ObjectiveTo explore the effect of comprehensive nursing service in patients with autoimmune encephalitis (AE).Methods32 patients with AE were selected and treated in our hospital from January 2017 to January 2019. There are 16 patients in the observation group and the control group respectively. The observation group received comprehensive nursing service and the control group received routine nursing intervention. Total satisfaction of clinical nursing was compared between the two groups.ResultsCompared with 10 cases (62.50%) in the control group, 15 cases (93.75%) in the observation group had better overall nursing satisfaction, and the difference between the two groups was significant (P<0.05).ConclusionsFor patients with AE, comprehensive nursing service can significantly improve the quality of life of patients, which has clinical application value.
Objective Review the status of the direct health cost of nonsmall-cell lung cancer , and to put forward policy recommendations. Methods Database including PubMed, Cochrane Library and Chinese BioMed were searched, and studies literatures about the direct health cost of nonsmall-cell lung cancer. Results Twenty two studies were analyzed in this paper including 20 foreign studies. Normally, international researches about direct medical cost of treating the nonsmall-cell lung cancer investigate total cost from the first diagnosis until several years later. The discrepancy in the results could be explained by different payments, treatment patterns and research methods in different countries. The direct medical cost of nonsmall-cell lung cancer is expensive especially the cost of in-patient. It’s increase with the time of therapy. Most of the researches in China about direct medical cost of nonsmall-cell lung cancer focus on per in-patient fees. Conclusion Facing the increasingly heavy economic burden of nonsmall-cell lung cancer, to lower the incidence of this disease and to reduce the treatment related cost should be taken into account., the prevention of nonsmall-cell lung cancer carcinoma should be enhanced, Such as tobacco control, environment improvement, etc. A proper incentive mechanism should be established.
ObjectiveTo analyze the perdictive value of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) for malnutrition or postoperative complications in children with critical congenital heart disease (CHD).MethodsA total of 875 children with critical CHD who were hospitalized in West China Hospital, Sichuan University form August 2019 to February 2021, including 442 males and 433 females with a median age of 30 (12, 48) months, were assessed by STAMP in Health Information System. Clinical data of postoperative complications were collected.Results(1) Based on World Health Organization Z-score as gold standard, 24.5% had malnutrition risk, and 34.3% were diagnosed with malnutrition. According to STAMP, the children were with medium malnutrition risk of 37.9% and high malnutrition risk of 62.1%. There was a statistical difference of incidence rate of malnutrition and detection rate of STAMP malnutrition risk in gender, age, ICU stay or length of mechanical ventilation (P<0.05); (2) with the optimal cut-off point of 5.5 in STAMP for malnutrition, the sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) were 68.3%, 84.3%, 48.1%, 88.3% and 0.82, respectively; (3) 12.0% of the children were with postoperative complications; (4) with the optimal cut-off point of 5.5 in STAMP for postoperative complications, the sensitivity, specificity, positive predictive value, negative predictive value and AUC were 83.8%, 73.1%, 18.8%, 99.1% and 0.85, respectively.ConclusionChildren with critical CHD have a higher incidence of malnutrition risk and postoperative complications. STAMP has a good perdictive value for malnutrition or postoperative complications, however, the sensitivity and specificity of STAMP are affected by the gold standard or the cut-off point.
Objective To analyze the relationship between preoperative anemia and postoperative infection and death in children with acyanotic congenital heart disease (CHD) after elective cardiac surgery. Methods Medical records and follow-up data of 3 859 children with acyanotic CHD who underwent elective cardiac surgery in our hospital from 2011 to 2018 were retrospectively collected, including 2 081 males and 1 778 females with a median age of 32.2 (13.7, 61.5) months. The relationship between preoperative anemia and postoperative infection and death within 90 days was analyzed by univariate and multivariate regression analyses. Results Preoperative anemia was found in 325 (8.4%) patients. There were 716 (18.6%) patients of postoperative infection, including 281 (7.3%) patients of confirmed infection and 435 (11.3%) patients of suspected infection. Forty-six (1.2%) patients died within 90 days after the operation. Univariate analysis showed that age, infection history within 3 months before admission, degree of pulmonary hypertension, the risk adjustment in congenital heart surgery-1 (RACHS-1) score, cardiopulmonary bypass (CPB), disease diagnosis, chromosome abnormality, preoperative left ventricular ejection fraction (LVEF)<55% and preoperative anemia were associated with postoperative infection. Age, degree of pulmonary hypertension, RACHS-1 score, CPB, disease diagnosis and preoperative LVEF<55% were associated with postoperative death within 90 days. Logistic regression analysis showed that preoperative anemia was significantly associated with confirmed postoperative infection [OR=1.82, 95%CI (1.18, 2.82), P=0.007], suspected infection [OR=1.60, 95%CI (1.11, 2.30), P=0.012] and total infection [OR=1.64, 95%CI (1.20, 2.24), P=0.002]. The results of modified Poisson regression analysis showed that there was no significant association between preoperative anemia and death within 90 days after the surgery [RR=1.59, 95%CI (0.69, 3.69), P=0.276]. Conclusion Preoperative anemia may be a risk factor for infection after elective cardiac surgery in children with acyanotic congenital heart disease.
