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Objective:To assess the clinical application of bedside X-ray photography assistor (Patent No. 202 023 219 898.1) in neonatal bedside photography.Methods:From April 2021 to February 2022, a total of 180 pediatric patients were selected who underwent bedside chest X-ray photography in neonatal intensive care unit (NICU) of Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology. These patients were divided into contrpol group, consisting of 48 males and 42 females aged at (3.3 ± 2.0) d (0-10 d), and experimental group, including 50 males and 40 females aged (3.1±2.2) d (0-12 d). For chest photography, routine workflow was followed in the control group while in experimental group bedside photography protection and body position fixing device was used. The examination time, reshoot rate and image quality were compared between the two groups.Results:The diagnostic physician score and patient comfort score in the experimental group were higher than those in the control group, with statistically significant differences ( t = 3.98, 3.82, P < 0.001). The success rate in the experimental group was higher than that in the control group, with statistically significant difference ( χ2= 7.84, P < 0.05). The average time of examination in the experimental group was not significantly different from in the control group ( P>0.05 ). Conclusions:The application of bedside X-ray photography assistor in neonatal bedside photography can significantly improve the success rate and image quality and reduce the radiation dose to pediatric patients without significantly increased examination time, which is worthy of clinical application and promotion.
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Objective:To evaluate the value of bedside ultrasound in evaluating volume responsiveness of patients with septic shock.Methods:A total of 102 patients with septic shock admitted to ICU of the First Affiliated Hospital of Hebei North University from April 2018 to February 2021 were selected. Patients were divided into response group and non-response group according to the value of stroke volume increase (ΔSV) after volume loading test (VE), and the hemodynamic parameters before and after VE were compared between the two groups. Pearson correlation was used to analyze the relationship between ΔSV and hemodynamic indexes. Receiver operating characteristic (ROC) curve was drawn to analyze the sensitivity and specificity of each hemodynamic index in evaluating volumetric reactivity in patients with septic shock.Results:Of the 102 patients, 54 responded and 48 did not. Before VE, the distensibility index of inferior vena cava (ΔIVC 1), espiratory variability index of inferior vena cava (ΔIVC 2), respiratory variability of aortic peak velocity (ΔVpeak AO), brachial artery maximum velocity variability (ΔVpeak BA) and respiratory rate of peak flow velocity of femoral artery (ΔVpeak CFA) in response group were higher than those in non-response group (all P<0.05), but there was no statistical significance in heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) between 2 groups (all P>0.05). After VE, the HR, ΔIVC 1, ΔIVC 2, ΔVpeak AO, ΔVpeak BA and ΔVpeak CFA in response group were significantly decreased, while MAP and CVP were significantly increased (all P<0.05). The CVP was significantly decreased in the non-response group ( P<0.05), while other indexes were not significantly changed. Before VE, the ΔIVC 1, ΔIVC 2, ΔVpeak AO, ΔVpeak BA and ΔVpeak CFA were positively correlated with ΔSV ( r=0.589, 0.647, 0.697, 0.621, 0.766; all P<0.05). There was no correlation between CVP and ΔSV ( r=-0.345, P>0.05). Before VE, the area under the curve of ΔIVC 1, ΔIVC 2, ΔVpeak AO, ΔVpeak BA and ΔVpeak CFA were all >0.7, indicating high sensitivity and specificity. Conclusions:Bedside ultrasound monitoring ΔIVC, ΔVpeak AO, ΔVpeak BA and ΔVpeak CFA can better evaluate the volume response of patients with septic shock, and can provide a reference basis for clinical fluid resuscitation treatment.
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Neonatal hypoxic-ischemic encephalopathy (HIE) is a perinatal hypoxic ischemic injury caused by hypoxia, which is one of the common neurological disorders in neonatal period, and the untimely treatment can lead to serious complications and sequelae, including poor neurodevelopmental outcome and death.Currently, no specific therapeutic drugs have been found for this disease, so early clinical intervention is very important.This article reviews the advantages and disadvantages of cranial ultrasound, amplitude-integrated electroencephalography, and near-infrared spectroscopy for the diagnosis of neonatal HIE and the monitoring of brain function, as well as the outlook for the use of portable magnetic resonance.The aim is to provide cerebral function monitoring and early diagnosis and treatment for children with HIE, and to better predict their immediate and long-term outcomes.
