Total Incidence Rate Of Complications Research Articles

Influence of standardized nursing intervention combined with mindfulness stress reduction training on the curative effect in patients with acute pancreatitis.

Acute pancreatitis (AP) is a common inflammatory disease of the pancreas with high mortality rates. It is of great significance to take scientific intervention measures for patients with AP in time. To explore the effect of standardized nursing combined with mindfulness stress reduction training on the curative effect, negative emotion, and quality of life in patients with acute pancreatitis. A total of 80 patients with acute pancreatitis admitted to The First People's Hospital of Jiangxia District Hospital from May 2021 to May 2023 were randomly divided into control group and observation group (n = 40). Patients in control group were given the standardized nursing intervention, and the observation group were given standardized nursing plus mindfulness stress reduction training intervention. The time of clinical symptom disappeared or improved, complication occurrence rate, emotional state, and quality of life score of the two groups were observed and compared. In comparison with the control group, the bowel sound recovery time, ventosity and abdominal pain improvement time, and venting and cacation time in observation group were shorter, and the total incidence rate of complications was reduced, showing statistically significant difference (P < 0.05). The scores of anxiety and depression in observation group were lower than those in control group (P < 0.05). Serum levels of tumour necrosis factor alpha, interleukin (IL)-6, IL-1β and IL-8 in observation group were lower than those in control group (P < 0.05). The scores of life quality in physiology, psychology, environment and social relations in observation group were higher than those in control group, and the differences were statistically significant (P < 0.05). The application of standardized nursing intervention combined with mindfulness stress reduction training in patients with acute pancreatitis has a definite effect, which can help to ameliorate the clinical symptoms, anxiety and depression of patients, reduce the incidence rate of complications, and improve the prognosis of patients.

Impact of Hepatitis B on Complications and Functional Outcomes in Patients Undergoing TKR.

In India, infected patients with hepatitis B virus (HBV) undergoing total knee replacement (TKA) are increasing. It is recognized that patients with HBV infection are more susceptible to complications after surgery. To evaluate the effect of HBV infection on complications and functional outcome after TKA was the aim of this study. This is the retrospective observation analysis of patients who underwent primary total knee replacement in our hospital from 2017 to 2019. A total of 92 patients were included in the study, of which 46 patients were asymptomatic HBV-positive, and these 46 patients were compared with a matched cohort of another 46 patients who were non-HBV. A total of 92 patients were analyzed (asymptomatic HBV n = 46, non-HBV n = 46). The incidence rate of total complications in patients undergoing TKA with asymptomatic HBV was 19.57% compared to 4.3% in non-HBV (p < 0.001). Applied with regression models, patients with HBV had an 8.6% increased risk of surgical complication which included one peri-prosthetic joint infection, three wound dehiscence compared with the non-HBV group which had 2.17% surgical complications (one wound dehiscence). Medical complications were higher in asymptomatic HBV group with 10.87% (which includes one pulmonary embolism, two DVT, and two strokes). In comparison with the non-HBV group which had 2.17% medical complications (one DVT), asymptomatic HBV group had 5.35-fold (95% CI 1.09-26.33; p < 0.01) increase in overall complications. Post-TKA surgical complications are 4.29-fold (95% CI 0.46-39.91; p < 0.01) higher compared to non-HBV group. Our study showed asymptomatic hepatitis B patients are at an increased risk of complications (peri-prosthetic joint infections and wound dehiscence) compared to normal patients. In hepatitis B and non-hepatitis B patients, functional outcomes in terms of OKS are comparable.

Clinical efficacy of laparoscopic radical hepatectomy and laparotomy for hepatocellular carcinoma and factors of postoperative recurrence.

