ObjectiveTo understand the characteristics of and risk factors for nosocomial infection in a newly built branch of a university teaching hospital, in order to investigate the control measures for prevention and control of nosocomial infection. MethodsA total of 598 cases of nosocomial infection from April 2012 to June 2014 were enrolled in this study. We analyzed statistically such indexes as nosocomial infection rate, infection site, pathogen detection, and use of antibiotics. Meantime, infection point-prevalence survey was introduced by means of medical record checking and bedside visiting. ResultsAmong all the 44 085 discharged patients between April 2012 and June 2014, there were 598 cases of nosocomial infection with an infection rate of 1.36%. Departments with a high nosocomial infection rate included Intensive Care Unit (ICU) (9.79%), Department of Orthopedics (2.98%), Department of Geriatrics (2.62%), and Department of Hematology (1.64%). The top four nosocomial infection sites were lower respiratory tract (45.32%), urinary tract (13.21%), operative incision (8.86%), and blood stream (8.86%). The samples of 570 nosocomial infections were delivered for examination with a sample-delivering rate of 95.32%. The most common pathogens were acinetobacter Baumanii (17.02%), Klebsiella pneumoniae (14.21%), Escherichia coli (13.68%), Pseudomonas aeruginosa (11.93%), and Staphylococcus aureus (9.12%). And urinary tract intubation (42.81%), admission of ICU (28.60%), and application of corticosteroid and immunosuppressive agents (26.42%) were the top three independent risk factors for nosocomial infection. ConclusionGeneral and comprehensive monitoring is an effective method for the hospital to detect high-risk departments, factors and patients for nosocomial infection, providing a theoretical basis for prevention and control of nosocomial infection.
ObjectiveTo analyze the risk factors for hospital infection in the medical physical examination center of a newly opened hospital, and to explore its prevention and control measures. MethodsBetween April and December 2012, we analyzed the risk factors for hospital infection in the physical examination center of a new hospital. A series of hospital infection prevention and control measures such as carrying out education and training of medical personnel, strengthening the prevention of needle stick injuries, implementing strict disinfection and sterilization, improving environmental hygiene, and implementing medical waste management, were developed. ResultsMedical staff's knowledge of disinfection and sterilization was improved; hand hygiene compliance was increased; hospital environmental hygiene was promoted, and medical waste was properly sorted out. ConclusionTaking reasonable measures for infection prevention and control can increase medical staff's awareness of hospital infection prevention and control, improve their practices of infection control and prevent hospital infections from occurring eventually.
ObjectiveTo observe the effect of acute normovolemic hemodilution (ANH) with autologous blood transfusion (ABT) and controlled hypotension (CH) during surgery on allogeneic blood transfusion and blood coagulation function. MethodsSixty patients in our hospital from February 2012 to January 2014 were chosen as our study subjects. They underwent surgeries of grade Ⅲ to Ⅳ, and the estimated amount of bleeding during surgery was more than 400 mL. The patients were randomized into group A (ANH+CH group) and group B (control group), with 30 in each. Patients in group A were first administered a standard endotracheal general anesthesia. Then an invasive arterial blood pressure monitoring was performed and the central venous blood was taken. ANH was implemented, and CH was applied to reduce bleeding. When the procedure was almost completed, ABT was implemented. The value of hematocrit, hemoglobin, platelet, prothrombin time (PT), activated partial thranboplastin time (APTT), fibrinogen, international normalized ratio (INR), heart rate, mean arterial pressure and central venous pressure were measured and recorded at the end of blood volume collection (T1), and before ABT (T2) and after ABT (T3). When hemoglobin was lower than 70 g/L during the surgery, ABT was implemented. After surgery, no allogeneic blood transfusion was performed if hemoglobin was higher than 90 g/L. Patients in group B received routine treatment. ResultsPatients' hemodynamics maintained relatively stable during ANH+ABT+CH. Blood volume collected from patients was (408.3 ±142.1) mL; blood loss volume was (705.4±586.8) mL. Compared with group B, the amount of bleeding was significantly lower, and it was reduced by (549.2±250.2) mL. No organ damage was found. For group A, compared with those values at T0, PT, hematocrit, hemoglobin, fibrinogen, and INR were significantly different at T1 and T2 (P<0.05), but the average value was within the acceptable range which did not affect the blood coagulation function. PT, APTT, platelet, hematocrit, hemoglobin, fibrinogen, and INR were significantly different before and after autologous blood transfusion (P<0.05). Postoperative infection and non-healing wounds rate was not significantly different between the two groups (P>0.05). ConclusionThis technique of acute normovolemic hemodilution with autologous blood transfusion and controlled hypotension is a useful, efficient and cost-effective blood conservation strategy. Moderate hemodilution has no influence on blood coagulation function in patients.
