Tertiary Hospital In Shanghai Research Articles

Clinical Outcomes of Posterior Percutaneous Endoscopic Cervical Foraminotomy and Discectomy Assisted with SNRB in Treating Cervical Radiculopathy with Diagnostic Uncertainty

Selective nerve root block (SNRB) has been used to facilitate the diagnostic process when radiologic abnormalities are not correlated with clinical symptomatology in patients with cervical radiculopathy. Meanwhile, minimally invasive posterior percutaneous endoscopic cervical foraminotomy and discectomy (PPECFD) has been widely used to treat cervical radiculopathy because of its advantages. However, combination of these 2 procedures in the treatment of cervical radiculopathy with diagnostic uncertainty has not been reported. To examine the clinical outcomes of PPECFD assisted with SNRB in patients who had cervical radiculopathy with diagnostic uncertainty. A retrospective design was used. This study was conducted in a university-affiliated tertiary hospital in Shanghai, China. Thirty consecutive patients with cervical radicular pain who had diagnostic uncertainty were included (January 2018 to January 2019). Diagnostic SNRB was performed to identify the responsible nerve root(s). PPECFD was selected as the treatment when the SNRB result was positive. Clinical outcomes were assessed by the Visual Analog Scale (VAS), Neck Disability Index (NDI), and modified Macnab criteria. Pre- and post-operative radiologic and clinical parameters were evaluated. Other information was retrieved from the electronic records. All patients had successful SNRB procedures. Four were excluded from the analysis because of the negative results of the SNRB. Among the remaining 26 patients who underwent the subsequent PPECFD surgery, the mean follow-up was 14 months. Compared with preoperative values, the mean VAS scores for radicular arm pain and neck pain, as well as the NDI score, improved significantly. According to the Macnab criteria, 22 patients (84.6%) had excellent or good results. No major peri- and postoperative complications were observed. This study used a retrospective design with relatively small sample size and medium follow-up duration. Diagnostic SNRB may be a helpful tool to identify the origin of cervical radicular pain for patients with diagnostic uncertainty. With the guidance of SNRB, PPECFD is likely to be an effective and safe option for the treatment of cervical radiculopathy with diagnostic uncertainty.

Emergency Response: A Cross-sectional Study of Core Competencies for Nurses Regarding Major Infectious Disease Outbreaks

IntroductionThe core competencies of nursing personnel have been identified as a main factor affecting nursing effectiveness. This study examined core emergency response competencies of Chinese nursing personnel related to the outbreak of major infectious diseases. MethodsA survey was conducted among 960 nurses working in a tertiary hospital in Shanghai, China. Data were collected on core emergency response competencies of nursing personnel caring for patients with major infectious diseases, measuring overall competency as well as by dimensions of prevention ability, rescue ability, and preparation ability. A t-test and one-way analysis of variance were first analyzed for differences between groups, followed by multiple linear regression to analyze main influencing factors for core emergency response competencies. ResultsThe average score for core emergency response competencies of nursing personnel delivering care to patients with major infectious diseases was 128.05 (SD 22.23) (range 36–180 points); or 71%, which is equivalent to moderate performance. Multiple linear regression analysis demonstrated that the main influencing factors for these nursing personnel were before participation in emergency drills for infectious diseases, current educational background, and working experience in the realm of infectious disease nursing. The final model explained 8.4% of the variance in core emergency response competencies. DiscussionThese findings indicate that it is necessary to strengthen the training of nursing staff with educational background deficits or no prior work or drill experience related to infectious diseases to effectively improve the core emergency response competencies of nursing personnel relative to infectious diseases.

