Objective
To investigate the status quo of knowledge and attitude towards pain among medical staff in West China Hospital of Sichuan University.
Methods
The medical staff in Emergency Department of West China Hospital of Sichuan University were investigated by the Chinese version of Knowledge and Attitudes Survey Regarding Pain (2008) questionnaire, the contents of which related to pain assessment, pain related knowledge, analgesic related knowledge, and comprehensive application, etc. And the questionnaire scores were compared among medical workers with different background.
Results
A total of 156 questionnaires were sent out and 130 valid ones were taken back, with an effective recovery rate of 83.3%. There was no statistically significant difference in questionnaire scores among the medical workers with different education background or different professional titles (P>0.05). The questionnaire scores were significantly different among nurses with different seniority (F=3.785, P=0.035), and the mean score of the nurses with more than 10 years of seniority was the highest (22.78±7.11). The questionnaire scores were significantly different among nurses working in different areas (F=3.043, P=0.033), and the mean score of the nurses working in rescue room was the highest (24.53±7.84).The erroneous items were concentrated on item 5, 17, 19. In the answers to the open questions, 97.7% (127/130) thought that the existing pain knowledge could not satisfy the needs of clinical work; 100.0% (130/130) believed that it was necessary to study pain related knowledge; 80.0% (104/130) acquired pain related knowledge from clinical experience, 40.0% (52/130) from books, 15.4% (20/130) from the network; 90% ( 117/130) commonly used numeric rating scale to evaluate the patients’ pain degree, 20.0% (26/130) evaluated the patients’ pain degree through facial expressions.
Conclusions
The overall level of pain management knowledge and attitude in medical staff in Emergency Department is low. The continuing education on pain knowledge should be strengthened, the attitude towards pain treatment and the importance of pain management should be paid more attention, and the standardized training and supervision should be enhanced.
Objective To investigate the clinical features, etiology and treatment strategies of patients with delirium in emergency intensive care unit ( EICU) . Methods Patients with delirium during hospitalization between January 2010 and January 2012 were recruited from respiratory group of EICU of Beijing Anzhen Hospital. Over the same period, same amount of patients without delirium were randomly collected as control. The clinical datawere retrospectively analyzed and compared. Results The incidence of delirium was 7.5% ( 42/563) . All delirium patients had more than three kinds of diseases including lung infections, hypertension, coronary heart disease, respiratory failure, heart failure, renal failure, hyponatremia, etc. 50% of delirium patients received mechanical ventilation ( invasive/noninvasive) . The mortality of both the delirium patients and the control patients was 11.9% ( 5 /42) . However, the patients with delirium exhibited longer hospital stay [ 14(11) d vs. 12(11) d, P gt;0. 05] and higher hospitalization cost [ 28, 389 ( 58,999) vs. 19, 373( 21, 457) , P lt;0.05] when compared with the control group. 52.4% ( 22/42) of delirium patients were associated with primary disease. 9. 5% ( 4/42) were associated with medication. 38. 1% (16/42) were associated with ICU environment and other factors. Conclusions Our data suggest that the causes of delirium in ICU are complex. Comprehensive treatment such as removal of the relevant aggravating factors, treating underlying diseases, enhancing patient communication, and providing counseling can shorten their hospital stay, reduce hospitalization costs, and promote rehabilitation.
【摘要】 目的 探討高血壓危象評估和處理原則及對高血壓危象急診處理的指導意義。 方法 依據高血壓危象評估和處理原則對2008年1月-2009年12月期間收治的160例高血壓危象患者進行診斷和治療。結果 160例高血壓危象患者中,高血壓急癥134例,高血壓亞急癥26例。高血壓急癥中,以心腦血管病變為主,包括腦卒中、急性冠脈綜合征和急性左側心力衰竭。依據高血壓危象評估和處理原則進行急診處理,能夠對高血壓危象進行準確評估和有效處理,減少診治失誤,降低死亡率并改善預后。結論 有關高血壓危象的評估和處理原則能夠指導高血壓危象的急診處理,取得良好的預后。【Abstract】 Objective To investigate the principles of evaluation and management of hypertensive crises in order to guide emergency clinical practice for better managements and prognosis. Methods One hundred and sixty patients with hypertensive crises admitted to our department from January 2008 to December 2009 had been diagnosed and treated. Results There were 134 patients with hypertensive emergencies (HE) and 26 patients with hypertensive urgencies(HU)in accordance with those principle. Cardiocerebralvascular diseases were the main symptom of HE including stroke, acute coronary syndrome and acute left ventricular failure. According to those principles,the emergency management was carried out, accuracy evaluation and effective management of hypertensive crises could reduce wrong diagnosis and treatment,decrease mortality and improve prognosis. Conclusion The principle of evaluation and management of hypertensive crises could guide the emergency management of hypertensive crises and obtain better prognosis．
To systematically and retrospectively analyze Chinese exploration of novel coronavirus pneumonia, including emergency command, medical treatment, health and disease prevention, resource scheduling and other aspects, in order to provide references for the prevention and treatment of global infectious diseases.
ObjectiveTo probe into the writing quality and rational use of drugs for Emergency Department prescriptions in West China Hospital of Sichuan University.
