OBJECTIVES: This study aimed to investigate the perception of dental outpatient care quality from multiple perspectives of administrators, physicians, nurses, and patients and propose nursing care quality evaluation indices that are consistent with the clinical reality to provide reference for the construction of a scientific, systematic, and comprehensive dental outpatient care quality evaluation system. METHODS: A total of 39 interviewees, including 7 administrators, 11 doctors, 11 nurses, and 10 patients, were selected for semi-structured in-depth interviews in five regionally representative tertiary-level A stomatological specialty hospitals nationwide during January-April 2024 by using a multistage sampling method. Colaizzi 7-step analysis was used to analyze and summarize the interview data. Themes were extracted on the basis of the Structure-Process-Outcome (SPO) three-dimensional quality assessment model. RESULTS: Five main themes and 15 secondary themes were extracted from three quality dimensions: structure, process, and result. The related topics of structural quality were as follows: disinfection and isolation norms, equipment and consumable management, nursing manpower ratio and nurse education structure, and emergency capability. The related topics of process quality were as follows: pre-diagnosis risk assessment, patient triage and guidance, communication and attitude, health education, humanistic care, continuous care, specialty operation, and four-hand operation. The related topics of result quality were as follows: satisfaction, adverse event management and analysis, effective complaints and disputes. CONCLUSIONS Structure quality is the foundation, process quality is the core, and result quality is the key in the evaluation of the quality of oral outpatient care. The standardization of disinfection and isolation, equipment and consumable management, allocation of reasonable nursing manpower and post capacity, implementation of high-quality nursing services, and improvement of the quality and satisfaction of medical cooperation are necessary guarantees to ensure the quality of oral outpatient care.
Humans ; Quality of Health Care ; Ambulatory Care/standards* ; Dental Care/standards* ; Outpatients

OBJECTIVES: This study aimed to construct an evaluation index system for nursing quality management in outpatient dental clinics based on the structure-process-outcome model and provide an objective standard for the evaluation of nursing quality in outpatient dental clinics. METHODS: Through literature review, multi-subject interviews, and expert meetings, the first draft of the evaluation index for nursing quality management in outpatient dental clinics was formulated. The Delphi method was adopted to select and invite 15 experts in the fields of hospital infection management, nursing management, and specialized oral care from across the country to modify the first draft. RESULTS: The positive coefficients of the experts in the two rounds of consultation were 86.7% and 92.3%, respectively. The total authority coefficients of the experts were 0.791 and 0.717, respectively. The mean scores of the importance and feasibility of the third-level indices in the two rounds of consultation were all ≥4.333; the coefficients of variation were all ≤0.150; and the Kendall's coordination coefficients were 0.308 and 0.184 respectively, with P<0.05 for all. These results indicated that the experts were motivated to participate in this study. They recognized the importance and feasibility of the overall items in this index system, and their opinions were relatively consistent. Finally, an evaluation index system, which included 3 first-level indices, 7 second-level indices, 22 third-level indices, and 69 index connotations, for nursing quality management in outpatient dental clinics was determined. The weights of the three first-level indicators were all 0.333. Patient satisfaction (0.076, outcome dimension), hand hygiene (0.061, outcome dimension), chair care ratio (0.057, structural dimension), and turnover rate (0.057, structural dimension) were the top tertiary indicators in terms of portfolio weight. CONCLUSIONS The construction method of the evaluation index system for nursing quality management in outpatient dental clinics is scientific and reliable. It can provide a reference for the evaluation of the management level of nursing quality in outpatient dental clinics and promote the continuous improvement of nursing quality in outpatient dental clinics.
Humans ; Dental Clinics ; Delphi Technique

