الملخص
Objective:To look for the problems faced in the construction of the tele-critical care system, explore the framework of construction of the tele-critical care system, and verify the application effects of the established tele-critical care system.Methods:Through literature review and on-site investigation and demonstration, the causes affecting the construction of the tele-critical care system were explored. Through on-site investigation of the actual situation of the critical care department in relevant hospitals, arguing and choosing intended intensive care unit (ICU) and cooperative third-party communication and equipment companies, and through the Internet of Things and 5G communication technology, a tele-critical care system with the core hospital of the group as the center and the member institutes within the group as the nodes was built. Via the established tele-critical care system, activities such as tele-monitoring, visual remote ward rounds, remote consultation, remote teaching were carried out to verify the functions of the system.Results:The insufficient cognition of relevant personnel, tele-medicine practice certification requirements, information security issues and the barriers of equipment information integration were the main causes affecting the construction of tele-critical care system. There were five parts in the tele-critical care system architecture foundations, including bed unit equipment and audio and video information collection system, lossless and secure transmission of collected information, real-time display of information in the remote center, real-time staff interaction between the centre and the nodal hospitals, and information cloud storage. It has been verified that patients' diagnostic and treatment information can be transmitted safely, losslessly and in real-time by a special line through private 5G network. Through this system, real-time and stable upload of audio and video information of patients and application information of monitors, ventilators and infusion work stations can be achieved; combined with tele-conference connections to conduct two-way communication with local medical staff, real-time tele-monitoring, visual remote ward rounds, remote consultation, remote teaching and other functions can be achieved.Conclusion:The tele-critical care system we established is feasible to construct within the medical group and can safely and effectively realize the functions of real-time tele-monitoring, visual remote ward rounds, remote consultation, and remote teaching.
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Objective:To summarize the establishment and management experience of extracorporeal membrane oxygenation (ECMO) rapid response team, and explore a more efficient rescue mode.Methods:From January 2015 to September 2020, 85 patients treated with ECMO in Affiliated Hospital of Qingdao University were selected as the research objects. Thirty-eight patients treated with conventional ECMO from January 2015 to December 2019 were selected as the control group, and 47 patients treated with ECMO rapid response team from January 2020 to September 2020 were selected as the experimental group. The differences in team preparation time, catheterization time, treatment success rate, incidence of complications and equipment failure frequency between the two groups were compared.Results:There were no significant differences in gender, age or disease types between the two groups. The team preparation time and catheterization time of the experimental group were significantly shorter than those of the control group [team preparation time (minutes): 31.79±6.10 vs. 67.16±30.49, catheterization time (minutes): 40.62±7.13 vs. 84.89±19.29], and the incidence of complications was significantly lower than that of the control group [4.3% (2/47) vs. 21.1% (8/38)], and the differences were statistically significant (all P < 0.05). Conclusion:ECMO rapid response team can shorten the rescue preparation time, reduce the occurrence of complications, improve the team treatment efficiency, and provide ideas for emergency and critical patients.
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Objective:To observe the impact of application of ward rounds checklist on the post competency of residents in the standardized residency training of critical care medicine.Methods:From April 2016 to January 2017, different batches of residents who were admitted to the Department of Critical Care Medicine for standardized residency training were randomized into the experimental group and the control group. Both groups were taught by experienced ICU senior attending physicians one-to-one. The control group routinely conducted rounds and handovers. The experimental group implemented a ward rounds checklist system during rounds and handovers. The training time for each group was 2 months. According to the characteristics of ICU combined with the requirements of post competency, a questionnaire was formulated. SPSS 17.0 was used for t test and chi-square test. Results:The resident physicians in the experimental group gave more satisfactory evaluations in terms of the actual patient care ability, medical knowledge mastery, clinical work under the system, learning and improvement from work, professional literacy, and communication skills to reflect the post competency, and had relatively higher degree of satisfaction with the teaching training, all with statistical significance ( P<0.05). Conclusion:It's helpful to improve the post competency and teaching satisfaction of ICU residents by implementing the ward rounds checklist system during the rotation of resident physicians in the standardized residency training of critical care medicine.
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Objective To investigate the basic perceptions, attitudes and needs towards delirium among ICU professionals in Shandong province, so that to help the ICU supervisors design target training for ICU professionals. Methods A survey was employed utilizing a self-designed questionnaire among 917 ICU professionals(doctors and nurses) from 62 hospitals in Shandong province. Results The score of ICU professionals′ basic perception and behavioral attitude concerning ICU delirium were (24.56 ± 6.36) and (19.00 ± 3.01) points respectively. The score had significant positive correlation and indicates statistic significance (r=0.53, P<0.01). Academic, work experience and title had influence on the score of basic perception (F=14.49, 26.25, 40.16, P<0.05), work experience, category of ICU, title and category of hospital were the effect on the score of behavior and attitude (F=11.87, 8.64, 6.55, P<0.05;t=4.81, P<0.05). The lower rate of correct responding to knowledge of ICU delirium were as follows:the correct rate of delirium in ICU of typing to 56.92%(522/917); the clinical manifestations of ICU delirium accuracy 65.32%(599/917); andrisk factors for delirium in ICU of the correct rate for 70.34%(645/917).ICU professionals acquire knowledge pertaining delirium mainly through lectures, conferences, knowledge brochure , exchange of experience. Conclusions The ICU professionals in Shandong province have less knowledge on ICU delirjum.ICU management should recognize the importance of ICU delirium to strengthen the training of relevant knowledge, enhance delirium management, ensure the patient's safety and improve the prognosis of patients.
