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Objective:To investigate the current situation and influencing factors of patients′ satisfaction with nursing humanistic care, and to provide reference for improving the quality of such care provided by hospitals.Methods:From July to August 2022, outpatients and inpatients in 30 provinces were selected by multi-stage stratified sampling as the survey objects. A cross-sectional survey was conducted on an online platform, using the general information questionnaire and Chinese version of methodist health care system nurse caring instrument revised by the research group. The latter instrument consists of 12 dimensions. namely care coordination, competence, teaching/learning, emotional support, respect for individuality, physical comfort, availability, helping/trusting relationship, patient/family engagement, physical environment, spiritual environment and outcomes. Descriptive analysis was performed on the data collected by the questionnaires, and independent sample t-test and one-way ANOVA were used to analyze the influencing factors of patient satisfaction. Results:A total of 107 hospitals were selected for questionnaire survey, including 86 tertiary hospitals and 21 secondary hospitals, and 29 108 valid questionnaires were recovered. The patient satisfaction with nursing humanistic care scored (5.40±0.86); the top three dimensions were competence (5.50±0.89), emotional support (5.47±0.88) and helping/trusting relationship (5.46±0.86); the lowest scoring dimensions were teaching/learning (5.38±1.01), spiritual environment (5.36±1.04) and patient/family engagement (5.11±1.28). Differences with gender, age, marital status, child status, educational level, occupation, place of residence, economic region, per capita monthly income of the family, type of medical insurance, medical department visited and surgery or not presented significant differences on the patient satisfaction with nursing humanistic care scores ( P<0.05). Conclusions:The satisfaction of patients with hospital′s nursing humanistic care in China was at the middle to upper level. In the future, health education for patients should be strengthened, and a mode of family-engaged nursing humanistic care should be constructed in line with the Chinese cultural background. In the process of nursing services, the particularity of patient groups should be considered to better meet their needs.
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Sufficient and organized sleep is a key factor during the developmental process of infancy while disrupted sleep schedule and diseases might lead to sleeping disorders in infants. Breastfeeding is considered to be the most beneficial way to meet the nutritional needs of infants for optimal growth and development. The α-lactalbumin-tryptophan-melatonin axis, nucleotides, and other factors are breast milk components that may affect infant sleep. Meanwhile, diet, feeding schedule, tobacco smoking, alcohol intake, and caffeine consumption will affect the circadian rhythms which might lead to the fluctuations of sleep-influencing factors in breast milk. This study reviews literature of previous studies on this topic to summarize information that can be considered for both breastfeeding practice and future basic research on the establishment of organized sleep patterns in infants.
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Objective:To explore the real maternal and infant care experience and needs of spouses of puerperal women, so as to provide a basis for improving maternal and infant care capacity and participation of spouses and promoting maternal and infant health.Methods:Guided by dyadic coping theory, the semi-structured interviews were conducted among 18 spouses of puerperal women who gave birth at the First Affiliated Hospital of Soochow University from July to September 2022 using the phenomenological research method, and the recording data were analyzed by Colaizzi phenomenon analytical method.Results:Three themes were extracted, including positive experience of maternal and infant care of spouses of puerperal women (positive psychological emotions, adjustment of perceptions and behaviors, understanding of social support), negative experience of maternal and infant care of spouses of puerperal women (negative psychological emotions, poor care competence, imbalance during life and work), diversified needs for maternal and infant care of spouses of puerperal women (the need for multidimensional knowledge and skills, the suggestion of building continuous health education platform, the expectation of support from family).Conclusions:Medical staff should provide the spouses of puerperal women with diversified maternal and infant care and professional continuing nursing according to their experience and needs. Meanwhile, the family support system should be improved to enhance their sense of competence and participation in maternal and infant care and promote maternal and infant health.
