Objective:To investigate the effect of ultrasound-guided midline catheter placement on the incidence of catheter-related bloodstream infection (CRBSI) in severe emergency patients.Methods:Five hundred and twenty-nine patients were chosen as the research objects from March 2018 to December 2019 at Emergency Intensive Care Unit, which was divided into the experimental group ( n=278) and the control group ( n=251). In the experimental group, ultrasound-guided midline catheter was used as central venous catheter (CVC) removal method of sequential, and in the control group, peripheral venous indwelling needle was used as sequential method after removal of CVC. CVC, midline catheter and the indwelling time of indwelling needle were counted. The utilization rate of CVC was compared between the two groups. Kaplan-Meier survival curve was plotted to describe the CVC indwelling time of the two groups and log-rank test was performed. Cox regression analysis was performed to analyze the influencing factors of CVC indwelling time and compare the incidence of CRBSI and other catheter-related complications. Results:The CVC indwelling time of the experimental group was significantly shorter than that of the control group (8 d vs. 13 d, P=0.000). The CVC utilization rate of the experimental group was significantly lower than that of the control group (49.83% vs. 80.45%, P=0.000). Multivariate Cox regression analysis showed that difficult intravenous access, length of ICU stay, the site of catheter placement, and midline catheter implantation without ultrasound-guidance were independent risk factors for prolonged CVC indwelling time ( P=0.000). The CRBSI rate of the experimental group was significantly lower than that of the control group (0.571‰ vs. 3.802‰, P=0.038). There was no significant difference in the incidence of other catheter-related complications between the two groups ( P=0.403). Conclusions:Ultrasound-guided midline catheter implantation can shorten the indwelling time of CVC, reduce the utilization rate of CVC, and reduce the incidence of CRBSI, which is worthy of clinical promotion.

Objective:To analyze the relationship between the clinical medical college students' time investment (including study, activities, entertainment and exercise) and general self-efficacy (GSE) in a medical university in Liaoning province, China.Methods:The first-year medical students were asked to participate the survey. Their GSE was measured by using general self-efficacy scale (GSES) in 2018. One year later, the independent variable table was used to investigate the extracurricular activity time, and 683 valid questionnaires were collected. Ordered logistic regression method was used to analyze the correlation between students' extracurricular activities and GSE.Results:Medical students' GSE was positively associated with their time in extracurricular study ( OR = 1.94, 95%CI = 1.49-2.54), volunteer activities ( OR=1.36, 95%CI = 1.01-1.83), and physical activities ( OR = 1.37, 95%CI = 1.01-1.85). However, there was no significant correlation with the time in activities organized by students ( OR = 1.09, 95%CI = 0.79-1.50) or activities organized by school ( OR = 1.15, 95%CI = 0.84-1.59). Furthermore, compared with clinical students of "5+3" year program, the 5-year program clinical students had a stronger correlation between medical students' GSE and the input of extracurricular study time. Conclusion:There is a positive correlation between medical students' GSE and their extracurricular time investment, which indicates that increasing medical students' GSE could be an effective method to improve their extracurricular time investment and eventually improve their comprehensive quality.