Assessing the accuracy of visual blood loss estimation in postpartum hemorrhage in Shanghai hospitals: A web‐based survey for nurses and midwives

Aims and objectivesThis study aimed at evaluating the accuracy of visual estimated blood loss in postpartum haemorrhage by midwives and nurses, as well as exploring its influencing factors.BackgroundTimely recognition of postpartum haemorrhage is critical in saving maternal lives. Yet midwives and nurses can barely distinguish whether the blood loss has reached a life‐threatening amount without precise measurement. Understanding their ability to accurately estimate the amount of blood loss and the influencing factors can help improve this ability with effective measures.DesignThis research was a multicenter cross‐sectional survey with convenient sampling.Material and MethodsUsing a modified online visual estimation questionnaire of blood loss, the QR code of this survey was sent to midwives and obstetrical nurses engaged in clinical practice in secondary and tertiary hospitals in Shanghai. A descriptive analysis was performed with demographics and the responses of visual estimated blood loss of each volume. The difference and consistency of the responses of each volume were evaluated. The relationship between each demographic characteristic and accuracy was explored. STROBE statement checklist was chosen for reporting the study process.ResultsA total of 361 midwives and nurses participated in the survey. The finding showed an overall accuracy of 30.52% (1763/5776), with 25.3% and 18.0% subjects distinguishing postpartum haemorrhage (500 ml) and severe postpartum haemorrhage (1000 ml), respectively. The Kappa coefficients were slight to moderate (0.037–0.590). There were no differences among the categories of gender, age, academic degree, position, title, working experience in years, working department and reported methods of blood loss estimation with regard to accuracy. However, having institutional guidance for blood loss calculation showed a significant relationship with higher accuracy.Relevance to clinical practiceWhile representing a relatively well‐developed area in China, the accuracy of visual estimated blood loss was not satisfactory, as suggested in other developed countries around the world. Training and institutional guidance on blood loss quantification should be provided in midwifery settings, regardless of how the level of medical development is advanced.ConclusionsThe accuracy of VEBL was low even with a visual aid, especially when the volume exceeds 500 ml. To improve accuracy, institutions should make standardadized assessment guidance and provide regular training for blood loss quantification.

Associations between Human Chorionic Gonadotropin, Maternal Free Thyroxine, and Gestational Diabetes Mellitus.

Background: Human chorionic gonadotropin (hCG) is a marker of placental function, which also stimulates the maternal thyroid gland. Maternal thyroid function can be associated with the pathophysiology of gestational diabetes mellitus (GDM). We aimed to study whether there is an association of hCG concentrations in early pregnancy with GDM and whether it is mediated through maternal thyroid hormones. Methods: This study included 18,683 pregnant women presenting at a tertiary hospital in Shanghai, China, between January 2015 and December 2016. GDM was diagnosed using a 2-hour, 75-g, oral glucose tolerance test (OGTT) according to the American Diabetes Association guidelines. Multivariable logistic or linear regression models were used to identify associations, adjusting for maternal age, education level, family history of diabetes, parity, fetal sex, thyroperoxidase antibody (TPOAb) status, and prepregnancy body-mass index. Results: Higher hCG concentrations were associated with a lower plasma glucose level during the OGTT, but not with fasting plasma glucose or hemoglobin A1c concentrations tested during early pregnancy. hCG in early pregnancy was negatively associated with GDM risk (p = 0.027). Mediation analysis identified that an estimated 21.4% of the association of hCG-associated GDM risk was mediated through changes in free thyroxine (fT4) concentrations (p < 0.05). In the sensitivity analysis restricted to TPOAb-positive women, hCG was not associated with GDM (p = 0.452). Conclusions: Higher hCG levels in early pregnancy are associated with a lower risk of GDM. Maternal fT4 may act as an important mediator in this association.

Comparison of Endoscopic Cartilage Myringoplasty in Dry and Wet Ears With Chronic Suppurative Otitis Media.

