RESUMEN
OBJECTIVE@#To assess the clinical efficacy and health economic value of non-invasive prenatal testing (NIPT) for the prenatal screening of common fetal chromosomal aneuploidies.@*METHODS@#10 612 pregnant women from October 2017 to December 2019 presented at the antenatal screening clinic of the General Hospital of Tianjin Medical University were selected as the study subjects. Results of NIPT and invasive prenatal diagnosis and follow-up outcome for the 10 612 pregnant women were retrospectively analyzed and compared. Meanwhile, NIPT data for two periods were analyzed for assessing the health economic value of NIPT as the second- or first-tier screening strategy for the prenatal diagnosis of fetal trisomies 21, 18 and 13.@*RESULTS@#The NIPT was successful in 10 528 (99.72%) subjects, with the sensitivity for fetal trisomies 21, 18 and 13 being 100%, 92.86% and 100%, and the positive predictive value (PPV) being 89.74%, 61.90% and 44.44%, respectively. The PPV of NIPT for sex chromosome aneuploidies was 34.21%. Except for one false negative case of trisomy 18, the negative predictive value for trisomy 21, trisomy 13 and other chromosomal abnormalities were 100%. For pregnant women with high risk by serological screening, advanced maternal age or abnormal ultrasound soft markers, NIPT has yielded a significantly increased high risk ratio. There was no statistical difference in the PPV of NIPT among pregnant women from each subgroup. NIPT would have higher health economic value as a second-tier screening until 2019, while compared to 2015 ~ 2017, its incremental cost-effectiveness ratio as a first-tier screening had declined clearly.@*CONCLUSION@#The screening efficacy of NIPT for trisomies 21, 18 and 13 for a mixed population is significantly better than conventional serological screening, but it is relatively low for sex chromosomal abnormalities. NIPT can also be recommended for populations with relatively high risks along with detailed pre- and post-test genetic counselling. From the perspective of health economics, except for open neural tube defects, it is possible for NIPT to replace the conventional serological screening in the future as its cost continues to decrease.
Asunto(s)
Embarazo , Femenino , Humanos , Trisomía/genética , Estudios Retrospectivos , Diagnóstico Prenatal/métodos , Síndrome de Down/genética , Aneuploidia , Aberraciones Cromosómicas , Síndrome de la Trisomía 18/genética , Aberraciones Cromosómicas Sexuales , FetoRESUMEN
Objective To quantify the workload rate of nurses at clinical departments and to clarify the current situation of clinical nursing work. Methods We randomly selected three departments respectively from the medical system and the surgery system as observation areas, and the nurses on the job as observation objects. Then we drew up the to-do-list of nursing work, and defined the concepts and activities of various items. The nurses of the department were observed and recorded every 5 minutes by uniformly-trained observers, and the data were collected and entered into the Excel software to set up the database by using the method of work sampling combined with the random starting point and other time intervals. Based on data collation and analysis of SPSS19. 0 statistical software, the improvement and control scheme was put forward. Results The average nursing workload rates of medicine and surgical systems were 93. 52％ and 92. 13％ respectively. Direct nursing in the surgical system accounted for 10. 59％, and indirect nursing accounted for 62. 89％; direct nursing for the medical system accounted for 16. 20％ and indirect nursing for 57. 32％. The proportions of nursing work belonged to operation increment were relatively large (77. 32％ and 81. 54％). Conclusions The work sampling method is more comprehensive and objective to reflect the intensity of nursing workload. To define the workload of clinical nurses and distinguish the increment and waste items of nursing process are helpful to improve the quality of nursing management and the efficiency of service.