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Objective To measure the abdominal muscle composition of maintenance dialysis patients using quantitative computed tomography(QCT)and to analyze its relationship with abdominal aortic calcification(AAC).Methods The abdominal CT data of 193 maintenance dialysis patients were analyzed retrospectively and their clinical data were collected.The abdominal muscle composi-tion,including muscle area and muscle fat area,was measured at the middle level of L3 vertebral by QCT.The abdominal aortic calcifica-tion scores(AACs)were calculated using the Agatston method.The groups were grouped according to the quartiles of AACs,and differences in muscle area,muscle fat area and their associated variables were compared between the four groups.The relationship between abdominal muscle composition and AAC was assessed using Spearman rank correlation analysis and partial correlation analysis.Results AACs were positively correlated with age,male,dialysis age,diabetes,hypertension,and abdominal muscle fat area(r=0.555,0.172,0.192,0.348,0.335,0.358,all P<0.05),while no significant correlation was found with abdominal muscle area.A partial correlation analysis controlling for age,sex,dialysis age,hypertension and diabetes showed that AACs were still positively correlated with abdominal muscle fat area(r=0.183,P=0.012).Conclusion Abdominal muscle fat area in maintenance dialysis patients is positively associ-ated with the degree of AAC,and high abdominal muscle fat area is a risk factor for AAC.Enhanced muscle exercise may prevent the risk of vascular calcification in dialysis patients.
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Objective:To evaluate the effect of nursing specialist nurses′ assistance on the ability of nursing home nurses to maintain venous catheter under the vision of combination of medical care and nursing care, providing reference for carrying out specialized nursing assistance work in grassroots hospitals.Methods:This study was an experimental study. According to Miller′s pyramid theory, a model of specialist nurse assistance was established with specialized technology as the core. From January to December 2021, three nursing hospitals in Suzhou were assisted. Convenience sampling method was used to investigate the ability of intravenous catheter maintenance, the incidence of central venous catheter maintenance defects, the incidence of central venous catheter complications and unplanned extubation, and the satisfaction of doctors and patients before and after help.Results:Totally 86 nurses were included, aged (33.17 ± 2.31) years old. After the help, the theoretical and operational skill scores of nurses in the nursing home were (89.77 ± 2.11) and (92.75 ± 1.62) points, respectively, which were significantly higher than those before the help (60.84 ± 2.71) and (79.81 ± 1.68) points, and the differences were statistically significant ( t=-84.96, -52.12, both P<0.05). Among the maintenance defects of central venous catheter in nursing homes, incomplete labeling, film wrapping, blood seepage, catheter discounting, non-standard film fixing, and incomplete information of extended care were 9.95% (21/211), 8.53% (18/211), 2.84% (6/211), 6.16% (13/211), 4.74% (10/211), 2.37% (5/211) after help, all lower than 50.57% (89/176), 43.18% (76/176), 14.20% (25/176), 25.57% (45/176), 18.18% (32/176), 11.93% (21/176) before help. The differences were statistically significant ( χ2 values were 14.00 to 77.81, all P<0.05). The incidence of medical adhesive related skin injury, catheter obstruction complications and unplanned extubation were 4.44% (4/90), 3.33% (3/90) and 2.22% (2/90), respectively, which were lower than 20.51% (16/78), 15.38% (12/78) and 11.54% (9/78) before help. The differences were statistically significant ( χ2=8.81, 6.06, 4.50, all P<0.05). Doctors′ satisfaction with nurses and patients′ satisfaction with nursing work were 96.43%(27/28) and 93.75%(45/48), respectively, both higher than 71.43%(20/28) and 72.73%(32/44) before help, and the differences were statistically significant respectively ( χ2=4.77, 5.97, both P<0.05). Conclusions:From the perspective of combination of medical care and nursing care, the maintenance and assistance of intravenous catheters by the team of intravenous therapy nurses in nursing hospitals can effectively reduce the incidence of central venous catheter complications and unplanned extubation, improve the maintenance ability of intravenous catheters of nurses in nursing hospitals, and help to improve the quality of nursing care in nursing hospitals.
