ObjectiveTo research on the influence of cluster management on the nutritional intervention for nasopharynx cancer patients undergoing intensity modulated radiation therapy (IMRT), in order to discuss effective and feasible nutrition management method. MethodEighty-three nasopharynx cancer patients undergoing IMRT between June 2013 and December 2014 were selected as the study subjects. They were divided into two groups randomly. Regular health education and nutritional guidance were carried out for the 41 patients in the control group, while nutritional risk screening (NRS)-2002 nutrition screening, nutrition assessment and nutritional intervention were carried out for the 42 patients in the intervention group. Nutrition risk, nutritional status and side-reaction were recorded and evaluated for both groups of patients. ResultsAfter treatment, NRS-2002 score of the intervention group was lower than the control group (P<0.05). Body weight, constitutional index, skinfold thickness of triceps brachii muscle, mid-arm circumference and mid-arm muscle circumference of the intervention group were better than the control group (P<0.05). Total serum protein, serum albumin, serum transferrin were better and the rate of levelⅢ-Ⅳ radiation-induced oral mucositis was lower in the intervention group than that in the control group (P<0.05). ConclusionsThe application of cluster management model in nutritional intervention is a way to promote patients' rehabilitation, which can effectively improve the whole body situation of nasopharynx cancer patients, and reduce malnutrition rate and side-reaction.
Objective To explore whether bundled care for anesthesia management can reduce the risk of postoperative nausea and vomiting (PONV). Methods The data of laparoscopic cholecystectomy patients admitted to the Day Surgery Center of West China Hospital, Sichuan University between July and November 2021 were retrospectively collected. Patients were divided into a bundled care group and a control group based on whether anesthesia management was implemented according to the bundled care. The demographic characteristics, intraoperative anesthesia management methods, postoperative conditions, and incidence of PONV between the two groups of patients were analyzed and compared. Results A total of 314 patients were included. Among them, there were 124 cases in the bundled care group and 190 cases in the control group; PONV occurred in 52 cases, the incidence of PONV was 16.6% (52/314). Except for surgical time and postoperative incision infiltration (P>0.05), there were statistically significant differences in age, gender, body mass index, anesthesia time, airway establishment, and postoperative analgesic use between the two groups of patients (P<0.05). There was no statistically significant difference in the occurrence of PONV between the bundled care group and the control group (17 vs. 35 cases; χ2=1.205, P>0.05). The results of logistic regression analysis showed that PONV was correlated with gender [odds ratio=0.107, 95% confidence interval (0.030, 0.375), P<0.001], and using bundled care [odds ratio=0.388, 95% confidence interval (0.169, 0.894), P=0.026]. Conclusions Women are at high risk of PONV among patients undergoing day laparoscopic cholecystectomy. The risk of PONV is lower when using bundled care.
ObjectiveTo explore the preventive role of maintaining constant pressure of the endotracheal catheter cuff on ventilator-associated pneumonia (VAP). MethodsFrom January to December 2015, 96 patients of type Ⅱ respiratory failure were selected as the trial group who underwent intubation and mechanical ventilation more than 48 hours in the Intensive Care Unit (ICU). We used pressure gauges to measure the endotracheal catheter cuff pressure regularly and maintained a constant pressure in addition to the application of artificial airway cluster management. We recorded the initial pressure value which was estimated by pinching with finger and set initial pressure to 30 cm H2O (1 cm H2O=0.098 kPa). We measured endotracheal catheter cuff pressure and recorded it during different intervals. We reviewed 88 patients with the same disease as the control group who only accepted artificial airway cluster management between January and December 2014. Mechanical ventilation time, VAP occurrence time, ICU admission time, the incidence of VAP were recorded and analyzed for both the two groups of patients. ResultsIn the trial group, the initial pressure of endotracheal catheter cuff which was estimated by pinching with finger showed that only 11.46% of pressure was between 25 and 30 cm H2O and 82.29% of the pressure was higher than 30 cm H2O. We collected endotracheal catheter cuff pressure values during different interval time by using pressure gauges to maintain a constant management. The ratio at the pressure between 25 and 30 cm H2O was respectively 41.32%, 43.75%, 64.20%, 76.54%, 91.13%, and 91.85%. ICU admission time, mechanical ventilation time in patients of the trial group decreased more, compared with the control group, and the differences were statistically significant (t=4.171, P<0.001; t=4.061, P<0.001). The VAP occurrence time in patients of the trial group was later than the control group (t=2.247, P<0.001). ConclusionThe endotracheal catheter cuff pressure estimated by pinching with finger has errors. We recommend using pressure gauges to detect pressure every four hours, which utilizes minimal time to maintain effective pressure. The method of artificial airway of cluster management combined with the pattern of maintaining constant endotracheal catheter cuff pressure can shorten ICU admission time, mechanical ventilation time and delay the occurrence of VAP.
In recent years, the widespread use of medical devices has led to the increasing frequency of device related pressure injuries (DRPI), which seriously affects the quality of life of patients and increases the burden on the healthcare system. The management model of DRPI has become an effective means of coping. This article reviews the application status of the care bundles model, SSKIN clinical management model, SECURE clinical management model in the prevention of DRPI. According to the characteristics of different management models, the key steps of implementation are given, aiming to provide a reference for exploring the prevention and management model of DRPI suitable for China’s national conditions.
