ObjectiveTo explore the application of different digestive system management strategies in the perioperative period of thoracolumbar fracture.MethodsThe clinical data of the patients with thoracolumbar fractures and pedicle screw fixation in Affiliated Hospital of Southwest Medical University from January 2016 to January 2018 were retrospectively analyzed. According to different perioperative management strategies of the digestive system, they were divided into two groups. Patients with careful management strategy were included in the observation group, and patients with routine management were included in the control group. The baseline conditions, the abnormalities of digestive tract function at admission and before and after surgery, the postoperative first feeding time, exhaust time, defecation time, the incidence of other postoperative complications except digestive tract complication, length of stay and patient satisfaction were compared between the two groups. At 6 months after surgery, the fracture healing, loosening or fracture of internal plants were compared between the two groups.ResultA total of 121 patients were included in the study, including 67 cases in the observation group and 54 cases in the control group. There was no significant differences in the baseline conditions between the two groups (P>0.05). There were no significant differences between the two groups in the incidences of digestive system dysfunction at admission (P>0.05). The incidences of digestive system dysfunction in the observation group before and after surgery were lower than those in the control group (29.9% vs. 53.7%, P<0.05; 35.8% vs. 61.1%, P<0.05). The first eating time [(3.7±1.1) vs. (6.7±2.6) h], exhaust time [(7.8±2.3) vs. (13.6±4.2) h], defecation time [(26.7±8.1) vs. (40.9±11.2) h] and length of stay [(6.5±2.4) vs. (9.0±2.7) d] in the observation group were shorter than those in the control group (P<0.005), and the patients’ satisfaction was better than that of the control group (8.3±1.1 vs. 7.6±1.3; t=?3.208, P=0.002). There was no statistically significant difference in the incidence of postoperative complications except digestive tract complication, and the fracture healing rate, the incidence of nail-rod breakage at6 months after surgery between the two groups (P>0.05). No internal plant loosening was found in the two groups of patients within 6 months after surgery.ConclusionThe application of the careful digestive system management strategy in patients with thoracolumbar fractures can help reduce the incidence of perioperative gastrointestinal dysfunction, promote the recovery of perioperative gastrointestinal function, shorten the length of hospital stay, and improve patient satisfaction.
Objective To compare the advantages between SmartCare weaning and protocoldirected weaning in COPD patients regarding five aspects including comfort degree of COPD patients in weaning stage, workload of medical staff, weaning success rate, weaning time, and complications associated with mechanical ventilation. Methods COPD patients who’s planning to receive ventilation weaning were randomly divided into a SmartCare weaning group ( SC group) and a protocol-directed weaning group ( SBT group) . The comfort degree of patients and workload of medical staff were assessed by the visual analogue scale ( VAS) as the weaning plan started. 0 was for the most discomfort and maximal workload, and 10 was for the most comfort and minimal workload. Data fromthe following aspects had been recorded: times of blood gas analysis, weaning success rate, weaning time, self-extubation rate, the rate of re-intubation within 48 hours, and ventilator-associated pneumonia ( VAP) incidences. Results 40 patients were selected and divided into the SC group ( n =19) and the SBT group ( n =21) . There was no significant difference in the enrolled age and APACHEⅡ between two groups. The VAS scores was higher in the SC group than that in the SBT group in the first three days ( Plt;0.01) . The weaning time was shorter in the SBT group than that in the SBT group [ ( 4.7 ±2.7) days vs. ( 5.5 ±3.2) days] , without significant difference between two groups ( P gt;0.05) . There were no differences in times of blood gas analysis, weaning success rate, weaning time, self-extubation rate, the rate of re-intubation within 48 hours, and ventilator-associated pneumonia ( VAP) incidences between two groups ( P gt; 0.05) .Conclusion As compared with protocol-directed weaning, SmartCare weaning can increase comfort degree of patients and reduce the workload of medical staff with similar weaning success rate, weaning time, and complications associated with mechanical ventilation.
