ObjectiveTo investigate the importance of nursing observation and intervention for extrahepatic bile duct stones with gallbladder stones treated by electronic duodenoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC). MethodsFrom July 2011 to February 2014, 157 patients with extrahepatic bile duct stones with gallbladder stones underwent EST and LC at the same time in our department. Combined with the surgery characteristics, we focused on the close observation and nursing of postoperative complications and drainage tubes for patients' timely recovery. ResultsOne patient with duodenal diverticulum papilla did not complete EST and LC surgery, which was then transformed to LC, bile duct incision and choledochoscopy with T tube drainage. All the remaining 156 patients completed endoscopic retrograde cholangio-pancreatography and LC with a completion rate of 99.36%. Under close observation and careful nursing care, this group of patients did not have duodenum perforation, bile leakage or other complications. No patient died. Seven to thirteen days after hospitalization, all the patients were cured and discharged from the hospital. ConclusionFor patients undergoing EST and LC at the same time, observation and timely intervention are very important in reducing serious complications, improving the quality of surgery, enhancing patients' comfort, and promoting postoperative recovery.
Shortly after the earthquake in Min county and Zhang county, the department of health of Gansu province immediately established a leadership team for earthquake relief and medical rescue, subordinated by psychological crisis intervention teams, which was responsible for training relevant personnel to carry out psychological intervention, and spreading related knowledge about earthquake. Then, emergency psychological intervention was provided for the key population (more than 90 times in total, involving 8 194 person-times). We also offered individualized psychological services (617 person-times), and diagnosed 31 patients with mental disorders through consultation. After the earthquake, the emotion of victims including depression, anxiety and acute stress disorder increased. The workload of psychological crisis intervention after earthquake was heavy and hard. However, Gansu province needs national support due to poor resources.
ObjectivesTo systematically review the efficacy and safety of intravascular ultrasound (IVUS) and coronary angiography-guided percutaneous coronary intervention (PCI) in left main coronary artery disease. MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) and cohort studies on the efficacy and safety of IVUS and coronary angiography-guided PCI in left main coronary artery disease from inception to March, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 7 studies involving 7 777 patients were included. The results of meta-analysis showed that: compared with PCI guided by coronary angiography, the incidence of cardiac death (OR=0.45, 95%CI 0.34 to 0.61, P<0.000 01), myocardial infarction (OR=0.67, 95%CI 0.53 to 0.84, P=0.004), major adverse cardiovascular events (OR=0.46, 95%CI 0.34 to 0.61, P<0.000 01), total deaths (OR=0.54, 95%CI 0.44 to 0.67, P<0.000 01), and in-stent thrombosis (OR=0.28, 95%CI 0.18 to 0.45, P<0.000 01) occurred in PCI guided by IVUS were lower. The differences were statistically significant. However, there were no statistical significance in the incidence of target revascularization in PCI (OR=0.80, 95%CI 0.40 to 1.61, P=0.54) and revascularization of target lesions (OR=0.68, 95%CI 0.36 to 1.27, P=0.23) between two groups.ConclusionsCurrent evidence shows that the IVUS-guided PCI can decrease the incidence of cardiac death, myocardial infarction, MACEs, stent thrombosis, total death and has no effect on target lesion revascularization and target vessel revascularization. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
For mitral valve disease with mitral annular calcification (MAC), surgery remains challenging. Up to now, there is no ideal management strategy or patient selection standard, and perioperative and periprocedural morbidity and mortality rates remain high. The recent surge of patients presenting with MAC has been accompanied by increased interest in MAC surgery and interventions. The American Association for Thoracic Surgery Clinical Practice Standards Committee is meant to provide a simplified outline for managing MAC. Combined with progress of MAC therapy, a detailed interpretation of the 2025 expert consensus is provided which include patient selection, preoperative evaluation (especially imaging evaluation), indications of intervention, surgical and transcatheter therapeutic options, and postoperative complications and remedial measures.
ObjectiveTo summarize our experience of emergency coronary artery bypass grafting (CABG) for the treatment of coronary accidents during percutaneous coronary intervention (PCI). MethodsFrom January 2011 to January 2013, 30 patients with coronary accidents during PCI from our hospital and other hospitals received surgical treatment in Xinhua Hospital, Medical School of Shanghai Jiaotong University. There were 21 male and 9 female patients with their age of 68±11 (54-84) years. Coronary accidents included coronary artery dissection in 12 patients, coronary artery perforation in 12 patients, acute in-stent thrombosis in 2 patients, dilation balloon rupture in 1 patient and balloon retention in 1 patient, and PCI guidewire retention in 2 patients. Among the 30 patients, 8 patients received intra-aortic balloon pump (IABP) implantation preoperatively. All the patients underwent emergency CABG, including 29 patients undergoing off-pump CABG and 1 patient undergoing CABG on pump with heart beating. The patients' medical history, PCI and surgical records were retrospectively reviewed, and surgical treatment strategies, clinical outcomes and prognosis were summarized. ResultsThe average number of grafts was 2.8±0.4. Postoperative length of ICU stay was 8.3±4.8 days, and mean hospital stay was 20.3±15.2 days. Postoperative complications included low cardiac output syndrome (LCOS) in 3 patients, tracheotomy in 2 patients, acute renal failure requiring continuous renal replacement therapy in 2 patients, and reexploration for bleeding in 1 patient. Twenty-eight were discharged, 1 patient died of multiple organ dysfunction syndrome caused by LCOS, and another patient died of refractory ventricular fibrillation. A total of 26 patients were followed up for 10.2±8.3 months and 1 patient died of stroke during the following up. ConclusionEmergency CABG can restore coronary artery blood flow quickly and provide good results for coronary accidents during PCI.