Objective:To investigate the effect of pressurized pedicled rectus abdominis flap for breast reconstruction.Methods:A retrospective study was conducted to include 37 female patients with breast cancer who underwent immediate breast reconstruction using a pressurized pedicle rectus abdominis skin flap transplantation after surgery at the Department of Plastic and Reconstructive Surgery, Hunan Provincial Cancer Hospital from March 2019 to December 2022. The patients were aged 29-61 years, with an average age of (37.7±3.5) years. According to the preoperative imaging and ultrasound data, 17 patients were planned to complete immediate breast reconstruction with free inferior abdominal artery perforator flap transplantation, and the operation was adjusted to directly prepare a pedicled rectus abdominis flap with long inferior abdominal vessel pedicle according to the actual situation. In addition, 20 patients were scheduled to use pedicled rectus abdominis flap alone, and the operation was changed according to the actual situation. The flap was trimmed according to the condition of the affected area and immediate intraoperative fluorgraphy. After cutting off the vascular pedicle, the recipient area was placed, and the recipient blood vessels were selected for vascular anastomosis. After shaping, the donor and recipient areas were sutured. The survival of the skin flap was observed.Results:Intraoperative fluorescein angiography was used to determine the blood supply of the flap. It was found that 37 cases of pedicled rectus abdominis flaps had different degrees of blood supply disorders. The affected vessels in the specific anastomosis comprised the intrathoracic vessels (19 cases, 51.4%), the lateral thoracic arterial vein (10 cases, 27.0%), and anterior branches of the thoracic and dorsal vessels (8 cases, 21.6%). In 37 cases, the lateral abdominal wall vein was carried in the flap, 20 of which carried the lateral abdominal wall shallow vein, 17 cases carried the lateral abdominal wall shallow vein, six of which were extra anastomosed and superficial vein, and the actual utilization rate was 16.2%. The follow-up was 47 months, averaging 22.7 months. 37 patients had fair reconstructed breast appearance, good elasticity, and no flap contracture deformation. Only linear scar was left in the flap donor area with no effect on abdominal wall function.Conclusions:Pressurized rectus flap can improve the survival rate and surgical safety.

Objective:To investigate the relationship between cerebrovascular variation and the occurrence and recurrence of cerebral infarction, and provide a theoretical basis for the precise prevention and treatment of cerebral infarction.Methods:Totally 13 939 patients who underwent magnetic resonance imaging(MRI) and magnetic resonance angiography(MRA) examination at the Second Affiliated Hospital of Shandong First Medical University from January 2020 to December 2021 were grouped according to clinical symptoms combined with the imaging report, including 4 412 cases in the cerebral infarction group and 9 527 cases in the control group.2 048 patients in the cerebral infarction group were eventually enrolled in the study according to the inclusion and exclusion criteria, including 1 479 cases of initial cerebral infarction and 569 cases of recurrent cerebral infarction.SPSS 25.0 statistical software was used for data analysis.The χ2 test was used to compare the incidence of cerebral infarction with different cerebrovascular variations.Univariate analysis of suspected risk factors for recurrent cerebral infarction was performed with χ2 test, nonparametric test and t test.The binary logistic regression was used to analyze independent risk factors of recurrent cerebral infarction. Results:The incidence of cerebral infarction in the dual-system cerebrovascular variant patients, the single-system cerebrovascular variant patients, and the non-cerebrovascular variant patients were 40.9%, 30.7% and 31.8% respectively.The incidence of cerebral infarction in the dual-system cerebrovascular variant patients was the highest compared with those in the single-system cerebrovascular variant patients and the non-cerebrovascular variant patients (both P<0.05). The incidence rates of embryonic posterior cerebral artery, vertebral artery dominance, and bilateral common origin anterior cerebral arteries were 14.09%, 10.76% and 5.32%, respectively.The incidence of bilateral common origin anterior cerebral arteries in the cerebral infarction group was significantly higher than that in the control group and the difference was statistically significant.Patients with cerebral infarction who were familial aggregation ( OR=2.207, 95% CI=1.591-3.062), hyperhomocysteinemia ( OR=1.262, 95% CI=1.014-1.570), hypertension ( OR=1.461, 95% CI=1.114-1.918), diabetes mellitus ( OR=1.348, 95% CI=1.072-1.694), coronary heart disease ( OR=1.491, 95% CI=1.196-1.858) were more likely to recurrent cerebral infarction ( P<0.05), and patients with cerebral infarction had a significantly increased risk of recurrent cerebral infarction with age ( OR=1.031, 95% CI=1.020-1.042, P<0.05). Conclusion:Dual-system cerebrovascular variation and bilateral common origin anterior cerebral arteries are risk factors for cerebral infarction.