For exploring the clinical efficacy of laparoscopic radical hepatectomy and laparotomy for hepatocellular carcinoma and analysing related factors of postoperative recurrence. Totally 212 patients with hepatocellular carcinoma admitted to our hospital between April 2017 and December 2020 were enrolled, and all of them were followed up after the operation. According to the treatment modes, the patients were assigned to a laparotomy group (n=106) and a laparoscopic group (n=106). Perioperative indicators, haematological examination results, complications and recurrence were compared between the two groups. The recurrence time of hepatocellular carcinoma after the operation was confirmed by imaging examination with definite mass, and logistic multivariate analysis was used for analyzing the risk factors associated with postoperative recurrence. Patients in both groups were comparable in terms of general baseline data. The laparoscopic group experienced longer operation time and shorter incision length, less intraoperative blood loss, early time to have the first off-bed activity and time to eat liquid and shorter hospital stay than the laparotomy group (all P<0.05). Seven days after the operation, the laparoscopic group showed notably lower levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), tumour necrosis factor-α (TNF-α), interleukin-8 (IL-8), and C-reactive protein (CRP) than the laparotomy group (all P<0.05), and also showed notably higher levels of immunoglobulin A (IgA), IgG and IgM than the laparotomy group (all P<0.05). Additionally, the laparotomy group showed a higher total incidence rate of complications than the laparoscopic group (19.81% vs. 9.43%, P<0.05). During the one-year follow-up, the laparotomy group was not greatly different from the laparoscopic group in recurrence rate (22.64% (24/106) vs. 16.98% (18/106), P>0.05). Multivariate analysis showed that average tumour diameter and microvascular invasion were risk factors for postoperative recurrence (P<0.05). Laparoscopic radical hepatectomy for hepatocellular carcinoma can reduce the influence on liver function and immune function, with less damage to tissues, and can ameliorate postoperative inflammatory reaction, and promote postoperative recovery of patients as soon as possible. There are many factors influencing the postoperative recurrence of hepatocellular carcinoma, and average tumour diameter and microvascular invasion are the risk factors.

Deep Learning-Based Digital Subtraction Angiography Characteristics in Nursing of Maintenance Hemodialysis Patients.

This study is aimed at exploring the diagnostic value of digital subtraction angiography (DSA) based on faster region-based convolutional networks (Faster-RCNN) deep learning for maintenance hemodialysis (MHD) diseases and to provide a theoretical basis for clinical nursing. A total of 50 MHD patients who were clinically diagnosed in the Blood Purification Center were randomly divided into the control group and the experimental group (25 cases for each group). The control group was given routine nursing intervention, and the experimental group was given overall nursing intervention under the supervision of DSA. A faster RCNN multitarget detection network was constructed to analyze the average accuracy of various vascular structures in the test set. The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate the degree of anxiety and depression. The urine volume before and after the operation, local hematoma after a puncture, the incidence of complications, and nursing satisfaction were recorded. The results showed that the average accuracy of the vein, internal carotid artery, circle of Willis, venous sinus, and venous vessels was 0.876, 0.916, 0.994, 0.925, and 0.732, respectively. The success rate of surgery in the experiment group was higher than that in the control group, and the difference had statistical significance (P < 0.05). The SAS score and SDS score in the experimental group were significantly lower than those in the control group (P < 0.05). The total incidence rate of complications in the experimental group (16.00%) was significantly lower than that in the control group (44.00%) (P < 0.05). The satisfaction rate of the experimental group was significantly higher than that of the control group (P < 0.05). The Faster-RCNN model had the best effect in differentiating the circle of Willis and a poor effect in differentiating venous vessels. DSA based on Faster-RCNN can significantly improve the success rate of puncture in MHD patients. The implementation of holistic nursing intervention under its supervision can significantly reduce postoperative complications and improve patient satisfaction with nursing compared with routine nursing.

Application of Doctor-Nurse-Patient Co-Decision-Making Nursing Intervention Based on Evidence-Based Problems in the Rehabilitation of Acute Ankle Lateral Collateral Ligament Injury.