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Objective To explore the association between C-reactive protein/albumin ratio(CAR)and the risk of cardiovascular events in maintenance hemodialysis(MHD)patients.Methods This study enrolled MHD patients who were treated in the blood purification center of the Second Affiliated Hospital of Guangzhou Medical University between August 2016 to December 2019,and the follow-up deadline was March 31,2021.Collected the clinical data of patients who conform to the inclusion criteria,including demographic,complications,primary basic disease,biochemical indicators of the patients who underwent 3 months regular dialysis treatment and the occurrence of cardiovascular events during the follow-up period.The Kaplan-Meier method was used to estimate the probability of cardiovascular incidents in MHD patients.The Cox proportional hazards model based on generalized propensity score weighting(GPSW)was used to estimate the relationship between CAR and cardiovas-cular events in MHD patients.Results A total of 170 eligible objects were included in this study,64 patients with cardiovascular events(37.6%).The Cox proportional hazards model which based on GPSW(HRCAR = 2.087,95%CI:1.085～4.015,P = 0.028),indicated that the hazard ratio of cardiovascular events was 2.087 when the CAR each additional a unit in MHD patients.Conclusion CAR and the risk of cardiovascular events in MHD patients have a significant positive correlation,which can help clinical workers recognize the MHD patients who have high risk of cardiovascular events and intervene in time.
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Objective To study the intervention effect of Ladder Model conversation training strategy on im-proving the conversation skills of children with autism.Methods A multi-probe design across participants was a-dopted to examine the intervention effectiveness of the strategy on two 7～8 year old autistic children.Intervention lasted for 4 weeks for subjuct A and 3 weeks for subject B.Thirty-five minutes each time,three times a week.The number and type of conversation initiation,maintenance and interruption were evaluated in the baseline period,in-tervention period,maintenance period and generalization period.The overlap rate and simplified time-series analysis were used to evaluate the outcome.Results The number of conversation initiation of subject A(overlap rate 8.33％,C=0.89,P＜0.01)and subject B(overlap rate 20％,C=0.83,P＜0.01)was significantly higher in in-tervention periods than that in baseline,but no significant difference was observed between the other adjacent peri-ods.The number of conversation maintenance of subject A(overlap rate 0％,C=0.89,P＜0.01)and subject B(o-verlap rate 10％,C=0.91,P＜0.01)was significantly higher in intervention periods than that in baseline,but no significant difference was found between the other adjacent periods.The type of conversation initiation and mainte-nance that subjects improved were mainly in verbal forms.The main type of interruption was"unexplained re-sponse",the proportion of interruption decreased obviously after intervention.Conclusion The strategy has posi-tive effect on improving conversation initiation and maintenance of children with autism,and reducing the proportion of interruption.
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Objective:To investigate the expression, prognostic value and mechanism of MCM10 in hepatocellular carcinoma (LIHC).Methods:The transcriptome and clinical data of hepatocellular carcinoma were obtained from The Cancer Genome Atlas database, and the rank sum test was used to analyze the expression level of MCM10 in tumor tissues and adjacent tissues. Cox regression analysis was used to analyze the relationship between MCM10 expression level and the survival prognosis of patients with hepatocellular carcinoma. Gene set enrichment analysis (GSEA) was utilized for pathway enrichment analysis between MCM10 high and low group gene expression profiles. The effect of MCM10 knockdown on the proliferation of HepG2 cells was determined by cell counting kit-8 (CCK-8) cell viability assay. The effect of MCM10 knockdown on the expression of G1/S-specific cyclin D1 was detected by Western blot.Results:The expression value of MCM10 in hepatocellular carcinoma was 0.709±0.595, and that in adjacent tissues was 0.077±0.094 ( P<0.0 001). Cox regression analysis showed that high expression of MCM10 was a risk factor and prognostic predictor of overall survival ( HR=1.32, 95% CI: 1.19~1.48) and disease-specific survival ( HR=1.40, 95% CI: 1.22~1.61) in LIHC. GSEA analysis showed that the differentially expressed genes were mainly enriched in cell cycle, p53 signaling pathway and positive regulation of G1-S phase transition, et al. CCK-8 assay showed that MCM10 knockdown could inhibit the proliferation of HepG2 cells. Western blot analysis further confirmed that knockdown of MCM10 expression inhibited the expression of cyclin D1 in HepG2 cells. Conclusions:MCM10 is a risk factor for the prognosis of patients with hepatocellular carcinoma, which can promote the proliferation of hepatoma cells through cyclin D1.