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Objective To evaluate the application of clinical cases related problem-based-learning (PBL) method in critical care medical standardized resident training program. Methods 84 residents were randomly divided into experimental group (n=42) and control group (n=42) by lottery way. The experimental group received PBL process during clinical case analysis while the control group learned completely through traditional teaching method . The residents' clinical competence were assessed by multiple scale mixed method including question bank examination (QBE), case-based discussion (CBD), direct observation of procedural skills (DOPS), simulation etc, and Likert-type scale questionnaire was used to evaluate the feedback of training residents. SPSS 17.0 was used to do line t test to the data of both groups. Results Finally 84 residents finished the study. There were no difference in the general conditions in two groups. The PBL group achieved higher examination score during QBE [(80.26 ±8.89) vs. (86.10 ±9.32)], CBD [(84.83±5.43) vs. (75.36±6.06)], DOPS [(88.81±6.68) vs. (82.70±6.98)], simulation [(79.86±10.09) vs.(72.71±9.30)]. Except two groups residents all gave high scores in enhancing cross connection in clinical knowledge [(4.786±0.470) vs. (4.571±0.859), P=0.16], and the questionnaire results showed that the resi-dents of PBL group gave higher points in exciting autonomous learning, improving clin-ical analysis ability, accelerating clinical thinking establish, developing independent thinking habits, improving the clinical communication skills and teamwork ability (P<0.05). Conclusion The clinical cases related PBL method can improve the training effects during critical care medical standardized resident training program. It can be used broadly after adapting modification in critical care medical education.
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ObjectiveTo study the characteristics of the distribution and drug resistance ofAcinetobacter baumannii, and the epidemiology of the main strains among wards and hospitals, and to investigate the role of outer membrane protein in producing resistance against carbapenems.Methods 145Acinetobacter baumannii strains were collected from July 2013 to July 2014 from Huangdao Hospital Affiliated to Qingdao University and 401st Army Hospital. Antimicrobial susceptibility test was carried out with K-B disk diffusion method. Enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR) was used for DNA typing and test of homology. The carO gene of outer membrane protein was amplified by PCR, and the outer membrane proteins were extracted by ultrasonication and ultracentrifuge method from 30 randomly selected carbapenem-resistantAcinetobacter baumannii and 17 carbapenem-sensitive strains. Sodium dodecyl sulfate-polyacrylamide gel electropheresis (SDS-PAGE) was used to analyze the expressions of outer membrane proteins.Results 145Acinetobacter baumannii strains were generally resistant to 16 common antimicrobial agents, with the highest susceptibility rate of 79.3% for minocycline, followed by susceptibility rate of 40.7% for amikacin. There were 128 carbapenem-resistant strains (resistance rate of 88.3%), 137 multidrug-resistant strains and 126 extensively drug-resistant strains. The detection rates of carO gene were 97.7%(125/128)and 17.6%(3/17) in carbapenem-resistant and sensitive strains respectively. Around position of relative molecular mass 47 000, 16 of 17 sensitive isolates were expressed this protein, while 20 of 30 resistant ones were detected nothing or fade; 13 of 17 sensitive isolates were expressed around position of relative molecular mass 37 000 and 29 000 while 25 were detected nothing or fade around position of relative molecular mass 37 000 and 23 were detected nothing or fade around position of relative molecular mass 29 000 in 30 resistant ones. 145Acinetobacter baumannii were classified into 8 types based on ERIC-PCR electrophoresis patterns, and the major prevalence types were type A (71 strains) and type E (37 strains).Conclusions Drug resistance of clinically isolatedAcinetobacter baumannii is a serious problem in two hospitals; drug-resistant strains are spread and epidemic among wards and hospitals. The carO gene of outer membrane protein is widespread in carbapenem-resistantAcinetobacter baumannii. The loss or fading of outer membrane protein may play an important role inAcinetobacter baumannii resistance to carbapenems drugs.
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Objective To investigate the effects of ulinastatin on the number of peripheral blood lymphocyte and the percentage of its subsets in patients with severe sepsis. Methods The scores of APECHE II and SOFA, the number of lymphocyte and the percentage of different subsets in these sepsis patients at different treatment time were measured. Results After treatment, the scores of APECHE II and SOFA of severe sepsis patients were decreased, the number of lymphocyte elevated and the percentages of different subset were corrected. Sepsis caused by Gram- positive pathogens had stronger suppression of peripheral blood lymphocyte and subsets compared with Gram - negative pathogens. Conclusion Patients with severe sepsis had less peripheral blood lymphocyte and abnormal subsets. Ulinastatin could help to correct such abnormality.