Objective The aim of this study is to study the application effects of doctor-nurse-patient co-decision-making nursing intervention based on evidence-based problems in the rehabilitation of acute ankle lateral collateral ligament injury. Methods 150 patients with acute ankle lateral collateral ligament injury who were treated in the hospital between December 2020 and December 2021 were selected, and they were divided into the routine group and the evidence-based group by the random number table method, with 75 cases in each group. The patients in the routine group received routine nursing intervention, while the patients in the evidence-based group adopted doctor-nurse-patient co-decision-making nursing intervention based on evidence-based problems, and both groups were intervened for 1 month. The rehabilitation time (swelling subsidence time, fixation removal time, and normal walking time), ankle active range of motion (dorsiflexion and plantar flexion), ankle function (ankle Kofoed score) before and after intervention, and the total incidence rate of complications (tendon injury, ankylosis, and traumatic arthritis) within 1 month of intervention were compared between the two groups of patients. Results The swelling subsidence time, fixed removal time, and normal walking time in the evidence-based group were significantly shorter than those in the routine group (P < 0.05). After 1 month of intervention, the ranges of motion of dorsiflexion and plantar flexion and ankle Kofoed scores of the two groups were significantly higher than those before intervention, and the abovementioned indicators in the evidence-based group were significantly higher than those in the routine group (P < 0.05). Within 1 month of intervention, the total incidence rate of tendon injury, ankylosis, and traumatic arthritis was significantly lower in the evidence-based group than that in the routine group (P < 0.05). Conclusion Nursing intervention of doctor-nurse-patient co-decision-making based on evidence-based problems in patients with acute ankle lateral collateral ligament injury can promote postoperative rehabilitation and restore the ankle function of patients.

Effect of Intelligent Medical Management Platform Combined with Perioperative Detailed Nursing on Cognitive Ability, Postoperative Complications, and Quality of Life of Patients Undergoing Hysterectomy.

Objective To analyze the effect of an intelligent medical management platform combined with perioperative detailed nursing on cognitive ability, postoperative complications, and quality of life (QOL) of patients undergoing hysterectomy. Methods The clinical data of 76 patients undergoing hysterectomy in our hospital from December 2019 to December 2021 were selected for the retrospective analysis, and the patients were divided into the experimental group (EG, n = 38, intelligent medical management platform+perioperative detailed nursing) and the routine group (RG, n = 38, routine nursing) according to their admission order, and the cognition of disease and QOL after intervention of patients in the two groups were evaluated by the self-proposed questionnaire on cognition of disease of our hospital and the MOS 36-item short-form health survey (SF-36). Results After intervention, the scores on cognitive ability, various nursing items, and QOL were significantly higher in EG than in RG (P < 0.001), and during the study, the total incidence rate of complications was significantly lower in EG than in RG (P < 0.05). Conclusion Combining an intelligent medical management platform with perioperative detailed nursing is a reliable method to improve QOL and reduce postoperative complications for patients undergoing hysterectomy. Further research will be conducive to providing a reliable perioperative intervention scheme for such patients.

Clinical effects of prophylactic transverse colostomy in patients undergoing completely laparoscopic transabdominal approach partial intersphincteric resection.

ObjectiveTo investigate the clinical effects of prophylactic transverse colostomy on gastrointestinal function recovery and complications in patients undergoing completely laparoscopic transabdominal approach partial intersphincteric resection (CLAPISR) of low rectal cancer.MethodsWe retrospectively analyzed the data of 74 patients with low rectal cancer who were treated with prophylactic transverse colostomy (Group A, n = 34) or without prophylactic transverse colostomy (Group B, n = 40). Surgery-related indicators, nutritional status indicators, systemic stress response indicators, and complications were compared between the two groups.ResultsOn postoperative day 5, the C-reactive protein concentration and white blood cell count were not significantly different between the two groups; however, the serum concentrations of total protein and albumin were higher in Group A than in Group B. Within 26 months postoperatively, the total incidence rate of complications was not significantly different, but the incidence rate of anastomotic leakage was lower in Group A than in Group B.ConclusionProphylactic transverse colostomy based on CLAPISR can lead to faster recovery of gastrointestinal function, better improvement of postoperative nutritional indicators, and a lower incidence of anastomotic leakage. These characteristics are conducive to the rapid recovery of patients, making this procedure worthy of clinical application.

