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Objective:To analyze the gaps between the allocation of nursing human resources and the workload of emergency department and intensive care unit in Zhongshan Hospital, Fudan University in Shanghai in the past five years, so as to provide basis for the formulation of optimal countermeasures for the allocation of nursing human resources.Methods:Based on the data from January 2016 to December 2020, a retrospective study was used to analyze the trend and correlation between the allocation of nursing human resources (educational background, professional title and years of work experience) and the workload of emergency department and intensive care unit(emergency rescue, 120 vehicle pick-up, triage of level-1 patient, extracorporeal membrane oxygenation, central venous catheter intubation, organ transplantation, blood purification and endotracheal intubation). So as to explore the change trend of human resources and the workload of emergency department and intensive care unit in the past five years.Results:By the end of 2020, the proportion of the nurses with bachelor′s or master′s degree had reached 61.44% and the proportion of nurses with professional titles of nurse in charge and above reached 73.85% in emergency department. The structure of working years was relatively stable, and there was no obvious change trend. At the same time, the proportion of the nurses with bachelor′s or master′s degree has reached 57.62% and the proportion of nurses with professional titles of nurse in charge and above reached 63.42% in intensive care unit. The number of nurses who had worked for more than 5 years had shown an upward trend. However, the proportion of nurses with master′s degree or above was still small both in emergency department and intensive care unit. The workload of acute and critical care for nurses was increasing year by year. The average annual growth rates of nursing workload for triage of level-1 patient, blood purification, organ transplantation, central venous catheter intubation and extracorporeal membrane oxygenation were 8.94%, 9.06%, 11.07%, 18.50% and 28.32% respectively.Conclusions:The allocation of nursing human resources for emergency department and intensive care unit in Zhongshan hospital is changing towards personnel quality improvement and structure optimization, but there is still a shortage of high-level nursing personnel. And the workload of nurses in relevant departments is increasing year by year. Hospitals should actively explore the innovative way for the reform of the allocation of nursing human resource to ensure the balanced development of "quantity" and "quality" of nursing human resources for emergency department and intensive care unit.
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Purpose@#Symptom experience after liver transplantation (LT) provides healthcare professionals with important information about the benefits and limitations of LT from patients’ perspective. This study aims to explore the multidimensional symptom experience and analyze related predictive factors in LT recipients. @*Methods@#This cross-sectional study evaluated the occurrence, frequency, intensity, and level of distress of 40 symptoms in 265 LT recipients. Stepwise multiple regression analysis was performed to analyze the influencing factors of symptom experience. @*Results@#The analysis of patient-reported data indicated that the ten most common symptoms were fatigue (42.3%), frequent sleep interruptions (38.9%), difficulty falling asleep (35.9%), decreased memory (34.0%), dreaminess (29.8%), itch (28.7%), muscular weakness (26.4%), shortness of breath (25.3%), anxiety (24.5%), and hand tremor (21.9%). Patients were classified into four groups according to survival time (1-month, 2–6-month, 7–12-month, and >1-year groups) after LT, and the most common symptom was fatigue in the one-month and 2–6-month groups, difficulty falling asleep in the 7–12-month group, and decreased memory in the >1-year group. Type of the primary caregiver, complications, concerns about the decreased ability to perform household and outdoor activities, and concerns about being a burden to the family were predictors of symptoms burden. @*Conclusion@#LT recipients experienced complicated symptoms. In clinical practice, it is critical to integrate physicians, nurses, and social workers as a medical team to help LT recipients develop suitable coping strategies that can potentially address patients’ concerns, increase the sense of confidence, and improve symptom outcomes.
