Hospitals In Shandong Province Research Articles

Safety and clinical outcomes of computed tomography-guided percutaneous microwave ablation in patients aged 80 years and older with early-stage non-small cell lung cancer: A multicenter retrospective study.

BackgroundPrevious studies have documented the therapeutic value of computed tomography (CT)‐guided percutaneous microwave ablation (MWA) for early‐stage non‐small cell lung cancer (NSCLC). However, few studies have focused on patients aged 80 years and older. This retrospective study aimed to evaluate the safety and clinical outcomes of CT‐guided percutaneous MWA in patients aged 80 years and older with early‐stage peripheral NSCLC.MethodsA retrospective analysis of 63 patients aged 80 years and older with cT1a‐2bN0M0 peripheral NSCLC who underwent CT‐guided percutaneous MWA was performed between January 2008 and January 2018 at 11 hospitals in Shandong Province, China.ResultsThe median follow‐up time was 21.0 months. The overall median survival time was 50 months. The cancer‐specific median survival time was not reached in five years. The one‐, two‐, three‐, four‐, and five‐year overall survival rates were 97.1%, 92.6%, 63.4%, 54.4%, and 32.6%, respectively. The one‐, two‐, and three‐year cancer‐specific survival (CSS) rates were 97.9%, 97.9%, and 69.4%, respectively. The four‐ and five‐year CSS rates were not achieved. A total of 14 patients (22.2%) had local progression. The one‐, two‐, three‐, four‐, and five‐year local control rates were 88.8%, 78.8%, 70.3%, 63.9%, and 63.9%, respectively. The mortality rate was 0% within 30 days after the procedure. Major complications included pneumothorax requiring drainage (21.1%), pulmonary infection (4.2%), and pleural effusions requiring drainage (2.8%).ConclusionsCT‐guided percutaneous MWA is a safe and effective modality for treating patients aged 80 years and older with early‐stage peripheral NSCLC.

Genomic Analysis Of A KPC-2-Producing Klebsiella Pneumoniae ST11 Outbreak From A Teaching Hospital In Shandong Province, China.

PurposeKlebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae bacteria causes nosocomial infections worldwide. However, KPC-producing K. pneumoniae outbreak has never been reported in Shandong Province, China. The purpose of our study was to elucidate the epidemiological and drug resistance mechanisms of KPC-producing K. pneumoniae strains collected from a large teaching hospital in Shandong during the outbreak. Moreover, we attempted to characterize the genetic environment and phylogenetic analysis of blaKPC-2 in outbreak isolates.MethodsWe monitored a 64-day outbreak of infection in a general hospital in Shandong Province, and the bacteria causing the infection were all ST11-type K. pneumoniae. The genotype correlation of KPC-producing K. pneumoniae isolates was assessed by whole-genome sequencing (WGS) phylogenetic analysis. Subsequent studies included antibiotic susceptibility testing, multilocus sequence typing (MLST) and S1-pulsed-field gel electrophoresis (S1-PFGE), Southern blot hybridization.ResultsFrom February 1, 2018 to April 5, 2018, 14 KPC-producing K. pneumoniae isolates from different wards were collected. All 14 isolates were resistant to carbapenems and carried the extended-spectrum β-lactamase (ESBL) gene as well as fosA, and sul genes. Whole-genome analysis showed that all 14 the outbreak isolates were all ST11 type. The blaKPC-2 carrying plasmids were all belong to IncFIIK2 type, and the size ranged from 94 kb to 368 kb.ConclusionAs far as we know, this report first describes the genomics characterization of KPC-2-producing K. pneumoniae outbreak isolates from Shandong Province, China. In our study, these isolates appeared to be cloned, and ST11 K. pneumoniae was the major clone caused the outbreak. Therefore, routine surveillance of such strains in this region is urgently warranted.

