ObjectiveTo analyze the influencing factors of ventilator-associated pneumonia (VAP) in comprehensive intensive care units (ICUs) in a certain district of Shanghai, and to provide evidence for developing targeted measures to prevent and reduce the occurrence of VAP.MethodsThe target surveillance data of 1 567 inpatients with mechanical ventilation over 48 hours in comprehensive ICUs of 5 hospitals in the district from January 2015 to December 2017 were retrospectively analyzed to determine whether VAP occurred. The data were analyzed with SPSS 21.0 software to describe the occurrence of VAP in patients and to screen the influencing factors of VAP.ResultsThere were 133 cases of VAP in the 1 567 patients, with the incidence of 8.49% and the daily incidence of 6.01‰; the incidence of VAP decreased year by year from 2015 to 2017 (χ2trend=11.111, P=0.001). The mortality rate was 12.78% in VAP patients while was 7.25% in non-VAP patients; the difference was significant (χ2=5.223, P=0.022). A total of 203 pathogenic bacteria were detected in patients with VAP, mainly Gram-negative bacteria (153 strains, accounting for 75.37%). The most common pathogen was Pseudomonas aeruginosa. The single factor analysis showed that gender, age, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, the length of ICU stay, and the length of mechanical ventilation were the influencing factors of VAP (χ2=9.572, 5.237, 34.759, 48.558, 44.960, P<0.05). Multiple logistic regression analysis found that women [odds ratio (OR)=1.608, 95% confidence interval (CI) (1.104, 2.340), P=0.013], APACHE Ⅱ score >15 [OR=4.704, 95%CI (2.655, 8.335), P<0.001], the length of ICU stay >14 days [OR=2.012, 95%CI (1.188, 3.407), P=0.009], and the length of mechanical ventilation >7 days [OR=2.646, 95%CI (1.439, 4.863), P=0.002] were independent risk factors of VAP.ConclusionsNosocomial infection caused by mechanical ventilation in this area has a downward trend, and the mortality rate of patients with VAP is higher. For the patients treated with mechanical ventilation in ICU, we should actively treat the primary disease, shorten the length of ICU stay and the length of mechanical ventilation, and strictly control the indication of withdrawal, thereby reduce the occurrence of VAP.
Objective To explore the influencing factors and improving measures of hand hygiene among healthcare workers. Methods From June to August 2016, several healthcare workers from clinical departments and nosocomial infection control department in Chengdu were selected by purposive sampling method. Data was collected by individual in-depth interviews, and was three-rank coded by Nvivo 8 software based on Grounded Theory. Results After three-rank coding, 6 important influencing factors were generalized which were re-categorized into 3 levels: personal cognition, behavior capacity and social support. At the last, the whole framework of the theory was constructed through core coding. Conclusion In clinical practice, we should take reasonable measures to strengthen the training of hand hygiene, improve the hand hygiene facilities, strengthen supervision and management, and effectively improve the implementation rate of hand hygiene.
ObjectivesTo investigate the present status of clinical nurses' attitude towards patient safety and its influencing factors.MethodsA total of 2 290 clinical nurses in 10 large general hospitals in Anhui Province were investigated by general data and patient safety attitude questionnaire (SAQ).ResultsThe total score of the nurse's patient safety attitude was 112.57±11.83, in which the 6 dimension scores arranged from high to low were management recognition, working conditions, job satisfaction, team cooperation, safety climate, and pressure perception. Nurses who were female, marriage, college degrees, head nurse, and receivded patient safety education had higher total scores.ConclusionsScores of nurses of tertiary 3A hospitals in Anhui Province are overall above average. The influencing factors of nurses’ safety attitude are gender, marital status, education level, length of service, whether being head nurse, and whether being received safety education.