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Purpose@#Symptom experience after liver transplantation (LT) provides healthcare professionals with important information about the benefits and limitations of LT from patients’ perspective. This study aims to explore the multidimensional symptom experience and analyze related predictive factors in LT recipients. @*Methods@#This cross-sectional study evaluated the occurrence, frequency, intensity, and level of distress of 40 symptoms in 265 LT recipients. Stepwise multiple regression analysis was performed to analyze the influencing factors of symptom experience. @*Results@#The analysis of patient-reported data indicated that the ten most common symptoms were fatigue (42.3%), frequent sleep interruptions (38.9%), difficulty falling asleep (35.9%), decreased memory (34.0%), dreaminess (29.8%), itch (28.7%), muscular weakness (26.4%), shortness of breath (25.3%), anxiety (24.5%), and hand tremor (21.9%). Patients were classified into four groups according to survival time (1-month, 2–6-month, 7–12-month, and >1-year groups) after LT, and the most common symptom was fatigue in the one-month and 2–6-month groups, difficulty falling asleep in the 7–12-month group, and decreased memory in the >1-year group. Type of the primary caregiver, complications, concerns about the decreased ability to perform household and outdoor activities, and concerns about being a burden to the family were predictors of symptoms burden. @*Conclusion@#LT recipients experienced complicated symptoms. In clinical practice, it is critical to integrate physicians, nurses, and social workers as a medical team to help LT recipients develop suitable coping strategies that can potentially address patients’ concerns, increase the sense of confidence, and improve symptom outcomes.
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Objective:To explore whether the inequality of economic development in different provinces in China leads to differences in pediatric nurses ′ health education literacy and to analyze related factors affecting pediatric nurses ′ health education literacy. Methods:Self-designed and tested online questionnaire of competencies in health education (scoring scale 10-50) were distributed to pediatric nurses in China in October 2018. We examined the influencing factors of competencies in health education and its relationship with the province-level data on gross domestic product (GDP) per capita.Results:A total of 15 443 pediatric nurses from 31 provinces were eligible for the analysis. At the regional of GDP per capital over than 20 000 US dollars, 15 000 to 20 000 US dollars, 10 000 to 14 900 US dollars and less than 10 000 US dollars, the health education literacy scores were 40.76±4.52, 40.66±4.08, 40.50± 4.02 and 39.69±4.32 respectively. Significant difference was found between the competencies in health education of pediatric nurses and provinces with different GDP per capita ( F value was 9.21, P<0.001). Regression and hierarchical analysis models based on GDP per capita showed that: nurses with senior professional titles, bachelor degrees or above, aged over 40, and those working in emergency rooms have higher competencies in health education ( OR value was 0.296-4.766, P<0.05) . Lower competencies in health education were demonstrated on nurses who have been working less than 5 years ( OR value was 0.319, P<0.05). Conclusions:Economic development is one of the main factors that affect the competencies in health education of pediatric nurses in China. Pediatric nurses who were young, had limited working experience, with low office titles, with low education background, and who working at non-emergency rooms require more training.
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Objective:To construct evaluation index system for the communication effectiveness of nursing WeChat public accounts in hospital, and to provide a scientific and systematic evaluation tool for the communication effectiveness of nursing WeChat public accounts in hospital.Methods:Based on Lasswell′s "5W" communication process model, the evaluation index system for the communication effectiveness of nursing WeChat public accounts in hospital was constructed by applying Delphi expert consultation method and analytic hierarchy process.Results:The the evaluation index system for the communication effect of nursing WeChat public accounts in hospital consists of 5 first-level index, which contained communicator, communication content, communication media, communication audience, communication environment, and 12 second-level index, which contained professional quality, function setting, public trust, using experience, internal environment, etc, and 52 third-level index.Conclusions:The evaluation index system for the communication effectiveness of nursing WeChat public accounts in hospital could provide nursing managers an systematic evaluation tool. It could promote the construction and development of nursing WeChat public accounts and ensure that patients receive the health information which were scientific, authoritative and standard.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause acute respiratory distress syndrome, hypercoagulability, hypertension, and multiorgan dysfunction. Effective antivirals with safe clinical profile are urgently needed to improve the overall prognosis. In an analysis of a randomly collected cohort of 124 patients with COVID-19, we found that hypercoagulability as indicated by elevated concentrations of D-dimers was associated with disease severity. By virtual screening of a U.S. FDA approved drug library, we identified an anticoagulation agent dipyridamole (DIP) , which suppressed SARS-CoV-2 replication . In a proof-of-concept trial involving 31 patients with COVID-19, DIP supplementation was associated with significantly decreased concentrations of D-dimers ( < 0.05), increased lymphocyte and platelet recovery in the circulation, and markedly improved clinical outcomes in comparison to the control patients. In particular, all 8 of the DIP-treated severely ill patients showed remarkable improvement: 7 patients (87.5%) achieved clinical cure and were discharged from the hospitals while the remaining 1 patient (12.5%) was in clinical remission.
