ObjectiveTo investigate the problems in the use of quick-drying hand disinfectants and formulate intervention measures to improve the hand hygiene compliance of nursing staff.MethodsFrom February 2014 to June 2016, the hand hygiene compliance of nursing staff was continuously observed according to the hand hygiene observation table recommended by the World Health Organization. The questionnaire on the use of quick-drying hand disinfectants, which passed the reliability and validity test, was used to find out the reasons leading to the low compliance rate of hand hygiene among nurses, and pertinent interventions were formulated. From November 2016 to December 2017, intervention measures were gradually implemented throughout the hospital, and the hand hygiene compliance of nursing staff was continuously observed again. Then we compared the compliance rate of hand hygiene and the compliance rate of hygienic hand disinfection among nurses in the second quarter of 2016 (before intervention) with those in the last quarter of 2017 (after intervention).ResultsThe compliance rates of hand hygiene and hygienic hand disinfection among nurses before intervention were 62.15% and 49.77%, respectively, and those after intervention were 91.64% and 90.80%, respectively. The differences were statistically significant (P<0.05).ConclusionThe factors affecting the hand hygiene compliance of nursing staff are identified through questionnaires and targeted intervention measures have effectively improved the hand hygiene compliance rate of nursing staff.
Forty-eight cases of multi-structural defects of hands were primarily repaired or reconstructed from July 1989 to 1997. The structural defects included: the defects of radial or ulnar aspect of hands involving fingers and skin, multiple fingers defects and the fingers and skin defects of whole hand. In this series, there were 32 males and 16 females with age ranged from 17 to 46 years old. The composite tissue grafts were obtained from wrap-around flap or 2nd toe skin flap of the foot. The result showed that composite 108 tissues transplantations, or 48 cases, were all survived. After a follow-up of 38.5 months (ranged from 5 months to 6 years), the grasp, pinch and opposition function of the reconstructed finger were restored, the two-point discrimination sensation was 4 mm-12 mm. Most of the patients had resumed their original works. So that the primary repair of multi-structural defects of hands by composite tissues transplantation was feasible and valuable, but thorough debridement and skilled microsurgecal technique were required.
Objective To hand search all formally published articles on randomized controlled clinical trials (RCT) and controlled clinical trials (CCT) for inputting into the database of Chinese Cochrane Center (CCC) and the Central Database of Cochrane Collaboration. Method All Chinese dental journals of the mainland of China that started publication before the end of 1996 were hand searched page by page. Criteria of RCT and CCT were based on the guideline of Cochrane Oral Health Group. All included articles were copied and the titles of the articles and names of the journals were translated into English and input to Procite for submission. A senior professional monitored the process and checked the translation item by item. Results Fifteen dental journals were included. One started from 1953, six from 80s, and the rest from 90s. Ten of them were listed by Ministry of Science and Technology as part of the government database for scientific articles. From 1953 to 1990, 42 RCTs and 97 CCTs were found in 291 journal issues, from 1991-1995, 157 RCTs and 154 CCTs in 241 issues, from 1996-2000 358 RCTs and 264 CCTs in 316 issues. In the three periods, the average RCTs per journal issue were 0.14, 0.65, 1.13 respectively, the averages of CCTs per issue were 0.33, 0.64, 0.84 respectively. The ratios of RCT to CCT are 0.43, 1.02, 1.36 respectively which showed greatly increasing along with time. There are 113 articles accounting 10.54% of the total specially for testing the effect of various Chinese traditional medicines and therapies. The common problems for the searched RCTs and CCTs is small sample size, insufficient descriptions on randomization and concealment, compliance and drop outs. Some titles were improperly written such as using trade name of drugs etc. In translation into English, some words indicating category or main components of the drugs were added. Conclusions In comparison of one fourth of the world population and more than 30 thousands dental professionals of China, 557 RCTs and 515 CCTs in dental literature are quite small number but the increasing speed is encouraging. More effort should be offered to spread knowledge of evidence-based medicine (EBM) to the dental care workers of China to produce more evidences. RCTs and/or CCTs should be good tools to determining real effects of traditional Chinese medicines in dental fields to make them applicable to all.
