Order Of Admission Research Articles

A nomogram incorporating functional and tubular damage biomarkers to predict the risk of acute kidney injury for septic patients

BackgroundCombining tubular damage and functional biomarkers may improve prediction precision of acute kidney injury (AKI). Serum cystatin C (sCysC) represents functional damage of kidney, while urinary N-acetyl-β-D-glucosaminidase (uNAG) is considered as a tubular damage biomarker. So far, there is no nomogram containing this combination to predict AKI in septic cohort. We aimed to compare the performance of AKI prediction models with or without incorporating these two biomarkers and develop an effective nomogram for septic patients in intensive care unit (ICU).MethodsThis was a prospective study conducted in the mixed medical-surgical ICU of a tertiary care hospital. Adults with sepsis were enrolled. The patients were divided into development and validation cohorts in chronological order of ICU admission. A logistic regression model for AKI prediction was first constructed in the development cohort. The contribution of the biomarkers (sCysC, uNAG) to this model for AKI prediction was assessed with the area under the receiver operator characteristic curve (AUC), continuous net reclassification index (cNRI), and incremental discrimination improvement (IDI). Then nomogram was established based on the model with the best performance. This nomogram was validated in the validation cohort in terms of discrimination and calibration. The decision curve analysis (DCA) was performed to evaluate the nomogram’s clinical utility.ResultsOf 358 enrolled patients, 232 were in the development cohort (69 AKI), while 126 in the validation cohort (52 AKI). The first clinical model included the APACHE II score, serum creatinine, and vasopressor used at ICU admission. Adding sCysC and uNAG to this model improved the AUC to 0.831. Furthermore, incorporating them significantly improved risk reclassification over the predictive model alone, with cNRI (0.575) and IDI (0.085). A nomogram was then established based on the new model including sCysC and uNAG. Application of this nomogram in the validation cohort yielded fair discrimination with an AUC of 0.784 and good calibration. The DCA revealed good clinical utility of this nomogram.ConclusionsA nomogram that incorporates functional marker (sCysC) and tubular damage marker (uNAG), together with routine clinical factors may be a useful prognostic tool for individualized prediction of AKI in septic patients.

Improving Timeliness of Hepatitis B Vaccine Birth Dose Administration.

When given within 24 hours of birth, the hepatitis B vaccine is up to 90% effective in preventing perinatal infection. The American Academy of Pediatrics now recommends administration within 24 hours for infants with a birth weight >2 kg, but a national benchmark for compliance with this time frame has not been established. We aimed to increase the monthly average of eligible newborns receiving the vaccine on time from 40% to 80% over a 9-month period. A series of plan-do-study-act cycles were conducted to improve timeliness of hepatitis B vaccine birth dose administration among newborns in the level 1 nursery at our academic community hospital. Interventions included staff education, nurse-driven consent and vaccine ordering, and earlier initial newborn assessments performed by nursing staff. Our primary outcome was the monthly percentage of newborns receiving the vaccine within 24 hours of birth, and our secondary outcome was the frequency of nonvaccination events. Statistical process control was used to analyze the effectiveness of interventions. Our mean monthly rate of vaccine administration within the 24-hour time frame increased from 40% to 92%. Predischarge vaccination rate improved from a mean of 13 to 61 cases between infants discharged without vaccination. Nurse-led interventions, including the ability to obtain consent and incorporation of the vaccine into our nurse-activated admission order set, were significant contributors to improvement in the timeliness of hepatitis B vaccine administration. We propose a mean of 90% compliance with the American Academy of Pediatrics recommendations as a benchmark for other institutions.

Vaccinations, Not Vaccines, Save Lives: Quality Improvement for Newborn Vaccination.

