3A Hospitals Research Articles

Study on the Relationship Between Core Competence and Fixed Surgery Specialty of Nurses in Operating Room

Core competence is important for high-risk and high-demand operating room nurses, while there are few reports on the core competence of operating room nurses and its influencing factors. This study was to investigate the core competence of nurses in operating room and to explore the effect of fixed surgery specialty on their core competence. The Competency Inventory for Registered Nurses scale, which includes 7 dimensions consisting of a total of 58 items, including ethics/legal practice, professional development ability, leadership ability, clinical nursing ability, interpersonal relationship ability, education/counseling ability and critical thinking/scientific research ability, was used to evaluate the core competence of nurses. Based on the core competence scale of registered nurses, the specific items of core competence of nurses in 5 operating rooms were added to investigate 408 operating room nurses in 8 Grade 3A hospitals in Guangzhou. The total average score of core competence of nurses in operating room was (2.80±0.54). The scores of core competence of nurses in fixed surgery specialty were higher than that in unfixed surgery specialty group (P<0.05). Fixed in a particular surgery specialty is beneficial to improve the core competence of nurses in operating room and improve the quality and efficiency of surgical nursing cooperation.

Effects of Yinzhihuang Granules on Serum Liver Enzymes in Jaundice Patients: A Real-World Study Based on HIS Data.

Objective Our aim was to analyze the influence of Yinzhihuang granules on serum liver enzymes in jaundice patients and to provide real-world evidence for the efficacy evaluation of Yinzhihuang granules in treating jaundice. Methods We constructed a data warehouse which integrates real-world electronic medical records from the hospital information system of multiple 3A hospitals in China and used a descriptive statistical method to analyze the changes in the serum liver enzymes of the jaundice patients treated with Yinzhihuang granules and then used Wilcoxon signed-rank to test the changes in the indicators caused by the treatment. Results After being treated with Yinzhihuang granules, the jaundice patients had a decrease in the average serum levels of total bilirubin, indirect bilirubin, aspartate aminotransferase, glutamyl transpeptidase, and alkaline phosphatase, and the differences were statistically significant (P < 0.05) but had no significant changes in the average serum levels of direct bilirubin and alanine aminotransferase (P > 0.05). Conclusion The data analysis on the real-world electronic medical records demonstrate that Yinzhihuang granules help to reduce jaundice patients' serum levels of total bilirubin, indirect bilirubin, aspartate aminotransferase, glutamyl transpeptidase, and alkaline phosphatase, but there is no evidence that Yinzhihuang granules help to reduce the jaundice patients' serum levels of direct bilirubin and alanine aminotransferase.

Analysis on the Influencing Factors of Job Burnout of Nurses in Haikou Tertiary Hospital

Objective: To understand the influencing factors of job burnout among nurses in Haikou 3A hospital and explore its direct and indirect effects, so as to provide a scientific basis for the work efficiency of nursing staff. Methods: Between November 2, 2015 and November 2015, using multi stage random sampling, self-administered questionnaire survey was conducted among 1049 nursing staff, using the path analysis method to study the effect of direct and indirect factors effect. Results: The total score of job burnout of nurses was 38.44 ± 7.55, high occupational burnout was 0.9%, moderate occupational burnout was 66.5%, and low occupational burnout was 32.6%. The scores of job burnout were compared among the nurses with different titles, and less achievement (F = 8.342, P 5 dimensions of work pressure source (0.125) > title (−0.112) job satisfaction scores (−0.097). Conclusion: Job stress, job satisfaction and job title are the factors that affect job burnout. The 4 and the direct and indirect effects of job stressors are the strongest, and measures should be taken to solve these problems.

