement (HAM),hyoid superior movement (HSM) and upper esophageal sphincter opening (UO) before and after the intervention.Results Before the treatment there were no significant differences between the two groups in all the measurements.After the treatment,there was a significant improvement in the average FOIS,PAS,HAM and HSM scores in both groups,but with significantly greater improvement in the treatment group.Significant improvement was observed in the average UO score after the intervention,but without significant differences between the two groups.Conclusion GBsEMGBF can significantly improve the swallowing function and hyoid motor function in dysphagic patients caused by brainstem injury.
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Objective To monitor the immediate effect of Passi-Muir speaking valve (PMV) on patients with tracheostomy after acquired brain damage.Methods Twelve patients with tracheostomy after acquired brain damage were recruited.All of them underwent the high resolution manometry to measure the pressure in pharynx and upper esophagus during swallowing before and immediately after wearing PMV.The parameters including the pharyngeal peak pressure,increasing rate of the pharyngeal pressure,pharyngeal pressure duration,upper esophageal sphincter (UES) residual pressure and UES relaxation duration were recorded.Results No significant differences were found in all the measurements before and immediately after wearing PMV (P＞0.05).Conclusion PMV has no instant impact on the swallowing function of patients with tracheostomy after acquired brain damage.