Preliminary proposal: a classification system for reconstruction with autologous femoral head after periacetabular tumors resection

BackgroundAlthough researchers have adopted various methods for the resection and reconstruction of periacetabular tumors, the total incidence rate of complications remains high. Aiming for preserving the acetabulum and reducing the risk of complications, we applied a surgery method using tumor-free autologous femoral head to reconstruct the defective acetabulum after resection of periacetabular tumors followed by performing a conventional total hip arthroplasty (THA). Moreover, we proposed a preliminary classification system for these surgery methods.MethodsWe retrospectively reviewed 6 patients treated with acetabulum reconstruction combined with autologous femoral head following peri-acetabulum resection between April 2010 and May 2018. All patients were diagnosed as periacetabular tumors including chondrosarcoma (n = 5) and chondroblastoma (n = 1). Clinical data such as age, diagnosis, complications, local recurrence or metastasis, and function (Musculoskeletal Tumor Society 1993, MSTS93) were documented. The average time of follow-up was 62.5 months (range, 17 to 106 months).ResultsA total of 5 patients survive with average MSTS93 score of 27.8 points (range, 26–30). One patient, suffering from multiple bone metastasis prior treatment, ended up dying. One who had received radiotherapy before surgery had poor incision healing. Further, a classification system was preliminary proposed in 2 patients involving the pubis (type A) and 4 patients involving ischium (type B).ConclusionsBased on the results, we preliminary proposed a classification system for reconstruction with autologous femoral head after periacetabular low malignant tumors resection. The clinical results suggested that surgery methods involving pubis (type A) and ischium (Type B) are safe and feasible. However, further researches should be conducted to verify our classification system.

Central Venous Catheter Insertion in Colorectal Cancer Patients, PICC or PC?

PurposeCentral venous catheters (CVCs) have been demonstrated as a feasible method for chemotherapy delivery in colorectal cancer patients. The objective of our study was to explore the preference of colorectal cancer patients (89%) in our institution for port catheters (PCs) through comparing the costs and complications between peripherally inserted central venous catheters (PICCs) and PCs.MethodsOverall, 777 colorectal cancer patients (89%) were eligible for central venous catheter (CVC) insertions from January 1, 2017, to January 1, 2019. We retrospectively compared the costs and complications following the introduction of PICCs and PCs in the infusion of intravenous chemotherapy agents in patients with colorectal cancer.ResultsA total of 773 colorectal patients were enrolled. The total cost of PICC and PC was US $436.20 and US $976, respectively. The complication rate was higher in the PICC compared with the PC group (45% versus 4%, P <0.001). The late complication rate of the two groups was particularly pronounced (52% versus 7%, p < 0.001). The incidence rate of total complications, that were developed in patients, with and without hemostatic prophylaxis, was 0.7% versus 5.7% (p < 0.001).ConclusionPort devices are associated with higher costs but fewer complications, compared to PICC in patients with colorectal cancer.

The Safety and Feasibility of&amp;nbsp;Robot-Assisted Pancreatic Surgery at&amp;nbsp;a High-Volume Center: A Nine-Year Retrospective Single-Center Analysis of 1396 Patients

Objective: We aimed to share our experience with 1396 cases of robot-assisted pancreatic surgery (RAPS) over nine years. Methods:The medical records of 1396 patients who underwent RAPS between May 2010 and December 2018 at Shanghai Ruijin Hospital were retrospectively analyzed. Operative outcomes, including the operative duration, estimated blood loss (EBL), and incidence of morbidities, especially postoperative pancreatic fistula (POPF), are discussed. We also recorded and illustrate our progress along the learning curve for RAPS in this large cohort. Results: During the study period, 1396 patients underwent RAPS at our center. Among them, 450 patients underwent robot-assisted pancreaticoduodenectomy (RPD), 605 patients underwent robot-assisted distal pancreatectomy (RDP), 144 patients underwent robot-assisted middle pancreatectomy (RMP), 119 patients underwent robot-assisted enucleation (REn), 40 patients underwent robot-assisted duodenum-preserving pancreatic head resection (R-DPPHR), 12 patients underwent robot-assisted total pancreatectomy (R-TP) and 26 patients underwent other types of surgery with a robot-assisted platform. A total of 442 patients (31.7%) suffered malignant tumors, while 357 (25.6%) patients had pancreatic ductal adenocarcinoma (PDAC). The mean operative duration was 195.3±107.4 min. The mean EBL was 197.5±107.4 ml. There were a total of 13 cases (0.9%) of conversion to open surgery due to adhesion and vascular invasion by the tumor. The total incidence rate of complications was 39.1% (546/1396). The incidence rate of clinically related (CR)-POPF of the total cohort was 16.5% (230 patients). The mean postoperative length of hospital stay (LOS) of the total cohort was 20.0±12.9 days. Conclusions: To the best of our knowledge, this is the largest sample size of RAPS cases ever reported. In conclusion, for benign and low-grade malignant pancreatic tumors, minimally invasive pancreatic surgery is safe and feasible and might be a good choice. Operative outcomes improve with accumulated experience. Further prospective analyses of RAPS should be designed to verify the advantages of RAPS. Funding Statement: The study was funded by National Natural Science Foundation of China (NSFC) directly to Baiyong Shen. Serial number: 81871906. It was also sponsored bu the Interdisciplinary Program of Shanghai Jiao Tong University directly to Jiabin Jin. Serial number: YG2019QNB26. Declaration of Interests: All the authors, Dr Yusheng Shi, Dr Jiabin Jin, Dr Junjie Xie, Dr Yuanchi Weng, Dr Mengmin Chen, Dr Kai Qin, Dr Hao Chen, Dr Xiaxing Deng, Dr Baiyong Shen and Dr Chenghong Peng have no conflicts or financial ties to disclose. Ethics Approval Statement: This retrospective study was approved by the institutional review board of Shanghai Ruijin Hospital. Every patient provided written informed consent to undergo the operation and for the use of the data we collected before and after the surgery.

