ObjectiveTo explore the application of PDCA cycle in the examination of medical quality of Tibetan area hospitals. MethodsIn the October 2014, PDCA cycle theory was introduced into the examination of Tibetan hospital medical quality. We collected quality problems existing in the medical activities actively, analyzed the reason and influencing factors and made corresponding plans. Then we implemented the plans and measures strictly, surveyed the results, found out and analyzed the problems, summarized the results of the examination, and turned the unsolved problems to the next PDCA circulation. Continuous follow-up was performed until the results were satisfactory. Based on Sichuan Province Secondary Comprehensive Hospital Evaluation Standard, we analyzed the medical quality of the hospital before PDCA application (July to September 2014) and after PDCA application (October to December 2014). ResultsThe incidence of medical nursing documents writing defects decreased from 12.4% to 5.9%. Hospital infection management defect rate declined from 13.5% to 5.3% and drug safety management defect rate declined from 11.8% to 2.5%, and all the differences were statistically significant (P<0.05). ConclusionPDCA cycle in the Tibetan hospital for medical quality examination has greatly improved the medical quality of Tibetan hospitals.
ObjectiveTo evaluate the efficacy of the continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) after the surgery of type A aortic dissection. MethodsWe retrospectively analyzed 58 hemodialysis patients with AKI after type A aortic dissection surgery in our hospital between January 2003 and January 2014.The 58 patients were divided into two groups including a bedside intermittent hemodialysis (IHD) group and a CRRT group based on the methods of hemodialysis. There were 38 patients with 29 males and 9 females at average age of 49.8± 13.7 years in the CRRT group. There were 20 patients in the IHD group with 14 males and 6 females at average age of 52.6± 11.0 years. ResultsCompared with IHD, CRRT had significantly greater effect on reducing the simplified acute physiology scoring system (SAPS)Ⅱscore (Ftime=60.964, P=0.000; Ftime * group=3.178, P=0.041). However, there was no significant difference in reducing the acute tubular necrosis individual illness severity index (ATN-ISI) score between the two groups (Ftime=13.803, P=0.000; Ftime * group=0.222, P=0.951). Lower incidences of dialysis-related complications including hypotension (P=0.027) and acute congestive heart failure (P=0.011) were found in the CRRT group. There was no statistical difference in operation time (P=0.367) between the two groups. While statistical differences in duration of hospitalization in intensive care unit (P=0.006), in hospital time (P=0.047), frequency of dialysis (P=0.001), and dialysis time (P=0.039) were found between the two groups. However there were no significant differences in mortality during hospital (P=0.544)and incidences of recovery (P=0.056) between the two groups. ConclusionCompared with IHD, CRRT had significantly positive effect on patients who suffered from AKI after type A aortic dissection surgery, which can help reduce incidences of dialysis-related complications, duration and cost of hospitalization in ICU.
Objective To investigate the efficacy of continuous blood purification ( CBP) in the treatment of severe sepsis, and explore the related immune regulatory mechanisms. Methods Forty-eight patients with severe sepsis were randomly divided into a control group ( n =23) and a CBP group ( n =25) .CD4 + CD25 + regulatory T cells ( Treg% ) in peripheral blood and APACHEⅡ score were measured dynamically before treatment and 12, 24, 36, 48, 60, 72 hours after treatment. Meanwhile the length of ICUstay, duration of mechanical ventilation, and 28 day mortality were determined. Results Compared with the control group, the length of ICU stay, ventilator time, incidence of multiple organ failure, and mortality decreased significantly in the CBP group ( P lt; 0. 05) . And CBP also decreased Treg% and APACHEⅡ score significantly. There was a positive correlation between Treg% and APACHEⅡ score ( r =0. 804, P lt;0. 01) .Conclusion Early CBP treatment can reduce Treg%, improve cellular immunity and improve the prognosis of sepsis.