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Objective To explore the mediation role of emotional labor in the relationship between workplace ostracism and emotional exhaustion, aiming to provide practical implications to manage workplace ostracism. Methods Using time-lagged survey, a total of 370 valid responses were collected at two time points from the nurses in a general hospital in Chengdu, including the data of demographics, workplace ostracism, emotional labor and emotional exhaustion. Structural equation model (SEM) was employed to test the relationships. Results The means of key variables were: workplace ostracism 1.30 (1.00, 1.73)，surface acting 1.50 (1.00,2.25), deep acting 3.00 (1.33, 4.00), and emotional exhaustion 3.53 (2.60, 4.20). There was a significant positive relationship between workplace ostracism and surface acting (P<0.01), just as well as the relationship with deep acting and emotional exhaustion (P<0.01). Surface acting led to emotional exhaustion of nurses (P<0.01) and mediated the positive relationship between workplace ostracism and emotional exhaustion. Deep acting was not significantly related to emotional exhaustion (P>0.05). SEM analysis demonstrated an acceptable and reasonable model fit. Conclusions The surveyed nurses reported a medium and low level of perceived workplace ostracism and emotional labor, but a high level of emotional exhaustion. Workplace ostracism has a positive effect on nurses' emotional exhaustion via surface acting. Hospital administration should take measure to prevent and intervene in workplace ostracism, provide organizational and supervisory supports to nurses, and particularly enhance nurse's emotional management skills and encourage use of deep acting strategy to minimize the detrimental effects of workplace ostracism.
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Objective:To explore the practice effect of phased transitional care on the growth of low birth weight premature infant and parenting stress in premature mother.Methods:A total of 82 low birth weight premature infant and its mother were randomly assigned to intervention group (42 cases) and control group (40 cases), the control group were given routine outpatient care, the intervention group received phased transitional care. The physical development status in premature infants and parenting stress in premature mother were compared at discharge time and 1 month, 3 months and 6 months older.Results:The body weight, body length, head circumference of premature infant were (7 179.92±477.69) g, (64.74±6.23) cm, (42.80±5.78) cm in the intervention group, which were significantly increased compared to (6 889.43±354.46) g, (61.26±5.06) cm, (39.60±5.54) cm in the control group at 6 months after discharge, the differences were statically significant ( t values were 3.063, 2.728, 2.515, P<0.05). The total stress scale in the intervention group at 1month, 3monts, 6 months after discharge were (76.73±8.51), (68.36±6.28), (67.39±5.09) points, which were significantly decreased compared to (81.10±8.95), (77.71±6.35), (75.75±5.59) pionts in the control group, the differences was statically significant ( t values were 2.225, 6.574, 6.948, P<0.05). Conclusion:Phased transitional care can effectively promote the growth and development of low birth weight preterm infants, as well as improve the parenting stress of premature mother.
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Objective:To study the correlation between fatigue symptoms and living condition of liver transplant recipients after discharge from hospital, so as to provide reference basis for preventing postoperative fatigue symptoms in recipients.Methods:From September 2018 to December 2018, 280 liver transplant recipients were selected from the liver transplantation clinic of a grade-three hospital in Shanghai by convenience sampling method, and clinical data of the patients were obtained by questionnaire survey to analyze factors of the symptom of postoperative fatigue.Results:A total of 280 patients were included, among which 130 patients showed fatigue symptoms, accounting for 46.4%. The results of single-factor analysis showed that the postoperative survival days, gender, total time of exercise, body mass index, working status, mode of payment of medical expenses, Sleep quality, negative emotions, and nutritional risk all exert an influence on fatigue symptoms ( P<0.05). The results of multi-factor analysis showed that the total time of exercise during a week ( OR=0.674, 95% CI:0.512-0.887), postoperative survival days ( OR=0.993, 95% CI:0.989-0.997) and the score of negative emotion scale ( OR=1.484, 95% CI:1.157-1.902) had significant influence on fatigue symptoms in patients ( P<0.01). Conclusions:Postoperative survival days, exercise time and negative emotions are the main factors affecting fatigue symptoms. Medical staff should evaluate and manage patients' psychological and activity exercise to improve fatigue symptoms.
