ObjectiveTo investigate the effectiveness of intramedullary nailing fixation in semi-extended position via extraarticular parapatellar approach for tibial shaft fracture.MethodsBetween July 2018 and September 2019, 22 patients with tibial shaft fracture treated with intramedullary nailing fixation in semi-extended position via extraarticular parapatellar approach. There were 15 males and 7 females, with an average age of 46.4 years (range, 25-68 years). The fractures were caused by falling in 7 cases, by traffic accident in 14 cases, and by a heavy object in 1 case. Sixteen patients were closed fractures and 6 were open fractures. According to the AO classification, there were 4 cases of 42-A1 type, 2 cases of 42-A2 type, 3 cases of 42-A3 type, 3 cases of 42-B2 type, 4 cases of 42-B3 type, 2 cases of 42-C1 type, 3 cases of 42-C2 type, and 1 case of 42-C3 type. Twenty cases complicated with fibular fractures. The time from injury to operation was 2-15 days (mean, 7.5 days). The fracture healing time, complications, the incidence of anterior knee pain during the follow-up were observed; and knee joint functions were evaluated by Lysholm score at last follow-up.ResultsThe operation time was 50-140 minutes (mean, 85 minutes). Two cases experienced incision exudation which healed after symptomatic treatment. The incisions of other patients healed by first intention. All patients were followed up 8-23 months (mean, 14.9 months). X-ray films reexamination showed that all fractures healed with the healing time of 12-20 weeks (mean, 14.4 weeks). Four patients (18.18%) experienced the anterior knee pain. No patellofemoral instability was observed during the follow-up period. Lysholm score of knee function was 85-100 (mean, 94.3) at last follow-up. ConclusionApplication of the intramedullary nailing fixation in semi-extended position via extraarticular parapatellar approach is effective for tibial shaft fractures, which can not only realize the effective fixation of the fracture, but also avoid the adverse factors including re-displacement and anterior knee pain in the application of the intramedullary nailing fixation via the sub-patellar approach.
The innovative behavior of clinical nurses is of great significance for the professional development of nurses and the improvement of nursing service quality. This research topic has received continuous attention from domestic and foreign scholars. There is still significant room for improvement in the level of innovative behavior among clinical nurses in China. Constructing effective interventions to enhance innovative behavior among clinical nurses in China is an urgent requirement to promote the development of nursing informatization and nursing quality. This article reviews the intervention forms, theoretical support, effectiveness, and limitations of innovative behaviors among clinical nurses both domestically and internationally. It proposes prospects for future intervention plans, aiming to provide ideas and references for nursing managers to develop tailored, scientific, and effective intervention strategies.
Objective To analyze trends in the burden of colorectal cancer in China from 1994 to 2023, providing evidence for colorectal cancer prevention and control. MethodsData on colorectal cancer incidence, mortality, and disability-adjusted life year (DALY) in China were obtained from the Global Burden of Disease 2023. Joinpoint regression was used to estimate the average annual percentage change (AAPC) and annual percentage change (APC). Age-period-cohort models were applied to estimate age, period, and birth cohort effects. Lagged correlation analysis was performed to assess the temporal association between burden of incidence and mortality. ResultsIn 2023, there were 611 364 colorectal cancer cases and 257 480 deaths in China, which increases 185.98% and 72.72%, respectively, compared with the year 1994. The crude incidence rate increased from 17.41 per 100 000 to 42.73 per 100 000 and the crude mortality rate from 12.14 per 100 000 to 18.00 per 100 000, which increase 145.43% and 48.27%, respectively. Over the same period, the age-standardized incidence rate (ASIR) increased from 22.18 per 100 000 to 26.60 per 100 000, whereas the age-standardized mortality rate (ASMR) decreased from 16.26 per 100 000 to 11.42 per 100 000 and the age-standardized DALY rate decreased from 429.75 per 100 000 to 281.61 per 100 000. The results of Joinpoint regression analysis showed that from 1994 to 2023, the overall change in ASIR was not statistically significant (AAPC=0.75%, P>0.05), whereas the ASMR and age-standardized DALY rate decreased (AAPCs were ?1.16% and ?1.38%, respectively; P<0.05). From 2020 to 2023, all 3 four indicators(ASIR, ASMR, standardized DALY rate)increased (APC were 5.89%, 3.92%, and 4.05%, respectively; P<0.05). The ASIR increased among males (AAPC=1.31%, P<0.001) but there were no significant differences in among females (AAPC=?0.19%, P>0.05). From 2020 to 2023, the ASMR increased significantly among males (APC=4.65%, P<0.01) but there were no significant differences in among females (APC=3.95%, P>0.05). Age effects showed that incidence, mortality, and DALY rates peaked at ages 85–89, 90–94 and 75–79 years, respectively. Period effects showed that the incidence rate ratio (RR) among males was highest in 2019–2023 [RR=1.08, 95%CI (1.04, 1.13)], whereas the mortality and DALY rate RRs for the overall population remained below those of the reference period (2004–2008). Cohort effects showed incidence RRs increased firstly and then decreased as year of birth gose by. Incidence and mortality were most strongly correlated at a lag of 0 years [r=0.993, 95%CI (0.985, 0.997)]. ConclusionsThe past 30 years, the burden of colorectal cancer in China increased substantially, whereas the ASMR and age–standardized DALY rate declined overall. The burden remained high among the aged, and changes among males and more recent birth cohorts warrant particular attention. The increases in several age-standardized measures during 2020–2023 underscore the need for continued surveillance of colorectal cancer burden and targeted prevention and control strategies.
Objective To improve the satisfaction of standardized remote consultation of epilepsy center in patients with refractory epilepsy, and initially establish a standardized remote consultation model of three-level comprehensive epilepsy center. Methods Based on the characteristics of our epilepsy center, we designed a set of standardized remote consultation process of epilepsy center in tertiary hospitals, including sorting out patient data before consultation, improving examination, application of multi-modal technology during consultation, notification of results after consultation, and decision of operation time and method. A total of 209 patients who received remote consultation in our epilepsy center from January 2022 to June 2023 were selected as the observation group, and 150 patients who received offline consultation in our epilepsy center during the same period were randomly selected as the control group. The satisfaction of patients in the two groups on the service of doctors and nurses in consultation and the consultation results were compared. Results Through the application of the new multi-modal remote consultation mode, the number of consultations gradually increased, Compared with the offline consultation mode, there was no significant difference in patients' satisfaction with the service of doctors and nurses in remote consultation mode (P<0.05). Conclusion The establishment of standardized remote consultation mode in epilepsy center has effectively reduced the economic burden of patients, simplified the medical treatment process and improved the service quality, but the consultation quality has not been affected.