ObjectiveTo explore effect of preoperative prognostic nutritional index (PNI) on clinically related postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP) and analyze its influencing factors in order to provide a basis for clinical prediction of CR-POPF. MethodsThe clinicopathologic data of patients who successfully completed DP in the Affiliated Hospital of Xuzhou Medical University and met the inclusion and exclusion criteria of this study from January 1, 2017 to January 31, 2021 were collected retrospectively. The preoperative PNI value was calculated and the optimal cut-off value was obtained according to the receiver operative characteristic (ROC) curve. The patients were divided into low and high PNI based on the optimal cut-off value. The clinicopathologic characteristics were compared between the patients with low and high PNI and CR-POPF or not. At the same time, multivariate logistic regression was used to analyze the influencing factors of CR-POPF. ResultsA total of 143 patients who met the inclusion and exclusion criteria were included in this study. The CR-POPF occurred in 33 cases (23.08%) after DP, and the average preoperative PNI was 52.26 (39.20–65.10), the optimal cut-off value of PNI was 50.55, with 49 cases in the low PNI group and 94 cases in the high PNI group. In patient with low PNI, the proportions of patients aged ≥65 years and with CR-POPF were higher than those with high PNI (P<0.05). In the patients with CR-POPF, the proportions of patients with soft pancreatic texture and with low preoperative PIN were higher than those without CR-POPF (P<0.05). Further, the multivariate logistic regression showed that the the preoperative low PNI (OR=5.417, P<0.001) and soft pancreatic texture (OR=4.126, P=0.002) increased the risk of CR-POPF. ConclusionLow preoperative PNI and soft pancreatic texture increase risk of CR-POPF after DP, and it is necessary to preoperatively evaluate PNI status of patients.
【摘要】 目的 了解四川省医护人员工作倦怠状况，分析其影响因素，为卫生行政管理部门进行有效的预防和干预提供依据。 方法 2008年8月采用分层随机抽样方法，对2 588名医护人员进行调查。 结果 有明显工作倦怠感的医护人员占被调查人员总数的1/4，其年龄、性别、文化程度、职称、专业类别与专业工作年数、行政业务管理职务与医疗机构级别等是影响工作倦怠的主要因素。 结论 优化医院人员配置，营造良好的工作环境和条件，重视和加强对医护人员专业知识、技能培训，对医护人员的工作付出及时予以积极评价等，是避免和降低医护人员工作倦怠的有效措施。【Abstract】 Objective To understand the situation of job burnout and its influential factors among doctors and nurses of Sichuan province and so as to provide evidences for relative departments to prevent job burnout. Methods Stratified random sampling was adopted to investigate 2588 doctors and nurses in August, 2008. Results The percentage of doctors and nurses with evident job burnout in Sichuan province was about 25%. And it was mainly affected by sex, age, education level, job title, job specialty, work experience, administration duty and level of medical institution. Conclusion Relative departments should emphasize on optimizing personnel combination, constructing favorable work condition, reinforcing professional knowledge and skill training, commending work achievement in time in order to avoid and reduce job burnout of doctors and nurses effectively.
ObjectiveTo explore the related factors of postoperative survival of patient with gastric cancer, so as to provide the corresponding evidence support for the prognosis evaluation.MethodsThe clinicopathologic data of patients with gastric cancer who underwent surgical treatment in the Fourth Affiliated Hospital of Baotou Medical College and the Fourth Hospital of Baotou City from January 2006 to December 2009 were retrospectively collected. The influences of clinicopathologic data (gender, age, tumor size, tumor location, lymph node metastasis, tumor thrombus, tumor differentiation, TNM stage, operation mode, and postoperative chemotherapy) on postoperative survival of patients with gastric cancer were analyzed. Univariate analysis was used to analyze the influencing factors of postoperative survival in the patients with gastric cancer and Cox proportional hazards regression was used to analyze the independent risk factors.ResultsA total of 80 patients with gastric cancer were included in this study. Up to December 31, 2014, the median survival time at 50% cumulative survival rate was 95 months. Univariate analysis showed that the survival of patients with gastric cancer was related to tumor size, lymph node metastasis, tumor differentiation, and TNM stage (P<0.05). Further multivariate analysis showed that later TNM stage was an independent risk factor for affecting postoperative survival of patients with gastric cancer (P<0.05).ConclusionPostoperative survival of patients with gastric cancer is related to tumor size, lymph node metastasis, tumor differentiation, and TNM stage; And later TNM stage is an independent risk factor for affecting survival of patients with gastric cancer.
