Objective To analyze different characteristics of extra-vascular lung water ( EVLW) in the patients with acute respiratory distress syndrome( ARDS) , and examine its prognostic value. Methods 23 patients with ARDS admitted between November 2010 and December 2011 were divided into a survival group( n=13) and a dead group( n =10) according to the outcome. The hemodynamic status including extravascular lung water index( EVLWI) was measured in 3 consecutive days, and the relationship between EVLWI and the prognosis of patients was analyzed. Results On the first day of diagnosis, the EVLWI was higher in both groups in comparison with normal value. It was ( 13. 9 ±3. 45) mL/kg in the survival group and ( 14. 87 ±5. 75) mL/kg in the dead group( P gt;0. 05) . However, on the second day, the EVLWI in the survival group dropped significantly after intensive intervention, but the patients in the dead group did not respond well to the treatment and the EVLWI declined slightly. The EVLWI of both groups began to diverge significantly fromeach other, showing average value of ( 11. 07 ±2. 51) mL/kg and ( 15.63 ±5. 05) mL/kg, respectively( P lt; 0. 05) . On the third day, this difference between two groups was still more remarkable, resulting in ( 10.32 ±1.57) mL/kg vs. ( 16. 6 ±4. 33) mL/kg( P lt; 0. 01) . Conclusions The changes of EVLWI can be used to evaluate the effectiveness of treatment and predict the prognosis of patients with ARDS. EVLWI would likely be an indicator to evaluate the pulmonary capillary leakage.
ObjectiveTo establish a systematic, scientific, and sensitive index system to provide a scientific basis for quality evaluation and comprehensive quality management of day surgery nursing.MethodsThe databases of Wanfang, China National Knowledge Infrastructure, CQVIP, PubMed, and Web of Science were searched. The retrieval time was from the establishment of the databases to 15th July, 2019. Based on the “structure-process-outcome” management model, Delphi method was used to conduct two rounds of expert consultation for nursing experts related to day surgery in five tertiary hospitals. The results of the consultation were sorted out and the consensus of experts was obtained, so as to determine the quality-sensitive indicators of day surgery nursing.ResultsA total of 20 nursing experts participated in the questionnaire survey. The final evaluation indicators determined by expert correspondence included 1 structural indicator, 9 process indicators, and 4 outcome indicators.ConclusionsThe construction of quality evaluation standard of day surgery nursing not only embodies the connotation of nursing management of day surgery, but also puts forward clear requirements and quality standards for specialized nursing management. It has high reliability, scientificity, and strong operability, which can effectively improve the quality of nursing management and service level of day surgery.
ObjectiveTo analyze the risk factors for seizures in patients with autoimmune encephalitis (AE) and to assess their predictive value for seizures. MethodsSeventy-four patients with AE from the First Affiliated Hospital of Xinjiang Medical University from January 2016 to March 2023 were collected and divided into seizure group (56 cases) and non-seizure group (18 cases), comparing the general clinical information, laboratory tests and imaging examinations and other related data of the two groups. The risk factors for seizures in AE patients were analyzed by multifactorial logistic regression, and their predictive value was assessed by receiver operating characteristic (ROC) curves. ResultsThe seizure group had a higher proportion of acute onset conditions in the underlying demographics compared with the non-seizure group (P<0.05). Laboratory data showed statistically significant differences in neutrophil count, calcitoninogen, lactate dehydrogenase, C-reactive protein, homocysteine, and interleukin-6 compared between the two groups (all P<0.05). Multi-factor logistic regression analysis of the above differential indicators showed that increased C-reactive protein [Odds ratio (OR)=4.621, 95% CI (1.123, 19.011), P=0.034], high homocysteine [OR=12.309, 95CI (2.217, 68.340), P=0.004] and onset of disease [OR=4.918, 95% CI (1.254, 19.228), P=0.022] were risk factors for seizures in AE patients, and the area under the ROC curve for the combination of the three indicators to predict seizures in AE patients was 0.856 [95% CI (0.746, 0.966)], with a sensitivity of 73.2% and a specificity of 83.3%. ConclusionHigh C-reactive protein, high homocysteine and acute onset are independent risk factors for seizures in patients with AE, and the combination of the three indices can better predict seizure status in patients.
ObjectiveTo explore the effect of continuous health data collection system on residents' heath management. MethodsFrom October 2012 to October 2013, 128 employees aged from 35 to 45 from a bank who volunteered to accept the health management were selected. They were to randomly divided into observation group and control group; the control group received routine outpatient management, while the health management group were observed with continuous data collection system (Zhengguangxing E Health System). We evaluate the changes in physiological indices of a healthy lifestyle one year later. ResultsOne year after administration, the poor lifestyle decreased in observation group obviously (smoking, drinking, poor diet and not take any exercise) compared with that in the control group (P<0.05). The relative health indicators including overweight, abnormal blood pressure, dyslipidemia, abnormal fasting blood-glucose, meliorated much more in observation group than that in the control group (P<0.05). ConclusionContinuous health data collection system for population health management is effective on health management.