BACKGROUND: Intensive phototherapy (IPT) and exchange transfusion (ET) are the main treatments for extreme hyperbilirubinemia. However, there is no reliable evidence on determining the thresholds for these treatments. This multicenter study compared the effectiveness and complications of IPT and ET in the treatment of extreme hyperbilirubinemia. METHODS: This retrospective cohort study was conducted in seven centers from January 2015 to January 2018. Patients with extreme hyperbilirubinemia that met the criteria of ET were included. Patients were divided into three subgroups (low-, medium-, and high- risk) according to gestational week and risk factors. Propensity score matching (PSM) was performed to balance the data before treatment. Study outcomes included the development of bilirubin encephalopathy, duration of hospitalization, expenses, and complications. Mortality, auditory complications, seizures, enamel dysplasia, ocular motility disorders, athetosis, motor, and language development were evaluated during follow-up at age of 3 years. RESULTS: A total of 1164 patients were included in this study. After PSM, 296 patients in the IPT only group and 296 patients in the IPT plus ET group were further divided into the low-, medium-, and high-risk subgroups with 188, 364, and 40 matched patients, respectively. No significant differences were found between the IPT only and IPT plus ET groups in terms of morbidity, complications, and sequelae. Hospitalization duration and expenses were lower in the low- and medium-risk subgroups in the IPT only group. CONCLUSIONS In this study, our results suggest that IPT is a safe and effective treatment for extreme hyperbilirubinemia. The indication of ET for patients with hyperbilirubinemia could be stricter. However, it is necessary to have a contingency plan for emergency ET as soon as IPT is commenced especially for infants with risk factors. If IPT can be guaranteed and proved to be therapeutic, ET should be avoided as much as possible.
Child, Preschool ; Exchange Transfusion, Whole Blood/adverse effects* ; Humans ; Hyperbilirubinemia, Neonatal/therapy* ; Infant ; Infant, Newborn ; Kernicterus/therapy* ; Phototherapy/methods* ; Retrospective Studies

Objective:To build a health education scheme related to discharge planning for adolescent idiopathic scoliosis surgery patients, and provide systematic and standardized health education related to discharge planning for adolescent idiopathic scoliosis surgery patients.Methods:From January to June 2021, through literature review and semi-structured interviews, the first draft of health education scheme for discharge planning of adolescent idiopathic scoliosis surgery patients was formulated. The Delphi method was used to conduct 2 rounds of consultation with 15 experts, and the final version of the health education scheme for the discharge plan was determined according to the expert consultation.Results:The effective recovery rates of the 2 rounds of expert consultation questionnaires were both 100.0%, the coefficients of expert authority were 0.93 and 0.94, and the Kendall's harmony coefficients of expert opinions were 0.251 and 0.273 ( P<0.01) . Finally, the health education program was constructed according to the health needs of patients and caregivers at 7 time periods including admission day, 1 day before surgery, operation day, postoperative day 1, 1 day before discharge, discharge day and 1 week after discharge, including 7 first-level items, 24 second-level items, and 78 third-level items. Conclusions:The health education scheme related to the discharge plan for adolescent idiopathic scoliosis surgery patients constructed in this study is scientific and reasonable in design, comprehensive, reliable and clinically practical. It is of great significance for the effective implementation of the discharge plan for adolescent idiopathic scoliosis surgery patients .