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Objective:To analyze the injury factors and prognosis of children with traumatic brain injury (TBI), and to explore the risk factors affecting its severity, so as to provide evidence for the prevention and intervention of TBI in children.Methods:A total of 6 040 children with TBI who were admitted to the Department of Neurosurgery of Children's Hospital of Soochow University from January 1, 2011 to December 31, 2020 were selected. The injury factors and prognosis were retrospectively analyzed. Univariate and multivariate Logistic regression analysis was used to analyze the factors affecting the severity of TBI in children.Results:Of the 6 040 children, 3 681 were males and 2 359 were females. The patients aged 1 to 3 years accounted for the highest proportion (34.0%, 2 056/6 040), and most of them were mild injuries (93.2%, 5 631/6 040). The main injury sites of children with TBI were road (35.9%, 2 167/6 040) and home (31.1%, 1 881/6 040), and the main causes of injury were falling from height (34.9%, 2 107/6 040) and falling (34.5%, 2 085/6 040). Children aged 1 to 3 years were most likely to be injured at home(41.9%, 861/2 056), mainly due to falling from height, while children aged 4 to 6 years were most likely to be injured on the road(43.8%, 828/1 891), mainly due to falling. Logistic regression analysis showed that children's residence, the presence of multiple injuries and the location of brain injury were independent influencing factors for the severity of TBI in children ( χ2=6.58, 138.15, 4.25, all P <0.05). Conclusions:TBI in children aged 1 to 3 years mainly occurred at home, and in children aged 4 to 6 years mainly occurred on the road. Falling from height and falling are the main causes of TBI in children. The society, schools and families should take targeted prevention education and intervention measures according to different age groups. Children who live in rural areas, have multiple injuries, and have multiple brain injury sites are more severely injured. In the process of treating children with TBI, the severity can be quickly predicted based on this, and the treatment efficiency of children with TBI can be improved.
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Objective:To deeply explore the real work of primary, secondary and tertiary prevention of stroke in general hospitals, rehabilitation and pension institutions and community health service centers (stations), and to provide reference for improving the level of comprehensive prevention of stroke in the medical system.Methods:From July to November 2022, face-to-face semi-structured interviews with 18 medical staff in general hospitals, 10 medical staff in rehabilitation and pension institutions, and 8 medical staff in community health service centers (stations) were conducted by phenomenological research methods. Colaizzi 7-step analysis method was used to analyze the interview data, and Nvivo12 software was used to code the interview data.Results:Four themes were extracted: hospitals, institutions and communities all played an important role in the comprehensive prevention of stroke and actively cooperated with each other; the public was still lack of comprehensive prevention awareness and correct cognition of stroke; lack of professional medical resources hindered the development of comprehensive stroke prevention; incomplete collaborative mechanism of comprehensive prevention of stroke in hospitals, institutions and communities.Conclusions:In the current comprehensive prevention of stroke, there are still problems such as weak public awareness of prevention, insufficient professional medical resources, and imperfect coordination mechanism. In view of the advantages of medical institutions at all levels, it is necessary to clarify the responsibilities of the system at all levels and explore efficient and sustainable coordination mechanism, so as to improve the comprehensive prevention level of stroke in the medical system.
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BACKGROUND: To date, variables predicting the recovery of dysphagia in patients after dysphagic stroke have not been well defined. However, despite the difficulties in predicting and understanding the dysphagia recovery trajectory, its significance for stroke care cannot be understated. This study aims to identify the factors for functional swallowing recovery and develop nomograms that predict dysphagia recovery after stroke. METHODS: The demographic, neurological, and swallowing characteristics were compared between patients who recovered from dysphagia and those who did not. Then, the factors with P <.1 through comparison were enrolled in the multivariable logistic regression analysis to build a prediction model. A nomogram was also built to provide a quantitative tool. Discrimination, calibration, and clinical usefulness of the prediction model were assessed by using the C index, calibration plot, and decision curve analysis. RESULTS: Predictors in the early-phase (T7) prediction nomogram included age, Functional Oral Intake Scale (FOIS), National Institutes of Health Stroke Scale (NHISS), hemispheric stroke, and brainstem stroke on admission. In the middle phase (T14), predictors included age, FOIS, and NHISS on admission. In the late phase (T30), predictors included age, FOIS, NHISS, bilateral stroke, and body mass index on admission. The C index for the day 7, day 14, and day 30 prediction nomograms were 0.847 (95% CI, 0.804-0.884), 0.817 (95% CI, 0.772-0.857), and 0.786 (95% CI, 0.739-0.829). CONCLUSION: These novel nomograms predicting dysphagia recovery after ischemic stroke are discriminative and well calibrated and could be used to guide enteral nutrition decision making, rehabilitation plans, and individualized care.
