ObjectiveTo understand the status and risk factors of care ability among main caregivers of stroke patients.MethodsA total of 395 stroke patients and their main caregivers were enrolled in the Department of Neurology, West China Hospital, Sichuan University from August 2017 to February 2018. General data of the patients and their main caregivers were collected. The caring ability of the main caregivers was assessed by the family care test inventory. Connor- Davision Resilience Scale and Mishel Uncertainty in Illness Scale-Family Member Form were used to assess the psychological resilience and uncertainty illness of caregivers. Single factor analysis and multiple linear regression analysis were all used to explore the risk factors.ResultsThe care ability of the main caregivers of stroke patients was basically at a high level. Multivariate analysis showed that patients’ age [non-standardized partial regression coefficient (b)=?0.051, 95% confidence interval (CI) (?0.079, ?0.024), P<0.001], family income [b=?0.455, 95%CI (?0.770, ?0.141), P=0.005], and activities of daily living ability at admission [b=?0.017, 95%CI (?0.029, ?0.006), P=0.003], and caregivers’ sleeping status [b=0.636, 95%CI (0.340, 0.932), P<0.001], scores of resilience [b=?0.143, 95%CI (?0.202, ?0.083), P<0.001] and illness uncertainty [b=?0.127, 95%CI (?0.153, ?0.100), P<0.001] were influencing factors of caregivers’ care ability.ConclusionsThe main caregivers of stroke patients have good care ability. The older the patients are, the higher the family income is, and the better the ability of activities of daily living at admission is, the better the caregivers’ care ability they have. The better the caregivers’ sleep is, and the stronger the caregivers’ psychological resilience and uncertainty of disease are, the better the caring ability they have. It is suggested that we should pay more attention to the physical and mental status of caregivers, raise their awareness of stroke, teach them relevant knowledge and care skills, so as to lighten the physical and mental burden of caregivers, improve the prognosis of patients and finally improve the quality of life of patients and their caregivers.
ObjectiveTo investigate the risk factors, prognostic factors and prognosis of Multidrug-Resistant Acinetobacter Baumannii (MDR-AB) infection of lower respiratory tract in Intensive Care Unit (ICU) of the Second Affiliated Hospital of Anhui Medical University.
MethodsUsing retrospective analysis, we reviewed and compared clinical data of 77 AB infections in lower respiratory tract cases in ICU from January 2013 to March 2015. According to the resistance, patients were divided into a MDR-AB group and a NMDR-AB group. Then the risk factors, prognostic factors and prognosis of MDR-AB infection were analyzed.
ResultsA total of 58 cases in the MDR-AB group, 19 cases in the NMDR-AB group were included. The result showed that, the MDR-AB infection in lower respiratory tract could significantly prolong the length of ICU stay (18.5±16.0 vs. 10.6±9.3 days, P<0.05) and increase the mortality (44.8% vs. 11.1%, P<0.01). Logistic regression analysis showed that the independent risk factors for MDR-AB infection in lower respiratory tract included Acute Physiology and Chronic Health Evaluation Ⅱ (Apache Ⅱ) score >15 (OR=0.138, 95%CI 0.03 to 0.625, P=0.01) and use of carbapenems (OR=0.066, 95%CI 0.012 to 0.0346, P=0.001). The independent prognostic factors included placement of drainage tube (OR=8.743, 95%CI 1.528 to 50.018, P=0.015) and use of vasoactive drugs (OR=12.227, 95%CI 2.817 to 53.074, P=0.001).
ConclusionThe MDR-AB infection in lower respiratory tract can significantly prolong the length of ICU stay and increase the mortality. The Apache Ⅱ score >15 and use of carbapenems are the risk factors, and the placement of drainage tube and use of vasoactive drugs can increase the mortality of MDR-AB infection of lower respiratory tract in ICU.
ObjectiveTo explore the psychological pressure in Intensive Care Unit (ICU) nurses and the sources of their pressure.
MethodWe investigated the ICU nurses in West China Hospital with a self-designed psychological pressure questionnaire from March to September 2013.
ResultsThe total stress level of ICU nurses was 2.89±0.86. The top five sources were low salaries and welfare benefits (3.37±0.61), high frequency of night work (3.31±0.88), wide need of knowledge (3.22±0.41), heavy workload (3.20±0.80) and chronic fatigue syndrome (3.19±0.75).
ConclusionsGreat psychological pressure exists in ICU nurses. We urgently need effective approaches to relieve the stress of ICU nurses in order to improve the efficiency and quality of nursing service.
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 explore the status of the career maturity of medical students (eight-year program) and its related factors.
MethodsFrom April to June in 2010, College Students Maturity Self-test Questionnaire was used for the investigation of the career maturity of the medical students (eight-year program) at West China Medical School of Sichuan University.