Objectives:To establish a grading model on prognosis of drug-coated balloon (DCB) treatment on femoropopliteal de novo lesions, and assess whether patients at high risk could benefit from combination of directional atherectomy(DA).Methods:The clinical data of 114 patients with femoropopliteal de novo lesions admitted to Department of Vascular Surgery, Peking University People′s Hospital from October 2015 to January 2019 were collected retrospectively. There were 95 patients(108 limbs) underwent DCB treatment, including 66 males and 29 females, aged 71.9 years old(range:48 to 91 years), and 19 patients (21 limbs) underwent DA combined with DCB treatment, including 13 males and 6 females, aged 69.5 years old(range: 62 to 80 years). The demographic data, intraoperative and postoperative conditions of the patients were collected. Cox regression model was performed for modeling and then goodness of fit was tested. Kaplan-Meier estimate was carried out between the two groups for patients at high risk and low risk, respectively.Results:All patients were followed up for more than 24 months. Restenosis occurred on 34 limbs in DCB group and 3 limbs in DA+DCB group. Severe calcification( HR=3.804, 95% CI:2.460 to 5.883), popliteal artery involvement ( HR=2.104, 95% CI:1.368 to 3.236), long lesion ( HR=1.824, 95% CI:1.196 to 2.780), poor runoff( HR=1.736, 95% CI:1.025 to 2.940), chronic kidney disease( HR=1.601, 95% CI:1.040 to 2.463) were independent risk factors of restenosis after DCB treatment, and were defined 3, 2, 1, 1 and 1 points, respectively. Total points≥3 was regarded as high risk group. Kaplan-Meier analysis showed that patients in low risk group did not benefit from DA+DCB comparing with DCB with regard to primary patency at 24 months (77.78% vs. 90.31%, P=0.271) while patients benefited from DA+DCB comparing with DCB in high risk group(88.26% vs. 20.80%, P<0.01). Conclusions:The grading model shows satisfying clinical value. The clinical effect of DA+DCB is better than DCB along in high risk group. Patients at high risk are supposed to receive aggressive vessel preparation like DA.

Objectives:To establish a grading model on prognosis of drug-coated balloon (DCB) treatment on femoropopliteal de novo lesions, and assess whether patients at high risk could benefit from combination of directional atherectomy(DA).Methods:The clinical data of 114 patients with femoropopliteal de novo lesions admitted to Department of Vascular Surgery, Peking University People′s Hospital from October 2015 to January 2019 were collected retrospectively. There were 95 patients(108 limbs) underwent DCB treatment, including 66 males and 29 females, aged 71.9 years old(range:48 to 91 years), and 19 patients (21 limbs) underwent DA combined with DCB treatment, including 13 males and 6 females, aged 69.5 years old(range: 62 to 80 years). The demographic data, intraoperative and postoperative conditions of the patients were collected. Cox regression model was performed for modeling and then goodness of fit was tested. Kaplan-Meier estimate was carried out between the two groups for patients at high risk and low risk, respectively.Results:All patients were followed up for more than 24 months. Restenosis occurred on 34 limbs in DCB group and 3 limbs in DA+DCB group. Severe calcification( HR=3.804, 95% CI:2.460 to 5.883), popliteal artery involvement ( HR=2.104, 95% CI:1.368 to 3.236), long lesion ( HR=1.824, 95% CI:1.196 to 2.780), poor runoff( HR=1.736, 95% CI:1.025 to 2.940), chronic kidney disease( HR=1.601, 95% CI:1.040 to 2.463) were independent risk factors of restenosis after DCB treatment, and were defined 3, 2, 1, 1 and 1 points, respectively. Total points≥3 was regarded as high risk group. Kaplan-Meier analysis showed that patients in low risk group did not benefit from DA+DCB comparing with DCB with regard to primary patency at 24 months (77.78% vs. 90.31%, P=0.271) while patients benefited from DA+DCB comparing with DCB in high risk group(88.26% vs. 20.80%, P<0.01). Conclusions:The grading model shows satisfying clinical value. The clinical effect of DA+DCB is better than DCB along in high risk group. Patients at high risk are supposed to receive aggressive vessel preparation like DA.