Objective To investigate the current situation and influencing factors of social phobia in patients with gastrointestinal neoplasms, and to provide evidence for psychological intervention and improving the quality life of patients with gastrointestinal neoplasms. MethodsGastrointestinal neoplasms patients admitted to the Colorectal Cancer Center Ward of West China Hospital, Sichuan University between December 2021 and March 2022 were continuously included. A self-made questionnaire, social phobia behavior professional test scale, and social support rating scale were used to investigate the included patients and analyze the possible influencing factors of social phobia in patients. Results A total of 483 patients were included. Among them, there were 299 males and 184 females. The median score of social support rating scale was 37 (31, 42), with 80.54% of patients received average levels of social support. The median score of social phobia behavior professional test scale was 14 (11, 17), with 98.34% of patients had mild social phobia symptoms and 1.66% had moderate social phobia symptoms. There were statistically significant differences in social phobia behavior professional test scale scores among patients with different levels of education and average monthly income. The results of multiple linear regression analysis showed that the average monthly income was a influencing factor for patients’ social phobia. Conclusions Generally, patients with gastrointestinal neoplasms have mild social phobia. However, patients with fixed income had a higher risk to suffer social phobia were compared to those without income. It is suggested that clinical workers should pay more attention to the mental health of gastrointestinal neoplasms patients and prevent the occurrence of anxiety and phobia.
Objective To analyze the drug resistance of Mycobacterium tuberculosis complex (MTBC) in West China Hospital of Sichuan University in recent years to provide reference for drug resistance monitoring and prevention strategies of tuberculosis in general hospitals. Methods The clinical strains of MTBC that performed drug susceptibility tests in West China Hospital of Sichuan University between January 2019 and December 2022 were collected. The drug susceptibility information of 13 anti-tuberculosis drugs, namely rifampicin, isoniazid, ethambutol, streptomycin, rifabutin, amikacin, kanamycin, ofloxacin, levofloxacin, moxifloxacin, para-aminosalicylic acid, ethionamide, and capreomycin, was collected and retrospectively analyzed. Results A total of 502 clinical strains of MTBC were included, and 366 of them were isolated from newly-treated patients while 136 form re-treated patients. The resistance rates of MTBC strains to the first-line anti-tuberculosis drugs in descending order were 28.69% (isoniazid), 19.72% (ethambutol), and 14.94% (rifampicin). Among the second-line drugs, the resistance rates to ofloxacin, levofloxacin, and moxifloxacin were 13.55%, 12.15%, and 11.95%, respectively. The resistance rates to amikacin, kanamycin, para-aminosalicylic acid, and ethionamide were all less than 10%. The resistance rates to streptomycin, capreomycin, and rifabutin were 17.53%, 13.55%, and 12.15%, respectively. The resistance rates to the remaining 12 anti-tuberculosis drugs except capreomycin of MTBC strains isolated from re-treated patients were higher than those of MTBC strains isolated from newly-treated patients, and the differences were statistically significant (P<0.05). The isolation rates of monodrug-resistant, polydrug-resistant, multidrug-resistant (MDR) and pre-extensively drug-resistant (pre-XDR) strains were 9.36%, 7.37%, 7.17%, and 7.77%, respectively. The isolation rates of strains with the four drug-resistant phenotypes generally showed a downward trend during the four years, and the changing trends were statistically significant (P<0.05). The isolation rates of MDR and pre-XDR strains from re-treated patients were higher than those from newly-treated patients, and the differences were statistically significant (P<0.001). Conclusion Tuberculosis drug resistance in West China Hospital of Sichuan University, which is a comprehensive tuberculosis-designated hospital, remained severe during the four years from 2019 to 2022, and the prevention of tuberculosis and the monitoring of drug resistance should be further strengthened.
Objective To review and evaluate the basic contents and development of the current global clinical guidelines for lung cancer practice so as to provide useful information for domestic study. Methods Six databases including PubMed (to June 2008) and relevant websites (both in Chinese and English) were searched. Articles were screened according to the predefined inclusion and exclusion criteria. The number of clinical guidelines was counted and the quality of guidelines was also assessed. Results A total of 208 articles were found to be clinical guideline-related and 133 were finally included. Of those, 78 were original versions and 55 were updated versions. And 86 articles mentioned guideline development methodology. The guidelines were issued by 14 countries/regions, mainly by USA (39.85%), Canada (24.81%) and France (8.27%). The earliest one was published by USA in 1984. 125 guidelines were issued by oncological or thoracic institutions, and the other 8 were not issued by specialized institutions or not specified. The 133 articles were classified into 3 major clinical categories: synthesis (24), multi-subject (21) and single-subject (88). As for quality evaluation, the average score of all guidelines was 72.09 (full score 100). The highest average score was found in 1996 which was 83.50, and the lowest in 1997 (66.80). The guidelines issued by France had the highest average score (79.80), and Japan, with the lowest average score (48.00). The average score of 4 categories of lung cancer were 73.54 (non-smallcell lung cancer), 65.74 (lung cancer), 74.72 (small-cell lung cancer), and 76.00 (bronchogenic lung cancer), respectively. Conclusion The number of clinical guidelines showed an increasing trend. Most guidelines were issued by developed countries. The subjects included in the synthetic guidelines showed an expanding trend covering about 20 subjects from prevention to palliative care. A trend of multi-country contribution to the guidelines development and revision was noted. Researches became more focused on different types and stages. Evidence-based methodology was accepted globally in the clinical guideline development, but unfortunately very few applied the method of health technology assessment. China issued only 2 original guidelines, which were based on literature review and expert opinions, respectively. Due to the limitation of language restriction, inaccessibility of full-text articles and unavailability of authorized and specific quality evaluation protocols, the conclusions of this study should be interpreted with caution.