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Objective Based on the process theory of stress effect,the structural equation model of the influencing factors of self-regulatory fatigue in maintenance hemodialysis patients is constructed,which provides theoretical bases and references for the formulation of intervention programs to relieve self-regulatory fatigue in patients.Method A total of 420 maintenance hemodialysis patients were surveyed using General Information Questionnaire,Self-Regulatory Fatigue Scale,Dialysis Symptom Index,Life Orientation Test-Revised,Perceived Social Support Scale,Brief Illness Perception Questionnaire and Medical Coping Styles Questionnaire.Results Total score of self-regulatory fatigue in maintenance hemodialysis patients was(49.52±10.93),and self-regulatory fatigue showed significant positive correlation with symptom distress,the illness perception,avoidance coping style,yieldly coping(r=0.476,0.428,0.303,0.611,all P＜0.01);self-regulatory fatigue showed significant negative correlation with perceived social support and dispositional optimism(r=-0.410,-0.652,all P＜0.01);it showed no significant correlation with facing coping(r=-0.032,P＞0.05).The Bootstrap analysis revealed that the mediation effect of yielding coping,dispositional optimism,perceived social support,and illness perception between symptom distress and self-regulatory fatigue was significant(95％CI:0.027～0.203).The overall effect of symptom distress on self-regulatory fatigue was(P＜0.001,95％CI:0.576～0.751);the direct effect was(P＜0.001,95％CI:0.170～0.357);the indirect effect was(P＜0.001,95％CI:0.332～0.485);the mediation effect accounted for 61.1％of the total effect value.Conclusion Maintenance hemodialysis patients have a high degree of self-regulatory fatigue,which needs to be further improved.Medical staff should timely identify and evaluate the symptom distress of patients,focus on guiding patients to adjust optimistic disease,provide patients with psychological guidance and stress coping strategies,reduce the negative coping behavior tendency,guide the patients correctly perceive support and care in social relations,help patients set up the correct disease cognition,thus reducing the patient's self-regulatory fatigue.
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Objective To illuminate the benefit finding experience of maintenance hemodialysis patients,and to provide a reference for promoting their mental health.Methods From March to May 2023,the purposive sampling was used to select 13 maintenance hemodialysis patients in a tertiary hospital in Shanghai for semi-structured interviews.The data were organized with the help of Nvivo software,and the Colaizzi's seven-step method was used to analyze the data.Results 3 themes were extracted:①the search of meaning,including approved hemodialysis,the desire to live;②gaining a sense of mastery,including adjusting self-psychology,developing healthy living habits,and learning hemodialysis related behavior management;(3)self-enhancement,including excavating external resources and affirming self-worth.Conclusion Maintenance hemodialysis patients have benefit finding experience in many aspects.Medical staff can guide patients to carry out positive psychological construction by strengthening disease knowledge education,building a psychological mutual assistance platform,forming a multidisciplinary nursing team,excavate and provide effective social support resources,and cultivate patients'self-health management,so as to improve the level and ability of benefit finding of patients,experience positive incentives,promote physical and mental health,and improve the quality of life of hemodialysis patients.
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Objective To search,evaluate,and summarize the best evidence of insertion and maintenance of mini-midline in adult patients,in order to provide a solid evidence-based foundation for establishing clinical standardized and safe utilization of mini-midline.Methods We systematically searched UpToDate,BMJ Best Practice,Guideline International Network,National Guideline Clearinghouse,Joanna Briggs Institute,National Institute for Health and Care Excellence,Centers for Disease Control and Prevention,Scottish Intercollegiate Guidelines Network,Canadian Medical Association:Clinical Practice Guideline,Registered Nurses'Association of Ontario,Intravenous Nurses Society,Cochrane Library,PubMed,CINAHL,Embase,Web of Science,Yimaitong,China National Knowledge Infrastructure,Wanfang Database,and China Biomedical Literature Database.It includes clinical practice guidelines,expert consensuses,evidence summaries,systematic reviews,meta-analyses,and best practice on mini-midline insertion and maintenance.The search period covered January 2013 to May 2023.2 researchers independently evaluated the literature quality and extracted the literature that met the standards.The evidence was graded using the JBI evidence pre-grading system(2014),and the extracted evidence was classified and summarized by themes.Results A total of 10 pieces of the literature were involved,including 6 guidelines,2 expert consensuses,and 2 systematic reviews.This study summarized 20 pieces of best evidence in relation to the following 4 themes:indications and contraindications for mini-midline,catheter insertion,catheter maintenance and catheter removal.Conclusion The study comprehensively and scientifically summarizes the best evidence regarding the insertion and maintenance of mini-midline.We recommend that clinical practitioners integrate this evidence into their practice,while considering individual patient preferences and medical contexts.This approach,in line with the principle of individualization,will contribute to enhancing the standardization and safety of mini-midline use in clinical settings.