Objective To explore the appl ication of 3D nerve visual ization system in processing 2D imageinformation of human ulnar nerve acquired by series freezing tissue section, staining and scanning. And to draw the 3Danatomical atlas of human ulnar nerve through 3D Nerve visual ization software system. Methods One left ulnar nerve (frommedial fasciculus of brachial plexus to transverse carpal l igament, about 50 cm ) was taken from a fresh donated cadaver. After marked with human hair and embedded in OCT, series freezing tissue sections were made and stained with acetylchol inesterasehistochemically. Series 2D image information was obtained through high resolution scanner. Then the microstructure of ulnar nerve was reconstructed with 3D Nerve visual ization software system. Results Different cross sections of ulnar nerve have different numbers, positions and characters of the internal nerve fibers. The microstructure of ulnar nerve could be observed in magnifying visual field at any cross section after reconstructed in 3D Nerve visual ization soft ware system, which made it possible to track stereo courser of fascicles. Conclusion Reconstructed 3D Nerve visual ization software system shows the whole microstructure of ulnar nerve and the 3D stereo-structure of its internal fascicles, thus provides exact topography atlas for medical teaching and facil itates precise repair of ulnar nerve injury to improve theraputic effect.
ObjectiveTo compare the clinical effects of continuous hyperthermic peritoneal perfusion chemotherapy (CHPPC) and intravenous chemotherapy for advanced gastric cancer patients, and find better nursing methods. MethodsSixty advanced gastric cancer patients who underwent chemotherapy between June 2013 and June 2014 were divided into CHPPC group (group C, n=30) and intravenous chemotherapy group (group V, n=30). We recorded the nursing methods for both the two groups, patients' satisfaction to the nursing and treatment, peritoneal metastasis rate and quality of life during the chemotherapy. ResultsThe life quality in group V was lower than that in group C (P<0.05). The differences in patients' satisfaction rate, peritoneal metastasis rate, and one-year survival rate were not significantly different between the two groups (P>0.05). ConclusionFor patients with advanced gastric cancer requiring chemotherapy, in spite of higher cost and more complicated operations, CHPPC is superior in lower adverse events rate, better quality of life during chemotherapy and doesn't decrease patients' satisfaction to the nursing and treatment.
ObjectiveTo explore the effect and significance of continuous nursing in patients with clean intermittent catheterization. MethodsFrom July to December 2013, 47 patients with spinal cord injury still relying on clean intermittent catheterization were selected as the control group, whom were given the routine care and guidance. From January to June 2014, 51 patients with spinal cord injury still relying on clean intermittent catheterization were selected as the study group; in addition to routine nursing instruction before leaving hospital, they were also guided with the continuous nursing. In the way of telephone follow-up, we analyzed the results via the questionnaire of the effect of continuous nursing for spinal cord injured patients with clean intermittent catheterization. ResultsThe incidence of catheter related complications such as urinary tract infections in the study group was significantly lower than that in the control group (P<0.05). The caregivers' ability for patients in the study group was significantly higher than that in the control group (P<0.01). ConclusionThe continuous follow-up nursing instruction can improve the nursing ability of caregivers, and effectively reduce the occurrence of catheter related complications.
Objective To investigate the effect of partial liquid ventilation (PLV) with perfluorocarbon(PFC) and continuous pulmonary artery perfusion (CPP) on lung gas exchange and lung inflammatory reaction in acute lung injury(ALI) induced by cardiopulmonary bypass (CPB). Methods Eighteen of either sex piglets(weighting10.2±1.6kg) were randomly divided into three groups: Control group, CPP+CPB group (CPP group), PLV+CPP+CPB group (PLV group). Animals in control group received no treatment but conventional mechanical ventilation.In CPP group lung perfusion with oxygenated blood at 20-25ml/kg·min was given during aortic clamping. In PLV group PFC (FDC)12ml/kg was instilled into the trachea right after CPB stopping. The changes of gas exchange were mearsured before CPB and at 0h, 1h, 2h, 3h after CPB stopping. Histological sections were taken from right and left downsides of lung. Results Compared with control group, the partial pressure of oxygen in artery (PaO2) significantly increased and alveolar-aterial oxygen gradient(AaDO2) markedly decreased after 1h in PLV group(Plt;005) and partial pressure of carbon dioxide in artery (PaCO2) also became small after 3h (Plt;005).The change of gas exchange in CPP group was markedly improved. And role of lung protection of PLV was more better than that of CPP. Light microscopy: Express of intercellular adhesion molecule-1(ICAM-1) in the histopathological lesions of lung was bely positive in control group than that of PLV group and CPP group. Conclusion PLV and continuous pulmonary artery perfusion can improve the oxygenation of lung and inhibit inflammatory reaction of acute lung injury induced by CPB