Investigation and analysis of influencing factors of health tenacity in unmarried female breast cancer patients after operation

Objective To explore the main influencing factors of health tenacity of unmarried female breast cancer patients after operation, and to provide theoretical basis for clinical nursing intervention. Methods A total of 222 unmarried female breast cancer patients were selected from 3 Grade 3A hospitals in Tianjin (Tianjin Cancer Hospital, Tianjin Central obstetrics and Gynecology Hospital, Tianjin People′s Hospital). The Simplified Coping Style Questionnaire (SCSQ), Social Support Rating Scale (SSRS), was used in the study. The Revised Health Hardiness Inventor (RHHl-24) and the self-designed general data questionnaire were used to analyze the main influence of the patient′s health tenacity. Results The total score of health tenacity among 222 unmarried female breast cancer patients after operation was 75.58 ± 8.87, which was located at the middle level; the score of positive coping was 2.16 ± 0.53 and negative coping was 1.56 ± 0.44; the total score of social support was 39.93 ± 8.45, which was higher than score of domestic norm. The regression analysis showed that the main factors of health tenacity were social support, the stages of breast cancer, the source of medical expenses, positive coping and place of residence in unmarried female breast cancer patients after operation (t=-5.403-5.908, P<0.05 or 0.01). Conclusions We should strengthen nursing intervention for unmarried female breast cancer patients with low social support, late course of disease, poor economic status, negative coping and non-urban residence, and encourage patients to adopt positive coping style. Provide all-round social support to patients in order to improve the patient's health and tenacity. Key words: Unmarried women; Breast cancer; Health tenacity; Influencing factors

Knowledge of laryngopharyngeal reflux disease among otolaryngologists in 3A hospitals in Beijing.

ObjectiveThis study aimed to evaluate knowledge of laryngopharyngeal reflux disease (LPRD) among otolaryngologists in 3A hospitals in Beijing.MethodsA cross-sectional questionnaire survey of LPRD knowledge was conducted with otolaryngologists in 40 3A hospitals in Beijing. A response rate of <80% was obtained from one hospital, so data from 331 valid questionnaires from the other 39 hospitals were analysed.ResultsThe most common source of LPRD knowledge was academic lectures (80.1%). The most commonly known risk factors, symptoms, clinical signs and associated diseases were unhealthy eating habits (49.2%), foreign body sensation in the pharynx (71.0%), hyperaemia (42.3%) and pharyngolaryngitis (63.7%), respectively. Only 57.7% of otolaryngologists knew about 24-hour pH monitoring as a gold standard diagnostic test for LPRD. The most commonly known treatment option was medication (93.1%). Most physicians (86.7%) had made a clinical diagnosis of LPRD; however, only 59.9% of them had followed up the treatment outcomes. The most common treatment provided was medication (82.6%).ConclusionsKnowledge of LPRD among otolaryngologists in 3A hospitals in Beijing was insufficient. Educational programs are needed to increase the knowledge of LPRD among otolaryngologists.

Effects of a comprehensive reservation service for non-emergency registration on appointment registration rate, patient waiting time, patient satisfaction and outpatient volume in a tertiary hospital in China

BackgroundIn China, a long waiting time for registration is a common occurrence in many tertiary hospitals. This study aimed to analyze the effects of a comprehensive reservation service for non-emergency registration on appointment registration rate, patient waiting time, patient satisfaction and outpatient volume at the Guangzhou Women and Children’s Medical Center.MethodsThis was a cross-sectional study. This study investigated the effects of a comprehensive reservation service for non-emergency registration in Guangzhou Women and Children’s Medical Center in China starting in October 2015. In total, 2194 patients completed a satisfaction survey administered by the Guangdong Situation Research Center. The content of the questionnaire consisted of six aspects: general impression, service attitude, service quality, hospital environment, price perception and medical ethics. A Likert 5-point rating scale was used in the questionnaire; answers were classified as “very satisfied”, “relatively satisfied”, “neutral”, “unsatisfied” and “very unsatisfied”. The method of application was paper-based. T-tests were used to compare the sample means, and chi-square tests were used to compare the rates. A multiple-test procedure was performed to evaluate the differences in the reservation rates during a 12-month period.ResultsAfter the implementation of the comprehensive reservation service for non-emergency registration in our hospital, which has an annual outpatient volume of approximately 4 million, the monthly appointment registration rate increased from (34.95 ± 2.91)% to(89.13 ± 3.12)%,P < 0.01. The patient waiting time was significantly reduced (P < 0.01), and the proportion of patients who believed that the waiting time required improvement was decreased significantly (P < 0.01). Moreover, the third-party evaluation result of outpatient satisfaction significantly improved (P < 0.01). The total hospital outpatient volume decreased(P < 0.01). The outpatient volume of the Department of General Pediatrics decreased.ConclusionThe implementation of the comprehensive reservation service for non-emergency registration in the hospital shortened patient waiting time and improved patient satisfaction, and the outpatient volume was effectively controlled. These results indicated that this program obtained the desired results in a Grade 3A hospital in China.