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OBJECTIVE To compare the effects of roxadustat and recombination human erythropoietin （rHuEPO） on coronary artery calcification in maintenance hemodialysis （MHD） patients. METHODS In retrospective analysis， MHD patients prescribed roxadustat in the Blood Purification Center of the First Affiliated Hospital of Chongqing Medical University from April 2019 to June 2021 were selected as the ROX group （56 patients）， and MHD patients prescribed rHuEPO during the same period were selected as the EPO group （60 patients）， and follow-up observation was conducted for 12 months. The differences in laboratory index， coronary artery calcification score （CACS）， and cardiac ultrasound parameters before and after treatment as well as the occurrence of cardiac and cerebrovascular adverse events during follow-up period were compared between the two groups. RESULTS There was no statistical difference in CACS between the two groups before and after treatment （P＞0.05）； but the difference of CACS in the ROX group was significantly lower than the EPO group （P＜0.05）. There was no statistically significant difference in cardiac ultrasound parameters and laboratory indexes between the two groups before and after treatment （P＜0.05）. The incidence of apoplexy and myocardial infarction in the ROX group was lower than that in the EPO group （P＜0.05）， and there was no statistically significant difference in the incidence of hospitalization due to heart failure between the two groups （P＞0.05）. CONCLUSIONS Compared with rHuEPO， roxadustat may have a positive effect on delaying coronary artery calcification in MHD patients and may be beneficial in reducing the incidence of myocardial infarction and apoplexy in MHD patients.
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Objective To evaluate the effectiveness of a hospital logistics operation and management based on the"one center,four platforms"model.Methods In line with the grading evaluation standards for hospital intelligent management,we used technologies such as big data,Internet of Things,Internet Plus,and artificial intelligence to develop a"one center,four platforms"model.This model consisted of a logistics intelligent operation and maintenance management center,an equipment control information platform,a security prevention information platform,an energy consumption monitoring information platform,and an operation management information platform.Results The equipment fault resolution capability,enhanced by the"smart linkage",showed a significant improvement.In 2022,false alarms decreased by 28.63%compared to 2021,with high-level and ordinary-level alarms decreasing by 69.53%and 33.15%,respectively.The"one-stop"logistics service capability was signifi-cantly improved,as indicated by a 2.92%decrease in maintenance frequency in 2022 compared to 2021.This improvement was further reflected in the quality of maintenance and a decrease in the repeated maintenance occurrences.The energy consumption control capability,based on the"data mining",showed a significant improvement,with an 8.71%year-on-year decrease in en-ergy expenditure of ten thousand yuan in 2022 compared to 2021.Conclusion The"one center,four platforms"model can sig-nificantly enhance the efficiency of logistics operation and maintenance management.
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The structure and working principle of the multi-leaf collimator(MLC)optical system of Elekta linear accelerator were introduced.The causes for the faults of the MLC optical system were analyzed,and the fault repair and maintenance of the MLC optical system were summarized.References were provided for medical engineers to repair and maintain the MLC optical system.[Chinese Medical Equipment Journal,2024,45(1):76-83]
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The structural composition and working principle of Senographe DS Digital Mammography System were introduced.The causes and elimination of 2 cases of faults of the system in exposure and artifact were proposed.References were provided for treating similar faults.[Chinese Medical Equipment Journal,2024,45(1):118-120]
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Objective:To analyze the characteristics and electrogastrogram features of patients with functional dyspepsia (FD) overlapping lower gastrointestinal symptoms (LGS).Methods:The clinical data of 61 patients with FD from January 2018 to December 2020 in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. Among them, FD overlapping LGS was in 33 cases (FD overlapping LGS group), and simple FD in 28 cases (simple FD group). The manifestations of patients with FD overlapping LGS were recorded. The dyspeptic symptom score was assessed using the Rome Ⅳ criteria. Anxiety and depression status were evaluated using the hospital anxiety and depression scale (HADS), and sleep disorder was assessed using the Pittsburgh sleep quality index (PSQI). The electrogastrogram was performed, and the normal slow wave percentage (N%), bradygastria percentage (B%), tachygastria percentage (T%), arrhythmia percentage (A%), dominant frequency, dominant power and postprandial-to-fasting power ratio (PR) were recorded.Results:The most common symptom in FD patients overlapping LGS was lower abdomen distention, the incidence was 84.85% (28/33). The upper abdominal bloating score in FD overlapping LGS group was significantly higher than that in simple FD group: 7.00 (6.50, 7.00) scores vs. 5.00 (0.50, 7.00) scores, and there was statistical difference ( P<0.01); there were no statistical differences in other dyspeptic symptoms scores and total score between the two groups ( P>0.05). The