Postoperative intraperitoneal hyperthermic perfusion improve survival for advanced gastric cancer.

To evaluate the value of intraperitoneal hyperthermic perfusion (IPHP) in the treatment of gastric cancer.Gastric cancer (GC) is a malignancy with poor prognosis, recent years have demonstrated advances in the use of IPHP for the treatment of advanced gastric cancer (AGC), but the outcome is controversial.Between January 2015 and January 2017, 134 patients with GC were treated with IPHP in our surgery department, 130 of them were advanced GC patients, and other 1439 cases were treated without IPHP for comparison. In this retrospective cohort study, demographic, perioperative data, and follow-up data were analyzed by univariant analysis, Kaplan–Meier and Cox regression survival analysis.We found the 1-year survival in IPHP group was significantly longer than it in non-IPHP group (85.5% vs 73.8%, P = .027). and IPHP decreased mortality 1.8 times in 2-year course (OR = 0.556, P = .004). The incidence rate of total complications in IPHP group was similar to that in the Non-IPHP group (6.67% vs 7.46%, respectively; P = .718). We classified all patients into four groups, operation alone, operation + chemotherapy, operation + IPHP, and operation + IPHP + chemotherapy. The 1-year survival in the groups was 70.2%, 77.5%, 83.1%, and 93.5%, respectively (P = .001), compared with the group of operation alone, the 2-year mortality risk was decreased 1.76 times (OR = 0.569, P = .030) and 2.59 times (OR = 0.385, P = .022) in operation + IPHP group and operation + IPHP + chemotherapy group.Our results suggest that IPHP could contribute to improve survival of patients with gastric cancer. And the modality of operation + IPHP + chemotherapy is the optimal treatment modality for gastric cancer.

Application of information-motivation-behavior model in nursing care for patients with long-term indwelling bladder stoma

Objective To investigate the application of information-motivation-behavior (IMB) model in nursing care for patients with long-term indwelling bladder stoma. Methods Totally 86 patients receiving long-term indwelling bladder stoma in the Department of Urinary Surgery, the Seventh Medical Center of Chinese PLA General Hospital from October 2015 to September 2017 were selected and divided into the control group (n=43) and the observation group (n=43) according to the random number table. Patients in the control group received conventional nursing care, while patients in the observation group received IMB-based health education on this basis. The self-care ability and quality of life of the two groups were assessed, and the incidence of complications during the follow-up was compared between the two groups after 12 months. Results The scores of self-care ability, self-responsibility, self-conception and health knowledge as well as the total score after 12 months' nursing care were higher than those before treatment. The scores of the observation group were (43.18±4.32) , (24.21±2.24) , (26.04±2.63) , (49.79±3.89) , and (143.22±6.82) , higher than those of the control group, which were (31.26±3.58) , (16.74±1.55) , (22.71±1.68) , (38.67±1.92) , and (109.38±5.04) , and there were statistically differences between the two groups (P<0.05) . The total incidence rate of complications of the observation group was lower than that of the control group (6.98% vs. 37.21%, P<0.05) . Conclusions The IMB model can enhance the self-care ability of patients with long-term indwelling bladder stoma, reduce the incidence of complications, and improve their quality of life effectively, which is worth promoting in clinical practice. Key words: Cystostomy; Quality of life; Self-care; Information-motivation-behavior; Complication