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Deglutition Disorders , Stroke , Deglutition , Deglutition Disorders/etiology , Humans , Nomograms , Recovery of Function , Stroke/complicationsABSTRACT
Objective:To explore the experience and true feeling of home care aides during nighttime caring at the first beginning stage of this program, find the difficulty of it and provide constructive suggestions for improvement.Methods:Semi-structed interviews were used to collect the data of 16 home care aides who were taking part in nighttime caring. Colaizzi phenomenological analysis was used to process and analyze the data.Results:Three themes were extracted by classifying and analyzing the details of the interview: the service content of nighttime care was easy, but had many constraint conditions; the caregivers had diversified emotional experience during nighttime care; the elderly would like to enjoy nighttime care, but they were unwilling to pay by themselves.Conclusions:Nighttime caring project deepens the service content of home-based care. But the nighttime care project needs to be standardized. We should establish risk prevention measures to guarantee the benefit and security of both home caregivers and care-receivers, changing the opinions of consumption among the elderly, increasing the amount of subsidy to enlarge the expansion of nighttime care and improve the equality of this caring program.
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Objective:To develop a questionnaire for voluntary care of the disabled elderly based on the theory of planned behavior, and test its reliability and validity.Methods:With the theory of planned behavior as the theoretical framework, a questionnaire entry pool was formed on the basis of extensive reading of domestic and foreign literatures and semi-structured interviews, and the questionnaire items were screened by Delphi method. From July to August 2020, 350 nursing staff from 10 hospitals in Suzhou were selected by convenience sampling method, and the reliability and validity of the questionnaire were tested, and the formal questionnaire was finally formed.Results:Totally 350 questionnaires were distributed in this study, and 330 copies of effective questionnaires were recovered, with an effective recovery rate of 94.29%. This questionnaire included a total of 26 items in 4 dimensions, including attitude, subjective norms, perceived behavioral control and behavioral intention. Cronbach′s α coefficient was 0.977, split-half reliability was 0.906, test-retest reliability was 0.84, the content validity index (CVI) of total questionnaire was 0.97, item-level CVI value was 0.88 to 1.00. Four exploratory factors were extracted, and cumulative contribution rate was 80.03%.Conclusions:The questionnaire has good reliability and validity, which can well explain and predict the willingness of nursing staff to volunteer for the disabled elderly, and can also provide incentive basis for policy makers and managers.
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Objective:To construct a cognitive training program suitable for elderly patients with mild cognitive impairment based on horticultural therapy, so as to effectively slow down the cognitive decline of patients with mild cognitive impairment.Methods:Through searching the Chinese and English database literature of cognitive intervention from July 2000 to July 2020 and field visits to nursing homes, the draft intervention plan was formed. Two rounds of focus group interview were held to consult experts in cognitive impairment and geriatric care, etc., and to revise the intervention plan.Results:In the two rounds of focus group interview, the expert positive coefficient was 100%, the expert judgment basis was 0.84, the expert familiarity degree was 0.84, and the expert authority coefficient was 0.84. In the end, a 10-week cognitive intervention program targeting six cognitive domains -- "visuospatial/executive ability", "memory ability", "language ability", "attention ability", "abstract ability" and "naming ability" was formed, and the implementation steps of the program were improved.Conclusions:The construction process of cognitive training program for patients with mild cognitive impairment based on horticultural therapy theory is rigorous, scientific and feasible, and can be used to guide the cognitive training of patients with mild cognitive impairment.
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Objective:To deeply explore the pain experience of patients with rheumatoid arthritis, so as to provide a basis for the practical interventions in the next step.Methods:Using the phenomenological research method, 18 patients with rheumatoid arthritis who experienced pain in the First Hospital of Soochow University from September 2020 to January 2021 were selected for semi-structured interviews, and the Colaizzi 7-step analysis method was used for data analysis.Results:The pain experience of patients with rheumatoid arthritis were summarized into six themes. Pain was complex and erratic, pain relief strategies were ineffective, pain negatively affected daily life, expected more pain relief, seeking help selectively when pain occurs, and experienced pain brings positive change.Conclusions:Medical staff must pay attention to the real experiences and demands of pain in rheumatoid arthritis patients, use information technology and multidisciplinary collaboration to provide patients with effective pain management strategies and encourage patients to make more positive changes to relieve pain symptoms.
