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The cultivation of medical students' humanistic care ability is one of the most important tasks of medical education. In this study, "Teddy Bear Simulation Hospital" was launched to cultivate humanistic care ability for pre-clinical medical students in the early stage. Firstly, pre-clinical students were organized to visit clinical functional zoning and diagnosis and treatment processes, listen to pediatrician lectures, and understand the diagnosis and treatment process of pediatric patients. Then, students were organized to build a simulated hospital for kids in the kindergarten with reference to the actual situation and carry out simulated diagnosis and treatment. In the process of implementation, students divide the labor, make the plan and take the action independently. After the simulation scenario was created, the kids played the role of parents of the sick children, and their favorite plush toy was pretended to be the sick baby; the medical students played the various roles of the medical staffs in the simulated hospital to carry out various diagnosis and treatment activities in an orderly manner. The results showed that the activity has provided a safe and friendly simulation diagnosis and treatment platform for pre-clinical students. In the interaction with children, the humanistic care ability of the students was significantly improved.
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Sarcopenia is a systemic syndrome characterized by decreased muscle mass and muscle strength and decline of motor function.Sarcopenia affects quality of life and disease prognosis of patients seriously, because of the low awareness rate, low treatment rate and high cardiovascular risk. Patients with uremia undergoing peritoneal dialysis are likely to suffer from sarcopenia due to dietary restriction, loss of protein and high catabolism. This article summarizes the diagnostic methods, risk factors, predictive markers and intervention measures for sarcopenia in peritoneal dialysis patients.
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Objective:Before the radiotherapy was performed, patients with pelvic tumors were analyzed for the consistency of bladder filling in the three steps of " Immobilization" , " CT Simulation" and " X-ray Simulation" .Methods:In 2014, 105 patients (68 cases of cervical cancer, 32 cases of rectal cancer, 3 cases of vaginal cancer and 2 cases of prostate cancer) with pelvic tumor radiotherapy were randomly assigned to monitor bladder urine volume to a target urine volume of 400 ml. First, patient were exhorted to empty the bladder, and the bladder volume meter BVI 9400 was used to measure the urine volume of the patient after emptying of the bladder. The patient immediately drank about 540 ml of water and suppressed urine, measurements were taken every 0.5 h. At the same time, when the patient complained of " urgency of urine" , bladder urine volume would be measured again and the time would also be recorded. Every other half an hour (emptying, 0.5 h after emptying, 1.0 h after emptying), when complaining of " urgency of urine" , when actually performing urine volume and time were described as: U 0 and t 0, U 0.5 and t 0.5, U 1.0 and t 1.0, U t and t, U T and T. Results:There was a statistically significant difference in gender and age, and women had stronger ability to urinate than men U 1.0( P=0.003), young people had stronger ability to urinate than middle-aged U 1.0( P=0.002). In the three-step comparison, there was no statistically difference between 1 hour after emptying urine volume U 1.0( P=0.177) and the actually performing urine volume U T ( P=0.052). And the final urine volume was concentrated at 298-526 ml. After the patient emptied the urine volume and complained of " urgency of urine" , the time slot was t=(75.2±49.9) min, with the urine volume of U t=(331.2±140.3) ml. And there was no statistically difference between U t and U T ( P=0.198) at X-ray Simulation. Conclusions:The patient emptied the bladder and immediately drank 540 ml of water. After 1 hour of suppressing urine, he complained of " urgency of urine" and achieved the target urine volume (400 ml). At this time, the bladder urine volume U 1.0 was consistency in the immobilization, CT Simulation, and X-ray Simulation.
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Objective:To compare the clinical outcomes and safety of haploidentical donor (HID)and HLA-matched sibling donor(MSD)hematopoietic stem cell transplantation(HSCT)for severe aplastic anemia(SAA).Methods:From January 1, 2012 to December 31, 2019, retrospective review of clinical data was performed for 75 SAA patients undergoing HSCT at Department of Hematology, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.Based upon donor sources, they were divided into two groups of MSD(49 cases)and HID (26 cases). And two groups were compared with regards to hematopoietic recovery, graft-versus-host disease(GVHD)infection and overall survival(OS).Results:Time of platelet and neutrophil engraftment of two groups was comparable(11 d vs.11 d, P=0.84; 11 d vs.12 d, P=0.08). Compared with HID group, MSD group had a lower incidence of acute GVHD(46.2% vs.18.4%, P=0.01)with a comparable incidence of grade Ⅱ-Ⅳ acute GVHD(26.9% vs.14.3%, P=0.24), grade Ⅲ-Ⅳ acute GVHD(15.4% vs.4.1%, P=0.09)and chronic GVHD(23.9% vs.23.1 %, P=0.71). A reactivation of CMV occurred in 27(55.1%)MSD and 22(84.6%)HID recipients( P=0.01). And the incidence of EB viremia was 69.4% and 61.5% respectively.After a median follow-up period of 54.0 and 18.5 months, the estimated 3-year OS rate of MSD and HID groups were 94.0% and 88.0% respectively ( P=0.35). Conclusions:HID HSCT is an effective and relatively safe option for SAA patients, especially for those in urgent need of treatment without MSD or refractory/relapse to immunosuppressive therapy.
