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AIMS: Trauma is the fifth-leading cause of death in China. Despite the establishment of the Chinese Regional Trauma Care System (CRTCS) in 2016, advanced trauma nurse practice has not been incorporated. This study aimed to identify the roles and responsibilities of trauma advanced practice nurse (APN), and to investigate the impact on patient outcomes in a Level I regional trauma centre in mainland China. DESIGN: A single-centre pre- and post-control design was used. METHODS: The trauma APN programme was established based on multidisciplinary experts' consultation. A retrospective study was conducted on all Level I trauma patients over a period of 5 years, spanning from January 2017 to December 2021, with a sample size of 2420. The data were divided into two comparison groups: a pre-APN programme (January 2017-December 2018; n = 1112) and post-APN programme (January 2020-December 2021; n = 1308). A comparison analysis was conducted to evaluate the effectiveness of trauma APN who were integrated into the trauma care team, with a focus on patient outcomes and time-efficiency indicators. RESULTS: The certification of the regional Level I trauma centre resulted in a 17.63% increase in the number of trauma patients. The integration of advanced practice nurses (APN) into the trauma care system led to significant improvements in time-efficiency indicators, with the exception of advanced airway establishment time (p < 0.05). The average emergency department length of stay (LOS) decreased 21%, from 168 to 132 min (p < 0.001); additionally, the mean intensive care unit LOS decreased by nearly 1 day (p = 0.028). Trauma patients who were treated by trauma APN had a higher likelihood of survival, with an odds ratio of 1.816 (95%CI: 1.041, 3.167; p = 0.033), compared to patients who received care prior to the implementation of the trauma APN program. CONCLUSION: A trauma APN programme has the potential to enhance the quality of trauma care in the CRTCS. IMPACT: This study elucidates the roles and responsibilities of trauma advanced practice nurses (APN) in a Level I regional trauma centre in mainland China. Trauma care quality was significantly improved after the application of a trauma APN programme. In regions with inadequate medical resources, the utilization of advanced practice trauma nurses can enhance the quality of trauma care. In addition, trauma APN can provide a trauma nursing education programme within the regional centres as a strategy to augment the proficiency of regional trauma nursing. No patient or public contribution, the research data all from trauma data bank.
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To summarize the emergency nursing experience of a patient with extremely severe burns and inhalation injury who developed laryngospasm when establishing an artificial airway.Nursing points include:identification and treatment of complications during artificial airway establishment for high-risk airway patients,and elimination of the risk factors of airway spasm in patients.Conduction of early sedation and awakening,the use of simple communication methods,and the conduction of off-line respiratory assessment and training.The use of active warming measures,and paying attention to fluid resuscitation and body temperature management of burn patients.Trauma team manages the whole process to shorten the emergency stay time of extremely severe burn patients.After 44 days of active treatment and meticulous nursing care,the patient was successfully treated and discharged from the hospital.
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Objective In order to improve the"high-dose blood transfusion procedure",shorten the preparation time for blood transfusion in patients with clinical traumatic hemorrhagic shock,and improve the outcome of patients.Methods Patients with emergency traumatic hemorrhagic shock from January to December 2021 were selected as the study subjects.Patients who received improved high-dose transfusion procedures from July to December were selected as the experimental group,and patients who received conventional transfusion procedures from January to June were selected as the control group.The timeliness indexes and outcome indexes of the 2 groups were compared.Results The delivery time for blood type and routine examination was shortened from 15 min to 8 min(U=143.50,P=0.024);transfusion preparation time was shortened from 31 min to 19 min(U=126.50,P=0.026);the time for decision-making blood preparation was shortened from 44 min to 18 min(U=152.50,P=0.007);emergency stay time was shortened from 135 min to 114 min(U=91.50,P=0.036);the outcome distribution of patients(x2=10.64,P=0.031)was improved.Conclusion The improved high-dose blood transfusion procedure can significantly shorten the blood transfusion preparation time for patients with traumatic hemorrhagic shock and improve the treatment rate of patients.
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Objective:To summarize the relevant evidence for the management of fixation in traumatic spinal cord injury patients, which provides a reference for the clinical care and care of patients.Methods:A systematic search was conducted for evidence related to spinal injuries from domestic and foreign databases, relevant guideline websites, etc. The types of literature were best practice, expert consensus, systematic review, evidence summary, clinical decision-making, etc. The search time was from the establishment of databases to January 31, 2022. Three researchers used the Multidimensional Systematic Review Tool to evaluate systematic review literature. Five researchers used the guideline research and evaluation tool AGREE Ⅱ to evaluate clinical practice guidelines, and used the Australian JBI Evidence-Based Health Care Center (2016) to evaluate expert consensus and expert opinion with the authenticity evaluation tool for expert opinions and professional consensus articles. And extracted and summarized evidence according to the subject.Results:Finally, 10 articles were included, including 4 clinical decision-making, 4 guidelines and 2 systematic evaluations. The 30 pieces of evidence include the assessment, prevention, cervical spinal fixation, and management after traumatic spinal cord injury.Conclusions:The evidence emphasizes the importance of standardized assessment of cervical risk factors in all emergency adult patients with traumatic spinal cord injury. In the emergency department, we need to improve the ability of spinal evaluation and fixation in patients with penetrating neck injury, optimize the timeliness process of emergency trauma, reduce the occurrence of potential complications, and improve patient outcomes.
