ObjectiveTo explore the influence factors on inpatients' satisfaction, in order to identify influence factors for improving inpatients' satisfaction. MethodsA sampling survey was conducted in hospitals at different levels in Sichuan province. The satisfaction of inpatients in these hospitals was investigated by self-designed questionnaire. Then, a structural equation model on influence factors of satisfaction was constructed. ResultsA total of 1 237 inpatients from 12 hospitals were surveyed. The total satisfaction of these patients was 82.14%. The patients' satisfaction of grade A tertiary hospital in Chengdu city was obviously lower than that of the prefecture- and county-level hospitals (all P values <0.05). The fitting degree of structural equation model was good; Inpatients' satisfaction was mainly influenced by 5 factors including hospital values (HV), service quality of doctors and nurses (SQ), service process (SP), convenience of resources (CR) and comfort of facilities (CF). Of the 5 factors, the HV and SQ respectively ranked the 1st and 2nd to the influence degree on satisfaction. ConclusionThis study identifies the key influence factors on inpatients' satisfaction. Specific measures should be taken by hospital administrators to improve the quality of medical services and the satisfaction of inpatients.
Objective To study the influence factors of surgical site infection (SSI) after hepatobiliary and pancreatic surgery. Methods Fifty patients suffered from SSI after hepatobiliary and pancreatic surgery who treated in Feng,nan District Hospital of Tangshan City from April 2010 and April 2015 were retrospectively collected as observation group, and 102 patients who didn’t suffered from SSI after hepatobiliary and pancreatic surgery at the same time period were retrospectively collected as control group. Then logistic regression was performed to explore the influence factors of SSI. Results Results of univariate analysis showed that, the ratios of patients older than 60 years, combined with cardiovascular and cerebrovascular diseases, had abdominal surgery history, had smoking history, suffered from the increased level of preoperative blood glucose , suffered from preoperative infection, operative time was longer than 180 minutes, American Societyof Anesthesiologists (ASA) score were 3-5, indwelled drainage tube, without dressing changes within 48 hours after surgery, and new injury severity score (NISS) were 2-3 were higher in observation group (P＜0.05). Results of logistic regression analysis showed that, patients had history of abdominal surgery (OR=1.92), without dressing changes within 48 hours after surgery (OR=2.07), and NISS were 2-3 (OR=2.27) had higher incidence of SSI (P＜0.05). Conclusion We should pay more attention on the patient with abdominal surgery history and with NISS of 2-3, and give dressing changes within 48 hours after surgery, to reduce the incidence of SSI.
Objective To study traits and influencing factors of coping styles in the military groups of social emergency responders for special service and provide a theoretical basis for epidemiologic intervention. Methods A cross-sectional survey on coping styles and their influencing variables was carried out among 12 special service companies from Armed Police Forces and Fire Units of Public Security stationed in Chongqing by means of cluster sampling. Then, different coping styles were compared with general military personnel, the types and maturity degree of coping behaviors were evaluated, and major influencing variables were screened. Results Of 396 subjects, 86.36% had field experience in handling emergencies. The population’s average levels of coping styles are significantly higher than the military norm (P≤0.01), and the overall type of coping behaviors is mature. Although the relevance between the performance type and the number of 6 coping styles scores reaching the military masculine norm is significant (Plt;0.001), the Pearson contingency coefficient（c=0.23）represents a relatively limited maturity in coping styles. In view of direction and extent effects of various influencing factors, lack of survival skills, disaccord on self and experience, self-inferiority as well as self-stereotypes are negative factors. In addition to social support, self-flexibility responsibility may be positive factors. Use of social support, disaccord on self and experience, self-confidence and knowledge about danger-avoiding take universal impacts, and other factors take single impact on a certain coping style. Conclusion Coping styles in military groups of social emergency responders for special service are comparatively mature and stable, but there are significantly individual differences and a wide range of influencing factors. So, it is very necessary to advance maturity in coping styles through targeted interventions.