Effects of humanities quality education on residents standardized training students in Sichuan Province

Objective To study the current situation of humanistic quality education among residents standardized training students in Sichuan Province and analyze the effect, so as to provide references for the enhancement of humanistic quality education for these students. Methods Five 3A hospitals in Sichuan Province were randomly chosen as the object hospital, and 15 administrators, 500 teachers, 500 students and 300 patients were included. From the aspects of cognition, opinion and suggestion on humanities quality education, a questionnaire survey was conducted. SPSS 19.0 was used to analyze data. Results The humanistic quality education among students in these hospitals were not good. Among students, 43.1% believed that humanities quality education received deficient attention, and 71.7% thought that curriculum could not meet the training requirement; among teachers, 54.1% thought that teaching ability needed to be strengthened and 60.9% considered that the current teaching conditions and methods were not good enough. Conclusion Effect of humanistic quality education is not good and we suggest solving the problem through improving humanistic management, teachers’ construction, humanistic courses and assessment system. Key words: Resident standardized training; Humanities quality education; Strategies

CN29 - Analysis on the implementation results of family sickbed for oncology patients in Dongshi Township Health Centers from 2015 to 2017

BackgroundCancer patients in good general condition can receive aggressive anti-cancer treatment, while palliative care is most appropriate for advanced cancer patients. In China, patients admit to 3A hospitals regardless of the disease stage. Given the limited number of 3A hospital beds, high price, low quality of life, family sickbed is emerging. With one-to-one help of The Second Affiliated Hospital of FMU, Dongshi Township Health Center (DTHC) established the first family sickbed project for oncology patients (FSOP) in China. MethodsA retrospective survey was adopted to analyze the general clinical data of patients, hospitalization days and expenses, the types of medical insurance and the opioid analgesics drugs used of 225 patients. And, we carried out telephone follow-up to collect the data concerning the patient’s survival and satisfaction with FSOP service. ResultsFrom 2015 to 2017, 225 patients were admitted to FSOP. Of 225 patients, 192 (85.3%) were males and 33 (14.7%) were females with ages from 24 to 91 years. The most common disease categories were lung cancer, esophagus cancer, liver cancer. 216 out of 225 patients purchased the NCMS Insurance. During those 3 years, the average total hospitalization expenses, the average personal expenses, the average personal expenses ratio, the average reimbursement ratio, and the average hospitalization days of all patients were 3824.24yuan, 1195.34yuan, 34.64%, 65.37% and 11.79 days, respectively. 51 out of 225 patients suffered pain and needed to eat painkillers. The use of Morphine tablets and OxyContin increased year by year, conforming to the principle of the WHO’s three-step analgesic ladder. Follow-up results showed that 37 (18.5%, 37/200) patients were survive, and 177 patients or family members (88.5%, 177/200) were fully satisfied with FSOP’s service. ConclusionsSince 2015, the DTHC has provided considerate home care, resulting in a high level of patient and family members satisfaction. Admitting to FSOP can lower the hospitalization expenses, decrease the burden of economy and life, improve the quality of life, and relieve the pain, both mental and physical. Moreover, FSOP will be a more appropriate place to spend the last days for advanced cancer patients. Legal entity responsible for the studyThe Second Affiliated Hospital of Fujian Medical University. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Status and risk factors of postoperative hemorrhage in patients undergoing surgery