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Objective:To investigate sedation level for postoperative patients with mechanical ventilation in ICU, and to explore the related factors and patient outcomes with different sedation level.Methods:Totally 163 postoperative ICU patients from 11th June to 30th October 2018 were prospectively analyzed. Medical information and all the RASS (Richmond Agitation Sedation Scale) scores was recorded by nurses.Results:The 163 enrolled patients received 11 261.62 hours mechanical ventilation therapy, and 2 815 RASS scores were assessed and recorded by nurses. Among these scores, 80.3% (2 261/2 815) were at light sedation level, while 17.4% (490/2 815) and 2.3% (64/2 815) were at excessive or insufficient sedation level, respectively. All patients were divided into satisfactory sedation group and unsatisfactory sedation group according to the recommendations of guidelines, and used both univariate analysis and multivariate analysis. Compared to males, female patients tend to be in a satisfactory sedation level ( OR value was 0.39, P<0.05); use of midazolam may increase the risk of unsatisfactory sedation level ( OR value was 5.60, P<0.05); the longer sedation assessment interval ( OR value was 1.70, P<0.05), the more likely the patient′s sedation level is unsatisfactory ( OR value was 1.70, P<0.05) . Patients in sedation unsatisfactory group have higher rate of tracheostomy ( χ 2 value was 9.70, P<0.01), longer ICU stay ( U value was -2.33, P<0.05) and more medical expense ( t value was -4.26, P<0.01). Conclusion:The current sedation management in our ICU is satisfactory, but there is still a small part of patients in a state of insufficient sedation or excessive sedation. Sedation level is closely related to sedatives, RASS assessments interval performed by the nurses. This study provides a reference and basis for clinical sedation management and the sedation assessment strategies in the ICU.
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Objective To explore the imaging features of brucellar spondylitis (BS).Methods The imaging data of 49 cases who were diagnosed as brucellar spondylitis by a positive standard tube agglutination titer test (≥1:100) and (or) the isolation of brucella species from blood or other tissue at our institution between September 2012 and October 2016 were retrospectively reviewed.X-ray,CT scan and MRI examination was performed in 49,28 and 42 cases,respectively,of which 19 cases underwent both CT scan and MRI examination.The imaging manifestations of the spine were analyzed.The x2 test or Fisher's exact test were applied to compare the imaging manifestations of the patients who underwent both CT scan and MRI examination.Results Of the 49 patients,34 patients (69.4％) had involvement of the lumbar vertebra.Forty-five patients (91.8％) had contiguous involvement at adjacent 2 vertebral bodies.There were 10 cases (20.4％) with bony spur or bone bridge,3 cases (6.1％) with spondylolisthesis and 3 cases (6.1％)with slightly kyphosis deformity.There were 8 cases (28.6％) showing bone destruction of more than half of the vertebral body and 6 cases (21.4％) with sequestra on CT.There were 14 cases (33.3％) with psoas abscesses,of which 2 (4.8％) had migrating abscess.Epidural abscesses with dural sac compression were found in 17 cases (40.5％) and 3 cases (7.1％) showed nerve roots compression.There were statistically significant differences in the detection of vertebral bone destruction,bone marrow edema,hyperosteogeny,intervertebral disc changes,abscess formation and sequestrum between CT and MRI (P＜0.05).Conclusion BS has characteristic imaging features.The presence of bone destruction,sequestrum,and migrating abscess should warrant the possibility of BS.
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Objective@#To investigate the relationship between sleep beliefs and attitudes and sleep quality in patients with stable coronary heart disease.@*Methods@#Totally 390 patients with stable coronary heart disease were investigated by the Pittsburgh Sleep Quality Index (PSQI), Dysfunctional Beliefs and Attitudes about Sleep Scale-16(DBAS-16) and a general information questionnaire which was designed by researchers.@*Results@#48.2% of patients with stable coronary heart disease reported poor sleep quality at home, and the total score of PSQI was (7.99 ± 4.061), the total score of DBAS was (47.44 ± 9.77). Univariate anova showed that age (F=14.567, P<0.01), gender (H=16.657, P<0.01), marital status (F=4.706, P=0.031), job status (F=15.738, P<0.01) and the number of comorbid diseases (F=4.674, P=0.003),are factors affecting sleep quality. Pearson correlation analysis showed that there were significantly negative correlation between PSQI and DBAS (r=-0.260, P<0.01). Multiple Linear Regression showed that sleep beliefs and attitudes, gender, age, the number of comorbid diseases were influencing factors of sleep quality (R2=0.247, F=17.907, P<0.01).@*Conclusions@#The sleep quality at home in patients with stable coronary heart disease was closely related to sleep beliefs and attitudes. Nurses should pay more attention to the sleep quality of patients, correct their incorrect sleep cognition timely, and improve their sleep quality.