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Objective:To explore the elements of the diversified caring bank based on long-term care insurance system to provide a basis for the construction of diversified caring bank framework system.Methods:The phenomenological research method was adopted to conduct semi-structured interviews with 15 nursing management personnel in pension institutions in Suzhou and Suzhou long-term care insurance policy implementation management personnel in March to May 2021. NVivo 11 was used to manage interview data, and applied Colaizzi 7-step analysis to conduct inductive analysis and extract the themes.Results:The elements of the diversified caring bank based on long-term care insurance system were divided into three main modules: diversified caring personnel, diversified caring content and diversified incentive measures. The diversified caring personnel module included full-time and part-time caring personnel. Diversified caring content included six elements: daily life assistance, professional life caring, professional medical caring, communication and emotional support, emergency caring and special disease caring. Diversified incentive measures module included two elements: labor currency and "benefit" care currency.Conclusions:The diversified caring personnel provides continuous power for disabled caring; diversified caring content provides ways to meet the various needs of the disabled elderly; diverse incentives are effective ways to attract and stabilize the caring workforce.
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Long-term care is a long-term guarantee mechanism to meet the care needs of the old adults and ensure the quality of life. Among them, the professionalism and stability of the care team is a key factor to ensure the development of long-term care work. This paper analyzes the possible reasons for slow development of time bank with volunteers as the main body in the process of localization, and constructs a new model of diversified caring bank from the construction of care team, so as to promote the high-quality and sustainable development of long-term care in China.
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Objective:To explore the feasibility of pretargeting technique for immunoPET with epidermal growth factor receptor (EGFR) monoclonal antibody in EGFR positive/negative tumor bearing mice.Methods:Cetuximab- Trans-cyclooctene (TCO)was obtained by modifying Cetuximab with TCO- N-hydroxysuccinimide (NHS). 2, 2′-((6-amino-1-(4, 7-bis-(carboxymethyl)-1, 4, 7-triazonan-1-yl)hexan-2-yl)azanediyl)-diacetic acid (L-NETA)was used as a chelating agent to prepare the radioligand 68Ga-L-NETA-tetrazine (Tz), then the labeling rate and in vitro stability of the product were determined. Human basal breast cancer cells MDA-MB-468 (EGFR+ ) and MDA-MB-231 (EGFR-) were cultured in vitro. In vitro experiments were performed to explore the specificity of the probe and the feasibility of pretargeting technique. Nude mice (Balb/c-nu) bearing xenografts of the above two cell lines were established. Cetuximab-TCO (50 μg) was injected into the tumor-bearing mice in advance, then 68Ga-L-NETA-Tz was injected at different time points (48, 36, 24 and 12 h), and pretargeting was realized through " click chemistry" . Small-animal PET imaging and biodistribution were performed to evaluate pharmacokinetic properties and specificity of the probe. The one-way analysis of variance was used to compare the data. Results:The 68Ga-L-NETA-Tz molecular probe was successfully prepared with the labeling yield >95%, and the radiochemical purity was >95% after 2 h. Cetuximab-TCO and 68Ga-L-NETA-Tz were added to MDA-MB-468 cells successively, and the cell uptake rate reached (0.69±0.04)% at 1 h, which demonstrated the feasibility of the pretargeting technique. PET imaging and biodistribution results showed that the best imaging results were obtained in 36 h pre-injection group, in which the tumor uptake was the highest ((0.77±0.05) percentage activity of injection dose per gram of tissue (%ID/g), 1 h) and the tumor/muscle ratio was optimal (4.67±0.46); the tumor uptake in the blocking group, the group without injecting Cetuximab-TCO, and the MDA-MB-231 group were significantly lower ((0.35±0.01), (0.39±0.05), (0.45±0.10) %ID/g; F=15.50, P=0.002). Conclusions:EGFR targeted immunoPET imaging is successfully performed in mouse models of breast cancer by injecting Cetuximab-TCO and 68Ga-L-NETA-Tz successively. It provides an effective method for immunoPET imaging of monoclonal antibodies.