Objective:To evaluate the application method and effect of standardized scenario simulation teaching based on Kirkpatrick model in vocational protection education for nursing students.Methods:A historical controlled trial study was designed. Practical nursing students enrolled in 2018-2019 and 2017-2018 were selected into the experimental group ( n=203) and control group ( n=196), respectively. The experimental group adopted standardized scenario simulation teaching in the prevention and control education of needlestick injuries, and the control group adopted traditional classroom lecture. Using the Kirkpatrick model, the teaching effect of needlestick injuries protection for nursing students were compared between the 2 groups from such 4 levels as in reaction level, learning level, behavior level and results level. Results:There was no significant difference in the baseline data between the two groups in terms of age, gender, educational background and test scores of nursing professional knowledge as compared to that before practice. In reaction level: the nursing students' satisfaction of experimental group in teaching methods ( t=25.149, P<0.001) and teaching environment ( t=12.827, P<0.001) are higher than that of the control group, with statistical significance. In learning level: the test scores of needlestick injury knowledge in experimental group were significantly higher than those in control group ( t=8.221, P<0.001). In behavior level: the level of needlestick injury protection behavior in the experimental group was significantly higher than that in the control group ( t=9.250, P<0.001), and the knowledge conversion rate in the experimental group was higher than that in the control group ( t=6.054, P<0.001). In results level: the needlestick injuries incidence of experimental group was significantly lower than that of the control group ( χ2=15.815, P<0.001), the reported rate of needlestick injuries of experimental group was significantly lower than that of the control group ( χ2=14.185, P<0.001). Conclusion:The implementation of standardized scenario simulation teaching can effectively improve the effectiveness of vocational protection learning and reduce the incidence of needlestick injuries.

OBJECTIVETo evaluation the performance of a heart-type fatty acid-binding protein (H-FABP) ELISA detection kit in the clinical diagnosis of acute coronary syndrome (ACS).

METHODSPlasma or serum samples from 160 suspected ACS patients hospitalized in General Hospital of PLA were examined using Lanzhou H-FABP reagent kit and Holland H-FABP kit. Correlation of the two kits was evaluated and Kappa test was used to examine the consistency of the results of the two products.

RESULTSThe sensitivity of H-FABP diagnosis of ACS detection Lanzhou kit was 91.8%, the specificity was 88.7%, and the total diagnostic rate was 90.42%. The sensitivity of H-FABP diagnosis of ACS detection Holland kit was 90.3%, the specificity was 86.8%, and the total diagnostic rate was 88.75%. The test results showed that two products yielded comparable results (P=0.668, >0.05) with a good consistency (Kappa=0.726, P<0.01).

CONCLUSIONSH-FABP ELISA detection kit produccted by LanZhou biological research institute has a good correlation with H-FABP detection kit produced by HBT company of Holland and has the potential for clinical application.

Acute Coronary Syndrome ; diagnosis ; Biomarkers ; blood ; Enzyme-Linked Immunosorbent Assay ; Fatty Acid Binding Protein 3 ; Fatty Acid-Binding Proteins ; blood ; Humans ; Reagent Kits, Diagnostic ; Reproducibility of Results ; Sensitivity and Specificity

OBJECTIVETo investigate the impact of proportional assist ventilation (PAV) on tolerance and breathlessness in ventilated chronic obstructive pulmonary disease (COPD), and to describe the patient-ventilator interaction, hemodynamic state, breathing pattern and work of breath during PAV and pressure support ventilation (PSV).

METHODSTen intubated COPD patients on weaning from mechanical ventilation were studied. Elastance and resistance were measured by both the inspiratory-hold technique during a brief period of volume control ventilation and runaway technique during PAV. Each assistance level of PAV (80%, 60% and 40%) and PSV was selected randomly. Patients' response, hemodynamics, blood gas and lung mechanics were monitored.

RESULTSTidal volume and respiratory rate didn't change in a consistent manner as the level of assist was decreased (P > 0.05). With the level of assist increasing, peak inspiratory pressure was increasing significantly (P < 0.05), while patients' work of breath had the tendency to decrease (P < 0.05). A significant difference in the Borg Category Scale was observed between PAV and PSV (0.50 [1.50] vs. 0.75 [2.00], P < 0.05) at the same degree of respiratory muscle unloading. PaCO(2) was significantly higher on PAV (54 [23] mm Hg) than on PSV (48 [23] mm Hg) (P < 0.05). Peak inspiratory pressure on PAV was significantly lower than on PSV (16 +/- 4 cm H(2)O vs. 21 +/- 3 cm H(2)O, respectively, P < 0.05). Hemodynamics and oxygenation remained unchanged.