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Translational research is well-known concept in healthcare still nurse-led translational research is an emerging area of multidisciplinary nursing research. This study intends to offer an in-depth look at translational research and the process for its applications in nursing education, practice, and research. Nurses, educators, researchers, and policymakers will better understand nurse scientists’ expanded role in education and clinical practice. This paper will assist the nurse educators, researchers to stay informed of translational research and its nursing impact. To develop a narrative synthesis study, a detailed systematic literature review was conducted in Pub Med, Web of Sciences, Scopus, ProQuest, Ovid using the keywords “translational research,” “nursing,” “implementation science,” “barriers in translational research” themes generated in selected paper are discussed in detail in this paper. 32 articles were found to be relevant to discuss the concepts of translational research in nursing practices. In contrast to basic research, translational research works cooperatively to assess the efficacy of evidence from the bench to the bed, from one realm to another. It requires the transparent method for dealing with roadblocks, such as following evidence-based recommendations while assessing evidence, so that policymakers can determine whether to embrace them for the development of the health-care system. Nurse-led translational research under the direction of a nurse scientist has the potential to advance nursing excellence in both clinical and community health settings.
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Objective:To evaluate the risk factors for diaphragmatic dysfunction of patients with sepsis and septic shock, and the application value of bedside ultrasound.Methods:Patients with sepsis and septic shock in the Intensive Care Unit (ICU), General Hospital of Ningxia Medical University from January 2020 to May 2021 were prospectively recruited as the research subjects, general postoperative patients and healthy volunteers were admitted as postoperative control and normal control groups. General clinical data were collected, patients with sepsis and septic shock were dynamically observed high sensitive c-reactive protein (hs-CRP), interleukin-6 (IL-6), serum albumin, transferrin, prealbumin levels, blood lactate, Pcv-aCO 2, ScvO 2, etc.; and indirect calorimetry was used to measure the resting energy level of the patient to calculate the missing energy value. Bedside ultrasound was used to dynamically evaluate the changes of diaphragm excursion (DE),inspiratory diaphragm thickness, and expiratory diaphragm thickness, to calculate relevant parameters. DE<10 mm or diaphragmatic thickness fraction (DTF) < 20% was diagnosed as diaphragmatic dysfunction. Results:(1) On day 1 in the ICU, the DE of the septic shock group, sepsis group and postoperative control group were significantly lower than that in the normal control group [10.3 (9.0, 13.6) mm, 12.3 (9.1, 15.0) mm, 12.9 (10.5, 15.7) mm vs. 22.0 (16.0, 24.6) mm, all P<0.05], and the incidence of DTF<20% was significantly higher than in the normal control group (32.7%, 41.9%, 33.3% vs. 0 %, all P<0.05), and the incidence of DE<10 mm in the septic shock group and sepsis group was significantly higher than that of postoperative control group and normal control group (36.7%, 35.5% vs. 10.0%, 0%, respectively, all P<0.05). On day 7, the DE in the septic shock group was significantly lower than that in the sepsis group [10.5 (6.8, 13.5) mm vs. 14.4 (10.6, 18.6) mm, P<0.05].(2) Correlation analysis of each index: The DE of patients with sepsis and septic shock on day 1, 3, and 7 was negatively correlated with the hs-CRP ( r=-0.253, -0.436, -0.455, all P<0.05); On day 3, DE was also negatively correlated with IL-6 ( r=-0.338, P=0.009); and DTF was negatively correlated with hs-CRP ( r=-0.375, P=0.004). On day 1, there was a positive correlation between DTF and serum transferrin levels in patients with sepsis and septic shock ( r=0.221, P=0.049). On day 3 and 7, the DE was positively correlated with serum prealbumin levels ( r=0.318, 0.408, both P<0.05). Conclusions:Patients with sepsis and septic shock have developed diaphragmatic dysfunction on day 1 in the ICU, which is mainly manifested as decreased in diaphragm mobility and diaphragmatic thickness fraction, and is related to inflammation and high protein catabolism.
