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Objective:To explore the short-term efficacy and safety of intra-arterial thrombolysis (IAT) in the treatment of retinal artery occlusion (RAO) with the assistance of the rescue green channel in the eye stroke center.Methods:A prospective, interventional, single-center study. Thirty-eight eyes from 38 RAO patients who received IAT treatment in Guangdong Provincial People’s Hospital were enrolled. All the patients were rescued via the green channel in our eye stroke center. Data from comprehensive ocular examinations including best-corrected visual acuity (BCVA) and optical coherence tomography angiography (OCTA) were collected. BCVA was measured with Snellen chart and converted to the logarithmic minimum angle of resolution (logMAR) unit for statistical analysis. RTVue XR OCTA was used to measure vascular densities (VD) of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and radial peripapillary capillary (RPC), and central retinal thickness (CRT). All RAO eyes attempted IAT treatment and 34 eyes were successful. Four eyes failed to complete IAT because of the occlusion of internal or common carotid arteries on the same side with the RAO eyes. Ocular examinations in post-operative 1-3 days were performed with the same devices and methods as those before surgery. Parameters measured before and after surgery include BCVA, VD of SCP, DCP, RPC, and CRT. Data of the green channel collected include the time intervals from onset of RAO to first presentation in local hospitals, and from onset of RAO to our eye stroke center. Comparisons of VD and CRT between the RAO eyes and contralateral healthy eyes were performed with independent samples Mann-Whitney U test; comparisons of VD and CRT in RAO eyes before and after IAT surgery were performed with paired samples Wilcoxon Rank Sum test. Results:Among the 34 RAO patients who had successful IAT surgery, 18 (52.9%, 18/34) were males and 16 (47.1%, 16/34) were females; the mean age was (51.0±12.9) years old. There were 30 and 4 eyes diagnosed as central RAO and branch RAO respectively. The logMAR BCVA before and after IAT surgery was 2.52±0.61 and 2.18±0.85 respectively, and the difference was statistically significant ( Z=-3.453, P=0.002). Before surgery, VD of SCP, DCP and RPC were significantly decreased and CRT was significantly increased in the affected eye compared with the contralateral healthy eyes, with the statistical significance ( P<0.001). Compared with those before surgery, the VD of SCP and DCP were significantly improved after surgery ( Z=-2.523, -2.427; P=0.010, 0.014), while there was no difference in VD of RPC and CRT ( Z=-1.448, -1.454; P=0.150, 0.159). The time interval between onset of RAO and first visit to the hospital was (6.56±6.73) hours; the time interval between onset of RAO and the arrival at our hospital was (24.11±19.90) hours. No cerebral stroke was observed in the early postoperative period and no cerebrocardiovascular events were observed later. he time interval between onset of RAO and the arrival at our hospital was (24.11±19.90) hours. No cerebral stroke was observed in the early postoperative period and no cerebrocardiovascular events were observed later. Conclusions:The short-term efficacy and safety of IAT in the treatment of RAO were satisfactory. The rescue time window might be prolonged.
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Intracerebral hemorrhage is one of the main causes of death and disability in adults, as a common emergency in neurology department. Hematoma expansion is related to early neurological deterioration and poor outcome in patients with intracerebral hemorrhage. Existing studies have not found effective treatment methods in reducing hematoma expansion. The effective time window of intervention should be paid attention to, and anti-expansion treatments, such as antihypertensive, hemostasis therapy and others, should be performed within the effective time window. The establishment of early emergency green channel for intracerebral hemorrhage is of great significance, to shorten the visiting time of patients with intracerebral hemorrhage and implement effective interventions for anti-hematoma within the anti-hematoma expansion treatment time window.
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As one of the four major types of organ transplantation, lung transplantation has been developed rapidly in recent years. With the establishment of Quality Management and Control Center for Lung Transplantation of National Health Commission, the formulation of Technical Management Specifications for Lung Transplantation and Standard Procedures and Technical Specifications for Lung Transplantation and the implementation of a series of measures, the quality and quantity of lung transplantation have been steadily increased in China. It will provide a guarantee for further promoting the development of lung transplantation in China by the establishment and improvement of scientific quality control parameters for clinical application of lung transplantation technology, the formulation of standard procedures and technical specifications for lung transplantation, strengthening the management of standardized training bases for lung transplantation, building up a multidisciplinary lung transplantation team and constructing a complete lung transplantation database.