The Research of Present Situation and Influencing Factors of Inflammatory Bowel Disease Nursing Competence in Gastroenterology Department of Grade A of level Ⅲ Hospital in Shandong Province

Objective: The research is to study the present situation and influencing factors of inflammatory bowel disease (IBD) nursing competency in grade A of level Ⅲ hospital in Shandong province. and provided reference for further training and education of IBD nurses. Methods: From October, 2018 to May, 2019, the research is a cross-sectional study including 17 cities, 327 IBD nurses (qualified group n=197, unqualified group n=130) based on the IBD nursing competency questionnaire. The questionnaire is self-designed on the reference of registered nurse core competence scale and the reliability and validity have been tested very well. Results: The IBD nursing competence questionnaire has 8 categories and 68 entries. The content validity index (CVI) is 0.90, while the Cronbach index is 0.992. The median score of IBD nursing competency is 70.59 and each category vary from 55.00 to 84.38. Among them, the critical thinking skills or research ability (55.00) and continuing nursing (58.33) behave not very well. According to the single factor analysis, the hierarchy (P=0.031) and the follow-up numbers of IBD patients (P=0.001) are two significant factors for the IBD nursing competency. In the Logistic multiple factors analysis, the hierarchy (N(1) and N(2)) and the follow-up numbers of IBD patients (21-50 patients) are also important factors. Conclusion: The present situation of IBD nursing competency of Shandong province is acceptable. But there is still a long way to go in the aspect of critical thinking skills, research ability, and continuing nursing. Nurse hierarchy level and follow-up of IBD patients affect nursing competence and we should reinforce the training and education of IBD nurses.

Investigation on work burnout of psychiatric nurses and its influencing factors

Objective To investigate the status quo and influencing factors of work burnout of psychiatric nurses, and to provide theoretical basis for formulating intervention strategies for work burnout of psychiatric nurses. Methods A questionnaire was conducted on 812 nurses selected from 6 tertiary A psychiatric hospitals in Shandong province as the research object by stratified random sampling, and the questionnaire was conducted by using the Maslach Burnout Inventory (MBI), the Kessler Psychological Distress Scale (K10) and Emotion regulation questionnaire (ERQ). Results There were significant differences in job burnout among psychiatric nurses with different educational background, age, nurse-patient conflict and income level. There were significant differences in the dimensions of job burnout among psychiatric nurses with different titles (P< 0.05), There were significant differences in emotional exhaustion (F=8.417, P=0.000) and depersonalization level (F=7.918, P=0.000) between psychiatric nurses with different frequency of nurse-patient conflict.There were significant differences in affective exhaustion (F=6.426, P=0.002) and personal accomplishment (F=3.444, P=0.032) between psychiatric nurses with different monthly income levels. Psychiatric nurses' age, working years, psychological distress, cognitive reappraisal, inhibition of expression were associated with job burnout (r=0.075~0.570) . Regression analysis revealed that the factors impacting emotion exhaustion (R2=0.374, F=81.627, P=0.000) and depersonalization (R2=0.240, F=65.014, P=0.000) were psychological distress, inhibition of expression, cognitive reappraisal, conflict between nurses and patients. The factors impacting diminished personal accomplishment (R2=0.199, F=68.332, P=0.000) were psychological distress, cognitive reappraisal and age. Conclusions The work fatigue of psychiatric nurses was at the moderate level. Emotional regulation and psychological distress were the influencing factors of job burnout.Nursing administrators in psychiatric department should pay attention to the improvement of nurses' sense of burnout, improve the ability of nurses' emotional management, cultivate positive mood and behavior pattern, reduce anxiety and depression and so on, so as to effectively improve the mental health level of nurses in psychiatric department. Key words: Burnout; Emotion regulation; Psychological distress; Psychiatric nurses

Association between sarcopenia and nutritional status in hospitalized patients aged 80 years and over