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Objective:To investigate the predictive value of emergency bedside echocardiography on acute pancreatitis (AP) severity by assessing cardiac dysfunction.Methods:The clinical data used in this study was prospectively collected from AP patients in the Emergency Department of Beijing Shijitan Hospital, Capital Medical University from June 2018 to December 2020. According to the Atlanta Classification revised at the 2012 Atlanta International Conference, patients were divided into three groups of mild acute pancreatitis (MAP), moderate-severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP). The differences of comprehensive score index, blood-related index, and echocardiography-related index were compared among the three groups. Besides, the predictive factors of SAP were analyzed by Logistic regression, receiving operating characteristic (ROC) curves of subjects were drawn, and the area under the curve (AUC) was analyzed to evaluate the predictive efficiency.Results:A total of 116 patients were enrolled in this study. Compared with the non-SAP group (MAP group+MSAP group), acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, Ranson score, procalcitonin, cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NTproBNP), EDD, A-peak, E/A, E'/A', and stroke volume (SV) exhibited significant differences (all P<0.05). There was no significant difference in end-systolic diameter, E-peak, and left ventricular ejection fraction among the three groups ( P>0.05). Logistic regression analysis revealed that SOFA score, Ranson score, cTnI, NTproBNP, E'/A', and SV were important predictors of AP severity (all AUC>0.7). Moreover, the predictive value of echocardiography cardiac function assessment index (E'/A' +SV, AUC=0.969) and score index (SOFA score +Ranson score, AUC=0.989) for SAP was better than that of blood index (cTnI+NTproBNP, AUC=0.732). Conclusions:Echocardiographic indicators E'/A' and SV have acceptable predictive values for SAP, providing certain guiding significance for the clinical treatment of AP patients.
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Based on the ideas of management systemization, system standardization, process specialisation, post accountability, duty formalization, form informatization, information digitization and digital intelligence, the smart, mobile and paperless bedside billing service was developed which incorporated both functional and financial prospects. The innovation was realized by Internet+ bedside billing and an integrated information platform, so that the inter-hospital billing system could be connected to the medical insurance system, electrical receive system and commercial insurance system. This saved manpower and equipment deployment, and improved service quality. The bedside intelligent mobile billing system of a hospital was launched in January 2021, and the average discharge billing time of inpatients in 2020 and 2021 was 44.36 min and 30.59 min, respectively, and the online billing fee time was significantly shorter than offline billing in 2021, and the differences were all significant( P<0.01).
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Objective:To analyze the clinical reliability of neonatal bedside photography protection and body position fixing device during neonatal bedside X-ray photography.Methods:A mobile X-ray diagnostic machine was used to project the phantom of children. The samples were divided into group A with conventional bedside photography mode, and group B using neonatal bedside X-ray photography protection device. X-ray diagnostic level dosimeters were placed at the projection and radiation sensitive sites, respectively. The three parts of the chest, pelvis and skull were used as the projection center, and the radiation dose to the projection site and the radiation sensitive site were collected and recorded, and the statistical analysis was carried out.Results:When the chest was taken as the center of the projection, the radiation doses to the lens of the eye, thyroid and gonad in the body model group B of children were 94.4%, 96.9% and 96.7% lower than those in the non-injected part of group A, respectively ( t=-152.55, -445.16, -129.07, P<0.05). When the pelvis was taken as the projection center, the radiation doses to the lens, thyroid and thymus in the body model group B were 85.5%, 87.1% and 94.9% lower than those in the non-projection part of group A, respectively ( t=-50.68, -194.18, -535.94, P<0.05). When the head was taken as the projection center, the radiation doses to thyroid, thymus and gonad in the body model group B were 99.3 %, 97.4 % and 94.3 % lower than those in the non-projection position of group A, respectively ( t=-1 859.97, -542.08, -66.26, P< 0.05). Conclusions:The use of neonatal bedside photography protection and position fixing device during neonatal bedside X-ray photography can significantly reduce the radiation dose to children in non-projected areas under the premise of ensuring image quality. At the same time, it can fix and protect the children, improve the success rate of examination, being worthy of clinical promotion.