ResultsThe subjects were graded into three groups according to the scores of their questionnaires:high, moderate, and low career maturity. The proportion of each group was 15.2%, 13.8%, 71.0%, respectively. Gender difference was not found in the overall career maturity (Z=-0.206, P=0.837), while there was positive correlation between grade and overall career maturity (rs=0.180, P=0.030).
ConclusionThe medical students (eight-year program) with relatively low overall career maturity account for a larger proportion than those with high and median career maturity. As grade increases, career maturity changes significantly. This research suggests that long schooling medical students are in urgent need for prompt and valid professional career education.
ObjectiveTo explore the effect of goal directed analgesia on patients with noninvasive positive pressure ventilation (NPPV) in the intensive care unit (ICU).MethodsThis was a retrospective study. Two hundred sixty-four patients requiring non-invasive positive pressure ventilation were enrolled in the ICU of this hospital, including 118 patients in the empirical analgesia group and 146 in the goal directed analgesia group. The empirical analgesia group was treated with remifentanil to analgesia and propofol, midazolam or dexmedetomidine to sedation. The sedative depth maintained <1 measured by the score of the Richmond restless sedative scale (RASS). The same analgesic and sedative drug were first used in the goal directed analgesia group to maintain the Critical Care Pain Observation Tool score <2, and the RASS score <1 was maintained after the analgesia depth were achieved. Whether the patients occurred delirium was assessed by the Confusion Assessment Method for the ICU. The dosage of analgesic and sedative drugs, the dependability (based on the total ventilation time in the first 24 hours after ventilation), the incidence of delirium, the rate of invasive ventilation, the total time of NPPV and the length of stay of ICU were observed in the two groups.ResultsThere were no significant differences in age, sex, APACHEⅡ score, mean arterial pressure, heart rate, respiratory rate, SpO2, arterial blood gas and the reason of NPPV between the two groups. The dosage of analgesic and sedative drugs in the goal directed analgesia group were less than the empirical analgesia group, and the dependability was higher than that of the empirical analgesia group ［(12.6±5.8)h vs. (10.9±4.8)h, P<0.05), and the incidence of delirium and the rate of invasive ventilation were also lower than those of the empirical analgesia group (15.8% vs. 25.4%, P<0.05; 32.9% vs. 44.9%, P<0.05). The total time of NPPV in the goal directed analgesia group was shorter than that of the empirical analgesia group ［(28.6±8.8)h vs. (37.3±10.7)h, P<0.05), but there was no significant difference in the length of stay in ICU.ConclusionGoal directed analgesia can improve the dependability of NPPV patients, reduce the use of sedative drugs, and decrease the incidence of delirium and rate of invasive ventilation.
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.
ObjectiveTo investigate the incidence of nosocomial infection and device-related infection in the Intensive Care Unit (ICU), analyze its related risk factors, and search for effective measures to prevent and control nosocomial infection.
MethodsBy prospective objective monitoring method, we surveyed 294 patients hospitalized in the ICU for at least 48 hours between January and December 2012. The doctor in charge filled in relevant information of the patients to complete the questionnaires, and hospital infection management staff was responsible for tracking, judging, and statistical analysis.
ResultsIn the 294 patients, 61 had hospital infections, and there were 78 cases. The hospital infection rate was 20.75%, and the case infection rate was 26.53%. The day incidence of patient infection was 16.01‰, and day infection rate was 20.47‰ for infection cases. After average severity of illness score adjustment, the day case infection rate was 7.48%, ventilator associated pneumonia (VAP) infection rate was 27.27‰, central venous catheter associated bloodstream infection rate was 6.58‰, and catheter associated urinary tract infection rate was 3.15‰.
ConclusionICU has a high risk of hospital infection. In the device related infections, VAP infection rate is the highest. Continuous improvement can be achieved through monitoring and discovering problems, strengthening hospital infection management training for the medical personnel of the hospital, close communication between doctors and hospital infection management staff, and strict implementation of hospital infection management measures.
ObjectiveTo assess the care needs of outpatients in stomatological hospital and provide evidence for the improvement of patients' satisfaction.
MethodsAccording to the characteristics of outpatients in stomatological hospital, a convenience sample of 150 cases was assessed with care needs survey based on Kano Model between May 2011 to February 2012.
ResultsAmong all the care needs, 6 were essential, 11 were expected, and 3 had an attractive quality. Essential and attractive care needs accounted for 70% of all items. In the quadrant chart analysis, there were 8 items in competitive advantage district and 12 in the urgent improvement district respectively.
ConclusionKano model is a quality attributive recognition tool. Through the analysis of the questionnaire, we believe the hospital should improve such aspects as information disclosure, public facilities, appointment, optimization process, and shortening patients' waiting time, in order to meet patients' needs by providing them with high quality services.
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.