incidences of depression and sleep disorder in FD overlapping LGS group were significantly higher than those in simple FD group: 42.42% (14/33) vs. 14.29% (4/28) and 69.70% (23/33) vs. 39.29% (11/28), and there were statistical differences ( χ2 = 5.77 and 5.68, P<0.05); there was no statistical difference in the incidence of anxiety between the two groups ( P>0.05). In FD overlapping LGS group, the postprandial T% in the gastric fundus and postprandial A% in the gastric body were significantly lower than those before meal: 13.79% (6.79%, 21.46%) vs. 20.69% (12.45%, 27.59%) and 3.45% (0, 6.90%) vs. 6.90% (3.45%, 13.79%), and there were statistical differences ( P<0.01). In simple FD group, the postprandial N% in the gastric fundus was significantly lower than that before meal: 55.92% (43.71%, 70.02%) vs. 69.27% (48.07%, 78.45%), and there was statistical difference ( P<0.05). In the gastric fundus, the preprandial N% in FD overlapping LGS group was significantly lower than that in simple FD group, preprandial B% and T% were significantly higher than those in simple FD group, and there were statistical differences ( P<0.01 or <0.05). In the gastric body, the preprandial N% in FD overlapping LGS group was significantly lower than that in simple FD group, and there was statistical difference ( P<0.05). In the pyloric region, the PR in FD overlapping LGS group was significantly lower than that in simple FD group, and there was statistical difference ( P<0.05). In the overall stomach, the preprandial N% in FD overlapping LGS group was significantly lower than that in simple FD group, the preprandial B% and T% were significantly higher than those in simple FD group, and there were statistical differences ( P<0.01 or <0.05). Spearman correlation analysis result showed that the disease course was not correlated with electrogastrogram parameters in patients with FD overlapping LGS ( P>0.05); the total score of dyspeptic symptoms was positively correlated with postprandial A% in the overall stomach ( r = 0.345, P<0.05), and negatively correlated with postprandial dominant frequency in the overall stomach and pyloric region ( r = -0.357 and -0.473, P<0.05 or <0.01). Conclusions:FD patients can overlap with various LGS. The patients with FD overlapping LGS have more severe dyspepsia symptoms, higher proportions of comorbid depression and sleep disorders, and more severe abnormalities in fasting proximal gastric electrical rhythm and emptying function. The severity of dyspeptic symptoms in patients with FD overlapping LGS is correlated with postprandial gastric electrical rhythm abnormalities.
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Objective To understand the infection status of patients with maintenance hemodialysis(MHD)in Guizhou Province,and provide basis for the prevention and control of hemodialysis-related infection.Methods MHD patients in hemodialysis centers of 124 secondary and or higher grade medical institutions in Guizhou Province from July to December 2022 were surveyed.Survey content included the general conditions of patients,hemodialysis-related conditions,infection of pathogens of blood-borne diseases,and other infection-related conditions.Results A total of 15 114 MHD patients were surveyed,with age mainly ranging from 36 to＜60 years old(55.83％).Hemodialysis history ranged mainly from 1 year to＜5 years(59.37％),and the frequency of hemodi-alysis was mainly 3 times per week(73.91％).Autologous arteriovenous fistula(AVF)was the major vascular access for dialysis,with a total of 12 948 cases(85.77％).The main primary disease was chronic renal failure(99.89％).The infection rates of hepatitis B virus(HBV),hepatitis C virus(HCV),human immunodeficiency vi-rus(HIV),and Treponema pallidum in MHD patients were 5.29％,0.64％,0.24％,and 1.70％,respectively.HBV infection rates among MHD patients of different ages,different numbers of dialysis hospitals,and dialysis in-stitutions of different scales showed statistically significant differences(all P＜0.05).HCV infection rates among MHD patients of different ages,with different dialysis times and from institutions of different scales were signifi-cantly different(all P＜0.05).TP infection rates among MHD patients of different ages and different numbers of dialysis hospitals were all significantly different(all P＜0.05).Infection rates of HBV and HCV in MHD patients aged from 36 to 60 years old(not included)were relatively higher(6.10％and 0.84％,respectively).Patients with dialysis time ≥10 years had a higher HCV infection rate(1.64％).Infection rates of HCV,HIV,and TP in pa-tients dialyzed in medical institutions with ≥90 dialysis beds were relatively higher(0.74％,0.28％,and 1.94％,respectively).Medical institutions with＜30 dialysis beds had the highest HBV infection rate(18.64％).There were 9 cases(0.06％)of vascular puncture infection,12 cases(0.08％)of bloodstream infection,7 cases(0.05％)of vascular access-related bloodstream infection,and 30 cases(0.20％)of pulmonary infection.Vascular access-re-lated bloodstream infection rate and pulmonary infection rate among MHD patients with different types of vascular access showed statistically significant difference(all P＜0.05).Vascular access-related bloodstream infection rate(0.37％)and pulmonary infection rate(1.10％)of patients with non-cuffed catheters vascular access were higher than those of other types.Conclusion MHD patients in Guizhou Province are mainly middle-aged and young peo-ple,with more males than females.The dialysis frequency is mostly 3 times per week,and AVF is the major vascu-lar access.MHD patients are prone to complications such as infections of HBV,HCV,HIV,and TP,as well as bloodstream infection and pulmonary infection.