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Objective@#To explore the application effect of triage-registration information systems in emergency patients.@*Methods@#A total of 18 964 emergency patients from 1 December 2016 to 31 December 2016 in Zhongshan Hospital of Fudan University Emergency Department were selected as control group and 18798 emergency patients as experimental group from March 1, 2017 to March 31, 2017. In the control group, the patients were used traditional mode of triage-registration and registration office respectively line. In the experimental group, the patients were used triage-registration information systems in line once. The emergency waiting time, patient satisfaction and medical staff satisfaction were compared between the two groups before and after the application of triage-registration information systems.@*Results@#The waiting time in the experimental group was significantly shorter than that in the control group, median (P25, P75) : 11 (6-28) min vs. 10 (4, 27) min, The difference between both groups was statistically significant (Z=-14.5433, P=0.000) . The patient satisfaction in the experimental group were better than those in the control group, (2.89±0.41 vs. 2.98±0.13), and with statistical difference (Z=-10.317, P<0.05) . And the acceptance of the medical staff in the experimental group were better than those in the control group, (2.90±0.35 VS 2.97±0.16), and with statistical difference (Z=-5.527, P < 0.05).@*Conclusions@#The development and application of the triage-registration information system can effectively shorten the waiting time of patients, improve the experience of emergency patients, improve the satisfaction of medical staff, and realize the optimization of the process of seeking medical treatment.
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Objective To investigate whether elevated parathyroid hormone (PTH) levels could induce endothelial - to - mesenchymal transition (EndMT) and adipocyte transition in endothelial cells (ECs), and to determine the possible underlying mechanism. Methods (1) A rat model of secondary hyperparathyroidism and chronic kidney disease (CKD) was established. The adiposity in bone marrow was detected by oil red O staining. Immunofluorescence staining was performed to detect the expression and localization of cluster of differentiation 31 (CD31) and fibroblast-specific protein 1 (FSP1). (2) The human umbilical vein ECs were cultured in vitro. Western blotting was performed to detect protein expressions of EndMT-related markers CD31, FSP1 and α-smooth muscle actin (α-SMA) in interference groups with different PTH concentrations (0, 10-11, 10-9, 10-7 mol/L PTH for 48 h) and times (0, 12, 24, 48 h, 10-7 mol/L PTH), as well as the expression of β-catenin in interference groups with different PTH concentrations. The localizations of CD31, FSP1 and β - catenin were observed by cell immunofluorescence. Protein expressions of adipocytes markers peroxisome proliferator - activated receptor-γ (PPAR-γ) and CCAAT/enhancer binding protein-α (C/EBP-α) by Western blotting and the degree of adipogenesis by oil red O staining were detected after transformed ECs were cultured in adipogenic culture medium for one week. Small interfering RNA (siRNA) was performed to silenceβ - catenin expression. ECs were divided into control siRNA group, β - catenin siRNA group, PTH +control siRNA group and PTH+β-catenin siRNA group. Protein expressions of CD31, FSP1 and PPAR-γby Western blotting and the degree of adipogenesis by oil red O staining were determined. Results (1) In vivo, compared with the control, CKD rats had increased adipocytes in bone marrow (P＜0.05), and the co-expression of CD31 and FSP1 in bone marrow ECs. (2) In vitro, PTH significantly inhibited the expression of endothelial marker CD31 and increased the expressions of mesenchymal markers FSP1 and α-SMA in concentration-and time-dependent manners. These indexes in 10-7 mol/L PTH group and 0 mol/L PTH group, in 48 h group and 0 h group showed statistical differences (all P＜0.05). In PTH group ECs with 10-7 mol/L PTH for 48 h showed FSP1 accumulation in the cytoplasm and reduced expressions of CD31, and ECs had higher expressions of PPAR-γ and C/EBP-α as well as the degree of adipogenesis than those in control group (all P＜0.05). Furthermore, PTH enhanced the nuclearβ-catenin protein levels in ECs in concentration-dependent. The expressions of β-catenin in 10-7 mol/L PTH group and 0 mol/L PTH group showed statistical differences (P＜0.05). β - catenin expressed in the cytoplasm in control group, while it enter into the nucleus in PTH group. Compared with those in PTH+control siRNA group, the expressions of CD31 and PPAR-γ as well as the degree of adipogenesis decreased in PTH+β-catenin siRNA group (all P＜0.05), while the expression of FSP1 increased (P＜0.05). Conclusions PTH induces ECs - to - adipocytes transition by the canonical Wnt/β - catenin signaling pathway, which might account for bone loss in CKD. Silenced β - catenin expression can inhibit PTH-induced EndMT and adipogenesis.