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Objective:To investigate the changes of quadriceps femoris thickness with the length of stay in intensive care unit (ICU) in patients with sepsis, and to evaluate the diagnostic value of muscle changes in mortality.Methods:A prospective study was conducted, and 92 patients with sepsis who were admitted to the ICU of the Affiliated Hospital of Jining Medical College from January 2020 to December 2021 were enrolled. The thickness of quadriceps femoris [including the quadriceps femoris muscle thickness at the midpoint of the anterior superior iliac spine and the upper edge of the patella (M-QMLT), and at the middle and lower 1/3 of the patella (T-QMLT)] measured by ultrasound 1 day (D1), 3 days (D3), and 7 days (D7) after admission to the ICU were collected. The atrophy rate of quadriceps femoris was calculated 3 and 7 days after admission to the ICU compared with 1 day [(D3-D1)/D1 and (D7-D1)/D1, (TD3-TD1)/TD1 and (TD7-TD1)/TD1, respectively]. The demographic information, underlying diseases, vital signs when admission to the ICU and in-hospital mortality of all patients were recorded, and the differences of the above indicators between the two groupswere compared. Multivariate Logistic regression was used to analyze the influence of quadriceps femoris muscle thickness and atrophy rate on in-hospital mortality of septic patients. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of quadriceps femoris muscle thickness and atrophy rate on in-hospital mortality of septic patients.Results:A total of 92 patients with severe sepsis were included, of which 41 patients died in hospital, 51 patients discharged. The in-hospital mortality was 44.6%. The muscle thickness of quadriceps femoris in severe septic patients decreased with the prolongation of ICU stay, and there was no significant difference between the two groups at the first and third day of ICU admission. The muscle thickness of quadriceps femoris at different measuring positions in the survival group was significantly greater than those in the death group 7 days after admission to the ICU [M-QMLT D7 (cm): 0.50±0.26 vs. 0.39±0.19, T-QMLT D7 (cm): 0.58±0.29 vs. 0.45±0.21, both P < 0.05]. The atrophy rate of quadriceps femoris muscle thickness at different measuring positions 3 and 7 days after admission to ICU in the survival group was significantly lower than those in the death group [(D3-D1)/D1: (8.33±3.44)% vs. (9.74±3.91)%, (D7-D1)/D1: (12.21±4.76)% vs. (19.80±6.15)%, (TD3-TD1)/TD1: (7.83±4.26)% vs. (10.51±4.75)%, (TD7-TD1)/TD1: (11.10±5.46)% vs. (20.22±6.05)%, all P < 0.05]. Multivariate Logistic regression analysis showed that M-QMLT D7, T-QMLT D7, (D3-D1)/D1, (D7-D1)/D1, (TD3-TD1)/TD1, (TD7-TD1)/TD1 were independent risk factors for in-hospital mortality (all P < 0.05). The results were stable after adjusting for confounding factors. ROC curve analysis showed that (TD7-TD1)/TD1 [area under the ROC curve (AUC) was 0.853, 95% confidence interval (95% CI) was 0.773-0.934] was superior to (D7-D1)/D1, T-QMLT D7, M-QMLT D7, (TD3-TD1)/TD1 and (D3-D1)/D1 [AUC was 0.821 (0.725-0.917), 0.692 (0.582-0.802), 0.683 (0.573-0.794), 0.680 (0.569-0.791), 0.622 (0.502-0.742)]. Conclusions:For septic patients in ICU, bedside ultrasound monitoring of quadriceps femoris muscle thickness and atrophy rate has a certain predictive value for in-hospital mortality, and a certain guiding significance in clinical treatment and predicting the prognosis of sepsis.
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The patients with trauma have a high mortality and disability rate, and the incidence of trauma is increasing year by year.Rapid and accurate diagnosis is the key to improve the prognosis of patients with trauma.The traditional diagnostic imaging techniques are X-ray and CT examination.Although X-ray examination can be completed at the bedside, its sensitivity is not high.The diagnostic sensitivity of CT examination is high, but it can not be completed by bedside.Moreover, the process of repeated transportation of patients will delay the best treatment time, even cause secondary injury.Bedside ultrasound has the advantages of fast, real-time, noninvasive and repeatable operation.With the continuous development of bedside ultrasound technology, it has been widely used in the diagnosis of trauma.This review summarized the clinical applications of bedside ultrasound in trauma patients.