Across the world, in medical journals, news media, social media, and personal discussions, one of the hottest topics of discussion is the coronavirus disease 2019 (COVID-19) vaccine. The rapid development of effective vaccines for COVID-19 is a remarkable success story of modern science, and it is a reminder for all of us about the significant health benefits of vaccines in general, benefits we often take for granted. Although the COVID-19 vaccine is the media star of the day, children receive numerous other routine vaccinations, including the hepatitis B vaccine, which significantly reduces the risk of hepatitis B virus infection. However, with all vaccines, including the hepatitis B vaccine, there are significant gaps in coverage, with high percentages of eligible children either not receiving the vaccine at all or receiving it late, thus exposing them to the risk of infectious diseases. A quotation from Orenstein1 has recently surfaced in discussions about the COVID-19 vaccine: “vaccines don’t save lives, vaccinations save lives.” Gaps in vaccine coverage generate the need for quality improvement (QI) projects to close these gaps. In this issue of the journal, Sarathy et al2 describe the results of a QI project in which they aimed to increase the monthly percentage of eligible newborn infants receiving the first dose of the hepatitis B vaccine within 24 hours of life to ≥80% within 9 months of project initiation. This article contains some important lessons that deserve to be highlighted about the conduct, description, and publication of QI projects. In 2008, the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines were first published. They were updated in 2015 as the SQUIRE …

Effects of a refined evidence-based toolkit and mentored implementation on medication reconciliation at 18 hospitals: results of the MARQUIS2 study

BackgroundThe first Multicenter Medication Reconciliation Quality Improvement (QI) Study (MARQUIS1) demonstrated that mentored implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals, but...

Hot off the press: Diagnostic testing differences between advanced practice providers and physicians.

Emergency departments (EDs) increasingly incorporate advanced practice providers (APPs), including physician assistants and nurse practitioners, into their staffing models.1, 2 APPs receive different medical education and training than emergency physicians. Notably, the required length of training in the United States is approximately 2 years for APPs compared with 7 years (4 years of medical education followed by 3–4 years of residency training). Some have postulated that differences in training may increase diagnostic test utilization and hospital admission among APPs. Given the significant burden of diagnostic evaluation on health care costs, discrepancies in testing could have important impacts. This is an observational cohort study that analyzes 3 years of data from approximately 90 EDs, including 663,599 patient visits for chest pain and 946,042 patient visits for abdominal pain.3 The authors used inverse propensity score weights to adjust for measured confounders in the assignment of a visit to an APP or physician. The primary outcomes assessed were laboratory tests, electrocardiograms, imaging studies, and hospital admissions. Observational studies have several limitations, most notably, the existence of both measured and unmeasured confounders. In this study, the authors used propensity scores in an attempt to mitigate the impact of unmeasured confounders. This included clinician-level variables (e.g., time in practice), patient-level variables (e.g., age, sex, insurance, Emergency Severity Index [ESI] level), and visit-level variables (e.g., time of day, day of week). Despite this statistical adjustment, it is possible that other variables that could not be accounted for influenced the diagnostic evaluation or admission rates. Additionally, the two chief complaints evaluated in this study, chest pain and abdominal pain, often have somewhat protocolized evaluations. Often adults with chest pain are evaluated to exclude acute coronary syndromes, pulmonary embolism, or aortic dissection. Diagnostic evaluation including blood work, electrocardiogram, and chest radiographs are often initiated by nursing protocols. Thus, it may not be surprising to find no significant difference between groups. Overall, physicians saw more patients over age 55 (28.1% vs. 17.4% for abdominal pain, 46.2% vs. 29.2% for chest pain) and more patients triaged as an ESI level 2 (7.6% vs. 2.9% for abdominal pain, 47.4% vs. 30.1% for chest pain). After adjustment, the average treatment effect of APP management on the probability of common laboratory, radiology, and hospital admission orders demonstrated little variation from the reference standard (physician). In this study of visits for chest and abdominal pain, APPs did not have higher rates of imaging or hospital admission; however, these results may not be generalized in all practice settings or patient presentations. Justin Hensley, MD FAWM (@EBMgoneWILD): This one is tough. The "chest pain" workup is so standardized in today's US medicolegal climate that you could probably do that study as "doctor" versus "kid with an order sheet that says ‘chest pain’ and ‘not chest pain'". Similarly for abdominal pain. Ryan Radecki, MD MS (@emlitofnote): I’m also not surprised it's hard to find a difference between MD/DOs and APPs when MD/DO practice variation is so profound, in general. Tanker_PA_Dave: Did the authors have the ability to differentiate between practice years for APPs and also for APPs who have gone through post graduate training in EM (fellowships/residencies)? Like all physicians coming out of school PAs and NPs are very green and comparing new PAs and NPs to residency graduate EM physicians is not very equitable. Additionally what is considered supervised in this system, is it case presentations, co-signing charts, full 100% chart reviews or a percentage of charts reviewed? Jesse M. Pines, M.D.: Hi Dave – We did use clinician time in practice in the inversion propensity weights (i.e. it was controlled for in the study), however, we did not have data on additional post-graduate training (i.e., what additional fellowships either physicians or APPs may have done). In terms of supervision, that varied across sites. However, the traditional practice is for physicians to be available for questions rather than staffing every case. In this retrospective observational study evaluating patients with chest pain and abdominal pain in the ED, physicians and APPs had similar practice patterns with regard to diagnostic test ordering and admission rates. The authors have no potential conflicts to disclose. Lauren M. Westafer drafted the manuscript. Christopher Bond and William Milne contributed to its revision.

