Objective To survey the knowledge of hand hygiene among nurses and to identify factors influencing the performance of hand hygiene.Methods A questionnaire of hand hygiene developed according to the Guideline for Hand Hygiene in Health Care Settings was used to investigate nurses’ knowledge about hand hygiene.Results The average score for nurses’ knowledge about hand hygiene was 18.59±2.19 out of a possible maximum score of 21. Knowledge about hand hygiene among nurses varied significantly in different departments (P=0.004). The main self-reported factors influencing the performance of hand hygiene were irritation and dryness caused by hand-washing agents (73.44%) and busy workload (65.53%).Conclusions Nurses generally have good knowledge about hand hygiene but are less aware of some hand hygiene indications. Effective measures are needed to improve compliance with hand hygiene among nurses.
Objective To summarize the clinical characteristics of patients with diffuse parenchymal lung disease (DPLD) combined with hematological diseases in order to improve the clinicians’ knowledge of these diseases. Methods The clinical data of 46 patients was collected, who were hospitalized in Nanjing Drum Tower Hospital from January 2010 to October 2020 for DPLD combined with hematological diseases. Their clinical manifestations, laboratory tests, imaging features, diagnostic methods, treatment and prognosis were analyzed retrospectively. Results Among the 46 patients, there were 26 males and 20 females, with an average age of 60±13 years old. The main symptoms were cough and sputum, dyspnea, fever, chest tightness, and so on. Laboratory tests showed that some patients had pancytopenia or two-line cytopenia, and increase in lactate dehydrogenase, C-reactive protein, erythrocyte sedimentation rate and β2-microglobulin. Bilateral ground glass opacity, consolidations, big or small nodules, reticular shadows, and traction bronchiectasis were showed on chest high-resolution computed tomography. Among the 13 patients who were diagnosed clearly by pathology, they had 5 cases of organizing pneumonia, 4 cases of pulmonary alveolar proteinosis, 2 cases of acute fibrinous and organizing pneumonia, 1 case of diffuse alveolar hemorrhage, and 1 case of lung amyloidosis. Thirty-three patients were clinically diagnosed, including 3-case drug-induced interstitial lung disease, and 1-case exogenous allergic alveolitis. The patients with diffuse pulmonary lesions as the first manifestation and subsequently diagnosed with hematological diseases accounted for 65.2% (30/46). Among these patients, 2 of them had two kinds of hematological diseases at the same time. In the rest of the 16 cases, hematological diseases were diagnosed before DPLD. Among the 46 cases, 26 patients improved after treatment, 18 of them were treated with glucocorticoid, 8 with N-acetylcysteine and pirfenidone, 4 with granulocyte-macrophage colony stimulating factor inhaling and/ or whole lung alveolar lavage, and 2 with clarithromycin for immune regulation, etc. Fifteen patients refused treatment and transferred back to local hospital after the diagnosis of hematological diseases. Five patients died, 2 of them died of respiratory failure and 3 of them died of diseases progression. Conclusions DPLD includes many kinds of diseases, with known or unknown etiology and lack of specificity in clinical manifestations. Therefore, diagnosis for them is quite difficult. Hematological diseases themselves can be the causes of DPLD. At the same time, the treatment for hematological diseases and the related immunosuppression after treatment can also cause DPLD. In the clinical practice, careful screening and systematic differentiation are urgently needed in order to treat different causes precisely, control the conditions and improve the prognosis.
ObjectiveTo conduct a scoping review of studies on the application of knowledge mapping in the field of rare diseases at home and abroad, in order to clarify the content and status of application and provide references for future research in this field. MethodsRelevant studies in PubMed, Web of Science, Embase, MEDLINE, CNKI, WanFang Data, VIP, and CBM databases were searched, using the Joanna Briggs Institute Scoping Review Guidelines in Australia as the methodological framework, and the search time frame was from the establishment of the database to June 1, 2023. ResultsTwenty-five papers were included, and the main applications of knowledge graphs in the field of rare diseases were knowledge management, assisted diagnosis, drug repositioning and decision support, involving techniques such as knowledge representation, knowledge extraction, knowledge reasoning, knowledge fusion and knowledge storage.ConclusionKnowledge graphs have shown positive results in fusing and exploiting multi-source information, aiding disease prediction and diagnosis and drug development, but further technical improvements are needed.
