OBJECTIVE To investigate the difficult point about the medical waste management at public region of outpatient service and to improve it.METHODS The form of questionnaire self-designed by the hospital about the medical waste related knowledge knowing rate among outpatients,the propaganda of medical waste related(knowledge) and the setting of special-purpose container for medical waste,was surveyed among 200 outpatients and 20 outpatient service medical personnel.RESULTS The medical waste related knowledge knowing rate was below 10% among outpatients,the medical waste related knowledge received ownself and from medical personnel was 13% and 2.5%,respectively.More than 35% of the medical personnel and 56% outpatients thought the setting of special-purpose container for medical waste was unreasonable.(CONCLUSIONS) The propaganda of medical waste related knowledge must strengthen,and the medical waste related knowledge knowing rate among outpatients must be higher.The improvement medical waste(special)-purpose facility at the public region of(outpatient) service is an important link for standardized management of medical waste.

OBJECTIVE To discuss the efficiency method of improving consciousness and action for occupational infection protection among grass root medical staff.METHODS To conduct multiform health education,found restrict system,inspect and supervise,optimize protection flow,consummate protection establishment,and strengthen important link management in key departments in order to realize the system intervention among grass root medical staff.RESULTS Due to the system intervenion,the understanding rate of occupational infection protection knowledge improved from 48% to 96%,the average rate of occupational infection protection improved from 56.6% to 97.7% with significant differences(P

Objective To observe the influence of traditional Chinese Medicine (TCM) Five-element music combined with language induction on the psychological status and quality of life among maintenance hemodialysis patients. Methods A total of 66 maintenance hemodialysis patients were divided into the Five-element music group (n=34) and the routine care group (n=32) according to date of hemodialysis. The routine group accepted routine care. The music group accepted the intervention of traditional Chinese Medicine Five-element music combined with language induction on the basis of routine care. Four weeks later, the changes of Hospital Anxiety Depression Scale (HAD), the MOS item Short From Health Survey (SF- 36) were observed to assess the effect before and after the intervention. Results HAD comparison in the group: After 4-week intervention, in Five-element music group, the depression and anxiety score of HAD and HAD total score were 3, 5, 9 (meadian score), which had improved significantly than before, which were 4, 7, 12 (meadian score), the difference was significant (Z=-2.645,-2.927,-3.220, P<0.01) . After 4 weeks, in the routine group the depression and anxiety score of HAD and HAD total score showed no significant change than before (P>0.05). SF-36 comparison in groups: After 4-week intervention, in Five-element music group, the physical, physiological function,overall health, energy status, social function, emotional function, mental health factors of SF-36 scored 63, 88, 74, 41, 75, 75, 100, 80 (meadian score), which had improved significantly compared with before, which were 45, 0, 68, 40, 58, 75, 17, 72 (meadian score), the difference was significant (Z=-3.895--2.027, P<0.01 or 0.05), body pain and mental health factors had no significant difference (t=-1.785,-1.576, P>0.05). After 4 weeks, the routine group′s each factor score had no significant difference compared with before (P > 0.05). Conclusions TCM Five-element music has a certain effect on improving the psychological status and the quality of life of the patients in maintenance hemodialysis.

Objective: To investigate the effect of early mobilization on gastrointestinal function and delirium in patients with mechanical ventilation of chronic obstructive pulmonary disease(COPD). Methods: A total of 87 mechanically ventilated patients with COPD who met the inclusion criteria were selected as subjects from April 2017 to March 2018 in intensive care unit(ICU) of Huxi Hospital Affiliated to Jining Medical College.The patients were divided into treatment group (44 cases) and control group (43 cases) by the random number table method.On the basis of the same conventional treatment, the treatment group received early mobilization.The incidence of acute gastrointestinal injury(AGI), duration of AGI, incidence of delirium, duration of delirium, days of mechanical ventilation and 28-day mortality were compared between the two groups. Results: The incidence rate of AGI in the treatment group was lower than that in the control group[40.9%(18/44) vs. 62.7%(27/43)], and the duration in the treatment group was shortened[(3.95±1.62)d vs. (5.23±2.03)d], and the incidence rate of delirium in the treatment group was lower[54.5%(24/44) vs. 76.7%(33/43)], the duration of delirium in the treatment group was shortened[(2.36±0.9)d vs. (3.25±1.27)d], the mechanical ventilation time in the treatment group was decreased[(6.39±1.76)d vs. (7.56± 1.49)d], the differences were statistically significant(χ²=4.17, t=-2.280, χ²=4.744, t=-2.919, -3.358, all P<0.05). There was no statistically significant difference in the rate of 28-day mortality between the two groups[2.3%(1/43) vs. 9.3%(4/43), χ²=-1.984, P>0.05]. Conclusion Early mobilization can reduce the incidence and duration of AGI and delirium in COPD patients with mechanical ventilation, reduce the severity of AGI, and shorten the time of mechanical ventilation.