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Objective To produce a plastic ampoule with an opening that fits syringe adapters to allow solutions to be drawn up without needles (to avoid needle stick and sharps injuries) and to test the effectiveness of the new design in terms of residual fluid volume and risk of microorganism contamination. Methods Evaluation study based on laboratory research was adopted. For the experimental group, 30 ampoules based on the new design were produced by 3D printing. The ampoules were sterilized and filled with 2 ml sterile water. The sterile water was drawn up without the use of needles, and the wastage fluid (i.e., 2 ml minus the quantity drawn up) was calculated. A 1 ml aliquot of sterile water from each ampoule was dropped onto a nutrient agar plate, and the number of colony-forming units was assessed after 48 h. For each ampoule, the experiment was performed twice. Sixty 2 ml glass-packaged sterile water injections constituted the control group. The fluid was drawn up with a needle, and the superfluous fluid and number of colony-forming units were assessed, as in the experimental group. Results The mean wastage fluid was 0.06 ml, 95% CI was 0.05-0.07 ml in the experimental group and the superfluous fluid was 0.06 ml, 95% CI was 0.06-0.07 ml in the control group, there was no significant difference between the two groups (Z=-1.194, P=0.233). The number of colony-forming units was 8 in the experimental group and 4 in the control group, there was no significant difference between the two groups (P=0.224). Conclusions The newly designed plastic ampoule opening could help health workers to avoid needle stick and sharps injuries when drawing up solution. The wastage fluid and microorganism contamination levels met the required standards, indicating that the new design is suitable for clinical application.
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Objective To prepare berberine chitosan sustained-release tablets and to study the in vitro release characteristics. Methods The chitosan sustained-release tablets were prepared by chitosan as the skeleton material,and the drug release rate of berberine hydrochloride at different time was determined by high performance liquid chromatography. Results The in vitro cumulative release of berberine chitosan sustained-release tablets was increased with time.Furthermore,it can sustain for 24 h and the accumulative release was above 95%, the dissolution time of 63. 2% of the drug was 12. 63 h. Artificial gastric juice had the best performance on the dissolution of berberine,while rotations only influenced the dissolution at the beginning of drug release. Conclusion This method is convenient, accurate and reproducible.Berberine chitosan sustained-release tablets have further development and application value.
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Objective To prepare berberine chitosan sustained-release tablets and to study the in vitro release characteristics. Methods The chitosan sustained-release tablets were prepared by chitosan as the skeleton material,and the drug release rate of berberine hydrochloride at different time was determined by high performance liquid chromatography. Results The in vitro cumulative release of berberine chitosan sustained-release tablets was increased with time.Furthermore,it can sustain for 24 h and the accumulative release was above 95%, the dissolution time of 63. 2% of the drug was 12. 63 h. Artificial gastric juice had the best performance on the dissolution of berberine,while rotations only influenced the dissolution at the beginning of drug release. Conclusion This method is convenient, accurate and reproducible.Berberine chitosan sustained-release tablets have further development and application value.
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Objective To select polyethylenimine polymer with proper molecular weight to enhance the gene expression efficiency of Adenovirus (Ad).Methods Ad was resepcitively complexed with PEI-600,PEI-1 800 and PEI 25 000 by electrostatic adsorption.Afterwards,MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) assay was used to investigate the cytotoxicity of the complexes with a serial concentration,followed by cell transduction assay to select the best amount of PEI with fixed dose of Ad.In the further,the physicochemical characteristics of the optimized complexes,Zeta potential,and size distribution were studied.Results MTT showed the higher the PEI moderate molecular weight was,the greater the cytotoxity was.PEI-25 000 showed a greater cytotoxicity than that of PEI-600 and PEI-1 800.As compared with PEI-600 and PEI-25 000,PEI-1 800 significanlty promoted expression of Ad gene in A549 cells.PEI turned the Zeta potential of Ad from negative to positive charge.Conclusion In the three kinds of polymer/adenovirus compounds,the cytotoxicity of the compound is positively correlated with the polymer molecular weight and concentration.The greater molecular weight the polymer as well as the higher the concentration are,the higher the cytotoxicity is.
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Objective To evaluate the clinical value of contrast-enhanced ultrasound (CEUS) in preoperative diagnosis of anal fistula. Methods Forty-five patients with fistula in ano were evaluated by physical examination, then CEUS were peformed by injecting SonoVue through the external opening to enhance the detection of the fistulous track and the internal opening. The results of CEUS were matched with surgical features to establish their accuracy in preoperative assessment of anal fistula. Results Simple typing fistula was found in 19 of 45 patients and 26 patients had complex fistulas. The accurate diagnostic rates by conventional ultrasound of simple typing fistula and complex fistulas were 89. 5% and 61.5%,respectively,the accurate diagnostic rates by CEUS of simple typing fistula and complex fistulas were 94. 7% and 92.3%, respectively, there was no significant difference between conventional ultrasound and CEUS about simple typing fistula( P ＞0.05), and there was significant difference about complex fistulas ( P ＜0. 05). Conclusions CEUS has a good visibility and accurate rate for diagnosis of anal fistula,It plays an important role for operation.