CONCLUSIONSPAV is a feasible method for supporting ventilator-dependent patients and was well tolerated. It can improve the breathing pattern and reduce inspiratory effort. At the same degree of respiratory muscle unloading, PAV can be implemented at much lower peak inspiratory pressure than PSV. It can also apply proportional pressure support according to the patients' ventilatory demand.

Aged ; Blood Gas Analysis ; Female ; Hemodynamics ; Humans ; Male ; Positive-Pressure Respiration ; Pulmonary Disease, Chronic Obstructive ; complications ; Pulmonary Gas Exchange ; Pulmonary Ventilation ; Respiration, Artificial ; methods ; Respiratory Insufficiency ; etiology ; physiopathology ; therapy

Objective To develop a scale of catheter-associated urinary tract infection (CAUTI) knowledge-attitude-practice (KAP) and to test its psychometric properties, and to provide effective assessment tools for clinical evaluation of knowledge, attitude and practice of CAUTI prevention. Methods Based on KAP theory and CAUTI preventive current guideline,the scale was developed by using literature review,Delphi expert inquiry.A questionnaire survey was conducted among 300 medical workers in a third grade A hospital in Qingdao.Exploratory factor analysis and confirmatory factor analysis were both conducted to screen the items further.The psychometric properties of scale was tested. Results The finalized scale included 4 subscales and 45 items,amount to 63.21% of the variance contribution rate. The total Cronbach's alpha was 0.914,and the split half reliability was 0.812.The content validity of the scale was 0.895,while it ranged from 0.846-1.000 for each subscale.The correlation of item-to total was 0.711-0.862,and the correlation coefficient of item-to-item ranged from 0.425-0.564. Conclusions The scale of CAUTI KAP has good reliability and validity. It can be used to evaluate CAUTI related knowledge,attitude and practice level of medical workers.

Objective To evaluation the performance of a heart-type fatty acid-binding protein (H-FABP) ELISA detection kit in the clinical diagnosis of acute coronary syndrome (ACS). Methods Plasma or serum samples from 160 suspected ACS patients hospitalized in General Hospital of PLA were examined using Lanzhou H-FABP reagent kit and Holland H-FABP kit. Correlation of the two kits was evaluated and Kappa test was used to examine the consistency of the results of the two products. Results The sensitivity of H-FABP diagnosis of ACS detection Lanzhou kit was 91.8%, the specificity was 88.7%, and the total diagnostic rate was 90.42%. The sensitivity of H-FABP diagnosis of ACS detection Holland kit was 90.3%, the specificity was 86.8%, and the total diagnostic rate was 88.75%. The test results showed that two products yielded comparable results (P=0.668,>0.05) with a good consistency (Kappa=0.726, P<0.01). Conclusions H-FABP ELISA detection kit produccted by LanZhou biological research institute has a good correlation with H-FABP detection kit produced by HBT company of Holland and has the potential for clinical application.

Objective:To study the clinicopathological features, diagnosis and differential diagnosis of myeloid sarcoma of the breast.Methods:Ten cases of myeloid sarcoma (MS) and 19 cases of diffuse large B cell lymphoma (DLBCL) of the breast were selected from Peking University People′s Hospital from February 2005 to September 2019. The cases were evaluated by microscopy and immunohistochemistry basing on WHO classification (2008 and 2017).Results:For the 10 cases of MS, the mean and median age was 33.8 and 31 years (range 23 to 47 years) respectively. All patients presented with breast masses; six presented with B symptoms (6/10); and LDH level was elevated in four patients. The largest tumor dimension was 1.0 to 5.3 cm (mean 2.7 cm). All 10 patients had history of acute myeloid leukemia (AML), and in one patient, the AML occurred after chemotherapy for hydatidiform mole. One case was classified as M0, four were M2, two were M4 and three were M5. For the AML, all patients received chemotherapy and nine were treated by allogeneic hematopoietic stem cell transplant (allo-HSCT) and the breast masses occurred4 months to 2 years post-transplant. Using Ann Arbor staging, five cases were stage Ⅰ, three were stage Ⅱ, and 2 were stage Ⅳ. The MS was found in the left breast (two cases); right breast (three cases) and both breasts (five cases). Lymphocyte in peripheral blood, B symptom and site of lesion had statistical significance between myeloid sarcoma and DLBCL( P<0.05). The tumor cells were primitive, expressing MPO, CD43, CD117, etc. All ten patients had follow-up information, and the median survival period was 14.4 months (range 1 to 50 months). Seven patients died. The prognosis of patients with MS was worse than DLBCL( P=0.002). Conclusions:The clinical history, pathologic morphology, immunophenotyping and molecular studies are very important for diagnosing MS tumors in the breast, and MS may occur after allo-HSCT for AML. Tumor resection, chemotherapy, radiotherapy and donor lymphocyte infusion are recommended for treatment. The prognosis is poor.