Comparison of the effects of interventional therapy and direct interventional therapy after thrombolysis in the treatment of elderly patients with acute myocardial infarction

Objective To compare the efficacy and safety of interventional therapy and direct interventional therapy after thrombolysis in the treatment of senile acute myocardial infarction. Methods From January 2014 to July 2017, a total of 110 elderly patients with acute myocardial infarction admitted to the First People′s Hospital of Hangzhou were enrolled in this study.The patients were randomly divided into two groups according to the digital table, with 55 cases in each group.The observation group received combination of intravenous thrombolysis and coronary intervention, and the control group received arterial intervention.The blood flow of IRA before and after treatment, TIMI level 3 open situation, cardiac function improvement(including LVEF, LVEDD), and electrocardiogram ST segment down after treatment, chest pain relief, stent implantation success or failure, incidence of complications were compared between the two groups. Results Before treatment, there were no statistically significant differences in the number of TIMI3 blood flow patients(10 cases, 15 cases) and number of TIMI3 patients (12 cases, 18 cases) between the two groups(P>0.05). After treatment, those in the observation group increased to 50 cases and 51 cases, respectively.Those in the control group only increased to 39 cases and 40 cases.The observation group increased more significantly(χ2=7.698, P<0.05). After treatment, the LVEF values of the two groups were increased, the LVEDD decreased significantly.The LVEF[(57.38±4.23)%]and LVEDD[(44.32±2.93)mm]in the observation group were improved more significantly than those in the control group[(51.07±4.17)%, (50.09±2.97)mm, t=7.878, 10.257, all P<0.05]. The incidence rate of ST segment depression(92.73%) and chest pain relief rate(90.91%) in the observation group after treatment were higher than those in the control group(65.45%, 61.82%, χ2=12.369, 12.894, 2.633, all P<0.05). The total incidence rate of complications of the observation group was 9.09%, which was lower than that of the control group(29.09%), the difference was statistically significant(χ2=7.122, P<0.05). Conclusion Interventional therapy after thrombolysis in the treatment of elderly patients with acute myocardial infarction, can effectively improve the patients' cardiac function, the effect is significant, safe and reliable, it is worthy of further study. Key words: Myocardial infarction; Percutaneous coronary intervention; Thrombolysis therapy; Myocardial reperfusion; Aged

Comparison of efficacy between internal fixation of minimally invasive elastic stable intramedullary nail and plate in the treatment of pediatric femoral shaft fracture.

Objective:To compare and analyze the clinical effects of internal fixation of minimally invasive elastic stable intramedullary nail and plate in the treatment of pediatric femoral shaft fracture.Methods:A total of 120 children with femoral shaft fractures who were admitted to our hospital from December 2016 to April 2018 were enrolled. The children were divided into an observation group and a control group by random number table, with 60 children in each group. The children in the observation group underwent internal fixation of minimally invasive elastic stable intramedullary nail, while those in the control group underwent open reduction based on internal fixation of plate. The surgical status and postoperative complications of the two groups were observed and compared, and Kolmert knee function scoring criteria were used for assessing the surgical effects of children.Results:The operation duration, intraoperative blood loss, hospitalization duration, fracture healing time and time of off-bed loaded activity of the observation group were significantly shorter than those of the control group, and the differences were statistically significant (P<0.05). The excellent and good rate of fracture healing in the observation group was 100%, which was higher than that of the control group, 83.33%, and the difference was statistically significant (P<0.05). The total incidence rate of complications in the observation group was 8.33%, which was lower than that of the control group, 10.00%, but the difference was not statistically significant (P>0.05).Conclusion:Pediatric femoral shaft fractures can be treated with internal fixation of minimally invasive elastic intramedullary nail, and it has advantages of significant curative effect, small trauma and fast postoperative recovery, which is conducive to fracture healing and worth promoting.