This study compared the rate of graft success, as well as hearing improvement and dry ear time between dry ears and wet ears with otomycosis or without otomycosis in patients with chronic suppurative otitis media (CSOM) after endoscopic cartilage myringoplasty. This retrospective study was conducted in a tertiary hospital in Shanghai. In total, 83 patients with CSOM (43 with dry ears and 40 with wet ears) were included. Among the 40 patients with CSOM and wet ears, 25 exhibited otomycosis. All patients underwent endoscopic myringoplasty, and perforations were repaired using tragal cartilage with a single-sided perichondrium. Patients were followed up for at least 6 months. Pure-tone hearing was examined preoperatively and at 3 months postoperatively. The graft uptake rate, hearing improvement, and dry ear time were compared between the groups. The graft success rate did not differ significantly between the dry-ear and wet-ear groups (95.35% and 90.00%, respectively). Furthermore, the graft success rate also did not differ significantly between patients with wet ears and otomycosis and those with wet ears without otomycosis (92.00% and 86.67%, respectively). Hearing gain did not differ significantly between the dry-ear and wet-ear groups. No significant difference in hearing gain was also found in patients with wet ears with or without otomycosis. However, the time to dry ear was significantly longer in the wet-ear group than in the dry-ear group. Patients with CSOM and wet ears required more time to achieve a completely healthy status. However, the graft success rate and hearing improvement were not affected by a wet middle ear and otomycosis. Thus, endoscopic myringoplasty using tragus cartilage is an effective treatment for refractory CSOM in patients with wet ears and otomycosis.

Limited knowledge and distrust are important social factors of out-patient' s 'inappropriate diagnosed seeking behaviour': a qualitative research in Shanghai.

This study is designed to present out-patient's 'inappropriate diagnosed seeking behaviour' in tertiary hospitals and interpret its association with some potential social factors. A qualitative study based on grounded theory was designed in this paper. The participates were recruited by a two-stage process. The field observation and in-depth interview were adopted for data collection. Multi-round (five rounds) sampling and continuing data analysis were adopted as well. Totally 26 out-patients from three tertiary hospitals in Shanghai were involved. Four focused codes, including 'limited policy-related knowledge', 'limited health-related knowledge', 'distrust on related policy' and 'distrust on medical networks', were identified. Then, a theoretical model about the association of out-patient's 'limited knowledge' with 'distrust' and its relationship with 'inappropriate first-diagnosed seeking behaviour' in tertiary hospitals was developed. 'Inappropriate first-diagnosed seeking behaviour' of the out-patients in tertiary hospitals is closely associated with their limited knowledge and related distrust. Great effort on improving publics' knowledge and rebuilding a benign trust relationship with out-patients and the medical networks is found to be essential for guiding publics' appropriate first-diagnosed health behaviour in various levels of medical institutions.

Association of shared decision making with inpatient satisfaction: a cross-sectional study

BackgroundWe assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China.MethodsA cross-sectional survey of 2585 inpatients in 47 public tertiary hospitals in Shanghai in July and August 2018 was conducted. We assessed overall SDM and 4 aspects of SDM and tested the factors influencing SDM and the association of SDM with patient satisfaction (patient satisfaction with physician services, medical expenses, outcomes and overall inpatient care), by adopting linear or two-level regression models.ResultsThe positive response rate (PRR) and high positive response rate (HPRR) to overall SDM among the inpatients of public tertiary hospitals in Shanghai were relatively high (95.30% and 87.86%, respectively), while the HPRR to “My physician informed me of different treatment alternatives” was relatively low (80.09%). In addition, the inpatients who underwent surgery during admission had higher HPRRs and adjusted HPRRs to overall SDM than those who did not undergo surgery. The study showed that the adjusted high satisfaction rates (HSRs) with physician services, medical expenses, outcomes and overall inpatient care among the inpatients with high level of overall SDM were higher (96.50%, 68.44%, 89.50% and 92.60%) than those among the inpatients without a high level of overall SDM (71.77%, 35.19%, 57.30% and 67.49%). The greatest differences in the adjusted HSRs between the inpatients with and without a high level of SDM were found in inpatient satisfaction with medical expenses and informed consent in SDM. Moreover, 46.22% of the variances in the HSRs with overall inpatient care across the hospitals were attributed to the hospital type (general hospitals vs. specialty hospitals).ConclusionsInpatient PRRs and HPRRs to SDM in public tertiary hospitals in Shanghai are relatively high overall but lower to information regarding alternatives. SDM can be affected by the SDM preference of both the patients and physicians and medical condition. Patient satisfaction can be improved through better SDM and should be committed at the hospital level.

Incidence and risk factors of symptomatic thrombosis related to peripherally inserted central catheter in patients with lung cancer.