Objective To investigate the association between sarcopenia and nutritional status among inpatients aged 80 years and over. Methods A total of 120 patients aged ≥80 years admitted into geriatrics department of a third-grade first-class hospital in Shandong province who met inclusion and exclusion criteria were enrolled from March 2017 to March 2018 in this cross-sectional study.According to diagnostic criteria of Asian Working Group for Sarcopenia, patients were divided into the sarcopenia group and the non-sarcopenia group.General clinical data were collected.Nutritional assessment was validated by using Mini Nutritional Assessment(MNA)and the determined nutritional indexes of serum levels of hemoglobin and albumin.Univariate and multivariate analysis were used to analyze the association between sarcopenia and nutritional status. Results Of 120 inpatients aged ≥80, 28 cases(23.3%)had sarcopenia, including 20 men(71.4%)and 8 women(28.6%). The incidences of sarcomenia were 1.4%(1 case)in patients with normal nutritional status and 100%(6 cases)in patients with malnutrition.Compared with the non-sarcopenia group, the sarcopenia group had lower levels of body mass index, serum hemoglobin, serum albumin and MNA scores[(20.0±2.2)kg/m2vs.(25.4±3.0)kg/m2, (34.5±3.4)g/L vs.(38.6±3.5)g/L, (114.4±14.0)g/L vs.(127.3±14.8)g/L, (8.8±1.9)score vs.(12.7±1.4)score, P<0.05]. After adjustment for all covariates, multivariate Logistic regression analysis showed that MNA score was an independent risk factor for sarcopenia(OR=0.118, 95%CI: 0.026-0.530). Conclusions The incidence of sarcopenia is high in hospitalized patients aged 80 years and older.MNA score is an independent risk factor for sarcopenia. Key words: Aged, 80 and over; Inpatients; Sarcopenia; Nutrition assessment

Combination of icotinib and chemotherapy as first-line treatment for advanced lung adenocarcinoma in patients with sensitive EGFR mutations: A randomized controlled study

ObjectiveTo explore the efficacy and safety of icotinib with chemotherapy as first-line therapy for advanced lung adenocarcinoma in patients with sensitive epidermal growth factor receptor (EGFR) mutations. MethodsThis prospective, randomized, controlled trial was conducted in 10 general hospitals in Shandong Province, China. Previously untreated patients with advanced lung adenocarcinoma and sensitive EGFR mutations were recruited between January 16, 2014 and December 31, 2016 and randomly allocated to the combination group (icotinib plus pemetrexed and carboplatin) or the icotinib only group. The patients were followed up until May 23, 2018. The primary endpoint was progression-free survival (PFS). ResultsThe efficacy analysis (intention-to-treat analysis) include 179 patients (n = 90 in the combination group and n = 89 in the icotinib only group). PFS was significantly longer in the combination group than in the icotinib only group (16.0 months vs. 10.0 months, hazard ratio [HR] = 0.59, 95% confidence interval [CI] 0.42–0.84, P = 0.003). The objective response rate and the disease control rate for the combination group were significantly higher than those for the icotinib only group (77.8% vs. 64.0%, χ2 = 4.094, P = 0.043; 91.1% vs. 79.8%, χ2 = 4.632, P = 0.031). However, overall survival did not differ between the two groups (36.0 months vs. 34.0 months, HR = 0.81, 95%CI 0.54–1.22, P = 0.309). The incidence rates of leukopenia and liver function damage of grades 3–4 were higher in the combination group than in the icotinib only group (12.2% vs. 0%, χ2 = 11.086, P = 0.001; 12.2% vs. 3.5%, χ2 = 4.488, P = 0.034). However, adverse events were resolved in most patients. ConclusionUse of the combination of icotinib and chemotherapy as first-line therapy significantly improved the PFS of advanced lung adenocarcinoma patients with sensitive EGFR mutations. Although the combination therapy increased the incidence of leukopenia and liver function damage, the observed adverse events were tolerable and manageable.

Analysis of HIV testing status and relevant factors in male sexually transmitted diseases patients in Shandong Province

A survey was conducted to analyze the HIV testing status and related influencing factors of male sexually transmitted diseases(STD) patients attending 18 county-level hospitals in Shandong Province from July 2015 to August 2016. The HIV detection rate of 1 570 subjects was 77.58% (1 218/1 570), and the HIV-antibody positive rate was 0.99% (12/1 218). Compared with general hospitals patients, urinary and anorectal patients, non-sexual patients, and patients with negative attitudes toward HIV testing, patients were more likely to be tested for HIV from specialized hospitals (OR=3.74, 95%CI:2.53-5.54), the skin and venereal section (OR=1.92, 95%CI: 1.31-2.79), the STD group (OR=2.02, 95%CI: 1.34-3.03) and patients with positive attitude (OR=15.20, 95%CI:10.74-21.52).