Admissible Pinnacle Orderings

A pinnacle of a permutation is a value that is larger than its immediate neighbors when written in one-line notation. In this paper, we build on previous work that characterized admissible pinnacle sets of permutations. For these sets, there can be specific orderings of the pinnacles that are not admissible, meaning that they are not realized by any permutation. Here we characterize admissible orderings, using the relationship between a pinnacle x and its rank in the pinnacle set to bound the number of times that the pinnacles less than or equal to x can be interrupted by larger values.

New decision-making methods with interval reciprocal preference relations: A new admissible order relation of intervals

Interval reciprocal preference relations (IRPRs) have been extensively applied to real-life decision-making problems. This paper aims at introducing two new decision-making methods with IRPRs. To overcome drawbacks of several extant order relations of intervals, a new admissible order relation of intervals is proposed. An algorithm is then introduced to rank a series of intervals. We define a new consistency index and the satisfactory consistency of IRPRs. For improving the consistency level of IRPRs, a linear programming model is built. Subsequently, a new individual decision-making (IDM) method with an IRPR is introduced. For group decision making, a group consensus index is proposed. To improve the group consensus degree, an interactive convergent iterative algorithm is designed. Decision makers’ weights are determined by combining the logarithmic Manhattan distance between two IRPRs with the consistency indices of IRPRs. Accordingly, a novel consistent and consensus-based group decision-making (GDM) method with IRPRs is presented. Eventually, a decision support system is developed based on the proposed IDM method and GDM method. Illustrative examples and simulation experiments are provided to illustrate the superiority of the proposed IDM method and GDM method.

The application of personalized rehabilitation exercises in the postoperative rehabilitation of breast cancer patients.

This study sought to explore the effects of personalized rehabilitation exercises in the postoperative rehabilitation of breast cancer patients. A total of 93 breast cancer patients admitted to our hospital from January 2018 to December 2019 were taken as research subjects for this study. Based on order of admission, patients were assigned to a control group (46 cases) or an observation group (47 cases). All patients underwent a modified radical mastectomy for breast cancer. Patients in the control group received routine nursing and rehabilitation training after their operations, while those in the observation group received personalized rehabilitation exercises (for a period of 6 months) in addition to the rehabilitation training received by the control group. The immune function indicators, the incidence of upper limb-related complications, the movement of the shoulder joint, upper limb function, ability of daily living (ADL), and quality of life (QoL) was then compared between the two groups before and after the intervention. Patients in the observation group had lower incidences of upper limb edema and subcutaneous fluid than those in the control group (P<0.05). Further, following the intervention, compared to patients in the control group, patients in the observation group had higher CD4+, CD4+/CD8+ levels, lower CD8+ levels, a greater range of motion in their shoulder joints (P<0.05), lower upper limb function impairment scores [based on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire] (P<0.05), higher ADL scores (P<0.05), and higher QoL scores (P<0.05). Personalized rehabilitation exercises reduced the postoperative upper limb complications experienced by breast cancer patients, improved their immune function, shoulder joint mobility and upper limb function, and improved their ADL and QoL.