To determine the incidence and risk factors associated with peripherally inserted central catheter-related thrombosis (PICC-RT) in patients with lung cancer. A retrospective cross-sectional design. Patients with lung cancer receiving PICC insertion during 1 March 2014-31 May 2019 at a tertiary hospital in Shanghai, China were enrolled (N=748). Symptomatic PICC-RT was confirmed by Doppler ultrasonography in the presence of clinical symptoms and signs. Univariate and multivariate logistic regression analyses were performed to identify risk factors of symptomatic PICC-RT. Among the patients (mean age, 60.7years; males, 67.1%), 55 (7.35%) had symptomatic PICC-RT. Based on the multivariate analysis, history of smoking [OR 2.49 (1.13-5.46), p<.05], use of Carboplatin [OR 2.23 (1.19-4.17), p<.05] or Docetaxel [OR 7.23 (1.65-31.56), p<.05], PICC size [OR 3.52 (1.78-6.99), p<.001], and level of D-dimer [OR 5.32 (2.39-11.83), p<.001] were significant risk factors of PICC-RT. Several modifiable factors (e.g., PICC size and level of D-dimer) were related to PICC-RT. In the future, prospective studies are warranted to examine whether those factors could increase the risk of PICC-RT. Meanwhile, healthcare professionals are recommended to perform a comprehensive assessment of the patients receiving PICC insertion. Close attention should be paid to those at risk for PICC-RT. Identification of risk factors associated with PICC-RT is an important step towards individualizing the care plan for patients receiving PICC. Our findings provided evidence for the management of PICC-RT in patients with lung cancer. In clinical practice, nurses could deliver appropriate interventions against modifiable risk factors to reduce the risk of PICC-RT.

Validation of the Simplified Chinese Version of the Brief Diabetes Quality of Life (DQoL) Questionnaire Based on a Cross-Sectional Study.

(1) Objective: To assess the reliability and validity of the simplified Chinese version of the brief Diabetes Quality of Life (DQoL) questionnaire in measuring health-related quality of life (HRQoL) in Chinese type 2 diabetes (T2D) patients. (2) Methods: A cross-sectional validation study including 277 patients was conducted at a tertiary hospital in Shanghai, China during April–May, 2018. The English brief DQoL was forward and back-translated into simplified Chinese. The expert interview, exploratory factor analysis (EFA), and Spearman correlation with the 5-level version of EuroQoL-5 (EQ-5D-5L) were employed to establish its validity. The internal reliability was assessed by Cronbach’s alpha. Participants were also stratified into subgroups to evaluate if the Chinese brief DQoL had more test effectiveness in a specific subpopulation. (3) Results: No items were removed from the original English brief DQoL based on the results of factor analysis and expert interview. The Spearman coefficient revealed a low-moderate inverse correlation between DQoL and EQ-5D-5L index and visual analogue scale (VAS), respectively (ρ1 = −0.364, p < 0.0001; ρ2 = −0.514, p < 0.0001). The Cronbach’s alpha coefficient of the final scale was 0.731. (4) Conclusions: The simplified Chinese version of the brief DQoL questionnaire showed reasonable reliability and validity, suggesting its potential appropriateness for evaluating quality of life in Chinese T2D patients. More future efforts should be made to generalize the application of the findings.

Application of Next-Generation Sequencing for Genetic Diagnosis in Neonatal Intensive Care Units: Results of a Multicenter Study in China.