ObjectiveTo systematically review the efficacy and safety of intravenous calcium infusion for preventing ovarian hyperstimulation syndrome (OHSS). MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 7, 2015), CNKI, Sinomed and WanFang Data were searched from inception to July 2015 to collect randomized controlled trials (RCTs) and non-RCTs about intravenous calcium infusion for OHSS. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of six studies involving 1 061 women were included. The results of meta-analysis showed that intravenous calcium infusion could reduce the incidence of moderate OHSS (RR=0.27, 95% CI 0.11 to 0.65, P=0.003), but not the incidence of severe OHSS (RR=0.77, 95% CI 0.23 to 2.63, P=0.68). In addition, intravenous calcium infusion had a tendency to increase the pregnant rate (RR=1.19, 95% CI 0.94 to 1.50, P=0.15). The subgroup analysis showed that, compared with placebo/no treatment, intravenous calcium infusion reduced the incidence of moderate OHSS, but not the incidence of severe OHSS. There were no statistical differences between intravenous calcium infusion and other positive control (cabergoline and hydroxyethyl starch) in the incidence of OHSS and pregnant rate. No side effect was reported in the studies included. ConclusionsCurrent evidence indicates that intravenous calcium infusion can reduce the incidence of OHSS without influence pregnant outcomes. Due to the quantity and quality limitations of included studies, more high quality case-control or cohort studies are needed to verify the above conclusions.
Objective To discuss the safety，feasibility，and advantages of two-port laparoscopic cholecystectomy （LC）．Methods The clinical data of 114 patients underwent LC from June 2008 to October 2010 were retrospectively analyzed，of which 46 underwent two-port LC （two-port LC group，n=46） and 68 underwent three-port LC （three-port LC group，n=68）. The operation time，intraoperative blood loss，postoperative feeding time，postoperative pain，postoperative hospital stay，and hospitalization expenses were compared between two groups. Results All the operations were successful，no postoperative complications occurred in both groups．The operation time in the two-port LC group was longer than that in the three-port LC group （P＜0.05）. The intraoperative blood loss，postoperative feeding time，postoperative pain，and postoperative hospital stay had no significant differences in two groups （P＞0.05）. The hospitalization expenses in the two-port group was less than that in the three-port group（P＜0.05）. Conclusions Two-port LC is a safe and feasible operation in the simple gallstone patients. It is cautious in those patients with acute cholecystitis because of the restricted vision and operation．
ObjectiveTo evaluate the feasibility and clinical effect of controlled hypotension in video-assisted thoracoscopic surgery (VATS) for subcarinal lymph node dissection in patients with lung cancer.MethodsWe analyzed the clinical data of 53 non-small cell lung cancer (NSCLC) patients undergoing VATS with controlled systolic blood pressure while dissecting the subcarinal lymph node from September to October 2016 in our department (a treatment group, including 31 males and 22 females with an average age of 53.20±8.80 years ranging 43-68 years). We selected 112 NSCLC patients undergoing VATS without controlled systolic blood pressure while dissecting the subcarinal lymph node from January to August 2016 in our department (a contol group, including 67 males and 45 females with an average age of 54.32±7.81 years ranging 39-73 years). The clinical data of both groups were compared.ResultsThe operation time and blood loss of the treatment group were less than those of the control group (177.6±39.4 min vs. 194.3±47.8 min, 317.9±33.6 ml vs. 331.2±38.7 ml, P<0.05). The duration of subcarinal lymph node dissection and total duration of lymph node dissection of the treatment group were also less than those of the control group (10.5±4.3 min vs. 13.6±5.2 min, 37.7±7.5 min vs. 48.7±6.4 min, P<0.001). The thoracic drainage at postoperative days 1, 2, 3 and total drainage volume, duration of tube placement and hospital stay of the treatment group were less than those of the control group (P<0.05). Whereas the postoperative complications of the two groups did not differ significantly (P>0.05).ConclusionControlled hypotension reduces the difficulty of dissecting subcarinal lymph nodes and the risk of bleeding, and produces less drainage volume, which is safe and effective.