ObjectiveTo compare the complication morbidity of mechanical and hand-sewn esophagogastric anastomosis systemically. MethodsMedline (January 1960 to June 2015), EMbase (January 1980 to June 2015), Cochrane Library (January 1996 to June 2015), Web of Science (January 1980 to June 2015) and other databases were searched to identify randomized controlled trials (RCTs) about comparing the complication morbidity of hand-sewn and mechanical anastomosis. Moreover, the references were searched by search engines such as Google Scholar. Papers were screened according to the inclusion and exclusion criteria. And then the data were extracted. The quality of current meta-analysis was assessed by GRADE profiler 3.6 software. The meta-analysis was conducted using Stata 12.0 software. ResultsA total of 1 611 patients in 14 RCTs were reviewed. The results suggested that the anastomatic leakage rate of mechanical method showed no significant difference from that of hand-sewn method[RR=1.07, 95%CI (0.76, 1.51), P=0.699]. While the anastomatic stenosis rate was even higher[RR=1.59, 95%CI (1.21, 2.09), P=0.001]. ConclusionMechanical method can't reduce the anastomotic leakage rate following esophagogastrostomy, while it maybe increase the risk of anastomotic stenosis on the contrary. The patients' physical condition should be considered when surgeons make the choice.
Objective To analyze the main problem of continuous hand hygiene improvement by PDCA cycle, find out the causes and carry out corresponding measures, in order to improve hand hygiene management continuously. Methods Between January and June 2014, PDCA cycle was used to strengthen comprehensive training, enhance awareness of hand hygiene, reinforce supervision, and evaluate the effect of continuous hand hygiene improvement. The knowledge of hand hygiene, increase of hand hygiene facilities, use of hand hygiene products and hand hygiene implementation before (from July to December 2013) and after PDCA application (from January to June 2014) were compared and analyzed. Results After the implementation of PDCA cycle, the pass rate of hand hygiene knowledge increased from 61.0% to 88.3%; the total amount of hand hygiene use increased from 1 817 046 mL to 3 347 386 mL; the hand hygiene compliance rate increased from 43.03% to 71.31%; and the correct rate of hand hygiene implementation increased from 62.68% to 87.68%. All the above differences were statistically significant (P<0.05). After the implementation of PDCA cycle, the compliance rate of different hand hygiene indications became significantly different (P<0.05). The growth rate of hand hygiene implementation before aseptic manipulation and after contact with body fluids were relatively higher (34.56% and 34.01%, respectively). Conclusion Through the application of PDCA cycle, hand hygiene compliance rate and correct rate have gradually increased.
Objective To study the repair and function reconstruction of complex soft tissue defect of posterior of hand and forearm. Methods From May 2001 to November 2003, 8 cases of soft tissue defect of posterior of hand and forearm were repaired with thoracico abdominal flaps with hilum for primary stage. The tendon transplantation and allogeneic tendon function reconstruction of hand were performed for secondary stage. The range of the flap was 9 cm×15 cm to 12cm×38 cm. Allogeneic tendon amounted to 6.Results All the flaps survived. The flap countour was good. The results of allogeneic tendon transplantation were satisfactory and the function of hand was good. Conclusion Repairing complex soft tissue defect of posterior of hand and forearm and reconstructing hand function by use of thoracico abdominal flaps with hilum and transplantation of allogeneic tendon have the satisfactory clinical results.