To identify next-generation-sequencing (NGS) clinical usability and to propose a standard diagnostic routine for critically ill infants, aged less than 100 days and suspected of having a genetically heterogeneous condition, a retrospective study was conducted between January 2016 and December 2018 at neonatal intensive care units (NICUs) of three tertiary hospitals in Shanghai, China. Whole-exome sequencing (WES) or panel sequencing was performed on 307 patients. Trio-WES, trio-panel, proband-WES, and proband-panel diagnostic yields were 39.71% (83/209), 68.75% (22/32), 59.09% (26/44), and 33.33% (4/12), respectively. Definitive molecular diagnoses of 142 infants (46.25%) uncovered 99 disorders; 21 disorders displayed on 44.37% of the diagnosed patients. Genetic etiologies were identified for 61.73% (50/81) of the deceased infants. One in three (29.58%) diagnosed infants exhibited one of the following four clinical traits which had a higher odds of diagnostic rate: integument abnormality (adjusted odds ratio [aOR], 19.7; 95% confidence interval [CI], 2.5–156.3), complex immune-related phenotypes (aOR, 9.2; 95% CI, 1.4–83.5), mixed nervous system phenotypes and congenital anomalies (aOR, 5.0; 95% CI, 1.3–19.1), or mixed metabolism and nervous system phenotypes (aOR, 4.5; 95% CI, 1.0–21.5). Our results demonstrated that NGS was an effective diagnostic tool. Infants exhibiting integument, complex immune-related conditions, metabolism, and nervous signs have higher chances of carrying variants in known disease-causing genes. The number of specific phenotypes could be used as an independent predictor of a positive molecular diagnosis, rather than an isolated abnormality. We developed a molecular diagnostic procedure for the use of NGS for diagnosis in Chinese NICU population based on individual characteristics.

Validation and psychometric properties of the self-efficacy for Appropriate Medication Use Scale in elderly Chinese patients.

Background Self-efficacy for appropriate medication use is an important construct when evaluating the optimal use of medications. However, no instrument that assesses this construct in elderly Chinese patients has been shown to have valid psychometric properties. Objective To investigate the psychometric properties of the Chinese version of the self-efficacy for Appropriate Medication Use Scale in elderly patients with type 2 diabetes. Setting Geriatric patients were recruited from the endocrinology department of a tertiary hospital in Shanghai, China. Method Self-efficacy was assessed by the Chinese version of the Self-Efficacy for Appropriate Medication Use Scale in subjects who were at least 65years old. Exploratory and confirmatory factor analyses were used to develop a psychometrically sound model of the scale. Main outcome measures Internal and test-retest reliability; convergent and discriminant validity of the scale; model fit indices of the factor model. Results The two-factor model of the self-efficacy for Appropriate Medication Use Scale was not suitable for elderly patients with respect to both item factor loadings and model fit indices. Conceptually overlapping scale items emerged when the scale was used in these patients. The final model developed appeared to achieve an ideal model fit and presented acceptable convergent and discriminant validity. Conclusions This study presented a Chinese version of the self-efficacy for Appropriate Medication Use Scale with psychometrically sound properties that will enable pharmacists, nurses and physicians to prospectively evaluate the impact of medication self-efficacy on a variety of health outcomes in elderly patients with type 2 diabetes.

The Effect of Postoperative Fluid Balance on the Occurrence and Progression of Acute Kidney Injury After Cardiac Surgery

In addition to the association between positive fluid balance (FB) and acute kidney injury (AKI) after cardiac surgery reported by former studies, this study examined the relationship between FB and progressive AKI. A retrospective, observational study. University teaching, grade A tertiary hospital in Shanghai, China. Adult patients after cardiac surgery from July-December 2016. Perioperative data relating to postoperative fluid intake and output were collected. AKI progression was defined as a worsening of AKI stage. FB was calculated as (fluid intake [L] - fluid output [L]/body weight [kg] × 100%). The study comprised 1,522 patients. The incidences of AKI and progressive AKI were 33.1% (n = 504) and 18.1% (n = 91), respectively. There was an exponential increase between 24-hour FB and AKI occurrence, and an approximate "U"-shape association between 48-hour FB and AKI progression. Multivariate logistic regression showed that 24-hour FB ≥5% was an independent risk factor for AKI incidence (odds ratio [OR] 3.976; p < 0.001) and 48-hour FB <-5% or ≥3% was associated with an increase of AKI progression (FB <-5%, OR 7.078 [p = 0.031]; FB 3%-5%, OR 6.598 [p = 0.020]; FB ≥5%, OR 16.453 [p < 0.001]). An exponential increase was found between 24-hour FB and AKI occurrence and a "U"-shape association between 48-hour FB and AKI progression. Both excessively negative and positive accumulative 48-hour FB increased the risk of AKI progression, suggesting cautious monitoring and application of fluid load in clinical practice.