High frequency oscillatory ventilation and conventional mechanical ventilation in the treatment of infants with severe respiratory syncytial virus pneumonia: a randomized controlled trial

To compare the clinical efficacy of high frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV) in the treatment of infants with severe respiratory syncytial virus (RSV) pneumonia. A prospective randomized controlled trial was conducted. The infants with severe RSV pneumonia who received invasive mechanical ventilation admitted to intensive care unit (ICU) of Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2018 to December 2019 were enrolled. According to the order of admission, each infant was assigned to HFOV group or CMV group by random number table. The basic data, pediatric critical score, blood gas analysis, ventilator parameters, oxygenation index [OI, OI = mean airway pressure (Pmean)×fraction of inspired oxygen (FiO2)/arterial partial pressure of oxygen (PaO2)×100], duration of mechanical ventilation, length of ICU stay, complications, prognosis, use of muscle relaxants and vasoactive drugs and other clinical indicators of the two groups were recorded. A total of 28 infants were enrolled in the analysis, including 15 infants receiving CMV and 13 infants receiving HFOV. There were no significant differences in age, body weight, pediatric critical score and OI before enrollment, type II respiratory failure, multiple organ dysfunction, basic diseases and laboratory examination indexes before enrollment between the two groups. Six hours after enrollment, compared with CMV group, heart rate (HR), respiratory rate (RR), case of transcutaneous oxygen saturation (SpO2) decrease, case of HR decrease, case of cardiopulmonary resuscitation (CPR) and OI in HFOV group were significantly decreased [HR (bpm): 130 (125, 138) vs. 144 (140, 160), RR (times/min): 35 (34, 38) vs. 40 (35, 45), SpO2 decrease (case: 1 vs. 10), HR decrease (case: 0 vs. 6), CPR (case: 0 vs. 4), OI: 6.5 (4.4, 8.9) vs. 9.3 (8.0, 12.8)], while case of use of muscle relaxants (case: 3 vs. 0) and volume of 7-day positive fluid balance [mL/kg: 167.1 (113.8, 212.6) vs. 90.8 (57.8, 112.7)] were significantly higher, the differences were statistically significant (all P < 0.05). There was no use of blood purification treatment, no severe complications such as pneumothorax and intracranial hemorrhage, and no death within 28 days in the two groups. Compared with CMV, HFOV in the treatment of infants with severe RSV pneumonia can improve the oxygenation level and clinical physiological indexes earlier, reduce the incidence of adverse events such as HR, SpO2 decrease and CPR, increase the use of muscle relaxants and the positive fluid balance, and do not increase the incidence of severe complications such as pneumothorax and intracranial hemorrhage, so its clinical application is safe.

Strategies on admissible total orders over typical hesitant fuzzy implications applied to decision making problems

Multi Expert-Multi Criteria Decision Making (ME-MCDM) problems have been well explored on hesitant fuzzy environments dealing with membership degrees as subsets which do not necessarily have the same cardinality. Admissible (total) orders collaborate by reducing the collapse in the ranking of alternatives related to preference relations. In such context, three classes of admissible orders are presented in a non-restrictive way, integrating the concepts of linearity and cardinality and providing support to the comparison between two typical hesitant fuzzy elements. In the sense of hesitant fuzzy logic, the study of fuzzy operators and their main properties is extended considering the admissible linear orders. Namely, the typical hesitant fuzzy aggregation functions, negations and implication functions are discussed mainly related to their (iso/anti)tonicity properties w.r.t. these admissible orders. An algorithmic procedure is introduced illustrating our strategy to solve an ME-MCDM problem, by selecting a Computer Integrating Manufacturing software and making use of the achieved theoretical results.

Multiple Biomarker Approach to Risk Stratification in COVID-19

Multiple Biomarker Approach to Risk Stratification in COVID-19

Testing of Defects per Million Medication Orders as a SMART Indicator for Monitoring Medication Safety in Admission and Discharge Orders.

The study investigated the use of defects per million medication orders (DPMMO) as a SMART (specific, measurable, achievable, realistic, and timely) indicator for monitoring medication safety in admission and discharge orders. The study aimed to develop and test a new indicator as an investigator of medication safety. The study was conducted in 2018 at King Saud Medical City in Riyadh City in Saudi Arabia. A retrospective cross-sectional design was used. The research sample had 292 patients. The selected medication orders included two types of medication orders (admission and discharge order). After sufficient data had been gathered from the hospitals, a statistical analysis was carried out. Analysis of admission and discharge orders indicated that defects per million opportunities (DPMO) and DPMMO count were slightly low, while the sigma level for admission orders was slightly high. Thus, the admission order process was slightly better than the discharge order process. The DPMMO indicator could serve as a SMART indicator of medical safety. It can be used as a standardized indicator in any healthcare facility, which serves as a recommendation guide in monitoring and evaluating healthcare processes or systems that affect the safety and outcomes of patients.