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Objective:To investigate the effect of different cleaning methods on the cleaning effect of Da Vinci robotic electrosurgical instruments and the feasibility of adenosine triphosphate(ATP) fluorescence detection technology for evaluating the cleaning effect of Da Vinci robotic electrosurgical instruments.Methods:A total of 180 electrosurgical instruments were divided into control group and test group by random digits table method from June 2018 to June 2019 after robotic surgery. For the control group, 90 cases were manually cleaned to complete the device cleaning process, and for the test group, 90 cases were mechanically cleaned to complete the device cleaning process. Through visual observation, magnifying glass examination and ATP fluorescence detection technology, the cleaning effect of the two methods and the correlation between the evaluation results obtained by ATP fluorescence detection technique and traditional inspection method were compared.Results:The qualified rate of visual observation, magnifying lens examination and ATP fluorescence detection in the control group were 95.56%(85/90), 86.67% (78/90) and 84.44% (76/90), respectively, and that in the test group were 100.00% (90/90), 97.78% (88/90) and 98.89% (89/90), respectively. The test group was higher than the control group. The difference between the two groups was statistically significant ( χ2 values were 4.310, 7.745, 12.291, P<0.05 or 0.01). In the control group, there was a positive correlation between the qualified rate of ATP fluorescence detection and visual observation ( r value was 0.374, P < 0.01), and a significant positive correlation between the qualified rate of magnifying lens examination ( r value was 0.538, P < 0.01). In the test group, There was also a significant positive correlation between the qualified rate of ATP fluorescence detection and visual observation ( r value was 0.754, P < 0.01), and between the qualified rate of magnifying lens examination( r value was 0.556, P < 0.01). Conclusions:Mechanical cleaning is used to clean Da Vinci robotic electrosurgical instruments, which is superior to traditional manual cleaning. ATP fluorescence detection technology is feasible for evaluating the cleaning effect of Da Vinci robotic electrosurgical instruments.
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Objective@#To investigate the clinical efficacy of colchicine tablets in the treatment of patients with gouty arthritis, and to observe the effect of colchicine tablets on erythrocyte sedimentation rate(ESR), C-reactive protein (CRP) and uric acid (UA).@*Methods@#From March 2016 to March 2017, 70 patients with gouty arthritis in our hospital were randomly divided into control group and observation group according to the random number table method.The control group was treated with celecoxib capsules 0.2g, 2 times a day.The observation group was treated with colchicine tablets 0.5mg three times daily, celecoxib capsules 0.2g, 2 times a day.The visual analogue scale (VAS) was used to evaluate the degree of joint pain in two groups.The Likert scale was used to evaluate the swelling of the two groups before and after treatment.The pain relief time was recorded in both two groups.The ESR, CRP and UA were measured before and after treatment.The clinical effects and adverse reactions in the two groups were analyzed.@*Results@#After treatment, the VAS score of the observation group was (2.04±0.52)points, which was significantly lower than (3.53±1.22)points of the control group(t=6.64, P=0.00). The joint swelling score of observation group after treatment was (0.62±0.24) points, which was significantly lower than (1.21±0.33)points of the control group(t=8.55, P=0.00). After treatment, the VAS score and joint swelling score in the two groups were significantly lower than those before treatment (all P<0.05). The pain relief time of the observation group was significantly shorter than that of the control group [(1.36±0.47)d vs.(1.79±0.63)d, t=3.23, P=0.00]. After treatment, the ESR, CRP and UA levels of the observation group were (12.65±3.17)mm/h, (12.14±2.27)mg/L, (417.82±55.88)μmol/L, respectively, which were significantly lower than those of the control group [(14.77±4.22)mm/h, (14.69±3.16)mg/L, (458.93±62.74)μmol/L, t=2.37, 3.87, 2.37, P=0.02, 0.00, 0.00]. After treatment, the ESR, CRP and UA levels of the two groups were significantly lower than those before treatment (all P<0.05). The total effective rate of the observation group was 80.00%, which was obviously higher than 57.14% of the control group(χ2=7.55, P=0.02). The incidence rate of adverse reaction of the observation group was 8.57%, which of the control group was 5.71%, the difference was not statistically significant (χ2=0.21, P=0.64).@*Conclusion@#Colchicine tablets combined with celecoxib capsules in the treatment of patients with gouty arthritis can reduce ESR, CRP and UA levels, improve the degree of pain and joint swelling, and will not increase the adverse reactions.
