ObjectiveTo analyze the increased risks of nursing due to expansion of ophthalmic day surgery indications, and the countermeasures.
MethodsWe collected the information in the last three years from January 2012 to December 2014 in the Department of Ophthalmology, including the number of operations, the proportion of cataract patients, patients aged over 70 and under 12 years old, patients with high-risk fall, the number of general anesthesia operations, adverse events, and the data from the satisfaction survey of the patients. All the data were analyzed by statistical method.
ResultsDuring the last three years, the relaxation of ophthalmic day surgery indications led to an increased admission rate of high-risk patients, and caused more nursing risk factors. Through the efforts of prevention and care, during the last three years, there were no adverse events, and patients had a satisfaction rate over 90%.
ConclusionAlthough the ophthalmic day surgery indication has been relaxed, through the establishment of nursing risk response system by pre-hospital guidance, admission assessment, peri-operative education and follow-up visit, with the continuous improvement of nursing management system and convenient workflow, we can not only improve the work efficiency, but also ensure nursing safety.
Objective To investigate the current status of clinical nursing risks to nursing students, so as to provide scientific references for medical universities and policy makers. Methods The self-designed questionnaires were distributed to 360 clinical nursing students in four Third-Level hospitals. The group leaders were trained as investigators regularly. All the other nursing students were asked to fill in the questionnaire alone within 30 minutes. The questions issued were the following four aspects: general information of nursing students, clinical intern operating situation, nursing defects and awareness of nursing risks. Results Among the total 400 questionnaires distributed, 360 valid ones were retrieved (90%). The analysis showed all 21 nursing operations could be performed by students alone, and 80% of the nursing students believed that they were able to do 11 routine operations alone, such as bed-making and vital sign monitoring. The incidence rate of eight nursing defects was between 0.56% and 12.22%. As for the four questions about nursing risks, 49.44% of the nursing students operated alone before getting themselves ready because of their eagerness for such experiences. According to the nursing students, the departments with the highest nursing risks ranked as emergency, operating theatre, surgery, pediatrics, internal medicine, and gynecology and obstetrics. Conclusion The current situation of clinical nursing risks to nursing interns is still far from being satisfactory, so it is necessary to improve the training at university, regulate the clinical education, and ensure the intern safety for nursing students.
ObjectiveTo explore risk factors of blood transfusion during liver transplantation and construct its prediction model. MethodsThe patients underwent liver transplantation who met the inclusion and exclusion criteria of this study from March 2020 to December 2020 in the Beijing Youan Hospital of Capital Medical University were retrospectively collected. The univariate and logistic multivariate analysis were used to evaluate the risk factors of blood transfusion during liver transplantation and construct the prediction model for intraoperative blood transfusion. ResultsA total of 151 eligible liver transplantation patients were collected in this study, including 51 non-transfusion patients and 100 transfusion patients. The univariate analysis results showed that the differences of primary diagnosis, preoperative hemoglobin (Hb), platelet count, prothrombin time, international normalized ratio, Child-Turcotte-Pugh score, and end-stage liver disease (MELD) score were statistically different between them (P<0.05). The above variables selected by the univariate analysis were selected by stepwise method, then the preoperative Hb and MELD score were selected into the multivariate logistic regression analysis, the results showed that the preoperative Hb≤113 g/L and MELD score ＞14 increased the risk of blood transfusion during liver transplantation [Hb: OR=6.652, 95%CI (2.282, 19.392), P<0.001; MELD score: OR=16.037, 95%CI (6.336, 40.592), P<0.001]. The logistic regression model predicted the area under receiver operating characteristic curve was 0.873 [95%CI (0.808, 0.919), P<0.001], the sensitivity and specificity were 91.0% and 67.5%, respectively, Youden index was 0.674, the accuracy was 86.1%. ConclusionsResults of this study suggest that preoperative Hb ≤113 g/L and MELD score＞14 increase risk of blood transfusion during liver transplantation. Logistic regression model constructed according to preoperative Hb and MELD score has a better sensitivity and specificity of intraoperative blood transfusion.