ObjectiveTo know the life attitude and its influence factors of nursing undergraduates in a school of nursing,so as to provide the theoretical evidence for the exploration of the way of life education. MethodsA cluster sample of 246 nursing undergraduates were asked to complete the survey,who were sampled from grade 2008 to grade 2011 in a University of Sichuan province between Nevember and December 2011.Then we used the way of questionnaire to analyze and research the life attitude and its influence factors of nursing students,and this study mainly used the Life Attitude Scale (LAS) questionnaire which was made by Taiwan scholar Manying Xie. ResultsThe total score of the investigated nursing students'attitude to life was 365.1±43.6,and the total and each level scores were higher than Taiwan college students and the differences were statistically significant (P<0.01).Female students'total score of attitude to life and the existence sense dimension were significantly higher than male students'(P<0.05).The third grade students'score of love and care level had a significant difference with the second grade and the first grade students (P<0.05).Through correlation analysis,nursing students'life attitude and self-rating interpersonal relationship (r=0.256,P=0.000),the situation of families talking about death (r=0.210,P=0.001),whether there was a Dutch act idea (r=0.172,P=0.007),family income (r=0.151,P=0.017),gender (r=0.130,P=0.042) and whether had siblings (r=-0.143,P=0.025) were positively correlated. ConclusionWe should carry out targeted life and death education for nursing students to promote them to establish positive life attitude and value.
Objective To evaluate the results of operative treatment of acetabular fractures and to investigate its influence factors. Methods The cl inical data were analyzed retrospectively from 82 patients with acetabular fractures treated between September 2004 and June 2009. Of 82 patients, 65 were male and 17 were female, aged 26-72 years (mean, 38 years).Fractures were caused by traffic accident in 62 cases, by crush in 13 cases, and by fall ing from height in 7 cases. The time from injury to admission was 30 minutes to 12 days (median, 7.6 hours) in 70 cases, 12 cases were transferred because poor result after 34-67 days of conservative treatment. According to Judet classification, there were 24 cases of posterior wall fracture, 3 cases of posterior column fracture, 1 case of anterior wall fracture, 2 cases of anterior column fracture, 6 cases of transverse fracture, 16 cases of transverse and posterior wall fracture, 4 cases of posterior column and posterior wall fracture, 5 cases of T-type fracture, 3 cases of anterior and posterior hemitransverse fracture, and 18 cases of complete both-column fracture; 24 cases combined with dislocation of the hip. During operation, Kocher-Langenbeck approach was used in 49 cases, anterior il ioinguinal approach in 19 cases, and the combination of anterior and posterior approaches in 14 cases. Reconstructive plate (74 cases) and hollow lag screw (8 cases) internal fixation were used. The function of the hip was evaluated according to the modified Merled’Aubigne- Postel hip score system postoperatively. According to fracture type, age, lower extremity fracture before operation, qual ity of reduction, timing of surgery, hi p dislocation and time of reduction, operative approach, deep vein thrombosis (DVT), and heterotopic ossification (HO), the patients were divided into the groups and the results were compared. Results Accordancewith the Matta X-ray evaluation criteria, anatomic reduction was achieved in 21 cases, good reduction in 37 cases, fair reduction in 16 cases, and poor reduction in 8 cases, and the excellent and good rate was 71%. All the cases were followed up 12-52 months mean, 34 months). Iatrogenic sciatic nerve injury occurred in 8 cases, infection in 3 cases, HO in 16 cases, DVT in 3 cases, hip posttraumatic arthritis in 12 cases, and avascular necrosis of the femoral head in 9 cases. X-ray examination showed that 80 cases achieved fracture union at 10-24 weeks after operation (mean, 14 weeks) and 2 cases had fracture delayed union at 10 months and 12 months after operation. According to the modified Merled’Aubigne-Postel hip score system, the function of the hip was rated as excellent in 26 cases, good in 32, fair in 20, and poor in 4 at 6 months after operation; the excellent and good rate was 71%. The affecting factors of cl inical results of acetabular fractures were fracture type, age, lower extremity fracture before operation, qual ity of reduction, timing of surgery, hip dislocation and time of reduction (P lt; 0.05). However the operative approach, DVT, and HO were not affecting factor of the acetabular fractures (P gt; 0.05). Conclusion Operative treatment of acetabular fractures has a satisfying therapeutic effect. Fracture type, age, lower extremity fracture before operation, qual ity of reduction, timing of surgery, hip dislocation, and time of reduction are risk factors affecting postoperative results.