An annotated dataset of tongue images supporting geriatric disease diagnosis.

Hospitalized geriatric patients are a highly heterogeneous group often with variable diseases and conditions. Physicians, and geriatricians especially, are devoted to seeking non-invasive testing tools to support a timely, accurate diagnosis. Chinese tongue diagnosis, mainly based on the color and texture of the tongue, offers a unique solution. To develop a non-invasive assessment tool using machine learning in supporting a timely, accurate diagnosis in the elderly, we created an annotated dataset of 15% of 688 (=100) tongue images collected from hospitalized geriatric patients in a tertiary hospital in Shanghai, China. Images were captured via a light-field camera using CIELAB color space (to simulate human visual perception) and then were manually labeled by a panel of subject matter experts after chart reviewing patients’ clinical information documented in the hospital's information system. We expect that the dataset can assist in implementing a systematic means of conducting Chinese tongue diagnosis, predicting geriatric syndromes using tongue appearance, and even developing an mHealth application to provide individualized health suggestions for the elderly.

Resilience is associated with post-stoke depression in Chinese stroke survivors: A longitudinal study

BackgroundOptimal strategies for prevention and treatment for post-stroke depression (PSD) remain unclear and a greater understanding of effect of resilience on PSD is promising. The aim was to examine the association between baseline resilience and depression at 1, 3, and 6 months after discharge, which contributes to early detection and management of PSD. MethodsA total of 217 ischemic stroke survivors were recruited in two tertiary hospitals in Shanghai, China from February 2017 to January 2018. The Chinese version of Connor-Davidson Resilience Scale (CD-RISC) was used to assess resilience at acute hospitalization. Hospital Anxiety and Depression Scale (HADS) was employed to ascertain baseline anxiety, baseline depression, and post-discharge depression. Social-demographic and disease-related information were obtained from participants’ self-report and medical records. Logistic regression analysis was used to determine which factors were independently associated with PSD. ResultsThe prevalence of depression at baseline was 21.2% and at 1, 3, and 6 months after discharge was 34.4%, 33.2%, and 29.2%, respectively. Logistics regression analyses indicated that resilience may independently predict PSD at 1 month (OR: 0.22, 95%CI: 0.097, 0.518), 3 months (OR:0.302, 95%CI: 0.151, 0.607), and 6 months (OR: 0.03, 95%CI: 0.006, 0.153) after controlling for social-demographics, disease-related characteristics, baseline anxiety, and baseline depression. LimitationsNon-multicenter survey and mild stroke severity may affect the generalization of these findings. Moreover, response bias should be acknowledged because some participants were read questionnaires out aloud. ConclusionResilience is independently associated with PSD at different timepoints. Our findings reveal the important role of resilience as a protective factor against PSD.

The Predominance of Strain Replacement Among Enterobacteriaceae Pairs With Emerging Carbapenem Resistance During Hospitalization.

Isolates of Enterobacteriaceae collected from the same patient can lose carbapenem susceptibility during antimicrobial therapy, but little attention has been given to how this conversion takes place. In the current study, we retrospectively analyzed microbiological and clinical data from patients with enterobacterial infections at a tertiary hospital in Shanghai, China. After screening 4795 patients and 7120 Enterobacteriaceae isolates over the 3-year study period, we found the change from carbapenem susceptible to carbapenem resistant in 41 pairs of isolates, of which 35 pairs (85.4%) were K. pneumoniae and 25 (61.0%) were from the same anatomic sites. Thirty-six isolate pairs showed different pulsed-field gel electrophoresis patterns between the carbapenem-susceptible and the corresponding resistant strain, and 5 pairs displayed identical pulsed-field gel electrophoresis patterns. Thirty-three (91.7%) of the 36 pairs of Enterobacteriaceae isolates were carbapenem-resistant K. pneumoniae with blaKPC-2, and 28 pairs (90.3%) of K. pneumoniae isolates had different sequence types (STs), with ST11 the most common ST found in carbapenem-resistant K. pneumoniae isolates. Forty of the 41 patients had received antimicrobial therapy such as carbapenems, cephalosporins, and fluoroquinolones, before the isolation of carbapenem-resistant Enterobacteriaceae. These results demonstrated that strain replacement is the main cause of emerging carbapenem resistance in Enterobacteriaceae during hospitalization. The loss of carbapenem susceptibility was not mainly due to in vivo development of carbapenem resistance.