Effect of N-acetylcysteine on exacerbations of bronchiectasis (BENE): a randomized controlled trial

BackgroundN-acetylcysteine is a classic mucolytic agent. This study aimed to investigate the efficacy of N-acetylcysteine on reducing the risk of exacerbations in bronchiectasis patients.MethodsA prospective, randomized, controlled trial was conducted between April 1, 2014 and December 31, 2016 in five general hospitals in Shandong Province, China. Adult bronchiectasis patients with at least two exacerbations in the past year were potentially eligible. Patients were randomly assigned to receive oral N-acetylcysteine (600 mg, twice daily, 12 months) or on-demand treatment.ResultsA total of 161 patients were eligible for randomization (81 to the N-acetylcysteine group and 80 to the control group). During the 12-month follow-up, the incidence of exacerbations in the N-acetylcysteine group was significantly lower than that in the control group (1.31 vs. 1.98 exacerbations per patient-year; risk ratio, 0.41; 95% CI, 0.17–0.66; P = 0.0011). The median number of exacerbations in the N-acetylcysteine group was 1 (0.5–2), compared with 2 (1–2) in the control group (U = − 2.95, P = 0.003). A total of 24.7% of the N-acetylcysteine group patients and 11.3% of the control group patients remained exacerbation-free throughout the 12-month follow-up (χ2 = 4.924, P = 0.026). Compared with the control group, the volume of 24-h sputum in the N-acetylcysteine group was significantly reduced (t = − 3.091, P = 0.002). Additionally, the N-acetylcysteine group showed a significant improvement in the quality of life. No severe adverse events were reported in the intervention group.ConclusionThe long-term use of N-acetylcysteine is able to reduce the risk of exacerbations for bronchiectasis patients in Shandong Province, China. The results of this study should be verified in a larger randomized controlled trial.Trial registrationClinicalTrials.gov (NCT02088216) (Registered date: March 5, 2014).

Student nurses' career motivation toward gerontological nursing: A longitudinal study

BackgroundThe intensity of student nurses' motivation toward a certain career can influence their behaviors for career choice and decision making. However, little is known about the career motivation among student nurses toward gerontological nursing and their influencing factors. ObjectivesThe objectives of this study were to examine student nurses' career motivation toward gerontological nursing and to explore potential predictors using Bandura's reciprocal determinism. DesignA longitudinal design was used in this study. Settings and participantsA total of 305 student nurses were recruited from six hospitals in Shandong province, and they completed the questionnaires over three stages. MethodsStudent nurses' career motivation toward gerontological nursing, geriatrics attitudes, aging anxiety, empathy, and clinical practice environment were measured using the motivation questionnaire, the Geriatrics Attitudes Scale, the Anxiety about Aging Scale, the Interpersonal Reactivity Index, and the clinical practice environment questionnaire, respectively. Measurements were performed at the first month, fourth month, and seventh month of student nurses' clinical practice. A series of Pearson correlation, multiple linear regression, and generalized estimating equations were applied to analyze the data. ResultsAmong 305 student nurses, the mean scores for career motivation toward gerontological nursing over three stages were 66.11 (SD = 8.98), 67.55 (SD = 8.53) and 66.78 (SD = 9.51), sequentially. There were significant differences in scores for career motivation over time (P < 0.05) and the lowest score was observed at the first month. Geriatric attitudes, aging anxiety, empathy, clinical practice environment and stage of clinical practice were notable predictors of student nurses' career motivation toward gerontological nursing. ConclusionsStudent nurses' career motivation toward gerontological nursing needs to be improved, especially at the first month of clinical practice. Targeted interventions should cultivate positive geriatric attitudes, relieve anxiety about aging, promote empathy, and enrich the clinical practice environment to improve student nurses' career motivation toward gerontological nursing.