Objective To retrospectively analyze the clinical characteristics of different lactate trajectories in sepsis patients receiving mechanical ventilation (MV) and to investigate their associations with acute kidney injury (AKI) and in-hospital death risk, aiming to provide references for early renal protection in critically ill sepsis patients. Methods Data from sepsis patients receiving MV were extracted from the Medical Information Mart for Intensive Care Ⅳ (MIMIC-Ⅳ) database. The daily mean lactate values over the first 10 days were calculated. The latent class trajectory model (LCTM) was used to identify lactate trajectories over time and group the patients accordingly. AKI was the primary outcome measure, while in-hospital death was the secondary outcome measure. Logistic regression and Cox regression analyses were used to explore the associations between different lactate trajectories and these outcomes. Kaplan-Meier curves were drawn to compare in-hospital death risks among different lactate trajectory groups. Results A total of 2 062 MV-treated sepsis patients were included. After LCTM analysis, 1 396 patients were classified into the low lactate trajectory group, 451 into the moderate lactate trajectory group, and 215 into the high lactate trajectory group. After adjusting for confounding factors, the high lactate trajectory group was associated with an increased risk of AKI and in-hospital death (P<0.05). Conclusions In sepsis patients receiving MV, those with high lactate trajectories have a higher risk of AKI. Lactate trajectory changes can serve as an early assessment indicator for AKI and mortality risk in critically ill sepsis patients.
ObjectiveTo investigate the knowledge and need of caregivers who perform self-nursing for children with peripherally inserted central catheter (PICC), in order to provide evidence for health education for children in-patients and children discharged from hospital with central venous catheter.
MethodsSelf-designed questionnaire was used to investigate 364 caregivers who performed nursing for 162 PICC pediatric in-patients bwtween December 2013 and July 2015. The investigation was carried out on the general information, nursing knowledge, and the acquisition approach of caregivers' existing nursing knowledge.
ResultsThe majority of indwelling PICC pediatric caregivers were elderly people, and the common care model was alternate caring carried out by core family members. The children were cared by the elderly in 59 families (36.42%). Twenty-one families had the parents of the children as the major caregivers (12.96%), and alternate caring by parents and the elderly happened in 82 families (50.62%). The total score of the investigation was ranged from 5 to 29 with an average of 11.37±5.68. Nineteen children were discharged with catheter, whose caregivers got a score from 6 to 11, averaging 8.41±4.33.
ConclusionThe ratio of self-nursing knowledge in caregivers for pediatric PICC patients is generally low, especially in those caregivers for patients discharged with central venous catheter. Nursing administrators should pay attention to training of the nurses, trying to improve the knowledge of nurses on PICC health education. Different forms of health education should be carried out for different caregivers. Finally, health education model should also be continuously improved to raise the quality of PICC pediatric nursing.
The UK's National Institute for Health and Care Excellence (NICE) published guideline of mental wellbeing at work on March 2, 2022. The guideline covers how to create the right conditions for mental wellbeing in the workplace, with the aim of promoting supportive and inclusive workplace environments and helping people with or at potential risk of mental health problems. This review will interpret the guidelines in detail.
ObjectiveTo formulate the Chinese version of Fear of Progression Questionnaire-Short Form/Caregiver Version (FoP-Q-SF/C) and examine the reliability and validity of the scale.MethodsA questionnaire survey of FoP-Q-SF/C was conducted among the caregivers of melanoma out-patients in West China Hospital of Sichuan University from June 2019 to March 2020. Convenient sampling method was adopted. The validity and reliability of the scale were analyzed.ResultsA total of 247 caregivers of melanoma out-patients were investigated by the FoP-Q-SF/C, and 101 valid questionnaires were finally collected. The Cronbach’s α of the FoP-Q-SF/C scale was 0.919, and the Guttman Split-Half coefficient was 0.906. Using exploratory factor analysis to extract 3 common factors, the cumulative explainable total variation was 73.964%. The model fit was as follows: chi-square/degree of freedom was 1.950, standardized root mean square residual was 0.067, goodness of fit index was 0.859, incremental fit index was 0.939, comparative fit index was 0.938, Tucker-Lewis index or non-normed fit index was 0.918, and the root-mean-square error of approximation was 0.097.ConclusionsThe FoP-Q-SF/C scale formulated in this study is divided into three dimensions, which has good reliability and validity, meanwhile, it is relatively simple and can be used to clinically screen melanoma caregivers’ FoP-Q-SF/C levels. However, the application of this scale in other diseases still needs further testing.