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Objective@#To explore the effect of optimizing the green channel intravenous thrombolysis process and nursing intervention in the treatment of acute cerebral infarction.@*Methods@#Forty-five patients with acute cerebral infarction admitted to emergency department of Beijing Tiantan Hospital Affiliated to Capital Medical University in 2018 were selected as observation group, and 45 patients with cerebral infarction admitted in 2017 were selected as control group, and treated with traditional process and nursing intervention. Door to needle time (DNT), hospitalization time, Emergency bed turnover rate and National Institute of Health Stroke Scale (NIHSS) scores before and after thrombolysis were compared between the two groups.@*Results@#The DNT time, hospitalization time and emergency bed turnover rate in the control group were (82.82±9.73) min, (11.31±2.96) days and 22.07(1 280/58), respectively, while those in the observation group were (37.62±8.40) min, (7.33±1.16) days and 31.93(1 852/58), respectively. There were significant differences between the two groups (t=25.526, 8.926, χ2=10.526, P < 0.01 or 0.05). There was no significant difference in NIHSS scores between the two groups at admission (P > 0.05); the NIHSS score of the observation group at discharge was 3.13±2.00, which was significantly lower than that of the control group (7.33 ± 1.95), and the difference was statistically significant (t=8.469, P < 0.05).@*Conclusion@#The cure rate of patients with acute cerebral infarction is closely related to the timeliness of treatment. The establishment of fast green channel can not miss the best opportunity for patients, but also help to promote the recovery of nerve function, so as to achieve the effect of improving the cure rate of patients.
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Stroke is the first cause of death in China, with high disability and causing serious economic burden to the society and families. Moreover it is one of the most important reasons for returning to poverty due to illness. Investigation shows that the awareness of active treatment and control for various risk factors of cerebrovascular disease is increasing in China. With the development of stroke diagnosis and treatment technology, the mortality of patients with severe stroke is reducing. However, there is still a long way to go to curb the rapid increase of stroke incidence and to reduce the mortality of stroke.
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Objective To investigate the effect of limitation in flow of people on medical care quality in emergency resuscitation room (ERR).Methods This study was retrospectively performed to compare emergency medical quality before and after (October to December,2015 vs.February to April,2016) limitation of flow of people in ERR.Variables included noise level,occupational exposure,adverse event,hospital-acquired infection,length of stay (LOS) in ERR,mortality rate,return of spontaneous circulation (ROSC) rate after cardiopulmonary resuscitation (CPR),the rate of unexpected return to ERR,door to drug and door to balloon time for patients with ST-segment elevated myocardial infarction (STEMI),patients' and emergency personnels' satisfaction level.The data were analyzed with t-test,chi-square test or Poisson Z test where appropriate.Results There were 5 031 and 5 097 patients respectively admitted in ERR before and after limitation of flow of people.Patients' main diagnoses and severity of illness between the two periods had no significantly difference (P＞0.05).After the limitation of flow of people,the noise level in ERR was lowered (P＜0.01),the numbers of occupational exposure events (14 cases vs.4 cases,Z=2.357,P=0.018) and adverse events (18 cases vs.5 cases,Z=2.711,P=0.007) were decreased,the rate of hospital-acquired infection was reduced (1.1％ vs.0.5％,x2=8.111,P=0.004),the LOS in ERR was shortened [(6.3±0.8) h vs.(4.6±0.6) h,t=121.083,P＜0.01],the door to balloon time for STEMI patients was also decreased [(91.2±12.8) min vs.(89.3±8.0) min,t=2.486,P=0.013].Moreover,patients' and emergency personnels' satisfaction level were elevated.No significant difference was observed in mortality rate,ROSC rate,rate of unexpected return to ERR and door to drug time for STEMI patients.Conclusions The limitation of flow of people in ERR can lower the noise level,reduce emergency personnels' working pressure,improve their working efficiency,avoid medical errors,elevate patients' and emergency personnels' satisfaction level.