RETRACTED: The application value of midwifery leading companion doula in puerpera birth nursing

Purpose To evaluate the effect of midwifery-led doula companion care in puerpera delivery nursing. Methods 126 primiparas were admitted to our hospital from June 2018 to November 2019 by random sampling method. According to the order of admission of primiparas, they were divided into conventional group (63 cases) and study group (63 cases). The routine group of primiparas were given routine delivery care, while the research group of primiparas were given doula accompanied care by midwives. The time of labor, pregnancy outcome, delivery pain score, delivery control and anxiety score of the two groups were compared and analyzed. Results Compared with the conventional group, the time of the first, second and total labor was significantly shorter in the study group (P &lt; 0.05). The amount of postpartum hemorrhage in the study group was significantly less than that in the conventional group (P &lt; 0.05). The rate of perineal incision and perineal laceration in the study group was significantly lower than that in the conventional group (P &lt; 0.05). There was no significant difference in Apgar score &lt;8 points compared with the control group (P &gt; 0.05). The scores of pain and anxiety in the second stage of labor were significantly lower in the study group than in the conventional group (P &lt; 0.05). The control score of the puerpera in the study group was significantly higher than that in the conventional group (P &lt; 0.05). Conclusion The intervention measures of companion doula led by midwives can effectively shorten the time of labor, reduce the anxiety and pain score and improve the sense of control during labor of primiparas. This nursing method has clinical promotion and application value.

Asymptotic Tracking and Linear-Like Behavior Using Multi-Model Adaptive Control

In this article, we consider the problem of tracking for a discrete-time plant with unknown plant parameters; we assume knowledge of an upper bound on the plant order, and for each admissible order we assume knowledge of a compact set in which the plant parameters lie. We carry out parameter estimation of an associated auxiliary model; indeed, for each admissible dimension, we cover the set of admissible parameters by a finite number of compact and convex sets and use an original-projection-algorithm-based estimator for each set. At each point in time, we employ a switching algorithm to determine which model and parameter estimates are used in the pole-placement-based control law. We prove that this adaptive controller guarantees desirable linear-like closed-loop behavior: exponential stability, a bounded noise gain in every <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$p$</tex-math></inline-formula> -norm, a convolution bound on the effect of the exogenous inputs, as well as exponential tracking for certain classes of reference and noise signals; this linear-like behavior is leveraged to immediately show tolerance to a degree of plant time-variations and unmodeled dynamics.

Changes and clinical significance of serum NSE and MBP levels in children with cerebral palsy at high altitude during comprehensive rehabilitation