The relationship between neuroticism and sleep quality of patients withpermanent pacemaker implantation:mediating effect of positive psychological capital

Objective To investigate the sleep quality of pacemaker implanted patients,to analyze the relationships among neuroticism,positive psychological capital and sleep quality,and to examine the potential mediating effect of positive psychological capital on the relationship between neuroticism and sleep quality. Methods Using convenience sampling, a total of 178 pacemaker implanted patients were interviewed and analyzed in two tertiary hospitals of Shandong province. They were assessed with Big Five Inventory,The Positive Psycap Questionnaireand Pittsburgh Sleep Quality Indexfor the evaluation of neuroticism,positive psychological capital and sleep quality.The Process macro was used to test the mediating effect. Results The mean score of PSQI in patients with pacemaker implantation was (8.48±4.50), and 71.3%of them had sleep problems.The scores of neuroticism had positively correlated with the PSQI scores(r=0.31, P<0.01), the scores of positive psychological capital had negatively correlated with the PSQI scores(r=-0.39, P<0.01).The confidence interval from Bootstrap output indicated positive psychological capital played a mediating role between neuroticism and sleep quality (95%CI:0.06-0.23), mediation effect was 0.14, the percentage of mediation effect in total effect was 43.75%. Conclusions The relation of positive psychological capital to neuroticism and sleep quality among pacemaker implanted patients are intimate.Positive psychological capital could mediate the relationship between neuroticism and sleep quality. It is suggested that nurses can improve the patient′s sleep by enhancing the intervention of positive psychological capital according to the personality characteristics of patients. Key words: Pacemaker implanted patients; Neuroticism; Positive psychological capital; Sleep quality; Mediating effect

Family resilience and psychological well-being among Chinese breast cancer survivors and their caregivers.

Walsh's family resilience theory indicated that families could foster resilient outcomes among their members when they are facing changes or crises. However, little is known about family resilience and psychological well-being among Chinese breast cancer survivors and their caregivers. Therefore, this study aimed to examine the direct and indirect relationships between family resilience, breast cancer survivors' post-traumatic growth (PTG), quality of life (QOL), and their principal caregivers' caregiver burden. A total of 108 breast cancer survivors/principal caregivers pairs completed a cross-sectional questionnaire survey in a comprehensive cancer of a public hospital in Shandong Province, China. The structural equation modelling (SEM) results showed that family resilience had direct and indirect effects on QOL and caregiver burden, and it was positively related to the PTG of the survivors. The survivors' PTG was positively related to their QOL, and their QOL was negatively associated with caregiver burden. Therefore, a better understanding of how family resilience contributes to PTG and QOL of the survivors and caregiver burden could help clinicians tailor interventions to enhance interventions aimed at improving both survivors' and caregivers' well-being.

A survey on night sleep quality and daytime tiredness among shift nurses in a tertiary teaching hospital

Objective: To explore the night sleep quality of shift nurses and the current situation of their daytime tiredness, sleepiness, and to provide evidence for nursing administrators and managers to allocate human resources reasonably and prevent adverse events. Methods: The cross-sectional method was utilized to conduct a questionnaire survey among shift nurses in a tertiary teaching hospital in Shandong Province from March to May inclusive, 2017. Results: There was a total of 233 valid questionnaires returned. The prevalence of sleep disorder, daytime tiredness and sleepiness was 45.92%, 16.31% and 13.30%, respectively. The differences of the nurses' sleep quality at night between different ages, marriages, educational backgrounds and professional titles were statistically significant (P<0.05) , while the differences of daytime burnout and sleep state between different shift systems were statistically significant (P<0.01) . Night sleep quality was positively correlated with daytime tiredness and sleepiness (P<0.05) . The results of multiple linear regression analysis showed that age, marriage, educational background and professional title had an impact on nurses' sleep quality at night (P<0.05) . Shift system had an impact on nurses' daytime burnout and sleep apnea (P<0.01) . Conclusion: There was a high prevalence of night sleep disorder, daytime tiredness and sleepiness among the shift nurses. Nursing administrators and managers should pay more attention to the night sleep quality of nurses who aged over 30 years old, married, without a bachelor degree and those with a lower professional rank. Furthermore, the current situation of daytime tiredness and sleepiness among two-shift only nurses was worrisome.