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Objective To explore the application effectiveness of medical team resource management model in the first aid green channel of acute ischemic stroke (AIS). Methods A total of 215 patients with acute ischemic stroke who underwent intravenous thrombolysis were enrolled from November 2015 to October 2017 as an observation group.The observation group adopted AIS first aid green channel based on medical team resource management mode.A total of 61 patients with acute ischemic stroke who underwent intravenous thrombolysis were enrolled from November 2013 to October 2015 as a control group.The control group adopted three districts and four treatment procedures.The time course of intravenous thrombolysis was compared between the two groups and to compare the satisfaction of the two groups with different AIS procedures. Results Application of medical team resource management model to establish a dedicated first aid green channel, the key links were significantly shortened,Door-to-Needle Time (DNT) decreased from (114.84 ± 8.05) minutes prior to establishment to (57.63 ± 6.30) minutes, the difference was statistically significant (t=51.263, P<0.05), the satisfaction degree of the medical staff was improved,the overall satisfaction increased from (2.86 ± 0.20) before establishment to (4.27 ± 0.20) points, the difference was statistically significant (t=-34.368,P<0.05).Conclusions The medical team resource management model applied to the treatment of AIS patients, the establishment of multidisciplinary integration of first aid green channel, to strengthen the team to effectively improve the timeliness of the key aspects of intravenous thrombolysis, shorten DNT, improve the quality of treatment of patients.
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Objective To explore the short-term efficacy of green channel surgery for hip fractures in the elderly patients.Methods A retrospective study was conducted of the 128 elderly patients with hip fracture who had been operatively treated at Department of Orthopaedics,The First People's Hospital of Beijing Fangshan from January 2015 to September 2017.They were 44 men and 84 women,aged from 65 to 91 years (average,75.5 years).The interval from injury to surgery ranged from 24 to 48 hours for the green channel group of 63 cases but exceeded 48 hours for the non-green channel group of 65 cases.The 2 groups were compared in terms of complications during hospitalization,mortality 3 months after operation and good to excellent rate of hip function.Results The 2 groups were compatible due to insignificant differences in age,gender,internal disease upon admission or fracture type (P ＞ 0.05).All the patients were followed up for 0.5 to 3.0 months (average,2.7 months).The total incidence of complications during hospitalization,and incidences of hypostatic pneumonia,acute cardiac and cerebrovascular accidents and venous thromboembolism were all significantly lower in the green channel group than in the non-green channel group (P ＜0.05).There were no significant differences between the 2 groups in terms of in delirium,sudden death,pressure sore,postoperative urinary infection,or mortality 3 months after operation (P ＞ 0.05).No wound infection or pulmonary embolism was observed in either group.According to the scoring system for hip functions modified by Li Zirong,the good to excellent rate was 76.6％ in the green channel group (36/47) and 68.6％ (35/51) in the non-green channel group,showing no significant difference between the 2 groups (P ＞0.05).Conclusions Establishment of green channel surgery and multidisciplinary collaboration can significantly reduce incidence of postoperative complications.Its effect on the mid-and long-term mortality in these patients needs further observation.
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Objective To observe the application of the Green channel in the treatment of elderly patients with hip fracture, so as to provide a reference for the standardized treatment. Methods We retrospectively analyzed the clinical data of 115 elderly patients (≥75 years) with hip fractures treated in hospital from Jun. 2014 to Jun. 2015. The patients were treated through the Green channel (Green channel group, n=58) or received conventional treatment (normal group, n=57). The waiting time for operation, operation time, bleeding volume, hospital stay, and postoperative systemic and local complications during hospitalization were compared between the two groups. Results The waiting time for operation of patients in the Green channel group (median 43.6 h) was significantly shorter than that in the normal group (median 136.8 h, P0.05). The incidence of complications of patients in the Green channel group (11/58, 19.0%) was significantly higher than that in the normal group (29/57, 50.9%; P< 0.01). The incidences of pulmonary infection and pressure sores of patients in the Green channel group were significantly lower than those in the normal group (3.4% [2/58] vs 14.0% [8/57], P<0.05; 3.4% [2/58] vs 15.8% [9/57], P<0.05). There was no significant difference in the incidences of pulmonary embolism, cerebral infarction, deep vein thrombosis, myocardial infarction, or incision infection between the two groups. Conclusion Application of the Green channel in the treatment of elderly patients with hip fracture can allow early surgery under suitable conditions, which is conducive to reduce hospital stay and postoperative complications, and can promote the recovery of hip function, indicating that the Green channel has an important significance for standardized treatment of eldery patients with hip fractures.