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OBJECTIVE:To explore an effective method to formulate management-related strategies for off-lable use of drugs by the evidence-based medicine. METHODS:The process of guideline formulation included seven procedures,i.g. establishment ofguideliesformulation workgroup;investigation and selection of the status quo on off-label drug use;identification of the clinical problems;retrieval and evaluation and comprehensing of evidence;applification of GRADE in evidence quality grading;formation of the recommendations consensus;peer review and result publication. And eventually guidelines were formed based on the steps. This study took off-label use of rheumatoid immunoprotective subjects as a case to explore. RESULTS & CONCLUSIONS:Based on the evidence evaluation system and above 7 steps,the methods and process of guideline formulation on off-label use of rheuma-toid immunoprotective subjects that integrated administration,law,clinical medicine,pharmacy subjects were made .The process of guideline formulation fully reflects multidisciplinary characteristics of the workgroup,the advanced nature of the process,the comprehensiveness of evidence ,the rigor of evidence quality grading,and the normalization of consensus. It provides reference in methodology for establishing a comprehensive evidence-based evaluation and management system of off-label use of drugs for all clinical specialist disease. Therefore,this scientific research results may promote the standardization and legalization of the off-label use of drugs management in China.
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This paper summarized nursing points for caring 23 cases undergoing pediatric heart transplantation,including:characteristics of accessing and protection of hearts,collaboration in pediatric heart transplantation,nursing of capacity management,temperature controlling,extracorporeal membrane oxygenation and delayed sternal closure during surgeries.The average length of hospitalization for 23 cases was 24.5±8.3 days,1 case died from primary graft failure after 19 months,the rest of 22 cases survived,and cardiac function recovered to NYHA class Ⅰ-Ⅱ.
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Object To explore the relationship of 25 (OH) D levels in cord and maternal peripheral blood to understand the maternal and neonatal vitamin D status in Songjiang District of Shanghai. Methods One hundred newborns delivered at the First People’s Hospital afifliated to Shanghai Jiaotong University and 20 pregnant women during November 2010 to January 2011 in Songjiang district were enrolled in the study. The levels of 25 (OH) D in cord and maternal blood were measured by ELISA and compared. Results Mean materna1 serum levels of 25 (OH) D was (23.42±5.23) nmol/L, and cord blood 25 (OH) D was (29.77±12.51) nmol/L. Maternal serum 25 (OH) D was positively correlated with cord blood 25 (OH) D (r=0.84, P<0.001). Conclusions This study shows that the prevalence of vitamin D deifciency in pregnant women is high in Shanghai Songjiang District, which could have adverse effects on newbowns.
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Objective To derive a questionnaire to assess the risk of developing motor complications through a 3-year prospective investigation on 71 patients of Parkinson' s disease (PD) in the out clinic at our hospital.Methods Three years after the first assessment,71 PD out patients were reassessed using various scales,including Unified Parkinson Disease Rating Scale,Hoehn-Yahr grade,Mini Mental State Exam,Hamilton Depression Scale and Hamilton Anxiety Scale.Results The incidence of motor complications was 43.6％ (31/71).Logistic regression analysis showed that the prognostic factors for motor fluctuation were age of onset ≤ 54 (OR =6.4,95％ CI 1.7-24.5,P =0.006),the occurrence of swallowing difficulty (OR =3.8,95 ％ CI 1.0-14.1,P =0.04) and depression (OR =4.0,95 ％ CI 1.1-13.7,P =0.03),and the prognostic factors for dyskinesia were age of onset ≤54 (OR =48.5,95％ CI 1.9-121.0,P:0.02),the occurrence of falling (OR =64.1,95％ CI 2.9-142.2,P =0.008) and the daily levodopa dosage ＞ 600 mg(OR =17.5,95％ CI 1.1-276.2,P =0.04).Based on the regression model,the assessment questionnaire for motor complicationsincludes the followings:the questionnaire for motor fluctuations:the age of onset ≤54,2 points; the occurrence of swallowing difficulty,1 point; the occurrence of depression,1 point; the questionnaire for dyskinesia:the onset age ≤54,2 points; the occurrence of falling,3 points; daily levodopa dosage ＞ 600 mg,2 points.In all patients in this study,21.7％ (10/46) was asscssed to a total scorc of 0-1 which is associated with a low risk of motor fluctuation,8/16 had a score of 2 which is associated with intermediate risk and 8/9 got a score of 3-4 associated high risk; 10.2％ (5/49) had a score of 0-2,a low risk of dyskinesia,4/13 had a score of 3-4,a intermediate risk and 7/9 got a score of 5-7 which is associated with a high risk.Conclusions Age onset ≤54,the occurrence of swallowing difficulty,falling and depression,daily levodopa dosage ＞ 600 mg were considered to be the prognostic factors of motor complications in PD.The questionnaire may help to stratify PD patients into low-risk,medium-risk and high-risk groups for motor complications and the higher the score in the questionnaire is related to the higher risk of motor complications.