Based on the guidelines of the diagnostic test systematic review, this study elaborated the statistical processing of the pooling of data detailed in the systematic review of diagnostic test, discussed the methods for identification and handling of the heterogeneity, evaluated the advantages and disadvantages of the index of the accuracy in diagnostic tests, and proposed the identification method of the publication bias. It also took the data from the published article entitled “Diagnostic Value of ProGRP and NSE for Small Cell Lung Cancer: A Meta-Analysis” as an example for analysis and illustration, which presented clearly the data processing and interpretation of the systematic review of diagnostic test, in order to provide references for clinical researchers to study and conduct the systematic review of diagnostic test.
ObjectiveTo investigate the value of neutrophil/lymphocyte ratio (NLR) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) by detecting the relationship between NLR and other well-known inflammatory biomarkers.MethodsRetrospective study of 610 AECOPD cases was performed. In order to analyze the influence of NLR level on disease condition, treatment plan and prognosis, the clinical data with acute exacerbation were collected and the value of NLR in AECOPD were analyzed.ResultsThe level of NLR was higher in the group with pneumonia than that in the non-pneumonia group (P<0.05), and the more severe the pulmonary inflammation, the higher the NLR level (P<0.05). The level of NLR was higher in the group with heart failure and the group treated with ventilator and glucocorticoid (P<0.05). The NLR level was higher in the group of hospital stay over 14 days than the group of hospital stay less than 14 days (P<0.05). The NLR value of the death group was higher than that of the survival group (P<0.05). With the increase of NLR value, the mortality rate in hospital increased gradually. Compared with C-reactive protein and interleukin-6, NLR had the highest odds ratio by binary regression analysis. Cutoff value of NLR was 5.92 by analysis of receiver-operating characteristic curve with a sensitivity of 88% and a specificity of 51%, and the area under the curve in predicting in-hospital death was 0.727 (OR=4.112, 95% confidence interval 0.609 - 0.849, P=0.02).ConclusionsNLR can be used as an inflammatory marker to evaluate the severity of AECOPD and to predict the prognosis.
Objective To investigate the predictive value of the prognostic nutritional index (PNI) for 28-day all-cause mortality in patients with chronic obstructive pulmonary disease (COPD) in intensive care unit (ICU). Methods The relationship between PNI and short-term mortality in COPD patients was analysed using COX proportional hazards and restricted cubic spline (RCS) models. Receiver operating characteristic (ROC) curves were plotted and area under the ROC curve (AUC) was calculated to assess the predictive performance of PNI. The optimal cut-off value for PNI was determined using the Youden index, and the data were divided into a low PNI group and a high PNI group. Kaplan-Meier curves were then constructed and the log-rank test was used to assess differences in survival between the two groups. Results A total of 980 COPD patients were included in the study. Multivariable COX regression analysis showed that PNI was an independent factor influencing short-term mortality in the severe COPD patients (HR=0.972, 95%CI 0.948 - 0.995, P=0.019). RCS curve results showed a non-linear relationship between PNI and short-term mortality in the severe COPD patients (P for non-linear=0.032), with the risk of death gradually decreasing as PNI increased. The ROC curve indicated that PNI had some predictive power, comparable to that of SOFA score [(AUCPNI=0.693) vs. (AUCSOFA=0.672)]. Kaplan-Meier curve analysis showed a significant difference in survival time between the low (≤38.3) PNI group and the high (>38.3) PNI group (P<0.05). Conclusions PNI has a certain predictive role for short-term all-cause mortality in patients with severe COPD. Patients with low PNI at ICU admission have a higher risk of short-term mortality.
Objective To analyze the research hotspots and trends of Chinese literature on medical quality evaluation indicators in China in recent years. Methods We searched for relevant Chinese literature on medical quality evaluation indicators on China National Knowledge Infrastructure from January 2000 to December 2024, and analyzed the annual publication volume, authors and institutions, research hotspots and frontiers. Results Finally, 177 articles were included in the literature. From 2000 to 2024, the number of Chinese literature on medical quality evaluation indicators in China showed a fluctuating upward trend, reaching 15 articles per year in both 2015 and 2024. The issuing units mainly included the National Institute of Hospital Administration, the School of Public Health of Peking University, Huazhong University of Science and Technology, etc. The publishing team mainly included author teams such as MA Xiemin, LIANG Minghui, XIA Ping, etc. The high frequency keywords and top 10 keywords for centrality ranking included medical quality, evaluation indicators, indicator system, Delphi method, evaluation, evaluation system, quality evaluation, indicators, clinical pathways, and hospital management. “Case classification” was the earliest emerging term in the study of medical quality evaluation indicators. In terms of burst intensity, the top 5 keywords for burst intensity included Delphi method, case classification, problem, data quality, and evidence-based evaluation. Conclusion The publishing institutions and research teams of Chinese literature on medical quality evaluation indicators in China are relatively loose, and there are still problems such as insufficient practical application of medical quality evaluation indicators and single research tools and methods.