Evidence produced by clinical trial is the main basis for health care decision-making at all levels. In recent years, some problems been revealed in the national data audit of new drug clinical trials have sounded the alarm for the quality of clinical research in China. In addition to strengthening the implementation of clinical trial process management and supervision, we call attention to the coherence and consistency of trial design and implementation, including the promotion of clinical trial design in the agenda of improving the quality of the trials and putting forward reasonable suggestions. We hope that our work could make research ideas clear from the source of a clinical trial, with a view to avoid violating protocol behavior and provide standardized recommendations for improving the quality of clinical trials in China.
ObjectivesTo explore the characteristics of Chinese methodological studies on patient compliance in clinical trials so as to provide reference for clinical trial of patient compliance in future.MethodsCNKI, VIP, CBM and WanFang Data databases were electronically searched to collect methodological studies on patient compliance in clinical trials published in Chinese language from January 2000 to December 2018. Two reviewers independently screened literature, extracted data and then, qualitative analysis of document characteristics was then performed.ResultsA total of 84 articles were included, in which 68 were studies on Western medicine and 16 were studies on traditional Chinese medicine (TCM). The results showed that: the quantity of studies on patient compliance increased along with time. However, those in TCM field did not increase. All included studies summarized their strategies to improve patient compliance, however key information for quality evaluation were missing.ConclusionsThere is still a lack of research on how to improve patients’ compliance in clinical trials to ensure the reliability of the results. Existing studies have not systematically and comprehensively explored the influencing factors of patients’ compliance. Clinical trials researchers in China have not focused sufficiently to patients’ compliance and lack the proper methodology to frame studies.
ObjectiveTo investigate the feasibility and clinical effect of controlled hypotension in 3 cm single-port video-assisted thoracoscopic surgery (VATS) for the lymph node group 7 dissection in the left lung resection. MethodsWe retrospectively analyzed the clinical data of 37 patients with lung cancer who underwent 3 cm single-port VATS from May 2015 to August 2015 in Tongji Hospital, and systolic blood pressure of 12 patients (7 males, 5 females, average age of 58.3 years, range 42-69 years) was controlled between 80-90 mm Hg by nitroglycerin or sodium nitroprusside while the pressure of 25 patients (14 males, 11 females, average age of 57.7 years, range 43-68 years) was not controlled when receiving lymph node group 7 dissection. ResultsControlled hypotension in lymphadenectomy achieved satisfactory results. The lymphadenectomy time of 12 patients with controlled hypotension (18.5±4.3 min on average, range 15.6-25.3 min) was shorter than that of 25 patients without controlled hypotension (24.3±5.1 min on average, range 18.2-29.8 min); the difference was statistically significant (P<0.05). ConclusionControlled hypotension is a simple and feasible method that increases the operating space, and reduces the difficulty of cleaning lymph nodes and the risk of bleeding.
Objective To assess the trend of prevalence, awareness, treatment and control rate of diabetes among elderly residents (≥45 years old) of Shunqin District in Nanchong City, and provide scientific references for the prevention and control of diabetes. Methods From February 2013 to August 2015, a cross-sectional survey was conducted in 9 sub-district offices of Shunqing District of Nanchong City. Households as a unit, the questionnaires and blood tests were investigated by clustering sampling in residents aged ≥45 years old. Results A total of 82 225 residents with complete information were enrolled in this study. Among them, 11 857 were with diabetes, in whom 6 260 had been diagnosed as diabetes before, only 5 054 were under treatment, and only 1 986 could control blood glucose to target level. The prevalence of diabetes was 14.4% among the participants. The rate of awareness, treatment, and control of diabetes in the 11 857 diabetes patients identified was 52.8%, 42.6%, and 16.7%, respectively. Conclusions The prevalence rate of diabetes is high, but the rate of awareness, treatment, and control of diabetes is low. It is necessary to popularize the knowledge and the cognition of diabetes, and it is urgent to make efficient measures to prevent and control diabetes in Nanchong City.