Objective To investigate the preparing procedures for the larger chemically acellular nerve allografts (CANA) and to establish an evaluation criteria and the preparation method.Methods The sciatic nerves ofthe dogs were exposed by a muscle-splitting incision and were isolated free of the underlying fascia. The 50-mm-long segments of the nerve were made. The proximal and distal ends of the nerve segments were labelled and stabilized by pinning the ends to a thin plastic support, and then they were treated according to the following decellularization processes: The nerve segments were rinsed with the distilled water for 9h, transferred in a 3% Triton-100 solution for 12 h, soaked in 7% sodium deoxycholate for 12 h, and washed in the distilled water for 6 h. All the decellularization steps were performed at room temperature. The nerve segments were divided into 5 subgroups. In Group Ⅰ, Group Ⅱ and Group Ⅲ, the nerve segments were decellularized for 2, 3 and 4 times, respectively. In Group Ⅳ and Group Ⅴ, the two ends of the nerve segments were ligated with a silk line and were decellularized for 2 and 3 times, respectively. Each nerve segment was subdivided into 5 portions from the proximal end to the distal end. The degrees of decellularization, activity of Laminin, degrees of demyelination, and integrity of the nerve fiber tube were observed under microscope and were assessed by a scoring system. Results In all the groups the activity of Laminin was present and the degrees of decellularization were complete. As for the demyelination of the nerve segments, the myelin sheath in Groups Ⅰ, Ⅱ and Ⅲ was partially preserved, but it completely disappeared in Groups Ⅳ and Ⅴ. The structure of the nerve fiber tube in Groups Ⅰ and Ⅳ was almost normal. The total score for the degrees of decellularization, demyelination, and structural integrity was the lowest in Group Ⅳ but the quality was the best. Conclusion The degrees of demyelination are not parallel to the times of decellularization processes. In the quality control of CANA, we should consider the following 4 factors: activity of Laminin, degrees of decellularization, demyelination, and structural integrity. For the larger CANA,ligation of the two ends of the nerve segments during the decellularization procedure may be a better method of ensuring the quality of the decellularization.
ObjectiveTo investigate the surgical complications and its influence factors of radical surgery in the treatment of elderly patients with colorectal cancer. MethodsTwo hundreds and sixteen patients with colorectal cancer who were treated in the Second People's Hospital of Lianyungang City from January 2010 to September 2014 as the research object, the clinical data were collected by the self-made general data questionnaire, and they were analyzed by descriptive statistics and logistic regression analysis using SPSS 19.0. ResultsFor elderly patients with colorectal cancer radical operation, pulmonary infection and wound infection were the common complications.Single factor and logistic regression analysis showed that medical comorbidity, hypoproteinemia, operation time, Dukes staging, and smoking were risk factors of postoperative complications in the colorectal cancer patients. ConclusionFor elderly patients with colorectal cancer underwent radical operation, pulmonary infection and wound infection are the common complications.It's occurrence by various factors.
Objective To investigate the medical charge of in-patients with diabetes and its influencing factors for effective hospital costs controlling. Methods The inpatients with diabetes (the first diagnosis was diabetes; the first three ICD-10 codes of which were between E10 to E14) in Fifth Peoples' Hospital of Chengdu during January to September of 2014 were analyzed for their hospital costs with descriptive statistical method, ANOVA and multiple linear regression method. Statistical analysis was conducted by using SPSS 18.0 software. Results A total of 1 389 cases of diabetes were included. The median of total medical costs and daily costs were 4 554.45 yuan and 446.46 yuan, respectively. The differences of total medical costs and daily costs between diabetes patients with different amount of complications were statistically significant (P<0.001). The factors including age, the way of the medical expense, the number of complications, with acute complications, CCI score and the hospital-stay length were proved to be significantly correlated to total medical costs of diabetes inpatients (P<0.05). Conclusion Age, the way of the medical expense, the number of complications, with acute complications, CCI score and the hospital-stay length are influence factors of medical costs of diabetes inpatients.
ObjectiveTo discuss and analyze the sense of dignity and its influencing factors of maintenance hemodialysis (MHD) patients.MethodsPatients with MHD in hemodialysis center of West China Hospital of Sichuan University were selected from November 2019 to January 2020. Patients were selected by convenience sampling. The patients were investigated with Patient Dignity Inventory (PDI), Connor-Davidson Resilience Scale (CD-RISC) and Hospital Anxiety and Depression Scale.ResultsA total of 150 patients were included. The average scores of CD-RISC, anxiety, depression and PDI were 61.20±14.54, 4.97±1.38, 5.90±2.42 and 41.32±16.24, respectively. Among them, 121 cases (80.67%) had mild dignity impairment, 22 cases (14.67%) had moderate dignity impairment, 6 cases (4.00%) had severe dignity impairment, and 1 case (0.67%) had very serious dignity impairment. The results of multiple linear stepwise regression showed that depression, economic burden, social support, and vascular access were all positive predictors of esteem scores (P<0.001).ConclusionsClinical nurses can aim at the main factors affecting the sense of dignity of MHD patients. And individualized nursing plan and intervention measures can be formulated to improve the sense of dignity of patients and improve the quality of life of maintenance hemodialysis patients.