ObjectiveTo explore the application effect of information-based circuit teaching mode for training refresher nurses in continuous renal replacement therapy (CRRT).MethodsCRRT refresher nurses studied in West China Hospital of Sichuan University from January 2016 to December 2019 were selected. The CRRT refresher nurses who were selected as the control group (studied from January 2016 to December 2017) accepted the conventional teaching method. The CRRT refresher nurses who were selected as the test group (studied from January 2018 to December 2019) accept the information-based combined with circuit teaching mode for teaching and training. After 6 months of training, the theoretical performance, operation performance, teaching satisfaction and the incidence of adverse events were compared between the two groups.ResultsA total of 112 CRRT refresher nurses were enrolled. Among them, there were 52 nurses in the control group and 60 in the test group. The scores of theory achievement (t=−2.421, P=0.017), operation achievement (t=−2.305, P=0.023) and teaching satisfaction [including teaching effect (t=−4.067, P<0.001), operation skill (t=−5.013, P<0.001), teaching mode (t=−5.589, P<0.001) and teaching content (t=−2.586, P<0.001)] of refresher nurses in the test group were higher than those in the control group. There was no significant difference between the control group (4 cases) and the test group (1 case) in the occurrence of adverse nursing events (adjusted χ2=1.169, P=0.280).ConclusionThe information-based circuit teaching mode has achieved good results in the teaching of CRRT refresher nurses, which is conducive to improving the post competency of CRRT refresher nurses.
Sample size, mean and standard deviation are necessary when conducting meta-analysis for continuous outcomes. Advanced methods of data extraction were needed if the mean and the standard deviation couldn’t be obtained from a literature directly. Eight methods were introduced and two examples were given to illustrate how to apply the methods.
Objective To compare the effect of two types of intermittent pressure on formation of pressure ulcer in rabbit hind l imbs and to investigate the mechanism of gradually changed intermittent pressure produced by waves bed in the prevention of pressure ulcer. Methods Gracil is (3 cm2) in both hind l imbs of 12 adult Japanese white rabbits were randomlyloaded with gradually changed intermittent pressure (50-160 mm Hg, 1 mm Hg=0.133 kPa) and sustained pressure (100 mmHg) serving as the experimental group and the control group, respectively. The experiment was terminated after 4 cycles, and a single cycle included 2 hours of compression and 30 minutes of compression-release. Blood velocity of hind l imbs and blood perfusion of wound were detected by bidirectional doppler blood flow detector and laser doppler perfusion imaging detection system before compression and at every 10 minutes in compression-release period of each cycle (0, 10, 20 and 30 minutes). After the termination, gross observation of the wound was conducted, pathomorphological changes of tissues from compressed area were observed by HE staining, and contents of NO, malondialdehyde (MDA), and superoxide dismutase (SOD) in muscle tissue were measured using colorimetry method. Results No significant difference was evident between two groups in terms of blood flow velocity before compression (P gt; 0.05); the blood flow velocity of two groups decreased significantly at 0 minute in every compressionrelease period of each cycle, and no significant differences were noted between two groups (P gt; 0.05); the blood flow velocity of theexperimental group was higher than that of the control group at 10, 20 and 30 minutes (P lt; 0.05). No significant difference was noted between two groups in terms of wound blood perfusion before compression (P gt; 0.05); the wound blood perfusion of two groups decreased significantly at 0 minute in every compression-release period of each cycle, and no significant differences were noted between two groups (P gt; 0.05); the difference between two groups was not significant at 10 minutes in the first cycle (P gt; 0.05), and the experimental group was higher than the control group at 20 and 30 minutes in the first cycle (P lt; 0.05). In the following 3 cycles, the recovery of perfusion in the experimental group was faster than that of the control group (P lt; 0.05). Gross observation showed the experimental group had less effusion than the control group. The experimental group had intact cutaneous appendage, less inflammatory cell infiltration, and no obvious ulcer formation, whereas the control group had obvious skin ulcer, depletion of cutaneous appendage, and more inflammatory cells infiltration. Significant differences were noted between two groups in terms of NO, MDA, and SOD content (P lt; 0.05). Conclusion Gradually changed intermittent pressure can maintain the blood perfusion of tissue, reduce ischemia-reperfusion injury and cell apoptosis, and prevent the formation of pressure ulcer.