ObjectiveTo systematically review the risk factors associated with sleep disorders in ICU patients.MethodsWe searched The Cochrane Library, PubMed, EMbase, Web of Science, CNKI, Wanfang Data, VIP and CBM databases to collect cohort studies, case-control studies and cross-sectional studies on the risk factors associated with sleep disorders in ICU patients from inception to October, 2018. Two reviewers independently screened literature, extracted data and evaluated the bias risk of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 9 articles were included, with a total of 1 068 patients, including 12 risk factors. The results of meta-analysis showed that the combined effect of equipment noise (OR=0.42, 95%CI 0.26 to 0.68, P=0.000 4), patients’ talk (OR=0.53, 95%CI 0.42 to 0.66, P<0.000 01), patients’ noise (OR=0.39, 95%CI 0.21 to 0.74, P=0.004), light (OR=0.29, 95%CI 0.18 to 0.45, P<0.000 01), night treatment (OR=0.36, 95%CI 0.26 to 0.50, P<0.000 01), diseases and drug effects (OR=0.17,95%CI 0.08 to 0.36, P<0.000 01), pain (OR=0.37, 95%CI 0.17 to 0.82, P=0.01), comfort changes (OR=0.34,95%CI 0.17 to 0.67,P=0.002), anxiety (OR=0.31,95%CI 0.12 to 0.78, P=0.01), visit time (OR=0.72, 95%CI 0.53 to 0.98, P=0.04), economic burden (OR=0.63, 95%CI 0.48 to 0.82, P=0.000 5) were statistically significant risk factors for sleep disorders in ICU patients.ConclusionCurrent evidence shows that the risk factors for sleep disorders in ICU patients are environmental factors (talking voices of nurses, patient noise, and light), treatment factors (night treatment), disease factors (disease itself and drug effects, pain,) and psychological factors (visiting time, economic burden). Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusions.
Objective To investigate the donor-site compl ications of the anterolateral thigh flap and its influencing factors. Methods Between July 1988 and July 2007, 427 patients were treated with anterolateral thigh flap. Among them, 33 patients had postoperative donor-site compl ications and their cl inical data were analyzed retrospectively. There were 21 malesand 12 females aged 14-47 years old (average 32.7 years old). The size of the wound defect ranged from 16 cm × 7 cm to 28 cm × 13 cm. The area of the flap harvested during operation ranged from 16 cm × 7 cm to 30 cm × 13 cm. The donor sites were treated by direct suture in 7 cases; free spl it-thickness skin graft in 23 cases, and reverse superficial epigastric artery flap repair in 3 cases. The size of graft in the donor site ranged from 10 cm × 5 cm to 18 cm × 8 cm. The occurrence of short-term (within 4 weeks) and long-term (over 6 months) compl ications were analyzed. Results All patients were followed up for 8-54 months (average 21 months). There were 26 patients (78.8%) with short-term and long-term compl ications and 7 patients (21.2%) with long-term compl ications. The short-term compl ications included skin graft necrosis in 23 cases (69.7%), wound infection in 17 cases (51.5%), and muscle necrosis in 2 cases (6.1%). The long-term compl ications included non-heal ing wounds in 21 cases (63.6%), serious scar in 28 cases (84.8%), discomfort in 25 cases (75.8%), and dysfunction of the quadriceps femoris in 16 cases (48.5%). Conclusion The occurrence of anterolateral thigh flap donor-site compl ications is related to the anatomical structure of the anterolateral thigh region, the surgical procedure, and the patient’s physique.
Objective To investigate the influencing factors of the hi p functional recovery after Pi pkin fracture surgery. Methods The cl inical data were retrospectively analysed, from 37 patients with Pi pkin fracture between May 2002 and February 2009. There were 32 males and 5 females, aged 26 to 98 years (median, 43 years). The causes of injury were traffic accident in 31 cases, a fall ing in 4 cases, and fall ing from height in 2 cases. The time from injury to operation was 1-28 days (mean, 8.6 days). According to the Pi pkin classification criteria, there were 23 cases of type II, 8 cases of type III, and 6 cases of type IV. Open reduction and internal fixation (ORIF) were performed in 27 cases, total hip arthroplasty (THA) in 10 cases.The relationships between gender, age, time from injury to surgery, type of fracture, treatment way and the hip functionalrecovery were analysed statistically. Results All patients achieved heal ing of incision by first intention, no infection anddeep venous thrombosis occurred. All patients were followed up 10 to 94 months with an average of 40.5 months. Bonefusion was observed at 5-11 months (mean, 8.9 months) in patients undergoing ORIF by X-ray examination; no prostheticloosening or subsidence occurred in patients undergoing THA. At last follow-up, Oxford Hip Score (OHS) was 16-58 points(mean, 37.2 points); the results were excellent in 12 cases, good in 13 cases, fair in 2 cases, and poor in 10 cases. The univarible analysis showed that the type of fracture and treatment way significantly affected the hip functional recovery (P lt; 0.05). The multivarible analysis showed that the type of fracture and treatment way had no significant effect on the hip functional recovery (P gt; 0.05). Conclusion Type and treatment way of Pi pkin fracture may affect postoperative hi p function recovery, so appropriate treatment should be selected based on fracture type to ensure the restoration of joint function.