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Objective:To evaluate the success rate and influencing factors of auscultation-assisted bedside blind placement of the spiral nasojejunal feeding tube in oldest-old patients.Methods:A case series study was conducted in those elderly hospitalized patients who met the indications for naso intestinal intubation from January 2019 to May 2021 in China-Japan Friendship Hospital. Auscultation-assisted bedside blind placement of the spiral nasojejunal feeding tube was implemented. In addition, abdominal X-ray imaging was performed to confirm the location of the catheter tip. The primary indicators included were the success rate and the first attempt success rate of nasojejunal tube placement;, while the secondary indicators included were the number of attempts and the time of insertion. The rate of operational-related adverse events was ustreated as to evaluate the indicator of safety. Logistic regression analysis was used to conduct multi factor analysis.Results:The total success rate and the first-attempt success rate of tube implantation reached were 90.1%(73/81) and 85.2%(69/81), respectively. The mean attempt per individual patient was (1.2 ± 0.2) times for each patient. The median length of operation time was 40.0(27.0, 45.0) minutes, more specifically, among which the median length time of nasogastric and gastrojejunal placement was 20.0(15.0, 25.0) and 18.0(12.5, 20.0) minutes, respectively; while the median lengthtime of nasogastric placement was greaterhigher than that of gastrojejunal placement ( Z = -2.78, P<0.05). As suggested by multivariate analysis, indicated that the conscious conditions of patients had a signific antlyimpact affect on the success rate of for tube implantation ( OR = 19.25, 95% CI 1.24-299.63, P<0.05). In addition, the incidence rate of operational-related adverse events was 37.0%(30/81). By contrast, there were no serious adverse events occurring during the study period. Conclusions:The auscultation-assisted bedside blind placement of the nasojejunal feeding tube technique is effective and safe for early nutrition support in oldest-old patients in terms of early nutritionsupport, the success rate of which is significant largely affected by the patients′ conscious conditions of patients.
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Objective:To explore the value of severe ultrasound measurement of internal jugular vein dilation index (ΔIJV) combined with passive leg raising (PLR) in predicting the volume responsiveness of septic shock.Methods:Patients diagnosed with septic shock under complete mechanical ventilation in the ICU of Jinshan Hospital Affiliated to Fudan University from January 2020 to March 2021 were prospectively selected as the research objects. After 500 mL crystals were injected within 30 min, the patients having the "gold standard" left stroke volume (SV) increased by 15% were allocated to the volume response positive group, and patient having an SV increased by less than 15% to the volume response negative group. First, the maximum anterior posterior diameter (IJV max) and the minimum anterior posterior diameter (IJV min) in the respiratory cycle of internal jugular vein were measured by ultrasound, then SV before and after PLR was measured, and finally SV, IJV max and IJV min were measured again after rapid infusion of 500 mL crystals, and ΔIJV=(IJV max-IJV min)/(IJV mean)×100%. The Wilcoxon rank-sum test was used to compare the hemodynamic indexes before and after capacity expansion and PLR. Spearman rank method was used to analyze the change rate of SV (ΔSV) after PLR and the correlation between ΔIJV and ΔSV of the "gold standard". The sensitivity, specificity and relevant cut-off values were obtained by drawing the subject function curve to evaluate the value of ΔIJV and PLR in predicting the volume responsiveness of patients with sepsis. Results:A total of 56 patients were enrolled in the study, and they were divided into two groups: 32 patients in the volume response positive group and 24 patients in the volume response negative group. There was a positive correlation between ΔIJV and ΔSV after capacity expansion ( r=0.778, P<0.01). Taking ΔIJV>17.3% as the threshold, the area under the curve (AUC) was 0.846 (95% CI: 0.716~0.977), the sensitivity was 84.4% and the specificity was 83.3%. PLR was also positively correlated with ΔSV ( r=0.698, P<0.01). Taking ΔSV>15.5% after PLR as the threshold, the AUC was 0.895 (95% CI: 0.796~0.993), the sensitivity was 96.9%, and the specificity was 79.2%. When ΔIJV combined with PLR predicted volume reactivity, the AUC was 0.944 (95% CI: 0.862~1.000), the sensitivity was 99.8% and the specificity was 87.5%. Conclusions:The measurement of internal jugular vein respiratory dilation index by bedside ultrasound is a reliable index to predict volume responsiveness in patients with sepsis. When combined with PLR, the sensitivity and specificity of prediction can be improved.