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Objective To design a mathematical calculation model for better understanding and grasping the logical problem of replacement fluid and citric acid anticoagulant infusion in continuous veno-venous hemofiltration (CVVH). Methods ① Parameter definition: A, B, and T were respectively called the main part of pre-replacement fluid, 5% sodium bicarbonate solution, and 4% sodium citrate infused before filter. And a and b were respectively called the main part of post-replacement fluid, and 5% sodium bicarbonate solution infused after filter. ② Logic conversion:The liquid in back terminal (Z) was artificially divided into two parts. One (X) was the original residual plasma after filtration. The second (Y) was the part excluding the plasma, including the left part of pre-replacement fluid with sodium citrate, and the post-replacement fluid. ③The mathematical formulas of liquid volume and electrolyte concentration at X, Y and Z in unit time were listed according to the principle of CVVH and the screening coefficient of filter for different substances. ④The calculation formulas were entered into Excel form, and a mathematical calculation model was made, and a simulation calculation with examples was carried out. Results An Excel model was established by inserting the calculation formulas of volume, electrolyte, and total calcium at X, Y and Z. And it was found that the concentration of Na+, K+, Cl-, HCO3- at Y point remained unchanged only when A, B and (or) a, b was kept in same side and proportion even with the change of blood flow and other parameters without sodium citrate as anticoagulant. Once any of the parameters (such as blood flow, replacement fluid volume, etc.) were adjusted in other infusion methods (such as different ratios, different directions of the same year, etc.), the calculation results at Y would vary, and the electrolyte concentration at Z would change accordingly. A change of dilution model or parameter would result in the change of the electrolyte concentration at Y and Z with sodium citrate as anticoagulant. The concentration of total calcium scarcely changed no matter in what model and parameters. Conclusions All kinds of infusion ways could be included in the Excel model. The infusion results of all kinds of infusion matching could be intuitively evaluated. It is helpful for the medical staff to make a logical analysis and risk prediction in CVVH.
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Objective To investigate the relationship between sleep beliefs and attitudes and sleep quality in patients with stable coronary heart disease. Methods Totally 390 patients with stable coronary heart disease were investigated by the Pittsburgh Sleep Quality Index (PSQI), Dysfunctional Beliefs and Attitudes about Sleep Scale-16(DBAS-16) and a general information questionnaire which was designed by researchers. Results 48.2% of patients with stable coronary heart disease reported poor sleep quality at home, and the total score of PSQI was (7.99 ± 4.061), the total score of DBAS was (47.44 ± 9.77). Univariate anova showed that age (F=14.567, P＜0.01), gender (H=16.657, P＜0.01), marital status (F=4.706, P=0.031), job status (F=15.738, P＜0.01) and the number of comorbid diseases (F=4.674, P=0.003),are factors affecting sleep quality. Pearson correlation analysis showed that there were significantly negative correlation between PSQI and DBAS (r=-0.260, P＜0.01). Multiple Linear Regression showed that sleep beliefs and attitudes, gender, age, the number of comorbid diseases were influencing factors of sleep quality (R2=0.247, F=17.907, P＜0.01). Conclusions The sleep quality at home in patients with stable coronary heart disease was closely related to sleep beliefs and attitudes. Nurses should pay more attention to the sleep quality of patients, correct their incorrect sleep cognition timely, and improve their sleep quality.