Complications and Risk Factors of Peripherally Inserted Central Catheters: A Review

Peripherally inserted central catheters (PICCs) are widely used in cancer and critical patients for it’s convenience and performance compared to central venous catheters (CVCs), however, PICCs are still associated with some complications which increase disease burden and health care cost. No agreement about incidence and risk factors of PICC-related complications has reached from previous studies although much work has been done in this area. Lack of targeted prevention may lead to difficulties and stagnation in prevention of PICC-related complications. Our review reviewed current literatures on PICC-related complications and risk factors aiming to provide reference for further PICC research and prevention measures. In this review, we searched PICC relate literatures, and listed the incidence and risk factors of PICC-related complications. Different studies reported different data and risk factors, and we have detailed in this review. The total incidence rate of complications ranged from 3% to 61.67%, infection and venous thrombosis are the most two common complications. The risk factors varied from study to study, but it is basically divided into patient related-, operation related- and material related-. For the prevention measures, we considered standardized operation and nursing according to guidance played an important role. In this field, better research and conclusions are needed to guide the work of medical staff.

Outcomes of basilic vein transposition versus polytetrafluoroethylene forearm loop graft as tertiary vascular access

BackgroundRadial-cephalic arteriovenous fistula and brachial-cephalic arteriovenous fistula are the first and second choices for creating vascular access in dialysis patients as recommended by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Basilic vein transposition or use of a forearm (polytetrafluoroethylene [PTFE]) loop graft is recommended thereafter. The aim of this study was twofold: first, to compare the outcomes and patency rates of patients treated with a basilic vein transposition with those of patients treated with a PTFE loop; and second, to identify patient-related factors of influence on patency rates. MethodsData collected in our prospectively maintained database of patients with chronic renal dysfunction requiring hemodialysis were analyzed. From April 2006 to August 2017, there were 55 patients with a basilic vein transposition and 75 patients with a PTFE loop included. Primary, primary assisted, and secondary patency rates were calculated. Multivariate analysis was used to identify factors of influence on survival. Incidence rates of complications and reinterventions were calculated and compared. ResultsMean follow-up time was 29 months. A significantly higher 2-year primary assisted patency rate was found for the basilic vein transposition group (72.7% ± 6.5% vs 47.6% ± 6.2%; P < .01). The 2-year primary patency rates and secondary patency rates were comparable between basilic vein transposition and PTFE loop (25.1% ± 6.6% vs 13.7% ± 4.4% [P = .11] and 75.5% ± 6.5% vs 73.9% ± 5.3% [P = .17], respectively). Cox regression identified body mass index (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.05-2.98; P = .03) and age (HR, 0.54; 95% CI, 0.32-0.91; P = .02) as predictors for failure regarding primary patency in PTFE loop patients. Previous catheter use (HR, 0.29; 95% CI, 0.12-0.70; P = .006) and the presence of diabetes (HR, 3.32; 95% CI, 1.50-7.39; P = .003) were independent predictors for failure regarding primary patency in basilic vein transposition patients. The incidence rate of total complications was significantly higher in the PTFE loop group with 0.70 per patient-year (PY−1) compared with 0.28 PY−1 in the basilic vein transposition group (P = .001). In terms of intervention rate, a significantly higher percutaneous transluminal angioplasty rate and surgical revision rate were found in the PTFE loop group than in the basilic vein transposition group (1.77 PY−1 vs 1.05 PY−1 [P = .022] and 0.20 PY−1 vs 0.07 PY−1 [P = .002], respectively). ConclusionsIn this nonrandomized study, basilic vein transposition has better primary assisted patency, fewer complications, and fewer reinterventions compared with PTFE loop.

