目的 探讨实习护士锐器伤发生情况及影响因素，为制订降低实习护士锐器伤政策提供依据。 方法 2012年3月，针对333名临床实习护士进行问卷调查；采用SPSS软件对锐器伤年发生率进行单因素和多因素logistic回归分析。 结果 共322名实习护士完成调查，锐器伤年发生率50.0%，发生频率为1.3次/人年。最近一次发生锐器伤时，仅6.5%上报登记。单因素分析显示，本科生、学校课程未针对预防锐器伤进行培训，临床实习带教老师未进行预防锐器伤培训的实习护士，其锐器伤发生率更高。在临床实习可能接触患者血液和体液的操作中，带手套的频率越高，锐器伤发生率越低；注射完成后，回套针帽的频率越高，锐器伤发生率越高。多因素分析表明，本科实习护士发生锐器伤的风险高于中专或大专实习护士[OR=4.603，95%CI（2.241，9.443）]；注射完成后，回套针帽频率增加，发生锐器伤的风险增加[OR=1.672，95%CI（1.032，2.729）]。 结论 在教学和临床实践过程中，针对实习护士，尤其是本科实习护士，应进一步加强培训，杜绝回套针帽现象；并进一步健全现有锐器伤上报登记制度。
ObjectiveTo investigate nurses' attitude on the reporting of clinical adverse events and analyze its correlated factors in the Emergency Department. MethodsA total of 130 nurses in a class-3 grade-A hospital were recruited in our study by convenience sampling method during November and December 2014. The Chinese version of Reporting of Clinical Adverse Events Scale was applied to assess nurses' attitude on reporting adverse events. ResultsThe nurses' willingness to report adverse events in the Emergency Department was generally low, and the attitude scores of nurses in the triage zone, rescue zone, monitoring zone and observation zone were respectively 65.62±1.16, 65.49±0.58, 65.06±0.80, and 63.20±0.86, without any significant difference among these zones (P>0.05). The attitude scores of nurses with a seniority of 1-2, 3-5, 6-9, and ≥ 10 years were respectively 67.37±3.27, 64.49±3.98, 63.77±4.82, and 64.30±4.52, with significant differences among these seniority groups (P＜0.05). The attitude scores of nurses with a rank of nurse-in-charge, primary nurse, and nurse were respectively 61.25±4.02, 63.97±4.52, and 65.92±4.02, also with significant differences among these groups (P＜0.05). ConclusionsThe willingness of reporting clinical adverse events in emergency nurses is not high. It is necessary to strengthen the training of nurses on their cognition of adverse events and encourage reporting, thus to create a non-punishment hospital security culture.
ObjectiveTo investigate the effectiveness of establishment of chest pain center and optimized process in the diagnostic and treatment progress and short-term prognostic value of acute non-ST segment elevation myocardial infarction (NSTEMI) patients. MethodsThis was a retrospective study. We included NSTEMI patients admitted in the Emergency Department in our hospital, 41 patients admitted before the establishment of the chest pain center (April 2015) were included as group A (30 males and 11 females at age of 64.7±11.8 years), 42 patients after the establishment of the chest pain center (April 2016) as group B (31 males and 11 females at age of 64.6±11.8 years), and 38 patients after the establishment of the chest pain center (April 2017) as group C (30 males and 8 females at age of 62.6±10.0 years). The clinical outcomes of the three groups were compared.ResultsThe time from admission to electrocardiogram was 20.0 (17.0, 25.5) min in the group A, 4.0 (2.8, 5.0) min in the group B, and 3.0 (2.0, 4.0) min in the group C (P<0.001). The first doctor's non-electrocardiogram advice time was 13.0 (10.0, 18.0) min, 9.5 (6.8, 15.3) min, and 9.0 (7.0, 12.0) min (P=0.001) in the three groups, respectively. The diagnostic confirmed time was 139.4±48.5 min, 71.1±51.5 min, 63.9±41.9 min (P<0.001). The proportion of patients receiving emergency dual anti-platelet load dose treatment was 53.1%, 70.0%, 100.0% (P=0.001), respectively. The time of receiving emergency dual anti-platelet load dose treatment was 208.0 (72.0, 529.0) min, 259.0 (91.0, 340.0) min, and 125.0 (86.0, 170.0) min (P=0.044) in the three groups, respectively. Emergency percutaneous coronary artery intervention (PCI) start time was 60.9 (42.1, 95.8) hours, 61.3 (43.3, 92.2) hours, 30.5 (2.8, 44.1) hours (P<0.001) in the three groups, respectively. Among them, the moderate risk patients’ PCI starting time was 63.0 (48.1, 94.2) hours, 62.3 (42.1, 116.2) hours, and 40.1 (17.2, 60.4) hours (P>0.05), respectively. The high risk patients’ PCI starting time was 47.9 (23.7, 102.4) hours, 55.2 (44.0, 89.6) hours, 23.2 (1.7, 41.8) hours in the three groups, respectively (P<0.001). The hospitalization time of the patients was 7.0 (5.4, 9.4) days, 5.9 (4.9, 8.7) days, 4.7 (3.1, 6.2) days in the three groups (P<0.001), respectively. The hospitalization time of the moderate risk patients was 6.9 (4.9, 8.8) days, 6.4 (4.9, 8.0) days, 4.8 (3.2, 6.5) days in the three groups (P>0.05), respectively. The hospitalization time of the high risk patients was 7.1 (5.5, 9.9) days, 5.9 (4.6, 9.8) days, and 4.4 (3.0, 6.1) days, respectively (P<0.001). The fatality rate of inpatients was 4.9%, 0.0%, and 0.0%, respectively (P>0.05). The correlation coefficient of hospitalization time, diagnosis confirmed time and PCI starting time was 0.219 and 0.456 (P<0.05), respectively.ConclusionThe establishment and optimized process of chest pain center can accelerate the time of early diagnosis of NSTEMI, which is helpful to obtain stratified and graded standardized treatment for patients according to their conditions, to accelerate the specific treatment process of high risk NSTEMI patients, and shorten the hospitalization time.