ObjectiveTo evaluate the reporting quality of systematic reviews (SRs)/meta-analyses on acupuncture focusing on literature screening results and explore the influencing factors of the complete reporting.MethodsPubMed, EMbase, CNKI, WanFang Data, and VIP databases were searched to collect SRs/meta-analyses on acupuncture from inception to December 31st, 2019. Two reviewers independently screened literature, extracted data and evaluated the reporting quality of literature screening results of SRs/meta-analyses on acupuncture based on PRISMA statement. Logistic regression model analysis was applied to explore the influencing factors of the complete reporting rate of literature screening results. Statistical analysis was performed by using Excel 2016 and SPSS 16.0 software.ResultsA total of 1 227 SRs/meta-analyses were included. Only 62.3% SRs fully reported the four parts of literature screening results. The parts with a low reporting rate included the number of studies assessed for eligibility (73.2%) and the reasons for exclusions at each stage (67.0%). And the reporting rate of the literature screening flowchart was also low (63.6%). The reporting rate of literature screening results in Chinese SRs was lower than that in English SRs, and there was significantly statistical difference (P<0.001). Multivariate logistic regression analysis showed that the type of published journal, publication year, pages of article and the number of searched databases were correlated with the complete reporting rate of literature screening results (P<0.001).ConclusionsThe complete reporting rate of the literature screening results of SRs on acupuncture is low, especially in Chinese SRs. The complete reporting rate of literature screening results is significantly higher for SRs published after PRISMA statement, in SCI journals, with longer length and more searched databases.
ObjectiveTo compare the complications and clinical scores of posterior lumbar intervertebral fusion (PLIF) in middle-aged and older patients of different ages, and to assess the risk of complications of PLIF in different ages, providing a reference for clinical treatment.MethodsThe clinical data of 1 136 patients, who were more than 55 years old and underwent PLIF between June 2013 and June 2016, were retrospectively analyzed. According to the age of patients undergoing surgery, they were divided into 3 groups as 55-64 years old, 65-74 years old, and ≥75 years old. The general characteristics, comorbidities, and surgical data of the three groups were compared, with comparison the morbidity of complications. According to the minimal clinical important difference (MCID), the improvement of patient’s pain visual analogue scale (VAS) score and the Oswestry disability index (ODI) score were compared. Univariate logistic regression analysis was used to analyze the difference of complications and the improvement of VAS and ODI scores. Multivariate logistic regression analysis was performed for the risk factors of complications.ResultsThere were significant differences in the number of surgical fusion segments and osteoporosis between groups (P<0.05); there was no significant difference in gender, body mass index, operation time, preoperative American Society of Anesthesiologists (ASA) classification, and comorbidities between groups (P>0.05). All patients were followed up 6-62 months with an average of 27.4 months. Among the results of postoperative complications, there were significant differences in the total incidence of intraoperative complications, systemic complications, minor complications, and the percentage of improvement of ODI score to MCID between groups (P<0.05); but there was no significant difference in the total incidence of complications at the end of long-term follow-up and the percentage of improvement of VAS score to MCID between groups (P>0.05). Univariate logistic regression analysis showed that after adjusting the confounding factors, there were significant differences in intraoperative complications and the percentage of improvement of ODI score to MCID between 55-64 and 65-74 years old groups (P<0.05); systemic complications, minor complications, complications at the end of long-term follow-up, and the percentage of improvement of ODI score to MCID in ≥75 years old group were significantly different from those in the other two groups (P<0.05). Multivariate logistic regression analysis showed that age was a risk factor for systemic complications, minor complications, and complications at the end of long-term follow-up. Except for age, long operation time was a risk factor for intraoperative complications, increased number of fusion segments was a risk factor for systemic complications, the number of comorbidities was a risk factor for minor complications, and osteoporosis was a risk factor for complications at the end of long-term follow-up.ConclusionThe risk of surgical complications is higher in the elderly patients (≥75 years) with lumbar degenerative diseases than in the middle-aged and older patients (<75 years), while the improvements of postoperative VAS and ODI scores were similar. Under the premise of fully assessing surgical indications, PLIF has a positive effect on improving the elderly patients’ quality of life.