Objective To investigate the effects of early mobilization therapy on gastrointestinal function and respiratory mechanics in mechanical ventilation patients with chronic obstructive pulmonary disease (COPD). Methods A prospective randomized controlled study was used. Eighty-five patients with COPD who had stable hemodynamics and required invasive mechanical ventilation from January to December 2017 were enrolled. The patients were divided into treatment group with 43 cases and control group with 42 cases according to the random number table method. The patients in both groups received conventional basic treatment, but the treatment group received early mobilization therapy. The conditions of acute gastrointestinal injury (AGI), incidence of ventilator-associated pneumonia (VAP), duration of mechanical ventilation, 28-day mortality and respiratory mechanics indexes before and after treatment including airway resistance (Raw), lung dynamic compliance (Cd), lung static compliance (Cs), intrinsic positive end expiratory pressure (PEEPi) were compared between 2 groups. Results There were no statistical difference in Raw, Cd, Cs and PEEPi before treatment between 2 groups (P＞0.05). The PEEPi and Raw after treatment in treatment group were significantly lower than those in control group:(6.51 ± 1.46) cmH2O (1 cmH2O=0.098 kPa) vs. (7.30 ± 1.61) cmH2O and (19.23 ± 2.62) cmH2O/(L·s) vs. (20.54 ± 2.50) cmH2O/(L·s), the Cs and Cd were significantly higher than those in control group:(53.14 ± 5.07) ml/cmH2O vs. (49.16 ± 5.10) ml/cmH2O and (26.63 ± 3.28) ml/cmH2O vs. (24.54 ± 1.97) ml/cmH2O, and there were statistical differences (P＜0.05 or＜0.01). The incidences of AGI, duration of AGI, duration of mechanical ventilation and incidence of VAP in treatment group were significantly lower than those in control group: 44.2% (19/43) vs. 66.7% (28/42), (3.56 ± 1.22) d vs. (4.26 ± 1.62) d, (6.79 ± 1.92) d vs. (7.64 ± 1.89) d and 2.3% (1/43) vs. 14.3% (6/42), the severity of AGI was significantly lower than that in control group (patients of gradeⅠ,Ⅱ,ⅢandⅣin treatment group were 11, 6, 1 and 1 case respectively, and patients of grade Ⅰ, Ⅱ, Ⅲ and Ⅳ in control group were 7, 12, 8 and 1 case respectively), and there were statistical differences (P＜0.05). There was statistical difference in 28-day mortality between 2 groups (P＞0.05). Conclusions The incidence of AGI in mechanical ventilation patients with COPD is high. Early mobilization therapy can reduce the incidence and duration of AGI in mechanically ventilated patients with COPD, and reduce airway resistance, increase Cd and Cs, reduce PEEPi, improve respiratory function, shorten mechanical ventilation time, and reduce the incidence of VAP, which is worthy of clinical promotion.