Objective To investigate the incidence and related factors of postoperative hemorrhage, so as to provide data support for preventing its occurrence and developing reasonable risk assessment tools. Methods The retrospective analysis of clinical data of 50 patients with postoperative hemorrhage after surgical operation in a 3A hospital in Shanghai from January to December 2016 was conducted. A 1∶2 matching case-control study was conducted to explore the risk factors of postoperative bleeding in surgical patients by univariate and multivariate regression analysis. Results The total number of surgical operations (excluding obstetrics and gynecology, five senses) was 18 942. Postoperative hemorrhage occurred in 50 cases, including 6 deaths. The incidence of postoperative hemorrhage was 0.26% and the mortality rate was 12%. The incidence of postoperative bleeding in the top four departments were gastrointestinal surgery (13 cases) , hepatobiliary and pancreatic surgery (11 cases) , cardiac surgery (10 cases) , neurosurgery (9 cases) . The statistical analysis of binary Logistic in the case group and the control group showed that postoperative albumin<35g/L, postoperative AST abnormality, postoperative ALT abnormality, postoperative hypertension were independent risk factors of postoperative bleeding. Conclusions The incidence of postoperative bleeding in this hospital is relatively low, but the mortality is relatively high. Medical staff should pay more attention to the patients undergoing gastrointestinal, liver, pancreas, heart and brain surgery. It is also necessary to pay more attention to the blood pressure, albumin and liver function of the patients after operation, and establish the evaluation of prevention of hemorrhage, which has a certain early warning effect on the prevention of postoperative hemorrhage. Key words: Postoperative hemorrhage; Bleeding incidence; Risk factors; Risk assessment

Correlations between transformational leadership behaviors and nurses′ performance for goal attainment among clinical nurses

Objective To understand nurses′ perceived transformational leadership behaviors of head nurses, and to survey the status quo of transformational leadership behaviors of head nurses and nurses’ performance for goal attainment, to explore the relationship between transformational leadership behaviors of head nurses and nurses′ performance for goal attainment. Methods A total of 450 clinical nurses from six 3A hospitals were chosen as the research objects, the nurse general information questionnaire, the transformational leadership questionnaire and nurse′s performance for goal attainment scale were used to analyze the status. SPSS17.0 was conducted to sort and analyze data. Results (1) The total score of nurses′ perceived transformational leadership behaviors of head nurses was 114.74±18.66, and moral modeling score was significantly higher in 4 dimensions. The total score of nurses′ performance for goal attainment was 172.87±25.96, autonomous decision-making score was significantly higher in 7 dimensions. (2) There was a positive correlation relationship between transformational leadership behaviors and each dimension of nurses′ performance for goal attainment (r=0.393, P<0.01). Conclusions The results show that the nurses′ performance for goal attainment can be positive predict by transformational leadership behaviors. Nursing managers should fully play the positive role of transformational leadership behavior so as to improve nurses′ performance for goal attainment. Key words: Head nurse; Nurses; Transformational leadership; Performance for goal attainment

Analysis of adverse reactions' factors to Danhong injection--nested case control study by using hospital centralized monitoring data

To study the adverse reactions' factors to Danhong injection in the real world. A multi-center, large sample and prospective hospital centralized monitoring method was adopted, and 30 888 cases of Danhong injection from 37 national 3A hospitals were collected to carry out a nested case control design study. These cases were divided into adverse reaction group and non-adverse group. Single factor logistic regression and multiple factor logistic regression were used to analyze data, and investigate the correlation between adverse reaction and gender, allergy history, methods of administration, and combined drug use. One hundred and eight cases of adverse reactions in 30 888 patients were determined, with an incidence of 0.35%. The results showed that Danhong injection combined with other medication(potassium mendoxine magnesium, thymic peptide, celecoxib, fumarate bisoprolol) with history of adverse reactions including scephalosporin allergy and proprietary Chinese medicine allergies had more adverse reactions than the control group(P<0.05, estimated coefficient>0), indicating that these six factors were the risk factors for the adverse reaction of Danhong injection. The adverse reaction of Danhong injection combined with the aspirin was less than that in the control group(P<0.05, estimated coefficient<0), indicating that the aspirin was a non-risk factor for the adverse reaction of Danhong injection. All the above results indicate that the adverse factors to Danhong injection include scephalosporin allergy, patent Chinese medicine allergy, Danhong injection combined with medication(potassium mendoxine magnesium, thymic peptide, celecoxib, fumarate bisoprolol), suggesting special attention shall be paid in clinical application.