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Objective:To explore the value of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) combined with bedside index for severity in acute pancreatitis (BISAP) score in predicting severe acute pancreatitis (SAP) in patients with hypertriglyceridemia pancreatitis (HTGP).Methods:Patients who met the diagnostic criteria of HTGP were retrospectively collected in the Emergency Department of Peking University People's Hospital from January to December in 2019. Patients were assigned to two groups according to the severity of acute pancreatitis: the mild acute pancreatitis group and severe acute pancreatitis (SAP) group. Blood samples were taken within 24 h after the onset of HTGP for analysis. White blood cell count, neutrophil count, lymphocyte count, and other laboratory indicators were detected. BISAP score was performed, and NLR and PLR were calculated in all patients within 24 h of the onset of HTGP. Comparison of various indicators was performed in the two groups. The risk factors of SAP patients with HTGP were analyzed by Logistic regression. The correlation of risk factors was analyzed by correlation. The receiver operating characteristic (ROC) curve was drawn, and the optimal thresholds of NLR and PLR were calculated respectively. The BISAP score, NLR combined with BISAP score (BN score), PLR combined with BISAP score (BP score), and NLR, PLR combined with BISAP score (BNP score) were compared respectively to predict SAP in patients with HTGP.Results:A total of 82 patients were collected. There were significant differences in the proportion of patients with fever, NLR, PLR, lactate dehydrogenase, urea nitrogen, Ranson score, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score and BISAP score between the two groups (all P<0.05). Logistic regression analysis showed that NLR ( OR=1.859, 95% CI: 1.385-2.497, P<0.001), PLR ( OR=1.074, 95% CI: 1.036-1.112, P<0.001) and BISAP score ( OR=2.880, 95% CI: 1.578-5.258, P=0.001) were risk factors for severe HTGP. Correlation analysis confirmed that NLR and PLR were positively correlated with BISAP, APACHE Ⅱand Ranson score. The AUC of BISAP score, BN score, BP score and BNP score for predicting SAP in HTGP were 0.865 (95% CI: 0.787-0.943), 0.925 (95% CI: 0.869-0.981),0.930 (95% CI: 0.885-0.987), and 0.936 (95% CI: 0.874-0.986). Conclusions:NLR and PLR combined with BISAP score has a higher sensitivity to predict the severity of HTGP, which can predict severe pancreatitis within 24 h of the onset of HTGP, so that providing better guidance for treatment.
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OBJECTIVES@#To study the value of bedside echocardiography in predicting persistent patency of the ductus arteriosus during the early postnatal period in very low birth weight (VLBW) infants.@*METHODS@#A retrospective analysis was performed for 51 VLBW infants who were admitted from March 2020 to June 2021, with an age of ≤3 days and a length of hospital stay of ≥14 days. According to the diameter of patent ductus arteriosus (PDA) on days 14 and 28 after birth, the infants were divided into three groups: large PDA group (PDA diameter ≥2 mm), small PDA group (PDA diameter <2 mm), and PDA closure group (PDA diameter =0 mm). The echocardiographic parameters measured at 72 hours after birth were compared among the three groups. The receiver operating characteristic (ROC) curve was used to evaluate the value of the echocardiographic parameters in predicting persistent patency of the ductus arteriosus (PDA≥2 mm) at the ages of 14 and 28 days.@*RESULTS@#On day 14 after birth, there were 17 infants in the large PDA group, 11 in the small PDA group, and 23 in the PDA closure group. On day 28 after birth, there were 14 infants in the large PDA group, 9 in the small PDA group, and 26 in the PDA closure group. There were significant differences in gestational age, birth weight, rate of pulmonary surfactant use, and incidence rate of hypotension among the three groups (P<0.05). PDA diameter, end-diastolic velocity of the left pulmonary artery, left ventricular output, and left ventricular output/superior vena cava flow ratio measured at 72 hours after birth were associated with persistent patency of the ductus arteriosus at the ages of 14 and 28 days (P<0.05), and the ratio of the left atrium to aorta diameter was associated with persistent patency of the ductus arteriosus at the age of 28 days (P<0.05). The ROC curve analysis showed that the area under the curve that the PDA diameter measured at 72 hours after birth predicting the persistent patency of the ductus arteriosus at the ages of 14 and 28 days was the largest (0.841 and 0.927 respectively), followed by end-diastolic velocity of the left pulmonary artery, with the area under the curve of 0.793 and 0.833 respectively.@*CONCLUSIONS@#The indicators obtained by beside echocardiography at 72 hours after birth, especially PDA diameter and end-diastolic velocity of the left pulmonary artery, can predict persistent patency of the ductus arteriosus at the ages of 14 and 28 days in VLBW infants, which provides a basis for the implementation of early targeted treatment strategy for PDA.