Objective To evaluation the performance of a heart-type fatty acid-binding protein (H-FABP) ELISA detection kit in the clinical diagnosis of acute coronary syndrome (ACS). Methods Plasma or serum samples from 160 suspected ACS patients hospitalized in General Hospital of PLA were examined using Lanzhou H-FABP reagent kit and Holland H-FABP kit. Correlation of the two kits was evaluated and Kappa test was used to examine the consistency of the results of the two products. Results The sensitivity of H-FABP diagnosis of ACS detection Lanzhou kit was 91.8%, the specificity was 88.7%, and the total diagnostic rate was 90.42%. The sensitivity of H-FABP diagnosis of ACS detection Holland kit was 90.3%, the specificity was 86.8%, and the total diagnostic rate was 88.75%. The test results showed that two products yielded comparable results (P=0.668,>0.05) with a good consistency (Kappa=0.726, P<0.01). Conclusions H-FABP ELISA detection kit produccted by LanZhou biological research institute has a good correlation with H-FABP detection kit produced by HBT company of Holland and has the potential for clinical application.

OBJECTIVETo estimate the feasibility and the efficacy of early extubation and sequential non-invasive mechanical ventilation (MV) in chronic obstructive pulmonary disease (COPD) with exacerbated hypercapnic respiratory failure.

METHODSTwenty-two intubated COPD patients with severe hypercapnic respiratory failure due to pulmonary infection (pneumonia or purulent bronchitis) were involved in the study. At the time of pulmonary infection control window (PIC window) appeared, when pulmonary infection had been significantly controlled (resolution of fever and decrease in purulent sputum, radiographic infiltrations, and leukocytosis) after the antibiotic and the comprehensive therapy, the early extubation was conducted and followed by non-invasive MV via facial mask immediately in 11 cases (study group). Other 11 COPD cases with similar clinical characteristics who continuously received invasive MV after PIC window were recruited as control group.

RESULTSAll patients had similar clinical characteristics and gas exchange before treatment, as well as the initiating time and all indices at the time of the PIC window. For study group and control group, the duration of invasive MV was (7.1 +/- 2.9) vs (23.0 +/- 14.0) days, respectively, P < 0.01. The total duration of ventilatory support was (13 +/- 7) vs (23 +/- 14) days, respectively, P < 0.05. The incidence of ventilator associated pneumonia (VAP) were 0/11 vs 6/11, respectively, P < 0.01. The duration of intensive care unit (ICU) stay was (13 +/- 7) vs (26 +/- 14) days, respectively, P < 0.05.

CONCLUSIONSIn COPD patients requiring intubation and MV for pulmonary infection and hypercapnic respiratory failure, early extubation followed by non-invasive MV initiated at the point of PIC window significantly decreases the invasive and total durations of ventilatory support, the risk of VAP, and the duration of ICU stay.

Adult ; Aged ; Female ; Humans ; Hypercapnia ; therapy ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; complications ; Respiration, Artificial ; methods ; Respiratory Insufficiency ; therapy