The current situation investigation on oral care of the tube intubation in the emergency department of the 3A hospital in Shanxi province

Objective To investigate the status quo of oral nursing in the emergency department of top three hospitals in Shanxi province, and to analyze the existing problems so as to provide the basis and reference for improving the clinical operation standard. Methods In the form of WeChat questionnaire, a questionnaire survey was conducted to investigate 190 nurses who met the requirements in emergency departments of 6 top three hospitals in Shanxi province. Results All the 6 hospitals surveyed did not incorporate oral care into the nurse examination program; 28.42%(73/190) of the subjects had oral assessments of endotracheal intubation according to their clinical experience; chlorhexidine (70.00%,133/190) and physiological saline (65.79%,125/190) were the most commonly used oral care solutions in clinic; 48.42%(92/190) of nurses performed this operation for 6-10 min; 91.58%(114/190) of nurses believed that oral care played an important role in the recovery of these patients. Conclusions The oral care and oral care of the patients in the emergency department are mostly clinical experience, so it is urgent to establish a unified standard of implementation on the basis of evidence. The professional knowledge of oral nursing of the patients undergoing oral trachea intubation is low, so it is suggested that the training of emergency nurses be strengthened and the operation should be included in the assessment of nursing operations. Key words: Emergency department; Oral trachea cannula; Oral care; Current situation investigation

Analysis of characteristics of bacteria in respiratory tract infection in 2013-2016 in Heibei 3A hospital: a single-center report of 7 497 patients

To analyze the changes and characteristics of respiratory tract bacteria in Hebei 3A Hospital, and to provide new rationale for clinical diagnosis and treatment. A single-center retrospective analysis was conducted. 7 497 patients with respiratory tract infection admitted to Hebei Chest Hospital from January 2013 to December 2016 were enrolled. Deep sputum was collected, and the bacterial cultures and susceptibility analysis was conducted in sputum and upper respiratory secretions were collected by fiberoptic bronchoscopy. A total of 7 497 patients with respiratory tract infection were enrolled in the study, and 11 909 strains of 13 kinds of dominant pathogens were isolated. The dominant pathogens for respiratory tract infection were Monilia albican (23.7%), Klebsiella pneumoniae (12.9%), Pseudomonas aeruginosa (11.6%), Escherichia coli (9.5%), Candida glabrata (9.1%), Acinetobacter baumanii (7.9%), Aspergillus (6.7%), Stenotrophomonas maltophilia (4.5%), coagulase negative Staphylococcus (3.7%) and some species of Pseudomonas (3.7%), Staphylococcus aureus (3.0%), Aerobacter cloacae (1.9%), and Candida tropicalis (1.8%). A total of 6 198 strains of 7 kinds of Gram negative (G-) bacilli infection dominant pathogens accounts for 52.0% of all infections, Klebsiella pneumonia (24.8%), Pseudomonas aeruginosa (22.3%), Escherichia coli (18.2%) and Acinetobacter baumanii (15.3%) were the main pathogens, and increased year by year. Susceptibility analysis showed that the preferred antibiotics for G- bacteria were carbapenems, followed by risperidone, sulbactam, cefepime, amikacin, and the third generation of cephalosporins. A total of 798 strains of 2 kinds of Gram positive (G+) bacilli infection dominant pathogens accounted for 6.7% of all infections, were coagulase negative Staphylococcus (54.8%) and Staphylococcus aureus (45.2%), each had changed little by year. Susceptibility analysis showed that G+ bacteria were sensitive to glycopeptides, followed by cefoxitin, cotrimoxazole, the tetracyclines, quinolones, azithromycin, erythromycin and so on. The advantages of 4 species of fungi were 4 913 strains, accounted for all of the 41.3% strains, with 57.5% of Candida albicans, and the trend was increasing year by year. Susceptibility analysis results showed that the antifungal susceptibility of dominant fungi were higher. G- bacilli is still the main source of infection, and showed an upward trend year by year. Fungal infection rate cannot be ignored, and we must pay attention to fungal infection incentives. We should strengthen the rational use of antibiotics.