OBJECTIVE: To explore a new surgical approach to repair skin and soft tissue defect of hands. METHODS: Based on the anatomical study of the origin, course, branch, distribution, and anastomosis of the posterior interosseous artery and its recurrent branches in 40 upper limbs of cadavers, the posterior forearm serial flap, pedicled with the posterior interosseous artery and its recurrent branches, was designed and applied clinically in 17 cases to repair the skin and soft tissue defect of hands from August 1998 to July 2000. The size of flaps ranged from 7 cm x 5 cm to 15 cm x 10 cm. All of the cases were followed up for 3 weeks to 6 months. RESULTS: The anatomy study showed that the posterior forearm serial flap had long vascular pedicle, suitable thickness and large skin area. The clinical application indicated that the flaps survived in 16 cases. But flap necrosis at the distal end, sized 2 cm x 3 cm, was observed in one case, in which the defect was repaired by delayed skin grafting, CONCLUSION: The posterior forearm serial flap pedicled with the posterior interosseous artery and its recurrent branch have the character of avoidance of sacrificing the major arteries of the extremity, longer vascular pedicle, larger area and suitable thickness. The posterior forearm serial flap is a safe and easily manipulated surgical approach to repair the skin and soft tissue defect of the hands, especially of the thumb, palm, and proximal part of the fingers.
OBJECTIVE: To investigate the clinical effect of skin flaps repairing severe thermopressure injury of hand. METHODS: From January 1989 to December 1998, 112 patients with severe thermopressure injury of hand were repaired by various skin flaps transfer, the size of skin flaps was 6 cm x 8 cm to 12 cm x 18 cm. Postoperative patients were treated by combined rehabilitation in early stage. RESULTS: All the flaps were survived with satisfactory effect. Sixty-six patients were followed up 6 to 12 months, skin flaps all showed better colour and texture, and function of the hand was satisfactory. CONCLUSION: Different skin flaps are adopted to repair severe thermopressure injury of the hand according to different skin defects of the hand, combined early rehabilitation treatment, to achieve good recovery of function and appearance of the hand to the greatest extent.
ObjectiveTo compare effect of enterovirus (EV) 71 nucleic acid detection and EV71-IgM antibody detection on clinically diagnosis of hand-foot-mouth disease in children. MethodsRectal swabs collected from 1379 children who were clinically diagnosed from April 20, 2011 to September 10, 2011 as suspected patients with the handfoot- mouth disease were detected by fluorogenic quantitative polymerase chain reaction to conduct EV71 nucleic acid detection. Meantime, enzyme-linked immunosorbent assay was used to conduct EV71-IgM antibody detection in serum samples collected from those children. ResultsIn these 1379 cases, 79 had positive EV71 nucleic acids with a positive rate of 5.73%; while 82 cases had positive EV71-IgM antibodies with a positive rate of 5.95%. There were 32 cases with positive EV71 nucleic acid and positive EV71-IgM antibody. The rate of consistent results of two detection methods was 95.2%. The positive rates of two methods had no negligible differences (χ2=0.093, P=0.761). ConclusionCombination of EV71 nucleic acid detection and EV71-IgM antibody detection, can improve the efficiency in diagnosing hand-foot-mouth disease in children and facilitate the protection and diagnosis of the disease.
Objective To discuss the safety and feasibil ity of treating complex renal aneurysm with ex vivo aneurysmectomy and renal revascularization and renal autotransplantation after hand-assisted retroperitoneoscopic nephrectomy. Methods In October 2006, one male patient with complex renal aneurysm was treated. The preoperative color Doppler ultrasonograph, CT and DSA showed that there was an aneurysm (3.4 cm × 4.3 cm × 4.5 cm) located in the main renalartery bifurcation and its five branches of the left kidney. The patient had a history of hypertension with no response to treatment. After successful hand-assisted retroperitoneoscopic nephrectomy, the kidney off-body was perfused by the renal irrigating solution immediately to protect the kidney. Then ex vivo aneurysmectomy and renal artery revascularization were performed, the renal artery was reconstructed with an autologous right internal il iac artery. The reconstructed left kidney was re-implanted into the right il iac fossa. Results The operation was successful and the patient recovered without perioperative complications. The postoperative renal function was normal and the color Doppler ultrasonograph showed that the blood circulation in the transferred renal artery of the right il iac fossa and its branches was smooth, the blood circulation of the renal venous was smooth and no stenosis in the ureter 2 weeks after operation. Thirteen months follow-up showed the blood pressure was recovered to normal and the renal function was normal. Conclusion The method of ex vivo aneurysmectomy and autotransplantation is safe, feasible and minimally invasive for treating complex hilar renal artery aneurysms.