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Objective:To analyze the pathogen distribution and prognostic risk factors of catheter-related bloodstream infection (CRBSI) in patients with maintenance hemodialysis (MHD) during non-hospitalization.Methods:A retrospective comparative study was conducted. Thirty-four patients of MHD with semi-permanent catheter admitted to the department of nephrology of Gansu Provincial Hospital from January 2020 to May 2023 due to CRBSI during non-hospitalization were enrolled. The distribution characteristics of pathogens causing CRBSI in MHD patients during non-hospital period were analyzed. All patients were actively given anti-infection treatment after admission. The general data, laboratory indicators and prognosis during hospitalization were collected through the electronic medical record system. Patients were divided into poor prognosis group (14 cases) and good prognosis group (20 cases) according to the treatment results during hospitalization. Univariate and binary Logistic regression were used to analyze the risk factors affecting the prognosis of patients, and receiver operator characteristic curve (ROC curve) was drawn to evaluate its predictive value for prognosis.Results:A total of 28 pathogenic bacteria were isolated from 34 patients, of which 25 were Gram-positive, Staphylococcus was the most common pathogen, accounting for 82.15% of the total, and 16 strains of Staphylococcus aureus (57.15%), including 6 methicillin-resistant Staphylococcus aureus (MRSA, 21.43%). There were 7 strains of Staphylococcus epidermidis (25.00%), including 3 strains of methicillin-resistant Staphylococcus epidermidis (MRSE, 10.71%). There were 3 strains of Gram-negative bacteria, 1 strain each of Pseudomonas aeruginosa, Escherichia coli and Acinetobacter baumannii. Univariate analysis showed that the fever duration of MHD patients with CRBSI in the poor prognosis group was significantly longer than that in the good prognosis group [days: 8.50 (3.75, 45.00) vs. 2.50 (1.00, 4.75), P < 0.01], serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and random blood glucose (GLU) were significantly higher than those in the good prognosis group [ESR (mm/1 h): 82.36±24.98 vs. 56.95±35.65, CRP (mg/L): 123.45±74.10 vs. 67.35±55.22, GLU (mmol/L): 8.74±3.66 vs. 6.42±1.95, all P < 0.05]. Binary Logistic regression analysis showed that serum CRP was an independent risk factor for poor prognosis in MHD patients with CRBSI [odds ratio ( OR) = 1.020, 95% confidence interval (95% CI) was 1.002-1.038, P = 0.025]. ROC curve analysis showed that the area under the curve (AUC) of serum CRP in predicting poor prognosis of MHD patients with CRBSI was 0.711; when the optimal cut-off value was 104.65 mg/L, the sensitivity was 64.3% and the specificity was 85.0%, indicating that it has good predictive value. Conclusions:Gram-positive bacteria are the main pathogens of CRBSI in MHD patients during non-hospital period. The poor prognosis is mainly related to the high level of serum CRP. Serum CRP level can effectively screen the high-risk group of MHD patients with CRBSI with poor prognosis.
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Objective:To construct a double-closed-loop management model for medical equipment and explore its application value in hemodialysis machine maintenance and fault management.Methods:Based on the closed-loop management of clinical operation of medical equipment and the closed-loop management of technical support,a dual closed-loop management model of equipment was constructed.65 hemodialysis machines in clinical use in Huashan Hospital Fudan University from January 2021 to January 2023 were selected and divided into a conventional mode and double-closed-loop mode according to different management modes.The conventional mode adopted conventional equipment management methods,and the double-closed-loop mode adopted a double-closed-loop management model.The cost-effectiveness,social benefit,failure occurrence,effective management quality matters,disinfection status,average patient waiting time and satisfaction were compared between the two groups.Results:The hemodialysis machine operating profit growth rate,diagnosis and treatment cost growth rate,service life index,scientific research service growth rate,diagnosis and treatment service growth rate,startup rate and operation rate of the double-closed-loop mode were(3.95±1.04)%,(3.80±0.58)%,(1.58±0.31)%,(4.30±0.95)%,(7.91±1.58)%,(96.58±2.76)%and(89.90±5.58)%,which were higher than those of the Conventional mode,the difference was statistically significant(t=5.418,10.070,7.490,17.570,11.820,8.849,6.840,P<0.05).The technical support expenses growth rate,bacterial colony count,bacterial endotoxin content and average patient waiting time of patients in the Double-closed-loop mode were(2.60±0.33)%,(0.370±0.008)cfu/ml,(0.0063±0.0011)EU/ml and(0.76±0.13)h,which were less than those of the conventional mode,the difference was statistically significant(t=23.040,82.985,14.482,19.530,P<0.05).The incidence rate of hemodialysis machine failure in the double-closed-loop mode was 9.23%(6/65),which was lower than that in the conventional mode,the difference was statistically significant(x2=6.392,P<0.05);among the 120 items of management data collected,quality control testing,maintenance and repair,clinical operation,information data,and scrap processing effectiveness rates were 95.83%(115/120),89.17%(107/120),96.67%(116/120),95.00%(114/120),and 97.50%(117/120),respectively,which were higher than those of the conventional mode,the difference was statistically significant(x2=15.238,16.596,9.808,15.585,16.119,P<0.05).Conclusion:The application of closed-loop management model to hemodialysis machine maintenance and fault management can effectively improve equipment cost-effectiveness,social benefits,management quality and patient satisfaction,and reduce the incidence of faults.