Study of clinically-indicated replacement of peripheral intravenous catheters in old adults

Objective To evaluate the safety of clinically-indicated replacement of peripheral intravenous catheters (PIVCs) in old adults. Methods Total of 1 627 patients with peripheral intravenous catheters in emergency wards at a tertiary hospital in shanghai were recruited. Patients were randomly divided into an experimental group (817 cases) and control group (810 cases) by random digits tale method. PIVCs in the experiment were replaced only when clinical indications appeared, while PIVCs in the control group were routinely changed every 72-96 hours. Indwelling time, complications associated with PIVCs and nurse compliance were compared after indwelling peripheral intravenous catheters. Results PIVC indwelling time was (3.43±1.36) days in the experimental group, and (3.18±1.16) days in the control group ,there was significant difference between two groups (t value was 4.07, P 0.05). The severity of phlebitis in the experiment group was higher than that in the control group, and there was significant difference between two groups (χ2 value was 20.99, P<0.05). Nurse compliance achieved in the experimental group 100.00% (817/817) was higher than that in the control group 87.65% (710/810), which showed statistically difference (χ2 value was 107.47, P<0.05). Conclusion Indwelling time in the clinically- indicated replacement group was longer than that of the routine replacement group. Peripheral intravenous catheters in old adults can be remove as clinically-indicated with a close monitoring of complications. Key words: Aged; Peripheral intravenous catheters; Clinically- indicated replacement

Risk prediction of hypertension complications based on the intelligent algorithm optimized Bayesian network

Hypertension and its related complications could be a major threat issue for cardiopathy and stroke. Effective prevention and control can decrease the incidence rate of complications in hypertension. Based on the medical data of 3062 patients with cardiovascular and cerebrovascular diseases from 2017 to 2018 in a grade-A tertiary hospital in Shanghai, the study identified the risk factors of hypertension complications by text mining. On this basis, the K2 algorithm based on the improved particle swarm optimization was proposed to optimize the structure of the Bayesian network (BN) by establishing a multi-population cooperative search mechanism. Then the optimized BN was used to analyze and predict the incidence rate of hypertension complications. Results indicate that the major indicators of accuracy, sensitivity, specificity, and AUC have been improved, and the proposed algorithm is superior to the common data mining algorithms such as the back propagation neural network and the decision tree. Through the proposed model and algorithm, the high-risk factors were identified and the occurrence probability of hypertension complications was predicted, which could provide the personalized health management guidance for hypertensive patients to prevent and control hypertension complications.

Smartphone and social media-based cardiac rehabilitation and secondary prevention in China (SMART-CR/SP): a parallel-group, single-blind, randomised controlled trial