Complex network analysis on Shenxiong glucose injection in combined use with Chinese and Western medicine for cerebral infarction in real world study

In order to analyze Shenxiong glucose injection in combined use with other medicines for cerebral infarction in real world, the basic information, Chinese and western medicine diagnosis information, doctors'advice information, and laboratory checking information for the patients with Shenxiong glucose injection in treatment of cerebral infarction were extracted from the hospital information system (HIS) of sixteen 3A hospitals. Apriori Algorithm was used to establish models, and Clementine 12.0 was used for correlation analysis. Then complex network was established to analyze the combined drug use and visualize the results. A total of 635 patients were included in the study, among which 599 patients (94.33%) showed superior effect. Shenxiong glucose injection was often used with platelet suppressant drug, neuroprotective agent, lipid regulating agents, free radical scavenger, vitamins and Chinese medicine blood activating and stasis eliminating agent in the treatment of cerebral infarction. In the patients with superior effect, neuroprotective agent and free radical scavengers were also used based on the combined use with Aspirin, hypolipidemic drugs and blood activating and stasis removing agents, highlighting the rain protection strategies. Shenxiong glucose injection in combined use with Chinese and western medicines for cerebral infarction complied with the latest clinical practice guideline on the treatment of cerebral infarction, and the application of neuroprotective agent was propitious to improve the therapeutic effect.

Relationship between nurses′ personality, family function and psychological resilience

Objective To investigate the status of personality, family function and psychological resilience towards employed nurses, and to explore the relationship among personality, family function and psychological resilience. Methods Four instruments were applied to investigate 240 employed nurses from comprehensive Grade 3A hospital of Fujian Province, which were the Characteristics Questionnaire, Family Intimacy Scale (FACEⅡ-CV), Self-resilience Scale and Personality Traits Questionnaire. Results The correlation analysis showed that nurses′ personality traits, family functions and psychological resilience were closely related. The multiple regression and analysis showed that 40% of the variance for employed nurses′ psychological resilience could be explained through considering personality dimensions, family cohesion and adaptability. Conclusions Personality, family functions and psychological resilience towards employed nurses are closely related as both internal and external protective factors. Key words: Employed nurses; Personality traits; Family cohesion and adaptability; Psychological resilience

Age-adjusted Charlson comorbidity index score as predictor of survival of patients with digestive system cancer who have undergone surgical resection.

Comorbidities have considerable effects on survival outcomes. The primary objective of this retrospective study was to examine the association between age-adjusted Charlson comorbidity index (ACCI) score and postoperative in-hospital mortality in patients with digestive system cancer who have undergone surgical resection of their cancers. Using electronic hospitalization summary reports, we identified 315,464 patients who had undergone surgery for digestive system cancer in top-rank (Grade 3A) hospitals in China between 2013 and 2015. The Cox proportional hazard regression model was applied to evaluate the effect of ACCI score on postoperative mortality, with adjustments for sex, type of resection, anesthesia methods, and caseload of each healthcare institution. The postoperative in-hospital mortality rate in the study cohort was 1.2% (3,631/315,464). ACCI score had a positive graded association with the risk of postoperative in-hospital mortality for all cancer subtypes. The adjusted HRs for postoperative in-hospital mortality scores ≥ 6 for esophagus, stomach, colorectum, pancreas, and liver and gallbladder cancer were 2.05 (95% CI: 1.45–2.92), 2.00 (95% CI: 1.60–2.49), 2.54 (95% CI: 2.02–3.21), 2.58 (95% CI: 1.68–3.97), and 4.57 (95% CI: 3.37–6.20), respectively, compared to scores of 0–1. These findings suggested that a high ACCI score is an independent predictor of postoperative in-hospital mortality in Chinese patients with digestive system cancer who have undergone surgical resection.