The correlation between job satisfaction and emotional labor surface performance of nurses in emergency department

Objective: To investigate the relationship between job satisfaction and emotional labor surface performance of nurses in emergency department of Shandong province, and to provide realistic basis for the nursing management to develop targeted improvement measures. Methods: The general situation questionnaire and emotional labor scale were used to investigate 276 emergency department nurses in 10 comprehensive hospitals in Shandong province. Results: The internal satisfaction and external satisfaction scores of the nurses in the emergency department were respectively (3.09±0.26, 3.07±0.49) , Through to the emergency department nurses of different nursing age inner satisfaction and external satisfaction scored an average of comparative analysis found that protecting ages pass to 15 years of emergency department nurses intrinsic satisfaction, extrinsic satisfaction is better than that of other age groups (P<0.05) . There was a significant negative correlation between job satisfaction and surface performance of nurses in the emergency department (r=-0.178) , with no significant correlation between job satisfaction and deep performance (r=-0.043) , and a positive correlation between job satisfaction and natural performance (r=0.111) . Conclusion: There was a certain correlation between job satisfaction and emotional labor surface performance and of the nurses in the emergency department.

An investigation of training effects of the Shandong oncology specialist nurses

Objective To investigate training effects of Shandong oncology specialist nurses. Methods A self-designed questionnaire about training effects was used to investigate 149 oncology specialist nurses in 48 hospitals in Shandong province. Results The total score of training effects was 202.075±17.918. Differences were significant in human relations of training effects of oncology specialist nurses (F=3.439,P<0.05). 94.74% (126/133) of the oncology specialist nurses had no changeable in their work after training, 62.41% (83/133) served as skeleton staffs, only 22.56% (30/133) published in journals, 58.65% (78/133) of the specialist nurses had no chance to attend meeting and only 3.01% (4/133) had experiences to study for a month or more. Conclusions The training effects of Shandong oncology specialist nurses some abilities still need to be increased, the training contents need to be enriched, the use and management of the specialist nurses need to be further regulated, and the development of the oncology specialist nurses need to be further improved. Key words: Oncology specialist nurse; Training effects; Questionnaire

Relationships between family resilience, breast cancer survivors’ individual resilience, and caregiver burden: A cross-sectional study

BackgroundCaregivers of breast cancer survivors experience various types of burden, which in turn is linked to patients’ physical and psychological status. Family resilience might be able to decrease caregiver burden and facilitate survivors’ individual resilience, and individual resilience might be related to caregiver burden. Nevertheless, these relationships have not yet been confirmed. ObjectiveTo determine the relationships between family resilience, breast cancer survivors’ resilience, and principal caregivers’ caregiver burden, as well as determine whether breast cancer survivors’ individual resilience plays a mediating role in the relationship between family resilience and caregiver burden. DesignCross-sectional study design. SettingThe comprehensive cancer center of a public hospital in Shandong Province, China. ParticipantsThe sample comprised 108 dyads of early-stage breast cancer survivors and their principal caregivers. MethodsThe principal caregivers completed the Shortened Chinese Version of the Family Resilience Assessment Scale and the Chinese Version of the Zarit Caregiver Burden Interview, while the breast cancer survivors completed the 10-item Chinese version of the Connor-Davidson Resilience Scale and provided their sociodemographic information. The mediating effect of individual resilience was estimated using the bootstrap method via IBM SPSS Amos 21.0. ResultsCaregiver burden was significantly negatively associated with both family resilience and breast cancer survivors' individual resilience (both p < .01). Furthermore, individual resilience mediated the relationship between family resilience and caregiver burden (b = −0.052; 95% confidence interval: −.412, −.036). ConclusionsThe findings suggest that both family resilience and breast cancer survivors’ individual resilience may ease caregiver burden among the principal caregivers of breast cancer survivors, and family resilience tends to promote the survivors’ individual resilience. Therefore, family resilience and survivors’ individual resilience should be enhanced for breast cancer survivors and their family to ease the principal caregivers’ caregiver burden.