Objective To analyze the influencing factors of single-center day surgery patients who are discharged from the hospital on the same-day, in order to provide reference and basis for the clinical practice of follow-up day surgery. Methods The electronic medical records of patients who underwent day surgery in the Day Surgery Center of the First Affiliated Hospital of the Air Force Military Medical University between February and October 2021 were analyzed retrospectively. The patients were divided into the same-day discharge group and non-same-day discharge group. The baseline data and perioperative indicators of the patients were analyzed. Results A total of 857 patients were included, including 264 patients (30.81%) in the same-day discharge group and 593 patients (69.19%) in the non-same-day discharge group. Univariate analysis showed that there were significant differences between the two groups in gender, age, body mass index, whether the first one, disease classification, anesthesia method, and intraoperative blood loss (P<0.05). Logistic regression analysis showed that gender, whether the first one, disease classification, surgical grade, anesthesia method, and intraoperative blood loss were independent factors affecting the delayed discharge of patients undergoing daytime surgery (P<0.05). Conclusions There are many factors that affect day surgery patients’ discharge. It is suggested that more rigorously screen patients for day surgery, improve medical technology, strengthen out-of-hospital continued care, and optimize management procedures, so as to shorten the time of patients in hospital and provide more information for patients, and provide more efficient and convenient medical services for patients.
Objective To investigate the risk factors associated with neovascular glaucoma (NVG) after pars plana vitrectomy (PPV) in eyes with proliferative diabetic retinopathy (PDR). Methods Retrospective study. One hundred and thirty-seven patients (137 eyes) with PDR who underwent PPV were recruited. There were 85 males and 52 females. The average age was (60.1±8.8) years old. The duration of diabetes was (10.2±3.6) years. There were 49 patients with ipsilateral carotid artery stenosis. Fifty-three eyes underwent intravitreal ranibizumab or conbercept injection before PPV. All eyes were treated with 23G standard three-port PPV. The average follow-up time after PPV was 11.5 months. Fundus fluorescein angiography (FFA) was conducted in postoperative 4-6 weeks to observe non-perfused retinal areas. Risk factors, such as ipsilateral carotid artery stenosis, the presence of non-perfusion in retina after PPV and the application of anti-vascular endothelial growth factor (VEGF) drugs before PPV, were identified by logistic regression. Results Twenty of 137 patients (14.6%) developed postoperative NVG after PPV. Ipsilateral carotid artery stenosis [odds ratio (OR) =5.048, 95% confidence interval (CI) 2.057-12.389,P=0.000] and the presence of non-perfusion in retina after PPV (OR=4.274, 95%CI 1.426-12.809,P=0.009) were significant risk factors for postoperative NVG, while the application of anti-VEGF drugs was not (OR=1.426, 95%CI 0.463-4.395,P=0.536). But the time from PPV to the onset of NVG varies significantly between the two groups of injection of anti-VEGF drugs or not (t=−4.370,P=0.000). Conclusions Risk factors associated with NVG after PPV in eyes with PDR included ipsilateral carotid artery stenosis and the presence of non-perfusion in retina after PPV. The application of anti-VEGF drugs before PPV can delay the onset of NVG in PDR eyes after vitrectomy.
Objective To analyze the factors influencing day surgery developing towards same-day surgery, and provide a reference for the promotion of same-day surgery. Methods A questionnaire on influencing factors of same-day surgery was prepared based on structural equation modeling (SEM), including 6 dimensions and 23 items. From January to October 2021, at the Day Surgery Center of West China Hospital, Sichuan University, the random sampling method was used to select the research subjects for a questionnaire survey, and SEM was used to analyze the factors impacting the iterative development of day surgery to same-day surgery service model. Results A total of 200 questionnaires were distributed, and 192 valid questionnaires were recovered, with an effective recovery rate of 96.0%. The Cronbach’s α coefficient of the questionnaire was 0.857, and the Cronbach’s α coefficient of each dimension was from 0.832 to 0.934. The KMO test value was 0.822, and the result of Bartlett sphericity test was χ2=4568.330, P<0.001. The model fit indexes met the standard requirements well. The result of SEM revealed that the standard path coefficients of “the hospital’s preliminary preparation for day surgery developing towards same-day surgery” impacting “the guarantee system related to surgical quality and safety”, “the guarantee system related to surgical quality and safety” impacting “the public’s awareness of day surgery developing towards same-day surgery”, “the guarantee system related to surgical quality and safety” impacting “the ‘hospital-community’ integrated collaboration network”, “the public’s awareness of day surgery developing towards same-day surgery” impacting “the ‘hospital-community’ integrated collaboration network”, and “the ‘hospital-community’ integrated collaboration network” impacting “the iterative upgrade of day surgery” were all larger than 0.5, indicating strong influences between these factors, but the absolute value of standard path coefficient of the “hospital’s development brought by the transform of day surgery to same-day surgery” impacting “the guarantee system related to surgical quality and safety” was smaller than 0.3. Conclusion The hospital’s preliminary preparation, the guarantee system related to surgical quality and safety, the development of the “hospital-community” integrated collaboration network, and the public’s awareness are the probable factors influencing the iterative development of day surgery to same-day surgery.