Study on the optimization of nursing mode for interventional open operation of symptomatic internal carotid artery occlusion guided by Joint Commission International concept

Objective To explore the influence of perioperative nursing for interventional open operation of patients with symptomatic internal carotid artery occlusion under the guidance of the Joint Commission International(JCI) concept. Methods The clinical data of 90 patients with symptomatic internal carotid artery occlusion treated by elective interventional open operation from January 2016 to February 2018 were retrospectively analyzed, of which 40 patients receiving routine nursing from January 2016 to January 2017 were set as control group, of which 50 patients receiving nursing guided by JCI concept from February 2017 to February 2018 were set as observation group. The Hamilton Depression Scale (HAMD) was used to evaluate the anxiety of patients at preoperative 1 h and postoperative 48 h, and the extubation time and hospitalization time were compared, as well as the incidence of complications and the patient's coordination degree. Results The HAMD scores of preoperative 1 h and postoperative 48 h of the observation group respectively was (26.58 ± 5.79) and (17.41 ± 4.18) points, of which the control group respectively was (29.75 ± 5.21) points and (22.26 ± 4.64) points, and the HAMD scores between the postoperative 48 h and preoperative 1 h in the 2 groups were statistically significant differences (t=9.080, 6.790, all P < 0.01), of which between the 2 groups were statistically significant differences (t=2.697, 5.208, all P < 0.01). The extubation time and hospitalization time of the observation group respectively was (3.81 ± 0.62) and (12.97 ± 3.65) d, of which the control group respectively was (4.39 ± 0.71) and (16.18±3.54) d, with statistically significant differences (t=4.134, 4.201, all P < 0.01). The total incidence rate of complications of the observation group was 18.00%(9/50), of which the control group was 40.00%(16/40), with statistically significant differences (χ2=5.361, P < 0.05). The good rate of coordination of the observation group was 76.00%(38/50), of which the control group was 55.00%(22/40), with statistically significant differences (χ2=4.410, P < 0.05). Conclusions The perioperative nursing based on the JCI concept guidance can relieve the anxiety of patients with symptomatic internal carotid artery occlusion treated by elective interventional open operation, shorten the postoperative recovery time, reduce the incidence of complications and improve the nursing coordination. Key words: Joint Commission International concept; Symptomatic internal carotid artery occlusion; Interventional open operation; Nursing care

Low-Intensity International Normalized Ratio (INR) Oral Anticoagulant Therapy in Chinese Patients with Mechanical Heart Valve Prostheses

The purpose of this study was to define the optimal international normalized ratio (INR) intensity of oral anticoagulant therapy in Chinese patients with valve replacement surgery. We studied 1,658 patients who underwent mechanical valve replacement in Beijing Anzhen Hospital; the focus of the study was on correlation between intensity of anticoagulant therapy and thromboembolism/hemorrhage complications. We further followed up 1,508 patients for 46 ± 16 months (range 1-61 months). Average INR was 2.13 ± 0.56, and warfarin dose was 3.09 ± 0.85 mg/day. The incidence rate of anticoagulation-related thromboembolism was 1.17 per 100 patient-years (%/pt-y), and the incidence rate of anticoagulation-related hemorrhage was 2.02%/pt-y. The incidence rate of total complications (i.e., combined thromboembolism and hemorrhages) was 3.24%/pt-y. The rate of total complications in group on INR 1.3-2.3 (aortic valve replacement: 1.3-1.8; mitral valve replacement and double valve replacement: 1.8-2.3) was the lowest among all anticoagulant therapy regimens followed. In conclusion, the relatively low anticoagulant strategy presented above efficiently prevents thrombosis and hemorrhage complications.

Study on effect of different family nursing methods on major catheter-related complications in cancer patients with PICC

Objective To study the effect of different family nursing methods on major catheter-re-lated complications in cancer patients with peripherally inserted central catheter (PICC) during chemother-apy intermission so as to reduce the incidence of complications and prolong the indwelling time and service life of the catheter. Methods We randomly divided 213 cancer patients who were discharged from hos-pital with PICC into two groups. One group(108 cases) routinely came back to our outpatient clinic and the other (105 cases) went to the community for nursing of the catheter. Results The total incidence rate of complications of the group who came back to our outpatient clinic for nursing of the catheter was 13.8%(15/ 108) and the other group was 51.4%(54/105). There existed statistical significance between the two groups (P<0.01). Conclusions There exists correlation between different family nursing methods and catheter complication rate. We suggest patients come back to our outpatient clinic for nursing of the catheter as pos-sible as they can. Key words: Peripherally inserted central catheter (PICC); Family nursing method; Cancer pa-tient