Objective:To investigate the effects of respiratory mechanics-guided sedation strategy on diaphragm function in chronic obstructive pulmonary disease (COPD) patients treated with mechanical ventilation (MV).Methods:A prospective study was conducted. Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) received invasive MV who were admitted to the Affiliated Huxi Hospital of Jining Medical University from May 2020 to May 2021 were enrolled. The patients were divided into observational group and control group by random number table method. All patients were intubated for MV, and received bronchodilators, glucocorticoid, anti-infectives, expectorant, nutritional support, analgesia and sedation. The sedatives were dexmedetomidine combined with propofol, and the analgesics were sufentanil in both groups. Respiratory mechanics monitoring was performed every 6 hours in the observational group, and the depth of sedation was adjusted according to the parameters of respiratory mechanics: when airway resistance (Raw) > 20 cmH 2O·L -1·s -1, deep sedation was given to maintain Richmond agitation-sedation scale (RASS) ≤ -3; when the Raw was 10-20 cmH 2O·L -1·s -1, the initial depth of sedation maintained to reach the RASS score of -2-0; when Raw < 10 cmH 2O·L -1·s -1, withdrawn the sedation, or given light sedation, and maintained the RASS score of -2-0. While the control group received light sedation. The patients' diaphragmatic excursions (DE) was measured by bedside ultrasound, tidal volume (VT) and respiratory rate (RR) were recorded, and the diaphragmatic rapid shallow breathing index (D-RSBI, D-RSBI = RR/DE) and diaphragmatic excursion efficiency (DEE, DEE = VT/DE) were calculated. The differences in DE, D-RSBI, and DEE before and 3 days and 5 days of treatment between the two groups were compared. The difference in the RASS score within 3 days of sedation between the two groups was compared. The differences in the duration of MV and 28-day mortality between the two groups were compared. Results:A total of 96 patients were selected. Six patients were excluded due to delirium or the duration of MV shorter than 3 days. Finally, 90 patients were enrolled, with 46 in the observational group, and 44 in the control group. There were no statistically significant differences in DE, D-RSBI or DEE before treatment between the two groups. After treatment, D-RSBI in both groups was gradually decreased, and DEE was gradually increased with time. The D-RSBI at 3 days and 5 days of treatment in the observational group were significantly lower than those in the control group (times·min -1·mm -1: 1.73±0.48 vs. 1.96±0.35 at 3 days, 1.45±0.64 vs. 1.72±0.40 at 5 days, both P < 0.05), and DEE were significantly higher than those in the control group (mL/mm: 19.7±4.3 vs. 17.1±3.9 at 3 days, 25.8±5.6 vs. 22.9±5.4 at 5 days, both P < 0.05). There was no significant difference in DE at all time points between the two groups. The RASS scores within 2 hours of sedation in the observational group were significantly lower than those in the control group (1 day: -3.78±0.92 vs. -2.34±0.68, 2 days: -2.87±1.04 vs. -2.43±0.79, both P < 0.05), while no statistical difference at 3 days was found between the two groups. The duration of MV in the observational group was significantly shorter than that in the control group (days: 5.78±2.01 vs. 6.84±2.27, P < 0.05). One patient died in each of the control group and the observational group, and there was no significant difference in the 28-day mortality between the two groups (2.3% vs. 2.2%, P > 0.05). Conclusion:For AECOPD patients undergoing MV, respiratory mechanics-guided sedation strategy can reduce D-RSBI, increase DEE, shorten the duration of MV, and have a certain protective effect on the diaphragm.

