Chronic kidney disease (CKD) is a public health issue of global concern, and nutritional management of CKD can improve the nutritional status of patients and slow down the progression of the disease. However, nutrition management is a complex scientific issue, and there are few clinical practices of nutrition management in CKD, so there is an urgent need for a theoretical framework of nutrition management to guide the construction of a scientific and standardized program. This review will systematically describe the relationship between nutrition and kidney disease, sort out the current status of nutrition management in CKD in China, introduce the experience of CKD medical and nursing nutrition integration in West China Hospital of Sichuan University, and provide thoughts for further improvement of standardized scientific formulation of nutrition management strategy.
ObjectiveTo explore the application and effect of integration of doctors-nurses-therapists continuous nursing management in patients with spinal cord injury.MethodsThe patients with spinal cord injury from June to December 2018 in the Department of Rehabilitation Medicine of West China Hospital of Sichuan University were selected. A set of numbers was generated by a computer. And the patients were randomly divided into the trial group and the control group. Patients in the control group were given routine discharge continuous nursing management, and patients in the trial group adopted the integration of doctors-nurses-therapists continuous nursing management to implement post-discharge guidance. The activity of daily living (ADL), quality of life or psychological status of the two groups were compared at discharge and 3 months after discharge. The compliance, satisfaction and readmission rates between the two groups were also compared 3 months after discharge.ResultsA total of 60 patients were included, with 30 cases in each group. There was no significant difference in the scores of ADL, quality of life or Huaxi Xinqing index between the two groups (P>0.05). Three months after discharge, the score of ADL (71.65±1.87 vs. 62.70±2.29), quality of life (302.90±2.71 vs. 292.95±3.39), compliance rate of medication on time (86.67% vs. 63.33%), compliance rate of exercise on time (86.67% vs. 60.00%), compliance rate of follow-up visit on time (90.00% vs. 63.33%), compliance rate of reasonable diet (83.33% vs. 60.00%), and satisfaction (90.45±1.82 vs. 79.55±1.39) of patients in the trial group were higher than those in the control group (P<0.05). There was significant difference in Huaxi Xinqing index between the trial group and the control group (14.57±1.36 vs. 21.60±1.88, P<0.001). The readmission rate of the trial group was lower than that of the control group (6.67% vs. 26.67%), but the difference was not statistically significant (P>0.05). Three months after discharge, the ADL and quality of life in both groups were significantly different from those at discharge (P<0.001); the score of Huaxi Xinqing index in the control group was higher than that at discharge (t=-17.971, P<0.001), which in the trial group was also higher than that at discharge, but the difference was not statistically significant (t=-1.352, P=0.187).ConclusionThe integration of doctors-nurses-therapists continuous nursing management can effectively improve the ADL, quality of life and compliance of discharged patients with spinal cord injury, improve the mental state of patients, and improve patient satisfaction, which is helpful for the rehabilitation of patients with spinal cord injury outside the hospital.
ObjectiveTo investigate the management methods of drug repercussion and its intervention measures in the Burn and Plastic Surgery Department by analyzing the reasons for drug repercussion. MethodBased on the drug repercussion data provided by the computer information center, we analyzed the common reasons and the status quo of drug repercussion. Active intervention measures were carried out, and real-time supervision and feedback of drug repercussion management were also performed. We compared such repercussion indexes before intervention (between May and September 2013) and after intervention (between October 2013 and February 2014):number of drug repercussion patients, times of drug repercussion, amount of money involved in drug repercussion, ratio of drug repercussion and dispensing and comprehensive ranking of the drug repercussion in the whole hospital. ResultsAfter intervention, the ranking of the causes of drug repercussion changed obviously. Changing orders casually dropped to the 3rd of the rank, and changing the department based on necessity rose from the 4th to the 2nd. All the indexes (including the times, number, and amount of money of drug of repercussion, and the ratio of repercussion and dispensing and compreheasive rank) reduced significantly (P<0.05). ConclusionsActualizing active intervention measures redounds to reducing drug repercussion, standardizing clinical use of drugs, insuring safety, and advancing the satisfaction of patients and quality of medical nursing.