ObjectivesTo explore the predictive value of platelet count at admission for long-term prognosis in patients with type B acute aortic dissection (AAD) undergoing endovascular therapy (EVT). MethodsWe investigated 131 consecutive patients with type B AAD after EVT in West China Hospital of Sichuan University from January to December 2012. The patients’ basic clinical data, blood test results, major adverse cardiovascular events, and in-hospital and out-hospital survival status were collected. According to the tri-sectional quantiles of platelet counts, the patients were divided into three groups. Chi-square test was used to analyze the correlation between platelet count and hospital complications. Kaplan-Meier survival analysis and Cox regression analysis were used to analyze the relationship between platelet count and survival in patients with type B AAD. The primary endpoint was all-cause death. ResultsThe overall in-hospital mortality of the 131 patients was 9.9%, and the mortality was 16.0% by the end of the follow-up, the median length of which was 2.1 years. There were 44 cases in T1 group (platelet count >200×10 9/L), 44 cases in T2 group [platelet count (155–200)×109/L], and 43 cases in T3 group [platelet count ≤155×109/L]. The mortality in T3 group (30.2%) was higher than that in T1 group (4.5%) and T2 group (13.6%) (P=0.004). Kaplan-Meier survival analysis showed that the cumulative survival rate of T3 group was significantly lower than that of T1 group and T2 group (69.8% vs. 95.5%, χ2=10.165, P=0.001; 69.8% vs. 86.4%, χ2=5.174, P=0.037). Cox multivariate analysis showed that age [hazard ratio (HR)=1.043, 95% confidence interval (CI) (1.009, 1.079), P=0.013], heart rate [HR=1.030, 95%CI (1.004, 1.058), P=0.024], and platelet count [HR=6.011, 95%CI (1.319, 27.391), P=0.020] were independent risk factors for mortality. Older age, rapid heart rate, and lower platelet count would increase the risk of death. ConclusionPlatelet count may be an independent factor that affects the prognosis of patients with type B AAD after EVT, and a low platelet count at admission increases the risk of death.
ObjectiveTo explore the predictive value of a simple prediction model for patients with acute myocardial infarction.MethodsClinical data of 280 patients with acute ST-segment elevation myocardial infarction (STEMI) in the Department of Emergence Medicine, West China Hospital of Sichuan University from January 2019 to January 2020 were retrospectively analyzed. The patients were divided into a death group (n=34) and a survival group (n=246).ResultsAge, heart rate, body mass index (BMI), global registry of acute coronary events (GRACE), thrombolysis in myocardial infarction trial (TIMI) score, blood urea nitrogen, serum cystatin C and D-dimer in the survival group were less or lower than those in the death group (P<0.05). Left ventricle ejection fraction and the level of albumin, triglyceride, total cholesterol and low density lipoprotein cholesterol were higher and the incidence of Killip class≥Ⅲ was lower in the survival group compared to the death group (P<0.05). Multivariate logistic regression analysis showed that age, BMI, heart rate, diastolic blood pressure, and systolic blood pressure were independent risk factors for all-cause death in STEMI patients. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve of simple prediction model for predicting death was 0.802, and similar to that of GRACE (0.816). The H-L test showed that the simple model had high accuracy in predicting death (χ2=3.77, P=0.877). Pearson correlation analysis showed that the simple prediction model was significantly correlated with the GRACE (r=0.651, P<0.001) and coronary artery stenosis score (r=0.210, P=0.001).ConclusionThe simple prediction model may be used to predict the hospitalization and long-term outcomes of STEMI patients, which is helpful to stratify high risk patients and to guide treatment.