ObjectiveTo observe the clinical effect of vitrectomy with internal limiting membrane peeling and air tamponade in the treatment of idiopathic macular hole (IMH).MethodsA prospective, non-randomized controlled case cohort study. Twenty eyes of 20 patients with IMH in Ophthamology Department of The Second Hospital of Jilin University from September 2016 to January 2017 were included in this study. There were 4 males (4 eyes) and 16 females (16 eyes), with the mean age of 60.60±9.50 years and the mean disease course of 9.55±15.5 months. The stage of macular hole ranged from Ⅱ to Ⅳ. All patients underwent BCVA, intraocular pressure, spectral-domain OCT (SD-OCT) and multifocal ERG examinations. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The minimum diameter (MIN), bottom diameter (BD), height (H), the defective diameter of ellipsoid zone, the defective diameter of external limiting membrane (ELM) of the macular hole were measured by SD-OCT (German Heidelberg). Then the macular hole index (MHI=H/BD), hole traction index (THI=MD/BD) and hole diameter index (DHI=H/MD) were calculated. The response density in P1 wave was detected by mf-ERG. The logMAR BCVA was 1.18±0.54. There were 5 eyes with less than 400 μm MIN, 13 eyes with 400-700 μm MIN and 2 eyes with over than 700 μm MIN. All the patients were underwent vitrectomy with internal limiting membrane peeling and air tamponade. According to the SD-OCT image features after surgery, IMH closure was divided into type Ⅰ closed, type Ⅱ closed and unclosed. The follow-up was equal or greater than 3 months. The closure rate of IMH, BCVA and the changes of microstructure parameters of macular area were observed. Spearman correlation analysis was used to analyze the correlation between BCVA and the wave response density in P1 before surgery and the efficacy after IMH surgery.ResultsClosure rate of IMH: 18 eyes (90.0%) were completely closed (all type Ⅰ closed). The closure rate of macular hole with the MIN less than 400 μm was 100.0% (5/5), 400-700 μm was 92.3% (12/13), and over than 700 μm was 50% (1/2). BCVA: the mean logMAR BCVA at 1 week, 1 month, 3 months after surgery were 0.83±0.54, 0.65±0.41, 0.48±0.34, and there was statistically significant difference between preoperative and postoperative BCVA (t=3.382, 4.459, 5.250; P=0.003, 0.007, 0.004). The outcomes of SD-OCT at 3 months after surgery: 18 eyes (90.0%) with intact ELM. The defective diameter of ellipsoid zone was 260.34±272.08 μm, there was statistically significant difference between before and after surgery (t=13.545, P=0.002). The outcomes of mf-ERG: the P1 wave response density of the ring 1 and ring 2 after surgery were increased compared with before surgery (t=-16.748, -6.151; P＜0.01,＜0.01). The results of Spearman correlation analysis: there was a positive correlation between postoperative BCVA and preoperative MIN, the defective diameter of ellipsoid zone and ELM, and postoperative the defective diameter of ellipsoid zone (r=0.56, 0.59, 0.68, 0.52; P=0.010, 0.006, 0.001, 0.019). The postoperative BCVA was negatively correlated with the P1 wave response density of ring 1 and ring 2 of mf-ERG (r=－0.34, －0.16; P=0.006, 0.020). The IMH closure had a significant negative correlation with MIN and the defective diameter of ELM (r=－0.449, －0.449; P=0.047, 0.047). MHI and THI were positively correlated with the closure of the hole (r=0.474, 0.546; P=0.035, 0.013). Intraocular pressure increased in 2 eyes during the follow-up period, and returned to normal within 1 week after the administration of antihypertensive drugs. There were no complications during or after the operation.ConclusionsVitrectomy with internal limiting membrane peeling and air tamponade in the treatment of IMH is safe and effective. The MIN, MHI THI are significantly correlated with the curative effect after IMH surgery, which could be used as the index to predict and evaluate the curative effect. The response density of ring 1 and ring 2 in P1 wave of mf-ERG is signifi-cantly improved compared with before surgery, and which is negatively correlated with BCVA.