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Humans , Infant , Infant, Newborn , Ductus Arteriosus, Patent/diagnostic imaging , Echocardiography , Infant, Very Low Birth Weight , Retrospective Studies , Vena Cava, SuperiorABSTRACT
Objective:To investigate the predictive value of intra-abdominal pressure (IAP) combined with bedside index for severity in acute pancreatitis (BISAP) score on the severity and prognosis of acute pancreatitis (AP).Methods:In this retrospective study, 204 AP patients admitted to the Department of ICU, Second Hospital of Anhui University from Jan 2015 to Dec 2020 were divided based on the severity: into SAP group (145 cases) and Non-SAP group (59 cases) with end point survival (177 cases) and death (27 cases). The receiver operating characteristic (ROC) curves were drawn, and the predictive value of IAP, BISAP score and I-B (IAP and BISAP scores) in the severity and the prognosis of AP was studied. Medcalc software was used to compare the areas under ROC curve for different predictors.Results:IAP and BISAP scores increased with the severity of AP ( P<0.001), the area under the ROC curve (AUC) was 0.791, 0.749 and 0.907 respectively,comparison of area under ROC curve showed that I-B combined assessment was superior to IAP value and BISAP score alone in predicting severity ( P<0.05). IAP and BISAP scores were higher in the death group than in the survival group ( P<0.001). The ROC curve results of IAP, BISAP score and I-B combined on the prognosis of AP showed that the AUC was 0.773, 0.841 and 0.950, respectively,comparison of area under ROC curve showed that I-B combined assessment was superior to IAP and BISAP score alone in predicting prognostic value ( P<0.05). Conclusion:Both IAP and BISAP scores can better predict the severity of and the prognosis of AP, and the combination of IAP and BISAP score is more valuable for prediction of prognosis in AP.
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Objective:To explore the early application effect of the bedside sitting respiratory training in patients with respiratory failure and noninvasive positive pressure ventilation of the acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:A total of 102 patients with respiratory failure and noninvasive positive pressure ventilation of the AECOPD treated in Shanghai Public Health Clinical Center from June 2018 to December 2019 were selected and divided into the control group and the research group by random digits table method with 51 cases in each group. The control group was given the conventional treatment and nursing measures; and the research group was given the bedside sitting respiratory training. Pulmonary functional and blood -gas analysis parameters, clinical outcome of patients, etc. before and after the intervention between the two groups were compared. Results:After the intervention, the forced expiratory volume in one second (FEV 1), forced vital capacity(FVC), FEV 1/FVC were (1.79±0.22) L, (3.09±0.28) L, (62.16±5.94)% in the research group, and (1.43±0.18) L, (2.66±0.23) L, (53.48±5.31)% in the control group, the differences were statistically significant(t values were 8.36, 8.00, 7.19, P<0.01). Arterial partial pressure of carbon dioxide (PaCO 2) and arterial partial pressure of oxygen (PaO 2) in blood gas analysis were (51.14±3.79) mmHg(1 mmHg=0.133 kPa), (71.07±5.49) mmHg in the research group, and (57.52±3.86) mmHg, (65.62±5.27) mmHg in the control group, the differences were statistically significant ( t values were -7.78, 4.72, P<0.01). The non-invasive positive pressure ventilation time, hospital stays were (7.41±1.76) d, (11.27±2.41) d in the research group, and (9.79±2.11) d, (15.46±3.12) d in the control group, the differences were statistically significant ( t values were -5.71, -6.70, P<0.01). The incidence of adverse events was 3 cases in the research group, 1 case in the control group, the difference was no statistically significant ( P>0.05). Conclusions:The application of the bedside sitting respiratory training in patients with respiratory failure and noninvasive positive pressure ventilation of the AECOPD can effectively improve the pulmonary physiological function, shorten the noninvasive positive pressure ventilation time and hospitalization time, which has clinical application value.