Objective To report our experience with enhanced recovery after surgery (ERAS) protocol in patients undergoing transapical transcatheter aortic valve implantation (TAVI) and to determine perioperative predictors for ERAS failure. Methods Between May 2018 and January 2019, 80 patients undergoing TAVI in our hospital were recruited. Among them, 40 patients (24 males, 16 females, aged 73.0±5.0 years) successfully received ERAS, defined as successful extubation in operating room (an ERAS group) and the other 40 patients (28 males, 12 females, aged 73.0±7.0 years, a non-ERAS group) failed to perform ERAS. Results Compared with the non-ERAS group, patients in the ERAS group were associated with a significantly lower incidence of postoperative complications (30.0% vs. 52.5%, P=0.04), shorter postoperative ICU stay (2.2±0.4 d vs. 4.0±4.8 d, P=0.00) and hospital stay (7.0±2.3 d vs. 9.5±4.8 d, P=0.00), and less medical cost (311±20 thousand yuan vs. 347±80 thousand yuan, P=0.00). Independent predictors of ERAS failure were poor preoperative heart function and elevated B-type natriuretic peptides. Conclusion ERAS protocol is feasible and effective in patients undergoing TAVI. Poor preoperative heart function is an independent predictor of failure in early extubation which, in turn, is associated with prolonged ICU and hospital stay and dramatic worsening of patient outcomes.
Objective To evaluate evidence from American medical risk monitoring and precaution system (AMRMPS) which may affect the construction of Chinese medical risk monitoring and precaution system (CMRMPS). Methods We searched relevant databases and Internet resources to identify literature on AMRMPS, medical errors, and patient safety. We used the quality evaluation system for medical risk management literature to extract and evaluate data. Results In 1999, a report from the Institute of Medicine (IOM) not only showed the severity and cause of medical errors in America but also gave the solution of it. In 2000, the Quality Interagency Coordination Task Force (QuIC) was appointed to assess the IOM report and take specific steps to improve AMRMPS. After 5 years, a well-developed medical risk management system was established with the improvement in the public awareness of medical errors, patient safety, performance criteria of medical safety, information technology and error reporting system. There was still some weakness of this system in risk precaution and prevention. Conclusion The experience from AMRMPS can be used to establish the CMRMPS. Firstly, we should disseminate and strengthen the awareness of medical risk and patient safety in public. Secondly, we should establish hospital audit system which includes auditing of medical staff and course of medical risk in continuing and academic education. Thirdly, we should develop regulations and guidelines on health care, medical purchase and drug supply which will benefit in management of regular work. Fourthly, we should develop computer information system for hospital which will regulate the management without the disturbance from human. Lastly, we should emphasize outcome evaluations and strive for perfection during the process.
ObjectiveTo explore risk factors associated with mortality and restenosis after the surgery for congenital pulmonary venous stenosis (CPVS) combined with congenital heart disease.MethodsFrom May 2007 to August 2019, 58 patients received surgical relief of CPVS combined with congenital heart disease, including 24 males and 34 females, aged 17.2±26.3 months, weighing 8.8±8.2 kg. Endpoints were death and restenosis, and the risk factors were analyzed. A univariate and multivariate risk analyses were performed.ResultsPreoperative pulmonary venous stenosis severity score (PVSSS) was 4.5±2.7. Average pulmonary vein counts with CPVS was 1.9±1.0. There were 2 (3.4%) early deaths. The mean follow-up time was 2-145 (49.8±40.0) months. The 1-, 2-, 3- and 5-year overall survival rates were 86.7%, 81.3%, 78.5% and 73.6%, respectively, and the pulmonary venous restenosis-free rates were 79.6%, 68.5%, 68.5% and 68.5%, respectively. Preterm birth was an independent risk factor for mortality. The pulmonary venous peak flow rate ≥1.2 m/s at discharge was an independent risk factor for mortality and restenosis.ConclusionThe prognosis of CPVS is still poor. Postoperative residual stenosis at discharge is an independent risk factor for death and restenosis.