Objective: To explore the changes of serum neuron-specific enolase (NSE) and myelin basic protein (MBP) in children with cerebral palsy at high altitude during comprehensive rehabilitation and their clinical significance. Methods: A clinical randomized controlled study design was used to select 144 children with cerebral palsy who were diagnosed and treated in the Rehabilitation Center of Xining Traditional Chinese Medicine Hospital of Qinghai Province from June 2018 to October 2019, including 83 males and 61 females, aged 3-5 years old. According to the order of admission, the random number table was used to divide into a conventional treatment group (n=72, 40 males and 32 females) and a comprehensive treatment group (n=72, 43 males and 29 females). The conventional treatment group was treated with conventional rehabilitation. The comprehensive treatment group was treated with monosialotetrahexose ganglioside sodium on the basis of conventional rehabilitation. In addition, 30 healthy children aged 3-5 years, 16 males and 14 females, were selected as the control group during the physical examination of the Pediatrics Department of Xining Hospital of Traditional Chinese Medicine, Qinghai Province. The serum levels of NSE and MBP in each group were detected, and the children's GMFM-88 scores were evaluated before and after treatment. The SPSS19.0 software was used for statistical analysis, the count data was tested by χ2. Results: The serum NSE and MBP levels of the control group were (5.96±0.80), (0.71±0.15) μg/L. Before treatment, the serum NSE and MBP levels of children with severe, moderate, and mild cerebral palsy were [(21.63±1.92), (3.63±0.49) μg/L], [(17.86±1.43) μg/L, (2.21±0.07) μg/L] and [(15.14±0.95), (1.76±0.30) μg/L], respectively. After treatment, the serum NSE and MBP levels of the conventional treatment group and the comprehensive treatment group were [(13.54±2.41), (2.07±0.85) μg/L] and [(12.09±2.37), (1.81±0.69) μg/L], respectively, and the GMFM-88 score was (116.75±27.41) points and (125.94±24.93) points. The levels of NSE and MBP in the serum of children with cerebral palsy were significantly higher than those of normal children in the control group, and their levels increased with the degree of disease, and the corresponding gross motor function scores were lower. After treatment, the GMFM-88 scale assessment scores of the two groups of children were significantly improved (t values were 310.97 and 70.86, P values were both<0.05), and serum NSE and MBP levels decreased to varying degrees compared with before treatment. The decline in the comprehensive treatment group was greater than that in the conventional treatment group. Conclusions: Serum NSE and MBP levels in children with cerebral palsy at high altitude are significantly higher than those in healthy children, and their levels are closely related to the degree of impairment and GMFM-88 scores in children with cerebral palsy. Dynamic monitoring of changes in NSE and MBP levels may be responsible for the condition and treatment effects of children with cerebral palsy judgments based.

On Admissible Orders on the Set of Discrete Fuzzy Numbers for Application in Decision Making Problems

The study of orders is a constantly evolving topic, not only for its interest from a theoretical point of view, but also for its possible applications. Recently, one of the hot lines of research has been the construction of admissible orders in different frameworks. Following this direction, this paper presents a new representation theorem in the field of discrete fuzzy numbers that enables the construction of two families of admissible orders in the set of discrete fuzzy numbers whose support is a closed interval of a finite chain, leading to the first admissible orders introduced in this framework.

Features of flow of victims after terrorist attacks in the subway

The objective of the studywas to compare the order of admission and distribution in hospitals of the incoming flow of victims with explosive peacetime injuries (based on the analysis of terrorist acts in Minsk on April 11, 2011 and in St. Petersburg on April 3, 2017).Methods and Materials. We analyzed the organization of inpatient medical care for 2 groups of victims who applied for medical care to hospital health organizations on the day of the terrorist attack. The first group – 195 victims of the explosion in the subway of Minsk. The second group – 55 victims of the explosion in the subway of St. Petersburg. Results. The order of admission of victims to the healthcare organization in both groups was similar, as was the number of requests for medical care within 1.5 hours from the time of the first treatment (72.7 and 63.6 %, p&gt;0.05). In both groups, there were identical indicators of the victims aimed at inpatient treatment (80.5 and 83.6 %, p&gt;0.05), and cases when the profile of the hospitalization department was crucial for the nature of medical care (74.5 and 76.1 %, p&gt;0.05). The victims of both groups hospitalized in hospital healthcare organizations had identical indicators of subsequent transfers to other medical institutions or to other departments.Conclusion. The first 1.5 hours after the first call to hospitals after explosions in the subway are the most stressful, which may require limiting medical care only to emergency operations. Up to 20 % of the victims had no serious injuries and were referred for outpatient treatment.

Application Effect of Time Nursing Theory Based Clinical Nursing Pathway on Gestational Hypertension Patients