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Objective:To explore the effects of competency-based diversified training on the bedside nursing comprehensive ability aand transition shock of newly recruited nurses.Methods:A total of 62 newly recruited nurses from the Second Affiliated Hospital of Zhengzhou University in June 2018 were selected as the control group, and 70 newly recruited nurses from June 2019 were selected as the experimental group by cluster sampling. The control group received routine pre-job training, and the experimental group received diversified training based on the control group. After one year of training, the differences in the scores of bedside nursing comprehensive ability, post competency and transition shock between the two groups of nurses were analyzed.Results:After 1 year of training, the total scores and the scores of nursing problems, nursing evaluation, nursing plan, nursing theory, nursing operation and bedside nursing comprehensive ability in the experimental group were 12.20±1.76, 24.29±2.38, 13.54±1.88, 9.77±1.35, 15.14±2.30 and 79.24±6.59, which were all higher than those of the control group (10.26±1.55,22.31±1.84,10.45±1.58, 8.56±1.80, 13.27±2.38 and 69.82±4.09), the differences were statistically significant ( t value was 4.582-13.679, P<0.05). The total scores and the scores of each dimension of the Post-competency the experimental group were 31.46 ±4.32, 51.03± 4.64, 20.27± 3.78, 17.86±3.99, 58.43± 4.44, 179.37±9.97, which were all higher than those of the control group 24.76±4.12, 40.56±5.55, 16.61±2.88, 15.15± 2.96, 49.74±3.07, 146.66±17.98, the differences were statistically significant ( t value was 4.466-13.197, P<0.05). The scores of psychological knowledge, skills, social culture and development and the total scores of Transition shock in the experimental group were 30.90±3.15, 19.69±2.74, 32.17±3.06, 103.81±12.24, which were all higher than those in the control group (25.69±2.76, 15.92±3.24, 27.50±4.15, 88.32±11.54), the differences were statistically significant ( t value was 7.237-10.040, P<0.05). Conclusions:competency-based diversified training can effectively improve the bedside nursing comprehensive ability and post competency, reduce their transition shock, and has strong clinical reference significance.
ABSTRACT
This research is based on data from clinical information systems such as HIS, EMR, LIS, etc, based on the functions of the traditional paper bedside card, relying on wired network technology, using the Internet of Things technology to design and develop a multi-functional intelligent interactive electronic bedside card system for inpatients. The functional framework of the system is introduced and discussed in detail, and the design is carried out from several aspects of system architecture, network architecture, software architecture, database and software system. The results show that the system has stable performance and can ensure the real-time and accuracy of medical information. The implementation of the system can fully meet the needs of clinical first-line ward management, reduce the workload of nursing staff, improve work efficiency, and reduce the possibility of medical accidents. At the same time, it can facilitate patients to see their own health information, improve patient experience. It has important guiding significance for the development of ward management and hospital information construction.
Subject(s)
Humans , Electronics , Hospitals , Inpatients , Internet of Things , TechnologyABSTRACT
This research is based on data from clinical information systems such as HIS, EMR, LIS, etc, based on the functions of the traditional paper bedside card, relying on wired network technology, using the Internet of Things technology to design and develop a multi-functional intelligent interactive electronic bedside card system for inpatients. The functional framework of the system is introduced and discussed in detail, and the design is carried out from several aspects of system architecture, network architecture, software architecture, database and software system. The results show that the system has stable performance and can ensure the real-time and accuracy of medical information. The implementation of the system can fully meet the needs of clinical first-line ward management, reduce the workload of nursing staff, improve work efficiency, and reduce the possibility of medical accidents. At the same time, it can facilitate patients to see their own health information, improve patient experience. It has important guiding significance for the development of ward management and hospital information construction.
Subject(s)
Humans , Electronics , Hospitals , Inpatients , Internet , Internet of Things , TechnologyABSTRACT
The coronavirus (COVID-19) pandemic has led to a critical need in treating severe respiratory disease while providing adequate protection to healthcare workers. Critically ill COVID-19 patients have required prolonged intubation and mechanical ventilation, not limited to those with multiple comorbidities or the elderly. At the height of the pandemic in New York City; our institution intubated 192 COVID-19 patients. Many institutions have avoided performing tracheostomy in this population due to high risk of virus aerosolization. This study is a retrospective, IRB approved, single center case series of 14 consecutive tracheostomies in COVID-19 patients at a community hospital in Flushing, New York City. Data from 1 March to 31 May 2020 was collected from electronic medical records. All COVID-19 positive patients undergoing tracheostomy were included; patients undergoing tracheostomy that were not COVID-19 positive were excluded. Fourteen patients underwent tracheostomy during the study period. Average age was 62 and 64.3% were male (n=9). Hispanic males represented 50% of patients undergoing tracheostomy and 71.4% were from home. Average days from initial intubation to tracheostomy was 20.6, ranging from 12 to 43 days. With the exception of two patients, all underwent a single intubation. No involved operating room staff became ill during or after these procedures. Tracheostomy may be safely performed in COVID-19 patients while minimizing risk to staff; however, patient outcomes may not be significantly altered. Further research is needed to determine the optimal timing and overall benefit of tracheostomy in this population.