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Objective To observe progression of motor symptoms and occurrence of motor complications in parkinsonian patients and investigate the rate of progression of motor symptoms and risk factors of motor complications.Methods One hundred and thirty patients diagnosed with PD in 2007 in Department of Neurology,Xinhua Hospital were followed up for 3 years.The Unified Parkinson' s Disease Rating Scale (UPDRS) and H-Y staging were used to assess and follow up motor symptoms and occurrence of motor complications,and analyze the rate of progression of motor symptoms and risk factors of motor complications with statistics.Results ( 1 ) Mean annual growth in H-Y staging was 2.5％,and UPDRS motor scores was 3.1％ ; the incidence of dysphagia at endpoint in patients was increased by 23.0％ compared with baseline; incidence of falls was increased by 16.7％;(2)Daily levodopa dose at endpoint ( OR =1.004,95％ CI 1.001—1.006,P =0.008 ) was independent risk factors with dyskinesia; While duration ( OR =1.637,95％ CI 1.083—2.473,P =0.019 ),levodopa treatment duration ( OR =0.698,95％ CI 0.494—0.987,P =0.042 ),daily levodopa dose at haseline ( OR =1.005,95％ CI 1.001—1.010,P =0.016) and at endpoint ( OR =1.014,95 ％ CI 1.001 —1.027,P =0.032 ) were risk factors with motor fluctuations.Conclusions As the disease progresses,motor function in parkinsonian patients gradually worsens,the incidence of swallowing difficulty and of falls is increased,and the incidence of motor complications is increased.The total exposure to levodopa in parkinsonian patients is predictor for motor complications.
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Objective To assess the development,progression and change of nonmotor symptoms in patients with Parkinson' s disease and its impact on patients' quality of life.Methods Eighty-seven consecutive patients with idiopathic Parkinson' s disease were studied.Parkinsonian status was assessed at baseline and 3 years follow-up using Unified Parkinson' s Disease Rating Scale (UPDRS) part Ⅲ & Ⅳ,Nonmotor Symptoms Questionnaire (NMSQuset),Parkinson-related quality of life (PDQ) scales.Paired ttest,Chi-square test,Spearman rank order correlation and hierarchical regression of the major statistical procedures were employed.Results At 3 years follow-up,compared to baseline,the UPDRS Ⅲ score (22.21 ±11.31 vs 30.49± 11.68),UPDRS Ⅳ score(1.00±1.54 vs 2.94±3.12),NMS score (7.98±3.96 vs 12.35 ± 5.12) and PDQ score (28.11 ± 22.88 vs 36.65 ± 26.95) were significantly higher ( t =- 5.54,- 5.75,- 6.46,- 5.29,all P =0.000,respectively).The aggravation of motor and nonmotor symptoms caused the decline of quality of life.The prevalence of constipation,problem of remembenng thing,nocturia ranked tops,and depression,and anxiety were still in the middle,compared with baseline.The prevalence of pains,sweating,dribbling,sense of incomplete emptying etc were significantly increased during the follow-up,△R2 were 21.6％ and 23.4％ respectively,resulting in the deterioration of quality of life.Conclusions PD nonmotor symptoms appear from the early stage.The motor and nonmotor symptoms aggravate over time.