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Objective:To understand the current situation of management ability and self-efficacy of medical undergraduates in Suzhou and their influence on the learning effect.Methods:General data questionnaire, present situation of college students' spare time management ability questionnaire and Chinese general self-efficacy scale were used to collect data from September 2018 to April 2019 in 5 colleges and 5 grades of medicine in a comprehensive university in Suzhou using cluster sampling method. A total of 450 full-time undergraduates completed the questionnaire. SPSS 22.0 was used for t-test, one-way ANOVA and Chi-square test. Multiple Logistics regression analysis was used to analyze the influence of extracurricular time management ability and self-efficacy on academic performance. Results:A total of 450 questionnaires were distributed, and 421 were recovered, with the effective recovery rate of 93.6%. The extracurricular time of full-time medical undergraduates was relatively low, and the management ability of extracurricular time was different in different grades, whether to be a student leader, professional interests, economic status and other aspects. Students of different grades had different levels of self-efficacy. Multivariate Logistics regression analysis was carried out with the dependent variables, with the model fitted χ2=220.488, P=0.002 and the determination coefficient = 0.660. The management ability and self-efficacy in spare time were independent influencing factors of academic performance. Conclusion:Schools should take specific measures to improve the learning effect and educational quality of medical students.
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Objective:To understand the real experience of emotional labor of hospice nurses.Methods:A total of 8 hospice nurses from Shanghai, Shenzhen and Lianyungang hospice care units took part in the field study. They were observed and interviewed for one week.Results:The emotional labor of hospice nurses included natural expression, surface expression and deep expression. The emotional labor of nurses was affected by individual factors, organizational factors and social factors, including factors of the setting of hospice nursing posts was not clear, the proportion of multi-disciplinary team was insufficient, public awareness of hospice care was insufficient, and social security policy was imperfect, which was easy to make the role of nurses maladjustment, increase nurses' occupational fatigue and make nurses' emotional labor behavior lack of stable and long-term power source, thus affect the expression of their emotional labor behavior.Conclusions:We should pay attention to the expression and outcome of emotional labor of hospice nurses, to intervene and improve the individual factors, organizational factors and social factors that affect the expression of nurses' emotional labor.
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Objective:To promote the application of the best evidence in the prevention of venous thrombosis in patients with lung cancer in thoracic surgery, so as to improve the nursing management, elevate the nursing quality and reduce the incidence of venous thrombosis.Methods:High quality literature guidelines related to perioperative venous thromboembolism prevention of lung cancer were searched and screened, and the evidence was extracted. Combined with clinical background, nursing strategies were generated through expert demonstration meetings and used as clinical review indicators. On the basis of evidence-based i-PARIHS as the theoretical framework, through the establishment of core groups, removal of existing obstacles, education and training and quality control, the evidence was applied to the clinical practice effectively, and the data were collected by means of on-the-spot observation and consulting cases, and the effect of evidence application was evaluated from the three aspects including system, nurses and patients.Results:Systemically speaking, in the process of evidence application, the department established the standards and procedures for perioperative venous thromboembolism prevention of lung cancer patients, improved thrombus risk assessment tools, made educational materials, brought thrombus prevention into the scope of quality control, and optimized the organizational environment with full consideration of manpower and materials. For nurses, after the application of evidence, the scores of nurses' knowledge, attitude and practice of venous thromboembolism prevention were (17.6 ± 1.8), (17.4 ± 1.8), (18.8 ± 1.2), (53.8 ± 2.9) respectively, which were higher than those before the application of evidence (12.0 ± 2.9), (14.5 ± 2.8), (11.6 ± 2.7), (38.3 ± 5.1), the differences were significant ( t values were -11.40 - -3.90, all P<0.05). For patients, the incidence of venous thromboembolism before the application of evidence was 4.7% (19/403), and venous thromboembolism after the application of evidence was 0 (0/118), and the difference was statistically significant ( χ2 value was 5.774, P<0.05). Conclusions:The best evidence of perioperative venous thromboembolism of lung cancer on the basis of evidence-based is of great scientificity. Its application on clinical practice could effectively optimize the systematic organizational environment, standardize nursing behavior, improve nursing quality, and reduce the occurrence of venous thromboembolism in patients with lung cancer surgical procedures.