A study of medical complaints against five tertiary general hospitals in Shandong province

Objective To analyze the causes, characteristics and solutions of medical complaints against five tertiary general hospitals in Shandong province, and provide references for the hospitals to improve their quality of care and to build a harmonious relationship between doctors and patients. Methods A retrospective analysis method was used to analyze the causes, solutions and subjects of 1 049 medical complaints against five tertiary general hospitals in Shandong province from 2012 to 2015. Results Among the departments complained, orthopedics(165 cases, 15.7%), and obstetrics and gynecology(136 cases, 13.0%)topped the rest.The causes of complaints mainly focued on the quality and effect of surgery(355 cases, 33.8%), diagnosis and treatment(269 cases, 25.6%), and service attitude(204 cases, 19.4%). For outpatient/emergency departments, the patients mostly complained on service attitude (125 cases, 36.1%), while the causes of complaints by inpatients were mainly quality of surgery and effects (332 cases, 44.8%). In terms of the dispute solution pathways, consultation between doctors and patients became the most useful one(353 cases, 84.5%), and the third-party mediation approach(56 cases, 13.4%)also played an important role. Conclusions The hospitals should comprehensively strengthen their medical quality management, improve the quality of service contact and patient satisfaction. They are also recommended to establish a perfect complaint handling mechanism for higher patient satisfaction. The government should set up specialized courts for medical disputes and improve the efficiency of judicial solution of such disputes. Key words: Hospital administration; Medical complaint; Doctor-patient relationship; Shandong province

A pilot screening of high-risk Gaucher disease children using dried blood spot methods in Shandong province of China

BackgroundThe study aim was to verify the feasibility of a diagnostic algorithm with the evaluation of beta glucocerebrosidase (GBA) activity on dried blood spots (DBS) in screening high-risk Gaucher disease (GD) children in China, and to investigate the GD prevalence in this selected population.MethodsChildren were recruited from 20 departments of pediatrics or children’s hospitals in Shandong Province, China, due to splenomegaly and/or thrombocytopenia associated with one or more of the following creteria: anemia, history of bone pain, monoclonal gammopathy of unknown significance (MGUS), polyclonal gammopathy and splenectomy. GBA activity on DBS was tested, and patients with DBS GBA activity under 30 nmol/h.ml were recalled to assess enzyme assay with gold standard and molecular GBA gene analysis on leukocytes.ResultsA total of 73 children (47 boys and 26 girls) were enrolled in this study. GBA activity DBS < 30 nmol/h.ml was found in 18 (23.7%) children among which four (three boys and one girl) were diagnosed as GD with a median age 1.5 years, and the prevalence in this pediatric population was 5.5% (1.5%~ 13.4%). Three new mutations of GBA found in the four GD patients, L264I, A100Cfs*7 and D399E, have not been reported before.ConclusionsWith evaluation of GBA activity on DBS as a preliminary screening method, the diagnostic algorithm used in this study is appropriate to make early diagnosis for GD patients with mild symptoms or atypical symptoms and avoid diagnosis delay.Trial registrationNot applicable.

Molecular epidemiology of Clostridium difficile in two tertiary care hospitals in Shandong Province, China.

PurposeThe incidence and severity of Clostridium difficile infection (CDI) have markedly increased over the past decade. However, there is very limited epidemiological data on CDI in China so far, specifically no data in Shandong Province. The aim of this study was to evaluate diagnostic algorithm for CDI and to gain data on molecular epidemiology of CDI in the Shandong Province of China.Materials and methodsNonrepetitive unformed fecal specimens (n=504) were investigated by the glutamate dehydrogenase (GDH), C. difficile toxin A&B (CDAB) tests and toxigenic culture. Furthermore, 85 isolates were characterized by toxin gene detection, multilocus sequence typing, ribotyping and antimicrobial susceptibility testing.ResultsThe algorithm of combining GDH and CDAB tests could define diagnosis of 54.2% CDI cases and excluded 90% of non-CDI. Further adding the toxigenic culture to the algorithm enhanced the detection sensitivity to 100%. Toxigenic strains comprised 84.7% of isolates, including A+B+CDT− (71.8%, 61/85), A−B+CDT− (11.8%, 10/85) and A+B+CDT+ (1.2%, 1/85) isolates. RT046/ST35 (13.9%, 10/72), RT014/ST2 (12.5%, 9/72) and RT017/ST37 (12.5%, 9/72) were the more common genotypes among toxigenic C. difficile strains. The clinical severity score of A−B+CDT− toxin genes genotype (3.50±0.85) was significantly higher than the A+B+CDT− type (2.59±0.93) (P<0.05). RT046/ST35 isolates were highly prevalent and had high clinical severity scores (3.80±0.92). Variations in resistance from different sequence types (STs) were observed. Toxigenic strains showed higher resistance rates to erythromycin, clindamycin and ciprofloxacin compared to nontoxigenic strains (P<0.05).ConclusionThe epidemiology of C. difficile in Shandong Province differed from other regions in China. Comprehensive optimized diagnosis strategy and continuous surveillance should be established and applied in order to curb the spread of toxigenic C. difficile strains, especially for hospitalized patients.

