ObjectiveTo investigate the establishment of a risk nomogram model for predicting vagus excitatory response in patients with functional epilepsy after radiofrequency thermocoagulation.MethodsA total of 106 patients with epilepsy admitted to the neurosurgery department of our hospital from January 2016 to June 2020 were selected and divided into the Vagus excitatory response (VER) group and the non-VER group according to their occurrence or absence. Logistic regression analysis was used to screen out the risk factors of VER during SEEG-guided Percutaneous radiofrequency thermocoagulation (PRFT) in patients with functional epilepsy, and R software was used to establish a histogram model affecting VER in SEEG-guided PRFT. Bootstrap method was used for internal verification. C-index, correction curve and ROC curve were used to evaluate the prediction ability of the model.ResultsLogistic regression analysis showed that age [OR=0.235, 95%CI (0.564, 3.076)], preoperative fugl-meyer score [OR=4.356, 95%CI (1.537, 6.621)], depression [OR=0.995, 95%CI (1.068, 7.404)], and lesion range [OR=1.512, 95%CI (0.073, 3.453)] were independent risk factors for the occurrence of VER in PRFT under the guidance of SEEG (P<0.05), and were highly correlated with the occurrence of VER in PRFT. Based on the above six indicators, a SEEG-guided colograph model of VER risk in PRFT was established, and the model was validated internally. The results showed that the C-index of the modeling set and validation set were 0.779 [95%CI (0.689, 0.869)] and 0.782 [95%CI (0.692, 0.872)], respectively. The calibration curves of the two groups fit well with the standard curves. The areas under the ROC curve (AUC) of the two groups were 0.779 and 0.782 respectively, which proved that the model had good prediction accuracy.ConclusionFor patients with functional epilepsy requiring seeg-guided PRFT therapy, age, preoperative Fugl-meyer score, depression and lesion range should be taken into full consideration to comprehensively assess the incidence of VER, and early intervention measures should be taken to reduce and reduce the incidence, which has good clinical application value.
ObjectiveTo explore the relation between preoperative serum gamma-glutamyl transpeptidase to platelet ratio (GPR) and overall survival (OS) of patients with hepatitis B virus-associated hepatocellular carcinoma (Abbreviated as “patients with HCC”), and to establish a nomogram for predicting OS. MethodsAccording to the inclusion and exclusion criteria, the clinicopathologic data of patients with HCC who underwent radical resection in the Department of Hepatobiliary Surgery of Xianyang Central Hospital, from January 15, 2012 to December 15, 2018, were retrospectively analyzed. The optimal critical value of GPR was determined by receiver operating characteristic curve, then the patients were divided into a low GPR group (GPR was optimal critical value or less ) and high GPR group (GPR was more optimal critical value). The Kaplan-Meier method was used to draw the survival curve and analyze the OS of patients. The univariate and multivariate Cox proportional hazards regression model were used to analyze the factors influencing prognosis in the patients with HCC. According to the risk factors of OS for patients with HCC, a nomogram was established. The consistency index and calibration curve in predicting the 3-year and 5-year accumulative OS rates of patients with HCC were evaluated. ResultsA total of 213 patients were gathered. The optimal critical value of GPR was 0.906. There were 114 patients in the low GPR group and 99 patients in the high GPR group. The Kaplan-Meier survival curve analysis showed that the 1-, 3- and 5-year accumulative OS rates were 99.1%, 81.8%, 60.6% in the low GPR group, respectively, which were 74.2%, 49.1%, 35.7% in the low GPR group, respectively. The OS curve of the low GPR group was better than that of the high GPR group (χ2=25.893, P<0.001). The multivariate analysis results showed that the microvascular invasion, incomplete capsule, intraoperative bleeding ＞1 000 mL, postoperative complications, GPR >0.906, low tumor differentiation, and late TNM stage did not contribute to accumulative OS in the patients with HCC (P<0.05). The consistency index (95%CI) of the nomogram in predicting accumulative OS rates at 3- and 5-year for patients with HCC were 0.761 (0.739, 0.783) and 0.735 (0.702, 0.838), respectively. The calibration curves of 3- and 5-year accumulative OS rates of the nomogram were in good agreement with the actual results. ConclusionsPreoperative GPR is associated with OS, and patients with higher GPR have worse prognosis. The nomogram based on GPR has a good accuracy and differentiation.