Coronary heart disease is rapidly increasing in developing countries, but access to cardiac rehabilitation and secondary prevention remains low. In this study, we aimed to assess the effectiveness of a smartphone-based cardiac rehabilitation and secondary prevention programme delivered via the social media platform WeChat (SMART-CR/SP). In this parallel-group, single-blind, randomised controlled trial, we recruited patients aged 18 years or older with coronary heart disease who had received percutaneous coronary interventions from a large tertiary hospital in Shanghai, China. Participants were randomly assigned (1:1) by block randomisation to either a 2-month intensive programme followed by a 4-month step-down phase of SMART-CR/SP or to usual care. In the SMART-CR/SP group, participants received comprehensive cardiac rehabilitation and secondary prevention via WeChat. The usual care group received standard outpatient cardiology follow-up but without formal cardiac rehabilitation and secondary prevention. Assessments were done at baseline, 2 months, 6 months, and 12 months. The primary outcome was change in functional capacity from baseline, measured by 6-min walk distance, at 2 months and 6 months. Analysis was by intention to treat. Research personnel involved in assessments were blinded to group allocation. Adverse-event analysis was based on percentage of patients who discontinued the study owing to adverse events. SMART-CR/SP programme-related safety issues were also recorded. This study was registered with the Chinese Clinical Trial Registry, number ChiCTR-INR-16009598. Between Nov 17, 2016, and March 18, 2017, 312 patients (mean age 60·5 years [SD 9·2]), of whom 58 (19%) were female and 254 (81%) were male, were recruited and subsequently randomly assigned to SMART-CR/SP (n=156) or usual care (n=156). The improvement in 6-min walk distance at 2 months was significantly greater in the SMART-CR/SP group (from 489·2 m [99·4] at baseline to 539·1 m [68·0]) than in the control group (from 485·0 m [93·5] at baseline to 517·8 m [74.6]), with an adjusted mean difference of 20·64 m (95% CI 7·50-33·77; p=0·034). This improvement was maintained at 6 months (mean 6-min walk distance 543·4 m [67·5] in the SMART-CR/SP group vs 523·5 m [60·2] in the control group), with a mean between-group difference of 22·29 m (8·19-36·38; p=0·027). No adverse events or SMART-CR/SP programme-related safety issues were reported by participants during the study. SMART-CR/SP was found to be a cardiac rehabilitation and secondary prevention service model with high efficacy and accessibility and to be easy to use. These results justify the implementation of similar models of care on a broader scale. Curtin University.

An investigation of recognition and needs of policies of science and technology achievement transformation among the medical personnel in 21 tertiary hospitals in Shanghai

Objective To understand the cognition, attitudes and needs of the science and technology achievement transformation policies among the medical personnel of 21 tertiary hospitals in Shanghai. Methods Convenient sampling method was used. The self-designed questionnaires were used to survey 420 personals in 21 tertiary hospitals in Shanghai, and 411 valid questionnaires were responded with a valid rate of 97.86%. Results The cognition of science and technology achievement transformation policies of the respondents was low, and the degree of cognition was related to the professional titles (P<0.05). While the recognition degree of some policies was high; 40.47% agreed that enterprises could be the decision-maker during the transformation process; 85.99% agreed that it is OK to hire the Technology intermediary service agencies to evaluate the achievements value, confirmed that need such agencies to provide the services of information collection and screening. Conclusions More Policy publicity should be enhanced among the medical personnel, communications about their needs and suggestions on the science and technology achievement transformation should be carried out to further update related policies, as well as improve the transformation of science and technology achievements in health system. Key words: Medical personnel; Science and technology achievement transformation; Policy; Recognition; Needs

Changing etiological frequency of chronic cough in a tertiary hospital in Shanghai, China.

The frequency distributions of the etiologies of chronic cough have changed over time. This study aimed to investigate the changing etiological frequency of chronic cough in a tertiary hospital in Shanghai, China, and to explore the clinical significance. Medical records of 1,311 patients with chronic cough who visit our hospital between January 2009 and December 2016 were retrospectively reviewed. The etiologies of chronic cough were identified according to a standardized step-by-step diagnostic protocol and the changes in the etiological frequency of chronic cough over the years were using the Chi-squared (χ2) test. Cough variant asthma (CVA) (449/1,311, 34.2%), gastroesophageal reflux-related chronic cough (GERC) (374/1,311, 28.5%), upper airway cough syndrome/postnasal drip syndrome (UACS/PNDs) (241/1,311, 18.4%), atopic cough (AC) (188/1,311, 14.3%), and non-asthmatic eosinophilic bronchitis (NAEB) (147/1,311, 11.2%) were the common causes of chronic cough in descending order. The post-infectious cough (PIC) (39/1,311, 3.0%) and angiotensin-converting enzyme inhibitor (ACEI)-induced cough (25/1,311, 1.9%) were less common. During the 8-year period, the proportion of CVA (χ2=72.86, P<0.0001) and UACS/PNDs (χ2=68.80, P<0.0001) decreased, while those of NAEB (χ2=51.38, P<0.0001), GERC (χ2=55.95, P<0.0001) and AC (χ2=39.09, P<0.0001) increased. The etiological frequency of chronic cough varies over time, and it may encourage the adjustment of the current diagnostic and therapeutic strategies for chronic cough.