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Objective To explore the effect of the Internet technology′s application on the hand hygiene compliance of medical staff. Methods Establishing Internet+hand hygiene management model to implement Internet based hand hygiene supervisory and reminding, Internet based hand hygiene publicity and education, and Internet based hand hygiene feedback and communication. This model was applied in Guangdong Provincial Dermatology Hospital to intervene the hand hygiene related activities. Before and after the intervention, the hand hygiene compliance of medical staff in the trial hospital was observed with WHO hand hygiene monitoring table by directly manual observation. Thereafter, the changes of hand hygiene compliance before and after the intervention were compared based on the statistical analysis of test results. Results With the application of Internet+hand hygiene management model, the hand hygiene compliance of medical staff increased from 41.75% (324/776) before the intervention to 72.14% (554/768) after the intervention, and the difference was statistically significant (χ2=145.264, P<0.01). The hand hygiene compliance of both doctors and nurses was significantly increased (doctors: χ2=94.784, P<0.01;nurses:χ2=58.798, P<0.01). In all the five indications, i.e., before patient care, before an aseptic task, after exposure to blood/body fluids, after patient care, and after environmental contact, the hand hygiene compliance was 35.42%(68/192), 63.33%(38/60), 84.38%(54/64), 44.83%(130/290), and 20.00%(34/170) respectively before the intervention;it was 65.38%(102/156), 83.33%(120/144), 95.45%(105/110), 68.52%(148/216), and 55.63%(79/142) after the intervention; and the difference before and after the intervention was statistically significant (χ2=6.305-42.529;P<0.01 or 0.05). Most of the medical staff of the trial department supported this model. Conclusions Internet+ hand hygiene management model could significantly improve the hand hygiene compliance of medical staff and were very popular. And, the model is worth of application in more hospitals.
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Objective To evaluate the dosimetric difference between fixed-field static intensity-modulated radiotherapy (IMRT), fixed-field dynamic multileaf collimator (DMLC), and volumetric modulated arc therapy (VMAT), all of which involve supraclavicular and infraclavicular regions, in breast cancer patients after breast-conserving surgery.Methods This study included 14 female patients with breast cancer who received radiotherapy after breast-conserving surgery in our hospital from October 2012 to April 2016.The radiation field included the chest wall and supraclavicular and infraclavicular regions.IMRT, DMLC, and VMAT plans were generated for each patient while using identical optimization conditions.The doses to planning target volume (PTV) and organs at risk (OARs) were compared based on dose-volume histogram (DVH);one-way analysis of variance or nonparametric Wilcoxon rank test was used for comparison.Results For the dose distribution of PTV, VMAT achieved the best V95, V98, CI, and HI (P<0.009).Concerning the doses to OARs, VMAT achieved the best V5, V20, and Dmean of the ipsilateral lung and the best V5 and Dmean of the contralateral lung (P<0.022).Dmean of the spinal cord was significantly lower in VMAT than in IMRT and DMLC (P=0.004).Conclusions VMAT is preferred for the patients with breast cancer to be treated with radiotherapy involving supraclavicular and infraclavicular regions after breast-conserving surgery.It can improve the dose distribution of target and reduce the doses to organs at risk and radiotherapy toxicities.
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Objective To examine the effects of gross tumor volume (GTV) and radiation dose on the prognosis of hepatocellular carcinoma (HCC) patients treated with whole body gamma knife.Methods The clinical data of 69 HCC patients who underwent body gamma knife treatment from January 2012 to June 2015 in the Radiotherapy Center of the PLA General Hospital were retrospectively reviewed.Based on a 50% or 60% isodose coverage of the planning target volume (PTV), patients were treated with a radiation dose of 4-5 Gy per fraction, and a total marginal dose of 36-50 Gy (median dose 45 Gy).Short-term efficacy, overall survival (OS), and the adverse effect of the treatment were evaluated.The optimal cut-off tumor volume was identified using the receiver operating characteristic curve, and survival was determined by the Kaplan-Meier method.Univariate and multivariate analyses were performed using the log-rank test and Cox proportional hazards regression model, respectively.Results The overall short-term response rate of the 69 patients was 67%.The 1-and 2-year OS rates were 62% and 40%, respectively, with a median survival of 18.6 months.The multivariate analysis showed that gross tumor volume (GTV)93 cm3(P=0.665).Conclusions GTV is an independent prognostic factor for overall survival of HCC patients.Although high-dose radiotherapy provides survival benefits to patients with small GTV, it is not necessarily suitable for patients with large GTV.