Objective To evaluate diagnostic accuracy of several relevant cut-off points of Montreal cognitive assessment (MoCA) for mild cognitive impairment (MCI) in Chinese middle-aged adults. Methods Databases including PubMed, EMbase, Web of Science, The Cochrane Library (Issue 5, 2016), OVID, CBM, CNKI, VIP, WanFang Data were searched for diagnostic tests about MoCA for MCI from April 9th 2005 to December 31st 2015. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality by QUADAS-2 tool. Then, meta-analysis was performed by Stata 14.0 software. Results A total of 27 studies involving 5 755 participants were included with mean ages from 60 to 80 years old. Among them, 1 997 were diagnosed as MCI patients by Petersen criteria. Based on maximal area under the ROC curve as well as optimal pooled sensitivity and specificity, the optimal cutoff value of MoCA was 25/26, the pooled sensitivity was 0.96 with 95%CI 0.93 to 0.97, specificity was 0.83 with 95%CI 0.75 to 0.89, and DOR was 107 with 95%CI 61 to 188. The subgroup analysis with different research designs, different sources of study participants and different MoCA versions all indicated 25/26 as an optimal cut-off value. Conclusion The optimal cutoff value of MoCA in Chinese middle-aged adults for screening MCI by Petersen criteria was 25/26.
Objective To investigate the clinical features and risk factors of diabetic foot. Methods A total of 100 patients with diabetic foot and 158 diabetic patients without diabetic foot were selected from April 2012 to May 2015 in Meishan Hospital of Traditional Chinese Medicine. Clinical data of the patients in the two groups was comparatively analyzed. Multiple logistic regression analysis was used to explore the risk factors. Results The age, duration of diabetes, incidences of complications, count of white blood cells, level of fibrinogen, level of high-sensitivity C-reactive protein (hs-CRP) and level of glycated hemoglobin (HbA1c) in diabetic foot group were significantly higher than those in non-diabetic foot group (P<0.05), while the ankle-brachial index, level of hemoglobin and level of albumin in diabetic foot group were significantly lower than those in non-diabetic foot group (P<0.05). The independent risk factors of diabetic foot were Wanger grade, age, ankle-brachial index, hs-CRP, albumin and HbA1c (P<0.05). HbA1c and hs-CRP level were independent risk factors of disease severity in patients with diabetic foot; the difference of prognosis in patients with different Wanger grading was statistically significant (Z=–4.394, P<0.001). Conclusions The risk of diabetic foot in diabetic patients increases with older age, the more serious Wanger grade, the higher hs-CRP and HbA1c level, and the lower ankle-brachial index and albumin level. Taking precautions based on the patient’s situation is conducive to early prevention of amputation in diabetic patients with diabetic foot.
ObjectiveTo systematically review the prevalence of elder abuse in China.MethodsPubMed, EMbase, Web of Science, CNKI, VIP and WanFang Data databases were electronically searched to collect cross-sectional studies on the prevalence of elder abuse in China from inception to June 2019. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies; then, meta-analysis was performed by R 3.5.1 software.ResultsA total of 11 cross-sectional studies involving 23 020 subjects were included. The results of meta-analysis showed that the prevalence of abuse among the elderly in China was 20.29% (95%CI 12.9% to 28.9%). The highest prevalence of elder abuse subtype was psychological abuse with 15.06% (95%CI 10.2% to 20.6%). The prevalence rates were 20.1% in male and 23.64% in female. The prevalence rates in individuals aged between 60 to 70, 70 to 80 and above 80 were 19.76%, 22.24% and 29.19%, respectively. Illiterates and non-illiterates were 29.39% and 22.52% respectively. Normal marital status was 28.24%, and abnormal status was 31.38%. The elderly living alone was the highest (50.67%), compared with family residents (39.42%) and elderly living in pension institutions (29.94%). The elderly without chronic diseases (16.05%) was lower than elderly with chronic diseases (25.49%), and elderly having normal capability of daily living (26.89%) was lower than elderly having reduced capability of daily living (48.78%). Urban residents were 18.46%, while rural residents were 19.69%.ConclusionsThere is a high incidence of elder abuse in China, and it tends to increase with the increase of age. There are certain differences in the prevalence of elder maltreatment among different genders, ages, educational levels, marital status, living forms and spaces, and health conditions. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.