A survey of the video training in the application of the nurse self-directed learning readiness

Objective To investigate the nurse self-directed learning readiness in some 3A hospital in Shandong province and discuss the strategies how to improve it. Methods Self-designed questionnaire and The Nurses Self-Directed Learning Readiness Scale were used to investigate 210 nurses from 23 departments in Shandong provincial hospital. Results Before and after the implementation of the video training, a total of 230 and 210 self-directed learning readiness scales were distributed, 210 and 210 questionnaires were returned, the effective recovery rate was 91.30% and 100% respectively. The data of questionnaires were statistically analyzed by the method of paired t test. The results showed that after the implementation of the project, the total score of the after test (156.63±19.48) was higher than the before(137.91±13.71). The difference was statistically significant (t=-9.54, P<0.05). The score in the three dimensions of self-management, self-control, and desire for study (48.03±7.25), (48.71±6.44), (59.89±7.61) points, were higher than (40.11±5.48), (43.40±5.34), (54.40±6.26) pointsbefore implementation. The difference was statistically significant (t=-10.22,-7.67, -6.83, P<0.05). Conclusions The video training would provide the convenient and quick way and could inspire the nurses′ learning motivation even more which is of great significance to improve the nurses ability of autonomic learning. Key words: Nurses; Video training; Self-directed learning; Survey

Lupus glomerulonephritis in 788 Chinese children: a multi-centre clinical and histopathological analysis based on 549 renal biopsies

Background: System lupus erythematosus (SLE) is a severe multisystem autoimmune disease.Objective: To describe the clinical and pathological features, treatment, and renal outcome in children under 18 years with lupus nephritis (LN).Methods: The study was undertaken by a questionnaire completed in 26 Grade 3A hospitals’ paediatric renal units in China. The study comprised 788 children (619 girls, 169 boys) diagnosed with SLE by the American College of Rheumatology criteria (1997) during 2005–2010. Results of renal biopsies were classified according to the guidelines of The International Association of Nephrology and the Renal Pathology Society (2003). Guidelines by the Chinese Society of Paediatric Nephrology were applied for the diagnosis and treatment (for trial implementation) in 2010 to determine inclusion. The data included the prevalence of acute kidney injury (AKI), SLE disease activity index (SLEDAI), renal histopathology and the induction of therapy mode.Results: The mean (SD) age of onset of SLE was 10.9 (2.90) years (range 1–18) and at diagnosis was 11.3 (2.9) years. The mean (SD) SLEDAI score was 13.5 (5.53). The clinical classification was as follows: about 36 (4.6%) patients had isolated haematuria, 99 (12.6%) isolated proteinuria, 60 (7.6%) isolated haematuria and proteinuria, 157 (19.9%) acute glomerulonephritis, 392 (49.7%) nephrotic syndrome, 20 (2.5%) rapidly progressive glomerulonephritis, 15 (1.9%) chronic nephritis, 2 (0.3%) tubule-interstitial damage and 7 (0.9%) subclinical LN. A total of 549 children (69.7%) underwent renal biopsy. The most frequent renal histopathological findings of LN were Class IV, followed by Class II and Class V + IV. There were no significant differences between the age groups in either renal pathological types or prognosis. In 242 (30.7%) patients, LN was complicated by AKI. Those with AKI had an older mean (SD) age at onset than the non-AKI patients [11.5 (2.8) years vs 10.7 (2.9) years, respectively, p < 0.0001] and a higher SLEDAI score [14.3 (5.8) vs 13.1 (5.4), respectively, p = 0.003]. In the induction phase, cyclophosphamide (CTX) and mycophenolate mofetil (MMF) were equally effective in the patients with the same pathological type. Follow-up records were only available for 482 (61.2%) patients, with a mean (SD) follow-up time of 21.5 (18.4) months. Six of the 35 patients who deteriorated required dialysis and seven died.Conclusion: In LN, AKI is a risk factor for poor outcome. Owing to different times of onset and remission, the pathological types of LN cannot be estimated by clinical manifestation alone, and therefore renal biopsy should be undertaken in all LN children with AKI. In the induction phase, there was no significant difference in efficacy between CTX and MMF. Follow-up of children with LN in China needs to be improved.

