Objective To explore the clinical effect of quality control circle(QCC)activities on the prevention of postoperative deep vein thrombosis(DVT)in inpatients in military hospitals.Methods A total of 318 patients who were diagnosed and treated in The First Affiliated Hospital of Air Force Medical University from January to December 2021 and 40 medical staff were enrolled in this study.Routine care was performed in 158 patients from January to June 2021,and QCC care was implemented in 160 patients from July to December 2021.The awareness of DVT prevention in medical staff and patients(or their famiy members)before and after QCC activities,lower limb DVT preventive measures taken by medical staff,and the occurrence of DVT were compared.Results The scores of the cause,clinical manifestations,nursing measures and preventive measures of DVT after QCC activities were significantly higher than those before QCC activities in both medical staff and patients(or their families)(P<0.05).The overall implementation rate of preventing lower limb DVT after QCC activities was significantly higher than that before QCC activities(94.14%vs.46.20%,P<0.05).The incidence of DVT after QCC activities was significantly lower than that before QCC activities(0.62%vs.5.06%,P<0.05).Conclusion Implementing QCC activities can improve the cognitive ability of military medical staff and patients(or family members)in DVT prevention,increase the implementation rate of DVT prevention measures,and reduce the incidence of DVT.

Objective To understand the incidence and risk factors of warfarin related hemorrhagic events during anticoagulation therapy with warfarin in patients with cirrhosis and portal vein thrombosis (PVT)after transjugular intrahepatic portosystemic shunt (TIPS). Methods The patients with liver cirrhosis who were treated with warfarin after TIPS due to portal hypertension were followed up from January 2012 in Xijing Hospital of Digestive Diseases,Air Force Military Medical University. The data of medical records and follow-up records up to the end of December 2015 in patients undergoing TIPS were collected and retrospectively analyzed. Cumulative incidence of hemorrhagic events related to warfarin treatment was calculated by Kaplan-Meier method. The patients were divided into warfarin-related bleeding group (bleeding group ) and non warfarin-related bleeding group (non-bleeding group ). The risk factors of hemorrhagic events related to warfarin treatment were analyzed using Cox regression model and the hazard ratio (HR)and the 95% confidence interval (CI)were calculated. Results A total of 179 patients were enrolled,including 117 males and 62 females with ages of 25-79 years and average age of (52 ± 12)years;the bleeding group comprised 47 patients (26.3%)and the non-bleeding group comprised 132 patients (73.7%). The follow-up time after discharge ranged 1-74 months and the average time was (28 ± 21) months. The average portal pressure gradient dropped from (25.4 ± 5.2)to (8.7 ± 3.7)mmHg before and after TIPS (P＜0.001). The median dose of oral warfarin in patients in the bleeding group was 2.5 (ranged from 2.5 to 3.75)mg and the median INR was 3.12 (ranged from 2.04 to 9.41);the median dose of oral warfarin in patients in the non-bleeding group was 1.8 (ranged from 0.63 to 2.5)mg and the median INR was 1.85 (ranged from 1.5 to 3.38). Fifty eight cases of hemorrhagic events occurred in 47 patients in the bleeding group,including 24 cases of gingival bleeding,16 cases of epistaxis,8 cases of cutaneous purpura, 4 cases of conjunctival hemorrhage,2 cases of hemorrhage of digestive tract,2 cases of intracranial hemorrhage,1 cases of hematuria,and 1 cases of menorrhagia. Nine of the 47 patients in the bleeding group had bleeding from multiple sites. The results of Kaplan-Meier analysis showed that the 1-,2-,3-,4-,5-and 6-year cumulative incidences of hemorrhagic events related to warfarin treatment after operation were 19%,23%,24%,30%,41%,and 45%,respectively. Warfarin was stopped in 11 patients and given at reduced doses in 36 patients among the 47 patients in the bleeding group. After that,43 patients'hemorrhagic symptoms disappeared and 3 patients' symptoms relieved,and then warfarin treatments were continued,except that 1 patient with a long history of hypertension died of intracranial hemorrhage. Multiple Cox regression analysis showed that the baseline serum creatinine level ＞115 μmol/L was an independent risk factor for hemorrhagic events related to warfarin treatment (HR＝1.82,95%CI:1.01-3.28,P＝0.045). Conclusions It is relatively safe for patients with liver cirrhosis and PVT receiving warfarin anticoagulation therapy after TIPS. Elevated serum creatinine is an independent risk factor for hemorrhagic events related to warfarin treatment.