MethodsFrom January 2012 to December 2013, the prescriptions for emergencies were selected randomly. According to prescription management method and standard management of hospital prescription comment requirement, the quality of prescription was analyzed.
ResultsFrom 2012 to 2013, the qualified prescription rate increased from 91.45% to 96.70%. The average number of drugs on each prescription was 1 or 2; the utilization rate of antibacterials was below 20.00%; the utilization rate of essential drugs increased from 60.68% to 66.15%; the utilization rate of generic drug name approached 100.00%. However, the utilization rate of injections increased from 82.92% to 85.67%.
ConclusionBy prescription reviews, we have listed the problems, and intervened irrational prescription to improve the rate of qualified prescriptions. The high rate of injection utilization is a warning for us to take more effective, more specific and stricter intervention measures.
Objective To summarize the experience of emergency coronary artery bypass grafting （CABG） after failed percutaneous coronary intervention. Methods From January 1998 to December 2002, 9 patients underwent emergency CABG after failed percutaneous coronary intervention. The indications of emergency CABG were coronary artery dissection （5 cases）or perforation （2 cases） and acute arterial occlusion （2 cases）. The time averaged 2 hours from onset of ischernia to revascularization. The CABG was performed under off-pump bypass in 3 cases and under CPB in 6 cases. The mean graft number was 3. Results There were no hospital death. The mean follow-up was 17 months. No death and angina occurred. The function of New York Heart Association class Ⅰ-Ⅱ were in 8 patients, class Ⅲ in 1 patient. Conclusion Emergency CABG is an effective management for failed percutaneous coronary intervention if the indication is right.
Objective
To investigate the core competencies of emergency specialized nurses and the influencing factors in Sichuan Province so as to provide a basis for improving the training systems.
Methods
The trainees who received specialized training in West China Hospital every March and September between 2012 and 2014 were investigated with questionnaire survey.
Results
A total of 270 questionnaires were given out, and 246 valid questionnaires were retrieved. The scores of emergency specialized nurses’ core competencies ranged from 165 to 258, with an average of 214.55±22.56. According to the scores, 4.88% of the emergency specialized nurses’ core competencies were at a low level, 67.07% were at a middle level and 28.5% were at a high level. The influencing factors of core competencies included education, professional title, position, level of hospitals and years of working experience in the emergency department.
Conclusion
Core competencies of emergency specialized nurses need to be further improved and the training systems need to be improved consistently.
Objective To provide references and recommendations about emergency physician training for our country by analyzing the characteristics of emergency physicians training objective, subject, process, content, appraisal and assessment in the United States, the United Kingdom, Canada and Australia. Methods Such databases as Ovid, Proquest, MDConsoult and relevant websites of national emergency medicine were searched to include literature covering guidelines and documents on emergency education and training in the United States, the United Kingdom, Canada and Australia. According to the evidence-based scientific principles and methods, we graded and analyzed the included information. Results A total of 40 articles were included, covering 12 guidelines and documents, 2 reviews and 26 research documents. Each of the four countries owned a sound emergency specialist training access system especially on how they used competency as the core to design the training content, courses and appraisal and assessment system to improve overall ability and quality of emergency physicians. Conclusion Our country’s emergency physician training certainly has lagged behind those of the developed countries. We should learn from positive experience of the developed countries to standardize emergency physician training, improve the emergency physician training content and curriculum, strengthen access management and the construction of appraisal system, and cultivate the competency of emergency physicians.
Objective To strengthen and improve the decision of emergency medical rescue and provide the experience for the world, the article evaluates the performance of emergency command in Yushu Earthquake.Methods All the materials seen during the first year after Yushu earthquake were collected, such as all documents, information notifications and work reports issued by the Central Government and the Ministry of Health, and all the information from the website of News Office of the State Council, Ministry of Health, State Seismology Bureau, Qinghai Provincial People’s Government, and Department of Health of Qinghai Province. The data were also searched from CNKI and descriptively analyzed after the retrospective study. Results Based on the experience from Wenchuan Earthquake, the emergency command in Yushu Earthquake was characterized by: a) Promptly starting a Level-1 response; b) Setting up and completing an integrated work mechanism of military, police and the local government; and c) Achieving an accurate command under the guidance of precise information. Conclusion As the successful precedent of large-scale medical and health rescue at the high-altitude area in the world, the experience of Yushu Earthquake supplements and enriches the Wenchuan’s, and provides references for both domestic and overseas disaster medical emergency response.
Objective To provide reference for hospital emergency preparedness for disasters in China by summarizing the main results from articles involving hospital emergency readiness. Method We systematically searched MEDLINE (1950 to June 2008), CNKI (1980 to June 2008) and some websites. The main results of the eligible articles are described. Results A total of 85 articles were included, of which expert articles and surveys accounted for 44% and 29%, respectively. An emergency hospital plan should address the following 4 phases of disaster management: mitigation, preparation, response, and recovery. The following factors should be considered when developing hospital emergency plans: surge capacity, disaster planning, collaboration, training, drill, personnel, equipment, triage, diagnosis, treatment, decontamination, funding, individual security, logistic, psychological support, etc. Questionnaires, checklists or specific tools could be applied to evaluate such emergency plans. Conclusion Hospital emergency preparedness is essential for effective disaster relief. Hospitals should develop emergency plans for a variety of disasters, based on their local situations.