ObjectiveTo determine the effects of the management mode participated by doctors, nurses and patients on the safety of medical tubes for restlessness patients in the Neurosurgery Intensive Care Unit (NICU). MethodsA total of 133 restlessness patients treated between May 17 and November 22, 2013 were included in the study as control group, who were admitted to the NICU before application of the management mode participated by doctors, nurses and patients; another 119 restlessness patients treated between May 17 and November 22, 2014 were included in the study as research group, who were admitted to the NICU after application of the management mode participated by doctors, nurses and patients. Then we compared the accidental extubation situation between the two groups. ResultsThe accidental extubation rate of all kinds of medical tubes in the research group was lower than that in the control group, among which the extubation rate of urethral catheter (0.67% vs. 4.32%), gastric tube (2.26% vs. 10.14%), trachea cannula (1.08% vs. 7.84%), and arterial cannulation pipeline (1.12% vs. 6.93%) was significantly different between the two groups (P<0.05). ConclusionThe management mode participated by doctors, nurses and patients can effectively reduce the accidental extubation rate of medical tubes for restlessness patients, prevent the occurrence of adverse events and ensure the treatment and nursing safety in the NICU.
ObjectiveTo deeply discuss the home care experience of parents of children with epilepsy, analyzed the current status of care ability and the real influencing factors, and provide a basis to improve their care ability.MethodsDescriptive research was used to conduct in-depth interviews with parents of 14 children with epilepsy who were admitted to the Children's Hospital of Zhengzhou University from December 2019 to January 2020, and data analysis was performed by using the generic analysis method.ResultsThe home care experience of parents of children with epilepsy includes four themes: weak nursing ability, physical and mental fatigue, weak support system, and expectation of medical professional support.ConclusionMedical staffs should combine the needs of parents of children with epilepsy and the influencing factors of care ability to carry out health education guidance of online and offline epilepsy knowledge and care skills to improve their care ability.
Objective
To investigate the effect of quality control circle in reducing ventilator-associated pneumonia in Pediatric Intensive Care Unit (PICU).
Methods
A total of 1 249 child patients who underwent mechanical ventilation between January and December 2013 were chosen as the control group, and they accepted routine management. Another 1 208 child patients treated between January and December 2014 were selected as the observation group, and quality control circle was adopted. The compliance of ventilator care bundles, the duration of mechanical ventilation, the length of PICU stay and the incidence of ventilator-associated pneumonia were compared between the two groups.
Results
Compared with the control group, compliance of ventilator care bundles was higher in the observation group (P<0.01), the duration of mechanical ventilation was shorter [(6.9±2.4) daysvs. (4.6±2.2) days], the length of PICU stay was shorter [(9.2±3.1) daysvs. (7.7±2.4) days], and the incidence of ventilator-associated pneumonia was lower (22.4‰vs. 9.1‰) (P<0.05).
Conclusion
Application of quality control circle can significantly promote the compliance of ventilator care bundles, and decrease the duration of mechanical ventilation, the length of PICU stay and the incidence of ventilator-associated pneumonia.
Objective To investigate the current status of higher education of allied health professions (AHPs), professional human resource as well as the career development of allied health professionals, and to provide references for the planning of higher education of AHPs in China. Methods Literature was reviewed in relation to the current status of higher education of AHPs and professional human resource in China. A questionnaire survey was conducted to determine the career development conditions of allied health professionals. Results a) Currently, the higher education of AHPs in China was faced with such problems as a limited scale, a lower structural level, and an absent degree system. b) The number of allied health professionals was small with lower qualifications. Higher-end professionals were in shortage. C) The professionals saw multiples glass ceilings over career orientation, academic advancement, and professional entitlement. Conclusion Efforts should be made to expand the scale of higher education of AHPs, elevate degree structure, and to construct a professional education system with multiple layers and categories. The professional education should be combined with the career development for planning and collaboration to provide assurance for the career development of the professional in China.