Survey of the current prevention status of hospital acquired venous thromboembolism in Shandong province

Objective To investigate the current prevention status of hospital acquired venous thromboembolism(VTE) in Shandong province, to further improve the prevention and control of VTE system, and provide reference for prevention of hospital care to improve the quality of VTE. Methods An electronic questionnaire survey was conducted among nurses in 81 hospitals of Shandong province. The questionnaire mainly included three parts: basic information, the current prevention status of hospital acquired VTE and the training needs of nurses. A total of 3 766 valid questionnaires were recovered. Results 59.26%(48/81) hospitals established multi-discipinary team to prevent VTE, 76.00% (38/50) of the tertiary hospitals established multi-discipinary team, which was higher than 32.26% (10/31) of the secondary hospitals, the difference was statistically significant (χ2=15.166, P=0.000). The VTE risk assessment scale had been routinely used to assess the risk of VTE in hospitalized patients, 80.37% (352/438) tertiary hospital departments implemented grading nursing care while 71.43% (175/245) secondary hospitals departments implemented grading nursing care, the difference was statistically significant(χ2=7.120, P=0.008). Each level hospital mechanical preventive equipment configuration rate was less than 70%. Training needs of nurses: 92.11% (3 469/3 766) nurses believed that it was necessary to organize the VTE related knowledge training for nurses, but there were significant differences in the training of nurses with different professional titles (Z=-12.607, P=0.000). 48.04%(1 149/2 392) nurses with junior grade professional titles were not trained. Conclusions The hospital attaches great importance to the prevention of hospital acquired VTE, but the construction level of VTE prevention system is unevenness, and primary hospitals should be further reinforced. The risk assessment scale selection lacks of uniform standards, mechanical preventive equipment allocation rate should to be further improved. And the training of primary nurses should be further strengthened. Key words: Venous thromboembolism; Questionnaires; Prevention

A Prospective Trial of Nebulized Amikacin in the Treatment of Bronchiectasis Exacerbation

Background: Pseudomonas aeruginosa is the most common pathogenic bacteria in bronchiectasis (BE) patients. The availability and security of nebulized amikacin treatment are unknown. Objective: The purpose of this study was to explore the efficiency and adverse effects of nebulized amikacin treatment for 2 weeks, administered as intravenous therapy during exacerbation of BE patients infected with P. aeruginosa. Methods: A total of 143 patients with exacerbation of BE were screened between January 2013 and March 2016 at five tertiary hospitals in Shandong Province, China. The BE patients were diagnosed by high-resolution computed tomography scans, and all of them were confirmed to be infected with P. aeruginosa after sputum culture test. Seventy-four patients were assigned to the intervention group and received amikacin nebulization (0.2 g) treatment twice daily for 2 weeks along with intravenous antibiotic therapy. Sixty-nine patients were assigned to the control group and received standard antibiotic therapy alone. The primary outcome was the rate of bacterial eradication from the sputum, and the secondary outcomes were drug resistance and adverse effects. Results: The bacterial eradication rate of sputum in the intervention group (51.4%) was significantly higher compared to that in the control group (23.2%) (χ² = 14.211, p = 0.030). Drug sensitivity testing showed that there were 5 drug-resistant cases in the intervention group and 7 in the control group, which was not significantly different. Three patients dropped out of the trial due to adverse effects. None of the patients hat renal injury. Conclusions: Nebulized amikacin treatment is a safe treatment for exacerbation of BE and significantly increases the bacterial eradication rate of sputum.