Objective:To investigate the differential expression of cyclooxygenase (COX) gene between familial aggregated atherosclerotic large-artery atherosclerosis(LAA) cerebral infarction patients and sporadic LAA cerebral infarction patients.Methods:Twenty-five patients with familial aggregation LAA cerebral infarction (familial aggregation LAA group) and 25 sporadic LAA cerebral infarction patients (sporadic LAA group) were collected.Another 25 patients with non-cardiovascular and cerebrovascular diseases were selected as control group.Real-time quantitative PCR and ELISA were used to detect COX-1 and COX-2 protein in the supernatant of samples.Results:The expression level of COX-1 gene was 0.5436±0.2737, 0.2400±0.1656 and 0.8340±0.3799 in the familial aggregation, sporadic LAA cerebral infarction and control groups.Compared with control group, COX-1 gene expression in sporadic LAA cerebral infarction group and familial aggregation LAA cerebral infarction group was significantly down-regulated, the differences were significant( P<0.05). The expression level of COX-2 gene was 1.3672±0.8249, 1.3932±0.7158 and 0.7212±0.9623 in the familial aggregation, sporadic LAA cerebral infarction and control groups.Compared with the normal control group, the expression of COX-2 gene in familial aggregation LAA cerebral infarction group and sporadic LAA cerebral infarction group increased significantly( P<0.05). The expression of COX-1 protein was 2.9956±0.5672, 2.5572±1.0289 and 2.6721±0.7944 in the familial aggregation, sporadic cerebral infarction and control groups.The expression of COX-2 protein was 16.63±4.06, 16.86±7.93 and 15.94±5.94 in the familial aggregation, sporadic cerebral infarction and control groups.There was no significant difference in the relative expression of COX-1 and COX-2 proteins among familial aggregation LAA cerebral infarction group, sporadic LAA cerebral infarction group and control group(all P>0.05). Conclusion:There is significant difference in COX-1 gene expression between patients with familial LAA and sporadic LAA cerebral infarction.

Objective:To investigate the effect of hemoglobin on Shp2 expression in brain tissues and adherens junction in blood brain barrier in rats after cerebral hemorrhage.Methods:Eighty male SD rats were randomly allocated into sham-operated group and groups of cerebral hemorrhage for 6 h, 24 h, 3 d, and 7 d ( n=16). Rat models in the groups of cerebral hemorrhage were established by intracerebral injection of 20 μL of hemoglobin. Six h, 24 h, 3 d, and 7 d after injection, neurological functions were assessed by Longa scale; brain water content and brain organ coefficient in the harvested cerebral tissues were calculated by wet-dry weighting method; Shp2 mRNA expression was analyzed by real-time fluorescence quantification reverse transcription PCR (qRT-PCR); Shp2 positive neurons was detected by immunohistochemistry; the protein expressions of Shp2, α-catenin, β-catenin and vascular endothelial (VE)-cadherin, and phosphorylated (p-) α-catenin, p-β-catenin and p-VE-cadherin were explored by Western blotting. Results:As compared with those in the sham-operated group, Longa scale scores in groups of intracerebral hemorrhage for 6 h, 24 h, 3 d and 7 d were significantly increased ( P<0.05). As compared with the sham-operated group, groups of intracerebral hemorrhage for 24 h, 3 d and 7 d had significantly increased brain water content and brain organ coefficient, statistically reduced Shp2 mRNA expression, statistically samller amount of Shp2 positive neurons, and statistically reduced Shp2 protein expression, and significantly increased protein expressions of p-α-catenin, p-β-catenin and p-VE-cadherin ( P<0.05). Conclusion:Intracerebral injection of hemoglobin can downregulate Shp2 expression and promote phosphorylation of adherens junction proteins, therefore induce the disruption of adherens junction, which might be a critical mechanism of blood-brain barrier disruption and brain edema.