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Objective:To establish a total normalized productive maintenance(TnPM)model for medical equipment,and to explore its application value in the management of multi-source treatment equipment.Methods:In accordance with the principles of self-management,economic efficiency and dynamic improvement,the TnPM management mode of the medical equipment lifecycle management system was developed.22 multi-source treatment equipment in clinical use in the of department of burn and plastic surgery of The Second Affiliated Hospital of Air Force Medical University were selected and divided into a control group(16 units)and an observation group(18 units,including 12 of control group and 6 newly added units)according to different management modes.The control group implemented the traditional management mode,and the observation group adopted TnPM management mode.The operation quality,comprehensive efficiency and team management capabilities of the two groups were compared.Results:The equipment failure rate of the observation group was(4.82±0.21)%,which was lower than that of traditional group,the self-repair rate,maintenance rate and operating standard rate were(91.63±3.59)%,(96.60±2.47)%and(97.31±1.54)%,respectively,which were higher than those of the control group,the difference was statistically significant(t=2.434,5.246,4.525,5.311,P<0.05).The equipment availability rate,performance index and quality index of the observation group were(90.82±2.78)%,(97.03±2.24)%and(97.85±1.26)%,respectively,which were higher than those of control group,the difference was statistically significant(t=6.231,4.671,5.997,P<0.05).The assessment scores of the personnel involved in the equipment on job responsibilities,basic equipment theory,usage assurance level and management performance of observation group were(93.95±2.81)points,(91.45±2.47)points,(90.75±2.54)points and(93.08±3.34)%,respectively,which higher than those of the control group,the difference was statistically significant(t=2.831,3.979,6.472,4.001,P<0.05).Conclusion:The TnPM management mode can improve the operation quality of equipment in the treatment of clinical patients,reduce the incidence of failure,enhance the comprehensive efficiency of equipment and clinical service level,and promote the construction of a management team.
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Objective:To study the application value of refined centralized management combined with scientific preventive maintenance in the standardized management of clinical ventilators.Methods:The ventilator failure information wad collected,a ventilator information management database was established,the refined and centralized management and scientific preventive maintenance measures for ventilators was developed in terms of planning,implementing,and updating the ventilator management system as well as training and assessment.119 ventilators in clinical use in People's Hospital of the Xinjiang Uygur Autonomous Region from 2021 to 2022 were selected,the conventional management mode(referred to as conventional mode,50 units)and the refined centralized management combined with scientific preventive maintenance mode(referred to as joint mode,69 units)were adopted respectively for management.The maintenance status of ventilators in the two modes and the total amount of work in 2021 and 2022 were compared.Results:There were 85 ventilator failures in 2021 and 58 ventilator failures in 2022 in conventional mode.34 ventilator failures in 2021 and 44 ventilator failures in 2022 in joint mode.The number of failures,maintenance time and satisfaction of clinical department with the ventilators of the joint mode in 2021 were(3.25±1.06)times/month,(12.57±10.31)days and(91.50±1.73)% respectively,the number of failures and maintenance time were less than those of conventional mode,satisfaction of clinical department was higher than that of the conventional mode,the difference was statistically significant(t=14.458,2.501,2.563,P<0.05).The number of failures of ventilators of joint mode in 2022 was(3.08±2.02)times/month,which was less than that of conventional mode,the difference was statistically significant(t=4.655,P<0.05).The number of failures,number of times to contact the equipment department,consumable costs,adverse events,and number of terminal disinfections for 119 ventilators of the two modes in 2021 were(10.25±2.34)times/month,(16.75±6.54)times/month,and CNY(44,000±49,300)/month,(2.49±0.92)pieces/month and(382.58±83.67)times/month,which were higher than those in 2022,the equipment completeness rate and frequency of clinical training were(88.27±1.29)% and(3.42±1.51)times/month,respectively,which were lower than those of 2022,the difference was statistically significant(t=5.124,6.103,4.099,7.884,1.980,5.607,3.564,P<0.05).Conclusion:Refined centralized management combined with scientific preventive maintenance can effectively reduce the number of ventilator failures,maintenance time and costs,etc.,and improve the quality of standardized management of clinical ventilators.