Objective To construct a sensitive indicator system for the quality of ambulatory chemotherapy nursing, and provide reference basis for the evaluation and scientific management of ambulatory chemotherapy nursing quality. Method Based on Donabedian’s three-dimensional quality structure model of “structure process result”, through literature review, a preliminary quality indicator system for ambulatory chemotherapy nursing was formulated. The Delphi method was used for two rounds of expert inquiry to determine the sensitive treatment indicator system for ambulatory chemotherapy nursing. The weight of the indicators was calculated using the hierarchical analysis method. Result Fifteen expert inquiry questionnaires were distributed through two rounds of inquiry, and the response rates of the two rounds of expert inquiry questionnaires were all 100%, with expert positivity coefficients of 100% and authority coefficients of 0.90 and 0.94, respectively. The second round of expert inquiry questionnaires Kendall’s coefficient of concordance were between 0.573 and 0.769 (P<0.01). The final constructed quality sensitive indicator system for ambulatory chemotherapy nursing included 3 primary indicators, 8 secondary indicators, and 27 tertiary indicators. The overall Cronbach’s α coefficient for the second round of inquiry questionnaires was 0.853, while the Cronbach’s α coefficients for structural indicators, process indicators, and outcome indicators were 0.879, 0.921, and 0.857, respectively. Conclusions The sensitive indicator system for nursing quality in ambulatory chemotherapy wards constructed has high systematicity, sensitivity, and scientificity, and the weight distribution is reasonable. This indicator system can provide a reference basis for objective evaluation and standardized management of nursing quality in ambulatory chemotherapy.
ObjectiveTo identify differences in blood routine indicators between lung cancer patients and healthy controls, and between different subgroups of lung cancer patients, so as to improve the early detection of lung cancer prognosis, and provide a basis for risk stratification and prognostic judgment for patients with lung cancer.MethodsThis study enrolled 1 227 patients pathologically diagnosed with lung cancer from December 2008 to December 2013 and 2 454 healthy controls 1∶2 matched by sex and age. The blood routine data of lung cancer patients were collected when they were first diagnosed with lung cancer. Gender and age stratified analysis of blood routine indicators between lung cancer patients and controls were conducted. Comparisons of blood routine indicators among lung cancer patients with different pathological types, stages, and prognosis were performed, followed by Cox regression survival analysis. Normally distributed quantitative variables were presented as mean ± standard deviation and non-normally distributed quantitative variables as medium (lower quartile, upper quartile).ResultsCompared to healthy controls, the counts of platelet [(206.84±80.47) vs. (175.27±55.74)×109/L], white blood cells [(7.04±2.29) vs. (6.08±1.40)×109/L], neutrophil [(4.90±2.08) vs. (3.61±1.07)×109/L], monocyte [0.42 (0.30, 0.54) vs. 0.33 (0.26, 0.42)×109/L], and eosinophil [0.14 (0.07, 0.24) vs. 0.12 (0.07, 0.19)×109/L], as the well as neutrophil-lymphocytes ratio (3.91±2.82 vs. 2.03±0.89) and platelet-lymphocyte ratio (160.35±96.06 vs. 96.93±38.02) in lung cancer patients increased significantly, while the counts of red blood cells [(4.41±0.58) vs. (4.85±0.51)×1012/L] and lymphocyte [(1.49±0.60) vs. (1.93±0.59)×109/L] in lung cancer patients decreased, and the differences were statistically significant (P<0.05). The counts of platelet, red blood cells, white blood cells, neutrophil, and monocyte differed among patients with different pathological types, tumor stages, and prognosis (P<0.05). Neutrophil-lymphocytes ratio and platelet-lymphocyte ratio were higher in squamous cell carcinoma patients than those in other pathological patients, higher in advanced lung cancer patients than those in early stage patients, and higher in dead lung cancer patients than those in survival patients (P<0.05). Neutrophil-lymphocyte ratio was an independent factor affecting the prognosis of lung cancer [hazard ratio=1.077, 95% confidence interval (1.051, 1.103), P<0.001].ConclusionsThe inflammatory index of blood routine indicators are higher in lung cancer patients than those in healthy controls, which indicates that lung cancer is closely related to chronic inflammation. There are significant differences in blood routine inflammation index among lung cancer patients with different pathological types, stages, and prognosis, which reflects the heterogeneity and complexity of lung cancer. Neutrophil-lymphocytes ratio inverse correlates with the prognosis of lung cancer.