Analysis of drug combination characteristics of Qingkailing injection for treating abnormal inflammatory factors in real world

To analyze the drug combination characteristics of Qingkailing injection for treating abnormal inflammatory factors such as elevated white blood cells and C reactive protein in real world. The patients with Qingkailing injection for abnormal C reactive proteins and abnormal white blood cells were extracted from hospital information system (HIS) of 16 Class 3A hospitals. Then the basic information, traditional Chinese medicine and Western medicine diagnostic information, doctor's advice information, and laboratory information were analyzed; Apriori algorithm was used to construct the models, and Clementine 12.0 was used for correlation analysis to analyze the clinical medication rules and drug combination characteristics in the patients with Qingkailing injection for treatment of elevated C reactive protein and white blood cells in the real world. The results of the study showed that when Qingkailing injection was combined with one kind of western medicine and traditional Chinese medicine in treatment of patients with abnormal C reactive protein, vitamin C (159 cases, 74.30%) and Tanreqing injection (71 cases, 33.18%) were most frequently used; when it was combined with 2 kinds of traditional Chinese medicines, Xueshuantong injection plus Tanreqing injection (support degree 10.75%) were most frequently used. When Qingkailing injection was combined with one kind of western medicine and traditional Chinese medicine in treatment of patients with abnormal white blood cells, vitamin C (596 cases, 56.02%) and Ganmao Qingre granules (247 cases, 23.21%) were most frequently used; when it was combined with 2 kinds of traditional Chinese medicines, Shuanghuanglian+Ganmao Qingre granules (support degree 5.26%) were most frequently used. In the patients with abnormal C-reactive protein and white blood cells, its combinations with antibiotics and nutritional support agents were most common from the pharmacological perspective, indicating that in the treatment of abnormal C-reactive protein, white blood cells and other increased inflammatory indicators, Qingkailing injection was most frequently combined with antibiotic drugs to achieve synergistic effect.

Method and Effect Evaluation of Implementing Health Management in Physical Examination Centers of 3A Hospitals

Objective To understand the changes of various routine indices for the people who received health physical examination after the implementation of health management, discuss the method of implementing health management in 3A hospitals, provide a reference for better management in 3A hospitals in the future. Methods A total of 1326 people (875 males and 451 females) were selected, whose physical examinations were performed in our hospital’s examination center each year in succession from January 2015 to September 2017 and examined items included weight, blood pressure, fasting blood-glucose, blood uric acid and blood lipid. The changes of indices of two examinations before and after implementing health management were compared to evaluate the effects of health management. Results All indices were normal: 192 people in 2015, 230 people in 2016, 243 people in 2017; proportion of normal people: 14.48% in 2015, 17.35% in 2016, 18.33% in 2017. Difference was statistically significant (P<0.01). Detection rates for obesity, hypertension, abnormal glucose metabolism, hyperuricemia and hyperlipidemia decreased and bad living behaviors improved obviously. Difference was statistically significant (P<0.05). Conclusion The health management is based on the health physical examination and implemented in physical examination centers of 3A hospitals, integrates with health education, disease consulting and lifestyle intervention, has high starting point of the platform and flexible, diverse, easy and feasible approaches, is able to raise the examined people’s understanding and management of life-style diseases and decrease morbidity.