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Objective To observe the change of door-to-needle time(DNT)and the intravenous thrombolysis rate by recombi-nant tissue plasminogen activator(rt-PA)in the patients with acute ischemic stroke (AIS)after establishing and perfecting the stroke green channel in our hospital.Methods A total of 3 990 patients with AIS in our hospital since 2010 were screened for the statistics on the number of the patients within the time window every year,conducting the analysis on the change trend of the annu-al intravenous thrombolysis rate and DNT.The change situation of DNT and the annual intravenous thrombolysis rate change were compared before the establishment of the stroke green channel and after the establishment and the continuous improvement of the stroke green channel.Results The proportion of AIS patients within the time window in our hospital was significantly lower than that in the domestic developed regions.The intravenous thrombolysis rate by rt-PA achieved the zero breakthrough since the estab-lishment of the stroke green channel in 2011.Along with the continuous improvement of the stroke green channel,the DNT median of the patients within the time window was reduced to 60 min in 2012 and 53.5 min in 2013,moreover the intravenous thrombolysis rate by rt-PA in the patients within the time window was increased from 0 in 2010 to 74.3% in 2013.Conclusion By gradually per-fecting the process of the stroke green channel and strengthening the cooperation of emergency,clinical laboratory and stroke team, DNT is reduced by a large margin and the intravenous thrombolysis rate is substantially increased,which indicates that establishing the perfecting and smooth stroke green channel in the serious pre-hospital delay areas is a necessary measure for increasing the in-travenous thrombolysis rate.
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Objective Acute poisoning is frequently encountered at emergency department. This study was to investigate the epidemiology and characteristics of patients with acute poisoning who were treated at the Emergency Center, Fujian Provincial Hospital, China. Method We retrospectively analyzed the gender, age, causes of poisoning, types of poisons, poisoning route, emergency diagnoses, outcomes, and prognoses of these patients.Results Altogether 2867 patients with acute poisoning were treated from January 2004 to December 2009. The ratween 18 and 40 years old. The incidence of acute poisoning was as high as 11.33% in January each year. The incidence of poisoning was in a descending order: alcohol poisoning (54.55%), medication poisoning (25.95%), pesticide poisoning (5.65%), and drug poisoning (4.88%). Most (56.44%) of the patients with drug poisoning were under 25 years and their mean age was significantly lower than that of patients with medication poisoning or alcohol poisoning ( P ＜ 0.01 ). Approximately 69.54% of the patients were followed up after emergency treatment, 30.39% were hospitalized, and four patients died. Conclusions Acute poisoning is largely alcohol poisoning and medication poisoning in a city. The emergency green channel "pre-hospital emergency care-emergency department-hospital treatment" can significantly improve the survival rate of patients with acute poisoning.
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BACKGROUND:Acute poisoning is frequently encountered at emergency department. This study was to investigate the epidemiology and characteristics of patients with acute poisoning who were treated at the Emergency Center, Fujian Provincial Hospital, China. METHODS:We retrospectively analyzed the gender, age, causes of poisoning, types of poisons, poisoning route, emergency diagnoses, outcomes, and prognoses of these patients. RESULTS:Altogether 2867 patients with acute poisoning were treated from January 2004 to December 2009. The ratio of male to female was 1:1.04, and their average age was 33.8 years. Of the 2867 patients, 76.39％ were between 18 and 40 years old. The incidence of acute poisoning was as high as 11.33％ in January each year. The incidence of poisoning was in a descending order:alcohol poisoning (54.55％), medication poisoning (25.95％), pesticide poisoning (5.65％), and drug poisoning (4.88％). Most (56.44％) of the patients with drug poisoning were under 25 years and their mean age was significantly lower than that of patients with medication poisoning or alcohol poisoning (P < 0.01). Approximately 69.54％ of the patients were followed up after emergency treatment, 30.39％ were hospitalized, and four patients died. CONCLUSIONS:Acute poisoning is largely alcohol poisoning and medication poisoning in a city. The emergency green channel "pre-hospital emergency care-emergency department-hospital treatment"can significantly improve the survival rate of patients with acute poisoning.