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IMPORTANCECoronavirus disease 2019 (COVID-19) is a global pandemic associated with high mortality and effective treatment to prevent clinical deterioration to severe pneumonia has not yet been well clarified. OBJECTIVETo investigate the role of several adjuvant treatments in preventing severe pneumonia in patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTSMulticenter, retrospective cohort study of 564 consecutively hospitalized patients with confirmed COVID-19 at Third Xiangya Hospital of Central South University, Changsha Public Health Treatment Center, First Hospital of Yueyang, Junshan Peoples Hospital of Yueyang, Central Hospital of Shaoyang, Central Hospital of Xiangtan, Second Hospital of Changde, Central Hospital of Loudi, and First Affiliated Hospital of University of South China in Hunan province from January 17, 2020 to February 28, 2020; The final date of follow-up was March 15, 2020. EXPOSURESNonspecific antivirals (arbidol, lopinavir/ritonavir, and interferon ), antihypertensives, and chloroquine. MAIN OUTCOMES AND MEASURESThe development of severe COVID-19 pneumonia; Demographic, epidemiological, clinical, laboratory, radiological, and treatment data were collected and analyzed. RESULTSOf 564 patients, the median age was 47 years (interquartile range, 36-58 years), and 284 (50.4%) patients were men. Sixty-nine patients (12.2%) developed severe pneumonia. Patients who developed severe pneumonia were older (median age of 59 and 45 years, respectively), and more patients had comorbidities including hypertension (30.4% and 12.3%, respectively), diabetes (17.4% and 6.7%, respectively), and cardiovascular disease (8.7% and 3.2%, respectively) and presented with fever (84.1% and 60.4%, respectively) and shortness of breath (10.1% and 3.8%, respectively) compared with those who did not. Nonspecific antiviral therapy did not prevent clinical progression to severe pneumonia, although fewer hypertensive patients on angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (ACEI/ARB) therapy developed severe pneumonia in contrast with those on non-ACEI/ARB antihypertensive therapy (1 of 16 [6.3%] patients and 16 of 49 [32.7%] patients, respectively [difference, 26.4%; 95% CI, 1.5% to 41.3%]). Multivariate logistic regression analysis showed that hypertension without receiving ACEI/ARB therapy was an independent risk factor (odds ratio [OR], 2.07; 95% CI, 1.07 to 4.00) for developing severe pneumonia irrespective of age. Besides, none of patients treated with chloroquine developed severe pneumonia, though without significance (difference, 12.0%; 95% CI, -3.5% to 30.0%) by propensity score matching. CONCLUSIONS AND RELEVANCEHypertensive patients on ACEI or ARB may be protective from severe pneumonia in COVID-19 and hence these therapies should not be ceased unless there is a strong indication or further epidemiological evidence. Though none of the current antiviral and immunoregulation therapy showed benefit in preventing COVID-19 progression, chloroquine deserved further investigation. KEYPOINTSO_ST_ABSQuestionC_ST_ABSDoes the use of adjuvant therapy reduce progression to severe pneumonia in patients with coronavirus disease 2019 (COVID-19)? FindingsIn this retrospective, observational cohort study involving 564 patients with confirmed COVID-19, hypertension was an independent risk factor for progression to severe pneumonia irrespective of age and those on angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy were less likely to develop severe COVID-19 pneumonia, while nonspecific antivirals or chloroquine did not have significant impact on clinical progression. MeaningHypertensive patients with COVID-19 should not have ACEI or ARB ceased, unless there is a strong indication or further epidemiological evidence, given its potential protective effects.
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ObjectiveTo determine the predictive value of CT and clinical characteristics for short-term disease progression in patients with 2019 novel coronavirus pneumonia (NCP). Materials and Methods224 patients with confirmed 2019 novel coronavirus (COVID-19) infection outside Wuhan who had chest CT examinations were retrospectively screened. Clinical data were obtained from electronic medical records. CT images were reviewed and scored for lesion distribution, lobe and segment involvement, ground-glass opacities, consolidation, and interstitial thickening. All included patients with moderate NCP were observed for at least 14 days from admission to determine whether they exacerbated to severe NCP (progressive group) or not (stable group). CT and clinical characteristics between the two groups were compared, and multivariate logistic regression and sensitivity analyses were performed to identify the risk factors for developing severe NCP. ResultsA total of 141 patients with moderate NCP were included, of which 15 (10.6%) patients developed severe NCP during hospitalization and assigned to the progressive group. Multivariate logistic regression analysis showed that higher neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR] and 95% confidence interval [CI], 1.26 [1.04-1.53]; P = 0.018) and CT severity score (OR and 95% CI, 1.25 [1.08-1.46]; P = 0.004) on admission were independent predictors for progression to severe NCP, and sensitivity analysis confirmed the consistent results in nonimported patients but not in imported patients. However, no significant difference in lung involvement was found on CT between imported and nonimported patients (all P > 0.05). Patients who were admitted more than 4 days from symptom onset tended to have more severe lung involvement. Spearman correlation analysis showed the close association between CT severity score and inflammatory indexes (r = 0.17[~]0.47, all P < 0.05). ConclusionCT severity score was associated with inflammatory levels and higher NLR and CT severity score on admission were independent risk factors for short-term progression in patients with NCP outside Wuhan. Furthermore, early admission and surveillance by CT should be recommended to improve clinical outcomes.