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Objective:To build a data-driven operation and maintenance management model for large-scale medical imaging equipment,and to analyze its application value in medical equipment management.Methods:The data-driven operation and maintenance management mode of large-scale medical imaging equipment was composed of operation and maintenance management mode architecture,equipment health status monitoring management platform architecture,historical data fault diagnosis model architecture and operation and maintenance management.16 medical imaging equipment in clinical use in Chengdu Public Health Clinical Medical Center from January 2020 to February 2022 were selected,and the traditional medical imaging equipment operation and maintenance management mode(referred to as traditional mode)and data-driven large-scale medical imaging equipment operation and maintenance management mode(referred to as data-driven mode)were adopted respectively for management according to different management modes.The imaging effect of equipment image,the frequency of equipment failure,the cost effectiveness of equipment and the satisfaction score of equipment management personnel were compared between the two management modes.Results:The scores of accuracy of diagnosis results,accuracy of patient information,image position qualification rate,image clarity,image pass rate,image quality rate and total image imaging score of the data-driven model were(9.78±1.25)points,(9.88±1.11)points,(9.54±1.08)points,(9.66±1.27)points and(9.83±1.43)points,(9.86±1.63)points and(58.55±1.44)points,respectively,which were higher than those in the traditional mode,the difference was statistically significant(t=4.958,5.268,6.522,4.327,9.765,3.923,21.474,P<0.05).The self-repair and human-made failures occurred 22 times and 10 times respectively in the data-driven model,which were lower than those of the traditional model,and 24 times of long-term use faults,which was higher than that of the traditional model,the difference was statistically significant(x2=4.363,4.294,18.692,P<0.05).The satisfaction scores of radiologists,equipment maintenance personnel,imaging technicians and patients with the data-driven mode were(94.52±6.15)points,(91.19±5.35)points,(89.27±4.93)points and(92.24±5.51)points,respectively,which were higher than those of the traditional mode,the difference was statistically significant(t=6.504,5.534,6.821,9.556,P<0.05).Conclusion:The operation and maintenance management mode based on data driven of large medical imaging equipment can improve the imaging quality of imaging equipment,reduce the incidence of failure,reduce equipment maintenance and maintenance costs,and improve user satisfaction.
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Objective:To optimize the preventive maintenance path of electric medical equipment by adopting multi-criteria decision analysis(MCDA),and to verify its optimization effect.Methods:The preventive maintenance paths for electric medical equipment were determined through literature research and management group discussions.An expert meeting was organized to discuss,determine,and demonstrate the preventive maintenance path evaluation criteria,and the weight of the criteria was set.Each preventive maintenance path was scored by experts based on criteria,the score of each maintenance path was calculated using the mean and sorted to form the optimal path.767 electric medical equipment of 7 categories in clinical use in the 960th Hospital of the PLA Joint Logistics Support Force from 2021 to 2022 were selected,conventional preventive maintenance management(referred to as conventional management mode)and preventive maintenance path management optimized by MCDA method(referred to as MCDA management mode)were adopted respectively according to different management modes.The changes in indicators such as failure rate,maintenance time,quality inspection pass rate and maintenance cost of electric medical equipment were compared between the two management models.Results:The failure occurrence rate of electric medical equipment of the MCDA management mode was 8.71%(67/767),which was lower than that of the conventional management mode,the difference was statistically significant(x2=3.960,P<0.05).The equipment maintenance time of the MCDA management mode was(2.24±1.17)days,which was lower than that of the conventional management mode,the difference was statistically significant(t=2.360,P<0.05).The quality inspection qualification rate of the MCDA management model was(96.57±2.74)%,which was higher than that of the conventional management mode,the difference was statistically significant(t=4.342,P<0.05).The average maintenance cost of equipment of the MCDA management model accounted for 2.37%of its assets,which was lower than that of the conventional management mode,the difference was statistically significant(x2=4.261,P<0.05).Conclusion:The MCDA method can provide a quantitative structural model for the optimization of preventive maintenance paths for electric medical equipment,and the optimized preventive maintenance paths can achieve efficient management of electric medical equipment,and focusing on the training of maintenance personnel's technical level can increase the self-repair rate and reduce the failure rate of medical equipment.