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Objective To explore the application effect of triage-registration information systems in emergency patients. Methods A total of 18 964 emergency patients from 1 December 2016 to 31 December 2016 in Zhongshan Hospital of Fudan University Emergency Department were selected as control group and 18798 emergency patients as experimental group from March 1, 2017 to March 31, 2017. In the control group, the patients were used traditional mode of triage-registration and registration office respectively line. In the experimental group, the patients were used triage-registration information systems in line once. The emergency waiting time, patient satisfaction and medical staff satisfaction were compared between the two groups before and after the application of triage-registration information systems. Results The waiting time in the experimental group was significantly shorter than that in the control group, median(P25, P75):11(6-28)min vs. 10(4, 27)min, The difference between both groups was statistically significant(Z=-14.5433, P=0.000). The patient satisfaction in the experimental group were better than those in the control group, (2.89 ± 0.41 vs. 2.98 ± 0.13), and with statistical difference (Z=-10.317, P＜0.05). And the acceptance of the medical staff in the experimental group were better than those in the control group, (2.90±0.35 VS 2.97±0.16), and with statistical difference (Z=-5.527, P<0.05). Conclusions The development and application of the triage- registration information system can effectively shorten the waiting time of patients, improve the experience of emergency patients, improve the satisfaction of medical staff, and realize the optimization of the process of seeking medical treatment.
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Objective To study the clinical effect of evidence-based prevention strategies of ventilator-associated pneumonia (VAP) in newborns with endotracheal intubation in neonatal intensive care unit (NICU).Method A retrospective analysis was carried out in neonates undergoing mechanical ventilation,who were admitted to the NICU of the hospital from 2016 to 2017.Intubated newborns from January 2016 to December 2016 were conducted with traditional method of preventing VAP and included as control group.While intubated newborns admitted from January 2017 to December 2017 with newly developed evidence-based prevention strategy for VAP were included as observation group.The positive rates of culture from swab or sputum or endotracheal intubation tube ends obtained within 48 hours after intubation and 48 hours after extubation were compared between groups.The neonates whose swab or sputum culture was negative before intubation were included.The positive rate was presented as the number of positive cases/1 000 intubation days.Result A total of 1 221 intubated infants were included,with 632 cases in the control group which were intubated 798 times,and 589 cases in the observation group which were intubated 720 times.The gestational age and birth weight of the observation group was lower than the control group.The rate of extremely low birth weight infant of the observation group was higher than that of the control group.The mechanical ventilation days were also longer in the observation group.The differences were statistically significant (P ＜ 0.05).In the control group,the number of positive cases was 112 and the total intubation days were 3 079 days,the positive rate was 36.4 cases/1 000 intubation days.In the observation group,the number of positive cases was 72 and the total intuhation days were 3 475 days,the positive rate was 20.7 cases/1 000 intubation days.The positive rate of observation group was lower than the control group,the differences was statistically significant (x2 =4.060,P =0.044).Conclusion Evidence-based neonatal VAP bundle can reduce the invasion of respiratory pathogenic bacteria in NICU.In the future work of NICU nursing,we should use bundle strategy to care for babies more and more,and the bundle should be supported by evidence.
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Objective To analyze job information of clinical nurse specialist (CNS) in comprehensive children′s hospital,andclarify CNS′s qualification requirements. Methods Using working log and questionnaires to conduct a survey on 39 nurses and doctors in children′s hospital. Results Qualified CNS position asks for academic requirements for the undergraduate or above;pediatric work experiences for more than 5 years, pediatric specialist work experiences for more than 3 years, and also 3-6 months ICU work experience; competency of clinical practice skills, interpersonal skills, analysis and evaluation of decision-making. Direct clinical nursing is the core of CNS daily work content. Conclusions Job descriptions should be established to meet the pediatric CNS job characteristics,to ensure the CNS personnel selects.
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Objective To investigate oral feeding progression and its influencing factors in very-low-birth-weight infants. Methods Investigation was conducted among 114 infants with the Gestational age≤30 weeks,birth weight≤1 500 g using very low birth weight infants clinical information questionnaire and oral feeding survey. Results The very low birth weight infants started enteral nutrition(20.61±4.67) h after admission, achieved a total enteral nutrition (41.47 ± 15.53) days after birth with the correct gestational age was (34.35 ± 2.76) weeks. The infants started oral feeding (41.47 ± 15.53) days after birth with the correct gestational age(34.58±1.98)weeks.The infants achieved full oral feeding(55.19±16.30) days after birth with the correct gestational age(36.40 ±1.99)weeks.Single factor and multiple regression analysis showed that birth weight,gestational age,BPD were significant factors of oral feeding progression. Conclusions The smaller gestational age, birth weight, the longer duration the infants reach the oral feeding milestones, Infants with BPD have obvious oral feeding progression. The medical staffs should learn that the very low birth weight have oral feeding difficulties and thus take positive and effective measures to promote the advancement of oral feeding.