Objective To investigate the effect of high-flow nasal cannula oxygen therapy (HFNC) on the clinical efficacy and diaphragm function of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods The patients with mild to moderate AECOPD (clinical classification Ⅰ-Ⅱ) admitted to Huxi Hospital Affiliated to Jining Medical College from January to October in 2018 were enrolled. The patients were divided into HFNC treatment group and routine oxygen therapy control group (each n = 37) by randomly number table method. The two groups were given bronchiectasis drugs, corticosteroids, expectorant, anti-infection treatment, at the same time, the HFNC treatment group was given HFNC with the initial flow rate of 40 L/min. The routine oxygen therapy control group was given low flow oxygen, and the initial flow rate was 3 L/min. General data such as gender, age, clinical grade, acute physiology and chronic health evaluationⅡ (APACHEⅡ) score were recorded. Bedside ultrasound was used to measure the diaphragmatic excursions during quiet breathing (DEq), diaphragmatic excursions during deep breathing (DEd), and diaphragmatic shallow fast breathing index (D-RSBI) before and 2, 24 and 48 hours after treatment in both groups and compared, meanwhile, arterial blood gas analysis was performed, and arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) were recorded. Results Two patients in the HFNC treatment group withdrew from the study because they could not tolerate HFNC, while other patients were enrolled in the analysis. There was no statistically significant difference in gender, age, proportion of AECOPDⅡ grade or APACHEⅡscore between the two groups, indicating that the general data of the two groups were comparable and balanced. There was no statistically significant difference in DEq, DEd, D-RSBI, PaO2 or PaCO2 before treatment between the two groups. After treatment, DEp in both groups was decreased gradually with time, it was decreased earlier in the HFNC treatment group, and it showed significant difference as compared with that before treatment at 2 hours after treatment (mm: 18.3±3.1 vs. 20.1±4.2, P < 0.01), and it was significantly lower than that in the routine oxygen therapy control group (mm: 18.3±3.1 vs. 20.3±3.7, P < 0.05); DEd was gradually increased in both groups, it was significantly increased in the HFNC treatment group, and it was significantly higher than that in the routine oxygen therapy control group at 24 hours and 48 hours after treatment (mm: 55.2±7.6 vs. 50.8±9.2 at 24 hours, 59.4±7.7 vs. 53.6±9.1 at 48 hours, both P < 0.05); D-RSBI was decreased gradually in both groups, it was decreased earlier and more significant in the HFNC treatment group, and it was significantly lower than that in routine oxygen therapy control group at 24 hours and 48 hours after treatment (times·min-1·mm-1: 0.41±0.13 vs. 0.51±0.20 at 24 hours, 0.31±0.12 vs. 0.43±0.17 at 48 hours, both P < 0.05). After treatment, there was no statistically significant difference in PaO2 or PaCO2 between the two groups. Conclusion HFNC can effectively relieve diaphragm fatigue in patients with mild to moderate AECOPD, but it had no effect on carbon dioxide retention.

Objective To investigate the effect of early mobilization on diaphragmatic function in patients with mechanical ventilation (MV). Methods Sixty chronic obstructive pulmonary disease with acute exacerbation (AECOPD) patients with respiratory failure (RF) and underwent MV admitted to intensive care unit (ICU) of Huxi Affiliated Hospital of Jining Medical College from January 2016 to January 2017 were enrolled. The patients were divided into treatment group (n = 30) and control group (n = 30) by randomly number table method. The two groups were given analgesia, sedation, MV, antibiotics, nutritional support and other treatments. An implementation plan was developed based on the clinical practice of pain, irritability and delirium in adult patients (PAD) with ICU, while the treatment group was given early mobilization (such as joint activity, stand to the bed, 3 times a day). The diaphragmatic thickness at the end of expiration (DTee), diaphragmatic thickness at the end of inspiration (DTei) and diaphragmatic thickening fraction (DTF) were measured by bedside ultrasonography before and 24 hours, 48 hours, 3 days and 5 days after treatment respectively. Results There were no significant differences in the parameters of the diaphragm before treatment between the two groups. In the control group, DTee was gradually decreased at 5 days after treatment and was significantly lower than that before treatment (cm: 0.26±0.06 vs. 0.28±0.08, t = 3.045, 1 = 0.005). While there was no significant change in DTee in the treatment group. There was no significant difference in DTee between the two groups at different time points after treatment. DTei and DTF were significantly increased in the two groups after treatment, and reached the peak value at 48 hours; with the prolonged of MV time, DTei and DTF in the control group at 3 days and 5 days were significantly lower than those at 48 hours [DTei (cm): 0.35±0.07, 0.34±0.07 vs. 0.36±0.08; DTF: (29.29±11.01)%, (28.62±11.97)% vs. (32.48±15.63)%, all 1 < 0.01]; there were no significant changes in the treatment group. DTF in the treatment group at 3 days and 5 days was significantly higher than that in the control groups [(38.53±11.39)% vs. (29.29±11.01)%, (37.27±11.26)% vs. (28.62±11.97)%, both 1 < 0.01]. Conclusion MV can lead to diaphragmatic dysfunction, while early mobilization can delay diaphragmatic atrophy and systolic dysfunction in MV patients.