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Objective To study the incidence of rapid eye movement sleep behavior disorder (RBD) and its impact on the clinical manifestations of patients with Parkinson' s disease (PD). Methods One hundred and twenty-four PD patients were included into this study and each of them was given the non motor symptoms questionnaire (NMSquest) to investigate the incidence of RBD. The PD patients were then divided into the RBD group and non RBD group, according to their answers to the NMSquest. Then the clinical differences were investigated between PD patients with and without RBD on the aspects of demographic characters, Hoehn-Yahr (H-Y) stage, the scores of Unified Parkinson Disease Rating Scale (UPDRS) sub-items, the incidence of non motor symptoms, and the dysfunctions of non motor systems (cognitive impairment, anxiety, depression and sleep disorders ). The evaluation tools of non motor functions include Mini Mental State Exam ( MMSE), Hamilton Depression Scale (HAMD), Parkins' s Disease Sleep Scale (PDSS) and Epworth Sleepiness Scale (ESS). Results ( 1 ) 62.9% (78/124) of the PD patients have been experiencing RBD. (2) The course of the disease in RBD group ( 3.8 ± 2.8 ) was significantly shorter than non RBD group (5.0 ± 2.5, t = - 1. 972, P = 0. 048 ) while the sex, age, onset age and the mode of onset, Levodopa dose equivalents (LDE) and the kinds of medicines showed no difference between the two groups. (3) H-Y stage, the scores of UPDRS sub-items and the incidence of motor complications showed no difference between RBD and non RBD group. (4) Most of the non motor symptoms, including the gastrointestinal dysfunctions, autonomic dysfunctions, mood disorders and sleep disturbances, occurred much frequently in RBD group, however, the scores of MMSE, HAMD, HAMA,PDSS and ESS showed no difference between the RBD and non RBD group. Conclusion RBD commonly occurred in PD patients, and PD patients with RBD have a tendency to suffer from dysfunction of non motor systems.
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Objective To determine the prevalence of rapid eye movement(REM)sleep behavior disorder(RBD)in patients with Parkinson' s disease(PD)and to investigate the risk factors of PD-RBD and its effect on the progress of PD. Methods Using the minimal diagnostic criteria of parasomnias described in the International Classification of Sleep Disorders-Revised(ICSD-R)to diagnose clinically probable RBD(cpRBD), patients were assessed by Unified Parkinson's Disease Rating Scale(UPDRS),MMSE, Montreal Cognitive Assessment(MoCA)at baseline and followed for 2.5 years. Results The frequency of cpRBD ranged from 35.6%(47/132)to 41.7%(55/132)during the study period. 11.4% (15/132)patients dropped out from the study. Lower MoCA score and type of onset are independent factors with cpRBD; Lower MoCA score(OR =0. 817 ,P =0. 004)is the risk factor while tremor(OR =0. 247 ,P =0. 020)is the protective factor. PD in patients with PD-RBD may progress more rapidly than non PD-RBD patients(UPDRS Ⅲ change from baseline 9. 86 ± 4. 96 vs 6. 76 ± 4. 26, t = 2. 909, P = 0. 005; H-Y change from baseline 0. 77 ± 0. 54 vs 0. 33 ± 0. 49, t = 3. 664, P = 0. 000). Conclusion RBD may be a symptom predictive for rapid PD progression, declining cognition and psychosis.
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Objective To assess the prevalance and distribution of pain in Parkinson' s disease (PD) patients, and to describe the relationship between pain and development of disease and its impact on the quality of life. Methods 113 PD patients were assessed with Visual Analog Scale (VAS), Brief Pain Inventory (BPI), Unified Parkinson' s Disease Rating Scale (UPDRS), Hoehn-Yahr Scale (H-Y), Hamilton Anxiety and Depression Scale (HRSD, HAMA) and Pittsburgh Sleep Quality Index (PSQI). Patients were divided into no pain group, PD-pain group and non-PD-pain group. PD-pain group was divided into PD-pain direct group and PD-pain indirect group. And statistical analysis was performed for each group. Results The incidence of PD-pain was 42. 5% (48/113). And compared with no pain group, PD-pain group had earlier age at onset of disease, longer duration, higher HAMA, HRSD, UPDRS and H-Y score, higher daily L-dopa dose, with statistical significance. Compared with non-PD pain group, the differences in the onset of age (57.4±9.6 vs 65.9±8.7, t= -2.596, P =0.012), HRSD(12. 9±7.9 vs 8.7±3.7, t =2.605, P=0.014) and VAS (61.6±25.9 vs 38.0 ± 30. 1, U = -2.290, P =0.022) were also statistically significant. BPI was different between PD-pain direct group and PD-pain indirect group except normal work and relations with other people. Conclusion Pain is frequent in Parkinsonian population. Most pain was chronic and related to PD (PD-pain). These patients always have earlier onset age and poorer quality of life.