Objective To evaluate the impact of an integrated management mode of prenatal diagnosis-postnatal treatment for congenital heart disease (CHD) on perioperative and long-term outcomes of the arterial switch operation (ASO), and to analyze the efficacy of ASO over six years in a single center. Methods This retrospective study analyzed the clinical data of 183 children who underwent ASO at Guangdong Provincial People's Hospital from January 2018 to December 2024. The cohort included 106 patients (57.9%) of transposition of the great arteries with intact ventricular septum (TGA/IVS), 61 patients (33.3%) of transposition of the great arteries with ventricular septal defect (TGA/VSD), and 16 patients (8.7%) of taussig-bing anomaly (TBA). Perioperative indicators were compared between 91 patients in the prenatal-postnatal integrated management group (an integrated group) and 92 patients in the traditional management group (a non-integrated group). Long-term survival and reoperation rates were analyzed using Kaplan-Meier curves. Results The overall perioperative mortality rate was 4.9% (9/183), showing a downward trend year by year. The primary cause of perioperative mortality was low cardiac output syndrome (LCOS), which occurred in 12 patients (6.6% incidence) with a mortality rate of 75%. The integrated group had a higher proportion of males (89% vs. 72.8%, P<0.05) and lower body weight [3.13 (2.75, 3.35) vs. 3.30 (3.00, 3.67), P<0.05] compared to the non-integrated group. The age at surgery was significantly earlier in the integrated group [7 (3, 10) vs. 14 (9, 48), P<0.05], and all children in the Integrated Group underwent ASO within the optimal surgical window (100% vs. 82.6%, P<0.05). Intraoperatively, cardiopulmonary bypass (CPB) time [173 (150, 207) vs. 186 (159, 237), P<0.05] and aortic cross-clamp (ACC) time [100 (90, 117) vs. 116 (97, 142), P<0.05] were significantly shorter in the integrated group. although the integrated group had longer postoperative mechanical ventilation time [145 (98, 214) vs. 116 (77, 147), P<0.05] and higher 48-hour maximum vasoactive inotropic score (VISmax) [15 (10, 21) vs. 12 (8, 16), P<0.05], there was no statistically significant difference in the incidence of severe complications (LCOS, NEC, ECMO) or mortality rate (3.3% vs. 6.5%, P=0.51) between the two groups, despite earlier surgical intervention and a higher proportion of critically ill cases in the integrated group. The length of hospital stay in the emergency surgery group was significantly shorter than that in the elective surgery group [20 (15, 28) vs. 25 (21, 30), P<0.05], suggesting that early surgery may be of potential benefit. A total of 163 patients were successfully followed up for a median of 4.7 years, with a 5-year survival rate of 95.1% and a freedom from reintervention survival rate of 95.1%. There were no late deaths, and the most common postoperative complication was pulmonary artery stenosis. Conclusion The integrated management model allowed critically ill children with lower body weights to safely undergo surgery, significantly optimizing the timing of surgery and shortening intraoperative times. The long-term risk of reoperation after ASO is primarily concentrated on pulmonary artery stenosis, necessitating long-term follow-up and monitoring.
Ultrasound Medicine has been through a rapid development during the past half century and has become an indispensable discipline for prophylactic medicine and clinical practice. Nowadays, the needs for ultrasound medicine diverse which leads to many challenges to the existing ultrasound physician scanning - diagnostic mode, including labor-intensiveness for the ultrasound physician, lacking of hierarchical management, contradiction of quality and quantity, irrational allocation of medical resources, and so on. This paper discussed several issues including the current situation of ultrasound education, domestic and western ultrasound work mode, necessity for ultrasound physician- sonographer integrated work mode, as well as the feasibility of standardized sonographer training. Combined with the experience of the West China Hospital, explore a Chinese way to carry out sonographer education and training program and try out ultrasound physician-sonographer integration mode.
Wearable monitoring, which has the advantages of continuous monitoring for a long time with low physiological and psychological load, represents a future development direction of monitoring technology. Based on wearable physiological monitoring technology, combined with Internet of Things (IoT) and artificial intelligence technology, this paper has developed an intelligent monitoring system, including wearable hardware, ward Internet of Things platform, continuous physiological data analysis algorithm and software. We explored the clinical value of continuous physiological data using this system through a lot of clinical practices. And four value points were given, namely, real-time monitoring, disease assessment, prediction and early warning, and rehabilitation training. Depending on the real clinical environment, we explored the mode of applying wearable technology in general ward monitoring, cardiopulmonary rehabilitation, and integrated monitoring inside and outside the hospital. The research results show that this monitoring system can be effectively used for monitoring of patients in hospital, evaluation and training of patients’ cardiopulmonary function, and management of patients outside hospital.