ObjectiveTo investigate the willingness and influencing factors of clinical medicine graduate students to study abroad.MethodsFrom September 2019 to January 2020, a survey was conducted among the clinical medicine graduate students in West China School of Medicine, Sichuan University. An anonymous self-report questionnaire was used to investigate their willingness to study abroad, and the related influencing factors were analyzed.ResultsA total of 600 questionnaires were distributed, in which 518 valid questionnaires were collected. Among the 518 graduate students, 96.14% anticipated to study abroad, and 93.05% expected to subsidize the study abroad through the state-sponsored study abroad fund. The major obstacle for studying abroad for joint training was concerning the negative effects on domestic clinical work or scientific research work, resulting in failure to graduate; meanwhile, difficulty in applying was the primary obstacle for studying abroad for a doctorate.ConclusionsThere is a strong willingness for clinical medicine graduate students to study abroad. However, it is affected by graduation time and application.
ObjectiveTo understand the status of life quality and fatigue level in patients with diabetic foot and to explore its influencing factors. MethodsRandom sampling method was used in collecting the general data of 80 diabetic foot patients from January 2013 to January 2014. The questionnaire of Fatigue Scale-14 and Diabetes Specific Quality of Life Scale were analyzed, and the influencing factors of fatigue and life quality were investigated. ResultsThe total score mean value of fatigue was 8.63±3.39 and the total score mean value of life quality was 71.00±19.84. The life quality and fatigue in patients with diabetic foot were positively correlated (P ＜ 0.01) . ConclusionsThe life quality of patients needs to be improved. We should especially pay attention to their mental health and try to meet their psychological needs, in order to ease the patients’ fatigue level and improve their life quality. The key for diabetic foot nursing is to discover and assess the fatigue symptoms of patients with diabetic foot diseases.
Objective To identify the factors which influence the effectiveness of clinical evaluation of undergraduate nursing students. Methods A self-made questionnaire was used in face-to-face interviews with 158 clinical teachers of undergraduate nursing students in four teaching hospitals in Sichuan. Results The main factors that influence the effectiveness of clinical evaluation of undergraduate nursing students included: clinical environment, duration of evaluation, degree of familiarity with the evaluation criteria of clinical teachers, and evaluation methods used by clinical teachers. The less important factors included: “halo-effect” of teachers to students, relationship between teachers and students, attitude towards evaluation and emotional status of clinical teachers. Conclusion It is of great importance to improve the clinical environment, provide enough time for clinical teachers to evaluate, cultivate and improve clinical teachers’ evaluation and competence, and establish a good relationship between teachers and students.This should improve the accuracy, objectivity and fairness of undergraduate nursing students’ clinical evaluation.
Objective To investigate the current situation of self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes mellitus (T2DM) in Sichuan province, and to analyze the influencing factors of SMBG, so as to provide evidence for improving the level of SMBG. Methods By the convenience sampling method, 410 patients with T2DM for more than 1 year were selected from 17 hospitals and community health service centers in 7 cities across Sichuan province, and their SMBG was investigated with a questionnaire. Results Among 410 eligible patients, the average frequency of SMBG was 7.3 times per month. There were 268 patients (65.4%) performed SMBG less than 4 times per month, 94 (22.9%) performed 4-15 times per month, 29 (7.1%) performed 6-29 times per month, and 19 (4.6%) performed over 30 times per month. Just 234 patients (57.1%) monitored the HbA1c in the past 6 months. FPG, 2-hour PPG and HbA1c were negatively correlated with the frequency of SMBG. The influencing factors of SMBG were insulin treatment and education. Conlusion The SMBG status in D2TM patients is relatively poor in Sichuan province, and the compliance of SMBG is expected to be improved by enhancing diabetic education.