Objective To explore the risk factors related to periprosthetic infection after breast augmentation, and to provide a basis for reducing the risk of postoperative infection. Methods A total of 1 056 female patients who underwent breast augmentation between January 2010 and January 2018 were analyzed retrospectively. The patients were 20 to 44 years old (mean, 31.6 years). The body mass index (BMI) was 19.0-31.1 kg/m2, with an average of 24.47 kg/m2. According to the periprosthetic infection standard of the United States Centers for Disease Control and Prevention (CDC), the patients were divided into infection group and non-infection group. Age, BMI, diabetes, previous history of immunosuppression, history of smoking, previous history of breast surgery, previous history of mastitis, combined with active dermatitis, surgical approach, the type and shape of breast prosthesis, implant in the different layers, combined with mastopexy, operation time, postoperative antibiotic time, postoperative breast crash, and postoperative potential infection surgery were analyzed by univariate analysis. The influencing factors of prosthetic infection were screened by logistic regression. Results Periprosthetic infection occurred in 60 cases after operation, and the infection rate was 5.68%. Among them, 11 cases were acute infection, 33 cases were subacute infection, 16 cases were delayed infection, and 20 cases were positive in bacterial culture. Postoperative breast crash occurred in 114 cases. Univariate analysis showed that diabetes, previous history of immunosuppression, history of smoking, previous history of mastitis, postoperative breast crash, postoperative potential infection surgery, and combined with breast suspension were the influencing factors of postoperative periprosthetic infection (P<0.05). Multivariate analysis showed that diabetes, history of smoking, and postoperative breast crash were the risk factors of periprosthetic infection (P<0.05). Conclusion Diabetes, smoking, and postoperative breast crash are the risk factors of periprosthetic infection after breast augmentation.
The artificial ventilation system is a multi-factor system with some high uncertain risks which should be under controlled by medical risk management of hospitals. The key suggestions for reducing the accidence caused by ventilator are recommented： 1 ） to clarify the risk factor of ventilators, 2 ） to set up management group of ventilators with a clinical engineer who is good at management and quality control of medical equipment on ventilators, 3 ） to develop ventilator clinical practice for safety use, 4 ） to explore the effective risk monitoring and early warning system and mechanism on ventilator application.
ObjectiveTo explore the risk factors and bleeding points associated with postoperative hemorrhage after thyroidectomy and provide clinical basis for prevention of postoperative bleeding.MethodsThe clinical data of 21 patients with postoperative hemorrhage and 63 patients without postoperative hemorrhage who underwent thyroidectomy from Nov. 2010 to Nov. 2017 in West China Hospital were retrospectively analyzed.ResultsUnivariate analysis showed that hypertension, maximum tumour dimension, lymph node metastasis, recurrent laryngeal nerval infiltration, T stage, N stage, serum triglyceride, and serum high density lipoprotein were significantly associated with postoperative hemorrhage (P<0.05). Multivariate analysis showed that lymph node metastasis (OR=16.219, P=0.002) and low serum high density lipoprotein (OR=0.035, P=0.006) were risk factors for postoperative hemorrhage. Among the patients with postoperative bleeding, the most common five bleeding sites were: ribbon muscle and sternocleidomastoid muscle (both was 19.2%), esophageal tracheal surface blood vessels (11.5%), thyroid bed (7.7%), and larynx recurrent paravascular small vessels (7.7%).ConclusionsLymph node metastasis and serum HDL are independent risk factors of hemorrhage after thyroidectomy. The predilection site for postoperative bleeding is mainly the neck muscle.
ObjectiveTo summarize the research progress of osteonecrosis of femoral head (ONFH) following femoral intertrochanteric fractures in adults.MethodsRelevant literature at home and abroad was extensively reviewed to summarize the pathogenesis, high-risk factors, and treatment of ONFH after femoral intertrochanteric fracture in adults.ResultsONFH after femoral intertrochanteric fracture mostly occurs within 2 years after operation, with a lower incidence. At present, it is believed that comminuted and large displacement fractures caused by high-energy injuries, fracture line close to the base of neck, excessive external rotation deformity, improper intramedullary nail entry points, and rough intraoperative manipulating may injury the deep branch of the medial circumflex femoral artery, causing ONFH. Hip replacement is the main treatment for necrosis, which can achieve good results.ConclusionAddressing the above risks, excessive external rotation, overstretching, and rough manipulating should be avoided. Anatomical reduction should be performed during the operation, the nail entry point should be accurate and avoid repeated drilling and thermally bone necrosis.