ObjectivesTo compare the clinical features of combined pulmonary fibrosis and emphysema (CPFE) and idiopathic pulmonary fibrosis (IPF).MethodsEighty-three patients diagnosed as CPFE or IPF for the first time were retrospectively analyzed from June 2014 to July 2018 in Nanjing Drum Tower Hospital, including 47 patients in the CPFE group and 36 in the IPF group. The demographic characteristics, clinical manifestations, pulmonary function, cardiac ultrasound, blood gas analysis and prognosis of the two groups were compared.ResultsThe proportion of smokers in the CPFE group was higher than IPF group (P<0.05), but dyspnea was lower (P<0.05). The FVC, FVC%pred, FEV1, FEV1%pred and VC% of the CPFE group were higher than IPF group (P<0.05), while FEV1/FVC%pred in the IPF group was higher than CPFE group (P<0.05). DLCO/VA%pred of CPFE group decreased more significantly than IPF group (P<0.05), RV/TLC%pred of CPFE group increased annually, while decreased annually in IPF group (P<0.01). The RV%pred of CPFE increased annually, while that of IPF group decreased annually (P<0.05). There was no significant difference in arterial oxygen pressure and pulmonary artery pressure between the two groups. As for prognosis, the 1- and 3-year survival rate of the CPFE group were 87.9% and 73.8% respectively, those of the IPF group were 84.1% and 65.8% respectively, and no significantly difference was observed between two groups (P=0.95).ConclusionsCompared with IPF, patients with CPFE usually have more smokers, less proportion of dyspnea, almost normal lung volume, more rapidly decreased DLCO/VA%pred, and no significant difference in prognosis.
ObjectiveTo improve the understanding of psittacosis, the clinical data of 8 cases are reviewed. The application of pathogen metagenomics next-generation sequencing (mNGS) in the diagnosis of nocardiosis is also investigated.MethodsThe clinical data of eight patients with psittacosis diagnosed by mNGS in Nanjing Drum Tower Hospital from January 2018 to May 2020 were reviewed. The clinical characteristics, laboratory examination characteristics and imaging changes were analyzed, and the treatment outcome was followed-up.ResultsAmong the eight cases, there were six males and two females, aged 43～83 years old, with an average age of 64±12 years old. Six of them had a clear history of poultry exposure. The major clinical manifestations were fever, cough, dyspnea, etc. Chest high-resolution computed tomography (HRCT) may have solid shadow, ground glass like shadow. Chlamydia psittaci was detected by mNGS in eight patients’ bronchoalveolar lavage fluid. Minocycline or moxifloxacin were administrated, six patients were discharged after their condition improved, and two patients died.ConclusionsThe incidence of psittacosis is low, and its clinical manifestations lack specificity. In the course of the disease, there may be different degrees of fever, cough, sputum, dyspnea and other symptoms. The lungs can be heard with wet rales, chest HRCT can be seen ground glass shadow, consolidation shadow, accompanied by air bronchogram. Chlamydia psittaci can be detected in alveolar lavage fluid by mNGS. The patients need to be treated for a long time, lasting at least 10 to 14 days. Tetracycline drugs should be the first choice, and can be combined with other antibiotics with activity against gram-positive and gram-negative bacteria in critical patients.
Objective To systematically review the performance of postpartum hemorrhage risk prediction models, and to provide references for the future construction and application of effective prediction models. Methods The CNKI, WanFang Data, VIP, CBM, PubMed, EMbase, The Cochrane Library, Web of Science, and CINAHL databases were electronically searched to identify studies reporting risk prediction models for postpartum hemorrhage from database inception to March 20th, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias and applicability of the included studies. Results A total of 39 studies containing 58 postpartum hemorrhage risk prediction models were enrolled. The area under the curve of 49 models was over 0.7. All but one of the models had a high risk of bias. Conclusion Models for predicting postpartum hemorrhage risk have good predictive performance. Given the lack of internal and external validation, and the differences in study subjects and outcome indicators, the clinical value of the models needs to be further verified. Prospective cohort studies should be conducted using uniform predictor assessment methods and outcome indicators to develop effective prediction models that can be applied to a wider range of populations.