ObjectiveTo construct a rapid screening tool for the donor of heart dead organ donation (donation after circulatory death, DCD) in the background of novel coronavirus (SARS-CoV-2) infection.MethodsBased on literature analysis and core group discussion, two rounds of expert consultation were carried out by Delphi method to establish dimension and index.ResultsThe screening tool included 3 dimensions, including epidemiological history, hospital exposure history, and clinical manifestations, with 15 entries. The mean of the two rounds of expert authority coefficient was 0.757 and 0.768, and the effective recovery rate of the expert consultation questionnaire was 88% and 100%, respectively. The second round dimension and index coordination coefficients was 0.417 and 0.319, respectively. The content validity of the questionnaire was 0.91.ConclusionsThe DCD liver transplant donor's new rapid screening tool for SARS-CoV-2 infection is scientific and reliable. During the epidemic period, the DCD liver transplant donor risk screening tool is of great significance to the prevention and control of liver transplantation risk.
Objective To develop an evaluation tool for the screening of high risk population for oral complications in critically ill patients, which can be performed accurately and scientifically. Methods Basing on the related foreign oral assessment scale, combined with the method of brainstorming, expert consultation, method of clinical status and so on, the item pool of the assessment scale was determined. Five nursing experts and two oral experts assessed the content validity and 50 ICU nurses were tested. Then, the screening accuracy of the assessment scale was proved by application in 100 critically ill patients selected randomly. Results The Cronbach’s a coefficient of final version of the High Risk Assessment Scale for Oral Complications in Critically Ill Patients (including seven parts contents of oral health assessment and oral pH value test) was 0.815, the content validity index (Sr-CVI/Ave) was 0.932. The results of 50 nurses to the 91.2% assessment items of the assessment scale were very important and important. For screening related indicators of oral complications in high-risk patients, the sensitivity of the assessment scale was 97.53%, the specificity was 94.11%, the positive predictive value was 98.75%, the negative predictive value was 88.89%, and the crude agreement was 95%. Conclusion There are good reliability, validity and a high accuracy of screening test in the High Risk Assessment Scale for Oral Complications in Critically Ill Patients. It can be used for screening patients at high risk for oral complications in critically ill patients, and help clinical nurses to complete the oral health status of the critically ill patients quickly.
ObjectiveTo analyze the influencing factors of acute exacerbation readmission in elderly patients with chronic obstructive pulmonary disease (COPD) within 30 days, construct and validate the risk prediction model.MethodsA total of 1120 elderly patients with COPD in the respiratory department of 13 general hospitals in Ningxia from April 2019 to August 2020 were selected by convenience sampling method and followed up until 30 days after discharge. According to the time of filling in the questionnaire, 784 patients who entered the study first served as the modeling group, and 336 patients who entered the study later served as the validation group to verify the prediction effect of the model.ResultsEducation level, smoking status, number of acute exacerbations of COPD hospitalizations in the past 1 year, regular use of medication, rehabilitation and exercise, nutritional status and seasonal factors were the influencing factors of patients’ readmission to hospital. The risk prediction model was constructed: Z=–8.225–0.310×assignment of education level+0.564×assignment of smoking status+0.873×assignment of number of acute exacerbations of COPD hospitalizations in the past 1 year+0.779×assignment of regular use of medication+0.617×assignment of rehabilitation and exercise +0.970×assignment of nutritional status+assignment of seasonal factors [1.170×spring (0, 1)+0.793×autumn (0, 1)+1.488×winter (0, 1)]. The area under ROC curve was 0.746, the sensitivity was 75.90%, and the specificity was 64.30%. Hosmer-Lemeshow test showed that P=0.278. Results of model validation showed that the sensitivity, the specificity and the accuracy were 69.44%, 85.71% and 81.56%, respectively.ConclusionsEducation level, smoking status, number of acute exacerbations of COPD hospitalizations in the past 1 year, regular use of medication, rehabilitation and exercise, nutritional status and seasonal factors are the influencing factors of patients’ readmission to hospital. The risk prediction model is constructed based on these factor. This model has good prediction effect, can provide reference for the medical staff to take preventive treatment and nursing measures for high-risk patients.