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Objective To observe the therapeutic effects of ganciclovir(GCV)with differentInjection methods on experimental acute retinal necrosis(ARN).Methods The right eyes of 41pigmented rabbits were infected by herpes simplex virus(HSV-1)(COS strain)to establish ARN animalmodel.After 24 and 72 hours,GCV was given by intravitreal injection(10 eyes),intravenous injection(11 eyes)and the intravitreal+intravenous injection(10 eyes);intravitreal injection of GCV anddexamethasone(6 eyes)was also included.Four eyes were not treated as the control.The dosage of GCVin intravitreal and intravenous injection was 800 μg and 5 mg/kg weight,respectively.Retina necrosis wasobserved and the grade was recorded 1-21 days after injection according to the grade standard ofretinopathy.The maximum grades of retinal necrosis in different groups were compared.Results Thegrade of retinal necosis was 3.8 in the control group,and 0.2,0.4,0.8,and 2.2 in intravitreal iniection,intravitrcal+intravenous injection,intravitreal injection with GCV and dexamethasone,and intravenousrejection,respectively,24 hours after the model was set up.The effects of the first 3 groups wereobviously better than the Iast group(P=0.003,0.011,0.045);while the difference among the first 3groups were not significant(P=0.881,0.054,0.107).Seventy-two hours after the mode J was set up,thegrades of retinal necrosis were above 1.4 in 4 groups,and the differences among the 4 groups were notapparent(P=0.214).Conclusions In the animal model of ARN,intravitreal injection with GCV caneffectively decrease the grade of retinal necrosis.The difference among intravitrealinjection,intravitreal+intravenous injection,intravitreal injection with GCV and dexamethasone,and intravenous injection is notsignificant.
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Objective To analyze the effect of intensive pupillary dilation on intraocular pressure(IOP) in early stage after vitreoretinal surgery(VRS).Design Retrospective case series.Participants 32 patients(34 eyes) with 30 mmHg or more of IOP at the first day after VRS were enrolled in this study.Methods Tropicamide-phenylephrine eyedrop(Mydrin-P~(?)) was applied to the operated eye 3 times with interval of 5 minutes and IOP was measured again 2 hours later.IOPs were compared with t test.Main Outcome Measures IOP.Results The mean IOP was 37.26?6.07 mmHg before using tropicamide-phenylephrine eyedrop and 34.82?8.46 mmHg after using it two hours later(P=0.02),and mean decline of IOP was 2.44 mmHg in general.IOP was decreased in 20/34 eyes(58.82%) with mean decline 6.2 mmHg.IOP was unchanged in 4/34 eyes(11.76%).IOP was increased in 10/34 eyes(29.41%) with mean IOP up 4.1 mmHg.Conclusions The IOP increasing after vitreoretinal surgery is not the reason for stopping pupillary dilator.On the contrary,the IOP of about 60%patients can decrease with rational using pupillary dilator.
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Objective To explore the clinical characteristics, surgical methods and outcome of recurrent retinal detachment in silicone oil-filled eyes after vitreoretinal surgery. Design Retrospective, observational case series. Participants 55 patients (55 eyes) diagnosed as recurrent retinal detachment with silicone oil-filled eyes. Methods To analyze the clinical manifestations of recurrent retinal detachments and adopt different methods to make retina reattach including vitreoretinal surgery with or without silicone oil removal and scleral buckle revision alone. Patients were followed up for 3 months. Main Outcome Measures Clinical manifestations, retinal re-attachment and visual acuity. Results The characteristics of recurrent retinal detachment in silicone oil-filled eyes were inferior location mainly, less than 2 quadrants, with proliferation and hole. Fifty of the 55 patients underwent repeat surgical repair. Surgical methods included re-vitreoretinal surgery in 39 eyes with silicone oil removal, re-vitreoretinal surgery in 9 eyes without silicone oil removal and scleral buckle revision alone in 2 eyes. After a follow-up of 3 months, retina re-attached in 41 eyes, partially attached in 7 eyes, and detached in 2 eyes. Conclusions Repair of recurrent retinal detachment in silicone oil filled eye is challenging. Favorable anatomic outcome may be achieved in selected patients with proper surgical measures according to the characteristics of recurrent retinal detachment.
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Objective To establish the rabbit model for acute retinal necrosis(ARN) and investigate the possible route of the virus migrates from one eye to the other. Design Experimental study. Participants 41 chinchilla rabbits. Methods HSV-1 COS strain was inoculated into subretina in 41 rabbits to establish ARN animal model. Ganciclovir was used to treat by intraocular and/or intravenous injection 1 day or 3 days after virus inoculation. PCR test of blood samples was performed for HSV detection. Histopathological examinations were also conducted in some eyeballs, optic nerves and brains of the rabbits. Main Outcome Measures Results of blood PCR and histopathology. Results 10 rabbits appeared bilateral retina necrosis (10 to 18 days after virus inoculation) and 15 rabbits appeared central nervous system damages. PCR samples of 5 rabbits obtained before and after the contralateral retina damages appeared (9 to 19 days after virus inoculation) had all negative results. Histopathological damages were found in bilateral eyeballs, optic nerves and brains. Conclusion The ARN model can be established by injection of HSV-1 into subretina of rabbits. Blood samples PCR don't support the hypothesis of virus transmission through circulation system in bilateral ARN cases. Trans-optic chiasm transmission may be a possible route.