To analyze the application effect of time nursing theory based clinical nursing pathway on gestational hypertension patients is the main objective. A total of 85 gestational hypertension patients admitted to our hospital from January 2018 to December 2019 were enrolled in this study and divided into 2 groups according to the order of admission. 42 cases in the control group received routine nursing and 43 cases in the study group received nursing according to time nursing theory based clinical nursing pathway. The blood pressure measurement results, delivery ways, maternal and infant outcomes and negative emotions were compared between the two groups. The systolic blood pressure and diastolic blood pressure were lower in both groups after nursing (p<0.05), with the systolic blood pressure and diastolic blood pressure lower in the study group than in the control group after nursing (p<0.05). The study group had higher proportion of natural delivery (p<0.05) and lower proportion of cesarean section than the control group (p<0.05). Fetal distress, neonatal asphyxia, premature delivery and postpartum hemorrhage had lower proportion in the study group than in the control group (p<0.05). Scores of self-rating anxiety scale and self-rating depression scale were lower in both groups after nursing (p<0.05), with self-rating anxiety scale and self-rating depression scale scores lower in the study group than in the control group (p<0.05). Application of time nursing theory based clinical nursing pathway in clinical nursing of gestational hypertension patients can help to control blood pressure, promote natural delivery, improve maternal and infant outcomes and alleviate patient’s negative emotions.

Study on the Efficacy and Safety of Policosanol in the Treatment of Senile and Elderly Patients with Hyperlipidemia

To investigate the efficacy, safety and tolerance of policosanol in the treatment of senile and elderly patients (≥75 y old) with hyperlipidemia is the main objective. 150 senile and elderly patients with hyperlipidemia from June 2011 to May 2013 were randomly divided into two groups (test group and control group) according to the order of admission. The test group was treated with policosanol 10 mg/d, while the control group was treated with atorvastatin 20 mg/d for 16 w. The changes and adverse reactions of total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, liver and kidney function, fasting blood glucose and creatine kinase were observed before and after treatment. There was no significant difference between the two groups in the indexes before treatment (p>0.05). After 16 w treatment, total cholesterol, triglyceride, low density lipoprotein cholesterol and high density lipoprotein cholesterol in the test group were 5.51±0.77, 1.79±0.88, 3.68±0.65 and 1.11±0.31 mmol/l before treatment and 4.90±1.03, 1.26±0.64, 3.21±0.92 and 1.31±0.30 mmol/l after treatment, respectively. The above indexes had statistical significance before and after treatment (p<0.01). Total cholesterol, triglyceride, low density lipoprotein cholesterol and high density lipoprotein cholesterol in the control group were 5.59±1.10, 1.90±0.76, 3.68±1.00, 1.18±0.37 mmol/l before treatment and 4.50±1.06, 1.39±0.81, 2.69±0.89, 1.32±0.35 mmol/l after treatment, the above indexes were significantly different from those before treatment (p<0.01). In terms of the magnitude of lipid lowering, the policosanol group was weaker than the atorvastatin group, especially in lowering low density lipoprotein cholesterol (p<0.01). No significant adverse reactions were observed in either group. Policosanol can effectively lower the level of blood lipid in patients and it is safe and well tolerated for senile and elderly patients.

Influence of Integrated Traditional Chinese and Western Medicine Nursing on the Living Quality of Patients with Angina Pectoris under the Concept of Evidence Based Nursing

To analyze the effect of integrated traditional Chinese and Western medicine nursing on the living quality of patients with angina pectoris under the concept of evidence based nursing. A total of 85 patients with angina pectoris in our hospital from July 2018 to December 2019 were selected as the research objects. They were divided into two groups according to the order of admission. The 42 cases in the control group were given routine nursing and 43 cases in the study group were given integrated traditional Chinese and Western medicine nursing under the concept of evidence based nursing. The living quality, self-rating anxiety scale score, self-rating depression scale score, complications and nursing satisfaction were compared between the two groups. Compared with those before intervention, the scores of each dimension of Seattle Angina Questionnaire of the two groups after intervention were significantly improved (p<0.05) and the scores of each dimension of Seattle Angina Questionnaire of the study group were higher than those of the control group (p<0.05). Compared with those before the intervention, the self-rating anxiety scale and self-rating depression scale scores of the two groups after intervention were significantly decreased (p<0.05) and the study group had lower self-rating anxiety scale and self-rating depression scores (p<0.05). Compared with the control group, the study group had lower incidences of insomnia, irritability, abdominal distention, urinary retention and low back pain (p<0.05). Compared with the control group, the study group had higher nursing satisfaction (p<0.05). The integrated traditional Chinese and Western medicine nursing under the concept of evidence based nursing was helpful to improve the living quality and nursing satisfaction of patients with angina pectoris and reduce their adverse emotions and complications.