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Objective@#To explore the risk factors of deep venous thrombosis(DVT) in lower limbs of orthopedic inpatients, and provide reference for clinical nursing and prevention of thrombosis.@*Methods@#A retrospective case-control approach was used in this study. A total of 148 orthopedic inpatients diagnosed with DVT in the First Affiliated Hospital of Soochow University from February 2014 to October 2018 were selected as the case group. At the same time, 148 orthopaedic inpatients with undiagnosed DVT in the same Department were randomly selected as the control group. The electronic medical history data and related laboratory examination indexes of the two groups of patients during hospitalization in Orthopedics Department were analyzed retrospectively. Gender, age, seven indicators of blood coagulation, as well as history of hypertension, diabetes, history of DVT and other common risk factors of DVT in the two groups were statistically analyzed.@*Results@#In the case group, 63 patients (42.5%) DVT developed in the right lower extremity. The differences in the clinical symptoms and characteristics of fever, pulmonary infection, cough, expectoration, chest distress and shortness of breath, pleural effusion and constipation between the two groups were statistically significant (χ2 value was 5.688-12.312, P<0.01 or 0.05). Single factor analysis of related risk factors showed the differences of age, type of injury, lower limb joint replacement, a plaster cast, hypertension, history of DVT, central venous catheter, D-dimer and preoperative albumin levels, fibrinogen degradation products, and red blood cell count between the two groups were statistically significant (t value was-7.275-3.998, χ2 value was 4.889-13.305, Z value was-3.500--3.454, P < 0.01). Multivariate Logistic regression analysis showed that lower limb joint replacement(OR=0.383, 95%CI0.190-0.773), cough (OR=0.085, 95%CI0.010-0.731), chest distress and shortness of breath (OR=0.240, 95%CI0.077-0.745), constipation (OR=0.312, 95%CI0.135-0.718), red blood cell count (OR=3.314, 95%CI 2.105-5.216), hypertension (OR=0.534, 95%CI0.292-0.976) were independent risk factors for DVT formation in orthopedic inpatients (P<0.01 or 0.05).@*Conclusions@#DVT in orthopedic inpatients is a common result of multiple factors, among which, lower limb joint replacement, cough, chest distress and shortness of breath, constipation, red blood cell count and hypertension are independent risk factor, which should be monitored and given preventive care.
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Objective:To explore the clinical features and managements of novel coronavirus (2019-nCoV) infection after kidney transplantation.Methods:The authors reviewed medical history, laboratory values, imaging studies, treatment options and clinical outcomes of two confirmed hospitalized cases of COVID-19 after kidney transplant in February 2020. Both cases were middle-aged males and confirmed as COVID-19 at 11 or 12 months after transplantation. They both presented initially with moderate-to-low fever, cough and fatigue. Chest computed tomography (CT) hinted at multiple peripheral patchy ground glass opacities or patchy exudation and in bilateral multiple lobular and subsegmental with obscure boundary. Both had varying degrees of renal function and cardiac insufficiency.Results:In case 1, the dose of immunosuppressants was tapered while a higher dose of glucocorticoids was prescribed during treatment. In case 2, the dose of immunosuppressants was not tapered and continuous renal replacement therapy (CRRT) performed thrice in the early disease course due to renal insufficiency and hyperkalemia. Both cases received oxygen inhalation, lopinavir/ritonavir, oral abidor and interferonα-2b antiviral therapy, antibiotics treatment. Both cases were cured.Conclusions:The clinical manifestations and diagnosis of COVID-19 patients after kidney transplantation are not significantly different from those of other people. However, early renal function and heart function abnormalities occur. How to adjust the immunosuppressant in the treatment course of severe COVID-19 after renal transplantation should be further explored.