ObjectivesTo assess the efficacy of non-drug interventions on improving sleep quality in ICU patients by network meta-analysis.MethodsThe Cochrane Library, PubMed, EMbase, Web of Science, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on non-drug interventions on improving sleep quality in ICU patients from inception to December, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, network meta-analysis was performed by using the Stata 13.0 software.ResultsA total of 12 RCTs, involving 1 223 patients and 9 non-pharmacological interventions (music therapy, comprehensive nursing intervention, TCM emotions, music therapy+TCM emotions, Chinese medicine pillow therapy, ear acupressure, eye mask+earplugs+music, eye mask+earplugs, regular care) were included. The results of Pittsburgh sleep quality index (PSQI) showed that eye mask+earplugs, eye masks, and comprehensive nursing interventions were superior to conventional care in improving sleep quality in ICU patients, and the rankings were: eye mask+earplugs>eye mask>comprehensive nursing intervention, music therapy+TCM emotional>Chinese medicine emotional>music therapy>general care. The results of Richards-Campbell sleep scale (RCSQ) showed that eye mask+earplugs+music, Chinese medicine pillow therapy, and auricular pressure beans were superior to conventional care, and the rankings were: eye mask+earplugs+music>Chinese medicine pillow therapy>music therapy>ear acupressure beans>general care.ConclusionsThe evidence shows that in improving the sleep quality of ICU patients, eye mask + earplug, eye mask, comprehensive nursing intervention, music therapy + TCM emotional characteristics may all be effective intervention methods. It is suggested that more non-drug interventions should be carried out in the future for enhancing the sleep quality of ICU patients.
Objective To evaluate the effectiveness and security through meta-analysis of a comprehensive study of efficacy of coronary artery bypass grafting (CABG) versus drug-eluting stent percutaneous coronary intervention (DES-PCI), for diabetes mellitus with multi-vessel coronary disease. Methods Databases including The Cochrane Library, PubMed, MEDLINE, EMbase, CBM, CNKI, WanFang Data and VIP were searched from their establishment dates to 2010. Published information and conference papers including references were handsearched. Relevant randomized controlled trials (RCTs) on diabetic patients with coronary multi-vessel disease treated with revascularization were collected and screened by two reviewers independently. After data extraction and quality assessment of the included studies, meta-analysis was performed using RevMan 5.0. Results A total of eight studies involving a total of 3 689 cases (CABG group: 1 814 cases; DES-PCI group: 1 875 cases) were included. Results of meta-analyses showed that: compared with the DES-PCI group, the CABG group could significantly reduce postoperative repeat revascularization rate (OR=0.27, 95% CI 0.10 to 0.69, P=0.006) and major cardio-cerebral vascular events (OR=0.49, 95% CI 0.38 to 0.62, Plt;0.000 01). But in reducing mortality rate (OR=0.84, 95%CI 0.64 to 1.10, P=0.21), cerebrovascular events (OR=2.00, 95%CI 0.97 to 4.14, P=0.06) and myocardial infarction incidence rate (OR=0.92, 95%CI 0.53 to 1.59, P=0.75), there were no significant differences between the two groups. Conclusion CABG is superior to DES-PCI in the treatment of diabetic patients with multi-vessel disease. However, due to the limitation of the quality and quantity of the included studies, the above conclusion should be tested by conducting more large-scale, multi-center and prospective RCTs in future.
Childhood is the key period of psychological and behavioral development of children. The changes of children's psychological behavior during this period have an impact on the psychological and behavioral patterns of adolescents and even adults. Epilepsy is a chronic and recurrent disease, which affect the development emotional behavior problem of children with epilepsy seriously. This paper reviewed the influencing factors, measuring methods and intervention of emotional behavior problems in children with epilepsy so as to alleviate the negative emotion and behavior problems and provide quality of life in children with epilepsy.
ObjectiveTo explore the effect of programmed family nursing intervention on medication compliance in hypertensive patients. MethodsA total of 160 patients with hypertension treated between August 2012 and July 2013 in our hospital were chosen to be our study subjects. They were randomly divided into two groups:control group (n=80) and trial group (n=80). Patients in the control group were given routine nursing intervention for six months, while those in the trial group received six-month programmed family nursing intervention. Then, we compared the effect of blood pressure control and medication compliance between the two groups. ResultsThe effect of blood pressure control and medication compliance in the trial group after the intervention was better than that in the control group, and the difference was statistically significant (P<0.05). ConclusionThe programmed family nursing intervention is better than the routine nursing intervention in terms of effect of blood pressure control and patients' medication compliance, and it is an effective nursing method for hypertensive patients.
In the hospital where centralized treatment was applied for the victims after Yiliang earthquake (on 7th September, 2012), a holistic rehabilitation service mode which centred on supportive psychological intervention promoting was developed by the Yiliang psychological crisis intervention team designated by the National Health and Family Planning Commision of the People’s Republic of China. The pattern takes psychological nurses as liaison, bases on the integrity and continuity of medical service, roots in comprehensive health assessment and key assessment of mental trauma stress, emphasizes on solving realistic problems for patients and their caregivers, provides supportive psychological intervention, and encourages psychological nurses to offer psychological support for earthquake victims with the help of quantitative self-assessment of social psychological support service. In practice, the mode of psychological services, which could be contiuously conducted, is welcomed by hospital managers, work staff, and earthquake victims and their caregivers.