Objective To evaluate the risk of management decision combined neo-adjuvant chemotherapy with operation for colorectal cancer by means of the colorectal cancer model of the Association of Coloproctology of Great Britain and Ireland (ACPGBI-CCM). Methods One hundred and eighty-one eligible patients (102 male, 79 female, mean age 58.78 years), which were pathologically proved colorectal cancer in our ward from July to November 2007, involved 62 colonic and 119 rectal cancer. The enrollment were assigned into multi-disciplinary team (MDT) group (n=65) or non-MDT group (n=116), according to whether the MDT was adopted, and the operative risk was analyzed by ACPGBI-CCM. Results The baseline characteristics of MDT and non-MDT group were coherent. The watershed of lower risk group (LRG) and higher risk group (HRG) was set as predictive mortality=2.07%. The time involving extraction of gastric, urethral and drainage tube, feeding, out-of-bed activity after operation in MDT group, whatever in LRG or HRG, were statistically earlier than those in non-MDT group (P＜0.05). The resectable rate in LRG was statistically higher than that in HRG (P＜0.05), and the proportion of Dukes staging was significantly different (P＜0.05) between two groups; Moreover, predictive mortality in HRG was statistically higher than that in LRG (P＜0.05), while actually there was no death in both groups. Conclusion Dukes staging which is included as an indispensable option by ACPGBI-CCM is responsible for the lower predictive mortality in LRG.Hence, the value of ACPGBI-CCM used to asses the morbidity of complications within 30 days postoperatively would be warranted by further research. The postoperative risk evaluation can serve as a novel routine to comprehensively analyze the short-term safe in the MDT.
Theory of risk control was introduced to medical instruments quality control management in West China Hospital. A quality control system for the whole life cycle management of instruments has been established, which includes evaluation before instrument purchase, policy and management of bidding, operation training, safe maintenance, maintenance management and waste disposal. Medical instrument quality system was introduced to provide information for medical instrument risk control and quality management in a large, general Chinese hospital.
目的 了解糖尿病患者院外自行注射胰岛素存在的风险。 方法 2010年1月－12月，通过随访调查老年组83例，中青年组69例糖尿病患者院外自行注射胰岛素的实施情况，对存在的问题进行归类、统计。调查的内容主要包括3个方面：胰岛素装置的正确使用、胰岛素的规范注射、血糖监测及低血糖处理。分析两组患者院外注射胰岛素的风险，并对存在的问题进行原因分析、提出解决方法。 结果 发放调查表152份，有效回收131份，其中老年组73份，中青年组58份。在胰岛素装置使用方面，老年组存在问题48项，中青年组27项，两者间差异无统计学意义（χ2=2.432，P＞0.05）。在胰岛素的规范注射方面，老年组存在问题176项，中青年组77项，老年组在胰岛素注射方面存在的问题明显高于中青年组（χ2=25.009，P＜0.001）。在低血糖的认识及正确处理上，老年组存在问题115项，中青年组33项，两组差异具有统计学意义（χ2=40.383，P＜0.001）。 结论 糖尿病患者院外自行注射胰岛素存在诸多风险。老年糖尿病患者院外胰岛素注射需在他人协助、监督下进行。