目的 探讨危重症手足口病的集束化综合救护的护理方案。 方法 通过比较儿科使用集束化综合护理方案后1年（2009年5月－2010年4月）的26例危重症手足口病并发症的发生率，确定预防危重症手足口病的集束化综合护理方案的有效性。 结果 使用集束化综合护理方案后，26例患儿均治愈出院，其中仅3例有后遗症。 结论 集束化综合护理救治作为主动预防措施比传统的被动预防更有针对性和有效。
Wuhan Leishenshan Hospital was built within 12 days during the key period of fighting against coronavirus disease 2019 (COVID-19) in Wuhan. It was a field infectious disease hospital with 1500 beds. Due to the emergency of the epidemic situation, the operation mode of “parallel of construction, acceptance, training and treatment” was employed. During the peak period, nearly 3000 medical workers and 13000 builders worked on the same site. In 67 days, 2 011 patients with COVID-19 were treated. Through the bundle infection prevention and control (IPC) measures, Wuhan Leishenshan Hospital achieved zero infection, zero accident, and low level pollution of SARS-CoV-2 (0.3%) by environment monitoring. The bundle IPC measures of Leishenshan Hospital not only provided prevention and control experience for other field infectious disease hospitals at domestic and abroad during the period of COVID-19, but also put forward ideas and work flow for other medical institutions to deal with emerging infectious diseases.
ObjectiveTo evaluate the effect of bundle strategies on the prevention and control of multidrug-resistant organisms (MDROs) in intensive care unit (ICU), in order to effectively prevent and control the severe situation of multiple drug-resistant bacteria in ICU.MethodsWe selected patients who admitted into the ICU from January 2016 to December 2017 as study subjects, and monitored 6 types of MDROs. Basic information was surveyed and collected from January to December 2016 (before intervention), while bundle strategies on MDROs were implemented from January to December 2017 (after intervention), including issusing isolation orders, hanging isolation marks, wearing isolation clothes, using medical articles exclusively, cleaning and disinfecting environment, implementing hand hygiene, etc. Then we compared the MDRO detection rate, nosocomial infection rate, MDRO nosocomial infection rate, and compliance rates of interventions between the two periods.ResultsThe MDRO detection rate before intervention was 77.10%, and that after intervention was 49.12%, the difference between the two periods was statistically significant (χ2=69.834, P<0.001). The nosocomial infection rate of ICU decreased from 23.51% before intervention to 15.23% after intervention, the MDRO nosocomial infection rate decreased from 13.70% before intervention to 5.84% after intervention, and the differences between the two periods were statistically significant (χ2=8.594, P=0.003; χ2=13.722, P<0.001). The compliance rates of doctor’s isolation orders, hanging isolation marks, wearing isolation clothes, using medical articles exclusively, cleaning and disinfecting environment, and hand hygiene, as well as the correct rate of hand hygiene after intervention (92.12%, 93.55%, 81.77%, 84.24%, 82.90%, 77.39%, and 96.37%) were significantly higher than those before intervention (31.94%, 52.00%, 23.43%, 48.18%, 67.16%, 59.46%, and 88.64%), and the differences were all statistically significant (P<0.001).ConclusionThe implementation of the above bundle strategies on the prevention and control of MDROs can decrease the MDRO detection rate and MDRO nosocomial infection rate.
ObjectiveTo explore the effect of the cluster intervention in new nurses in the Department of Neurosurgery in occupation training, so as to provide reference for the clinical training of new nurses. MethodsEight nurses who entered the Department of Neurosurgery in January 2013 were set as control group and the 8 new nurses entering in January 2014 as the observation group. The control group was adopted the traditional training methods, while the observation group underwent used extra cluster intervention. The differences in the results of theory, technology, operation and the 360-degree evaluation between the two groups were analyzed at the end of year. ResultsIn the observation group, the median theory examination score was 91.50, median operation assessment grades was 95.00, which were higher than those in the control group (82.00 and 83.00). The average scores of 360-degree evaluation in the observation group were higher than those in the control group with a significant difference (P < 0.01). ConclusionsIntensive intervention should be used for new nurses' training. It helps to improve the training effect and new nurses' ability.
Objective To investigate the effect of a real-time compliance dashboard to help reduce ventilator-associated pneumonia ( VAP) with ventilator bundle. Methods 240 patients who were admitted into the intensive care unit ( ICU) of Shougang Hospital of Peking University and had received mechanical ventilation ( MV) for over 48 hours, between January 2010 and November 2011, were studied prospectively. The patients were divided into two groups by random number table, ie. a dashboard group ( n = 120) with implementation of a real-time compliance dashboard to help reduce VAP with ventilator bundle, and a control group ( n=120) with implementation of usually routine order to help reduce VAP with ventilator bundle. The success rate of ventilator bundle implementation, incidence of VAP, duration of MV, duration within ICU, mortality within 28 days, cost within ICU were compared between two groups. Results Compared with the control group, the success rate of ventilator bundle implementation obviously increased ( 81.6% vs. 52.5%) , incidence of VAP ( 14. 5/1000 days of MV vs. 36.2 /1000 days of MV) , duration of MV [ 5( 4,7) days vs. 8( 6,11) days] , duration within ICU [ 8( 6,12) days vs. 13( 8,16) days] , mortality of 28 days ( 12.6% vs. 28.6% ) , and cost within ICU ( 36,437 vs. 58,942) in the dashboard group obviously reduced ( Plt;0.05) . Conclusions Implementation of a real time compliance dashboard to help reduce VAP with ventilator bundle can obviously improve medical personnel compliance and reduce incidence of VAP, duration of MV, duration within ICU, mortality and cost in ICU than those of routine medical order to help reduce VAP with ventilator bundle.