Objective To understand the incidence and risk factors of warfarin related hemorrhagic events during anticoagulation therapy with warfarin in patients with cirrhosis and portal vein thrombosis (PVT)after transjugular intrahepatic portosystemic shunt (TIPS). Methods The patients with liver cirrhosis who were treated with warfarin after TIPS due to portal hypertension were followed up from January 2012 in Xijing Hospital of Digestive Diseases,Air Force Military Medical University. The data of medical records and follow-up records up to the end of December 2015 in patients undergoing TIPS were collected and retrospectively analyzed. Cumulative incidence of hemorrhagic events related to warfarin treatment was calculated by Kaplan-Meier method. The patients were divided into warfarin-related bleeding group (bleeding group ) and non warfarin-related bleeding group (non-bleeding group ). The risk factors of hemorrhagic events related to warfarin treatment were analyzed using Cox regression model and the hazard ratio (HR)and the 95% confidence interval (CI)were calculated. Results A total of 179 patients were enrolled,including 117 males and 62 females with ages of 25-79 years and average age of (52 ± 12)years;the bleeding group comprised 47 patients (26.3%)and the non-bleeding group comprised 132 patients (73.7%). The follow-up time after discharge ranged 1-74 months and the average time was (28 ± 21) months. The average portal pressure gradient dropped from (25.4 ± 5.2)to (8.7 ± 3.7)mmHg before and after TIPS (P＜0.001). The median dose of oral warfarin in patients in the bleeding group was 2.5 (ranged from 2.5 to 3.75)mg and the median INR was 3.12 (ranged from 2.04 to 9.41);the median dose of oral warfarin in patients in the non-bleeding group was 1.8 (ranged from 0.63 to 2.5)mg and the median INR was 1.85 (ranged from 1.5 to 3.38). Fifty eight cases of hemorrhagic events occurred in 47 patients in the bleeding group,including 24 cases of gingival bleeding,16 cases of epistaxis,8 cases of cutaneous purpura, 4 cases of conjunctival hemorrhage,2 cases of hemorrhage of digestive tract,2 cases of intracranial hemorrhage,1 cases of hematuria,and 1 cases of menorrhagia. Nine of the 47 patients in the bleeding group had bleeding from multiple sites. The results of Kaplan-Meier analysis showed that the 1-,2-,3-,4-,5-and 6-year cumulative incidences of hemorrhagic events related to warfarin treatment after operation were 19%,23%,24%,30%,41%,and 45%,respectively. Warfarin was stopped in 11 patients and given at reduced doses in 36 patients among the 47 patients in the bleeding group. After that,43 patients'hemorrhagic symptoms disappeared and 3 patients' symptoms relieved,and then warfarin treatments were continued,except that 1 patient with a long history of hypertension died of intracranial hemorrhage. Multiple Cox regression analysis showed that the baseline serum creatinine level ＞115 μmol/L was an independent risk factor for hemorrhagic events related to warfarin treatment (HR＝1.82,95%CI:1.01-3.28,P＝0.045). Conclusions It is relatively safe for patients with liver cirrhosis and PVT receiving warfarin anticoagulation therapy after TIPS. Elevated serum creatinine is an independent risk factor for hemorrhagic events related to warfarin treatment.

ObjectiveTo screen the items of Advanced Cancer patient Needs Questionnaire (ACNQ)and develop a short version.MethodsA total of 80 cancer patients of middle and advanced stage were recruited.The items were screened with variation degree method and factor analysis method,combined with clinical meaning of the items.The reliability and validity of newly-development scale were confirmed with new sample of 60 cancer patients.ResnltsThrough statistical methods 12 items were removed from the original scale,forming a short version of Advanced Cancer patient Needs Questionnaire:ACNQ-29.The correlation coefficient of split half reliability was 0.913.The Cronbach′s α coefficient of all items was 0.923.Through principal components and factor analysis,7 principal components were gained including basically the 4 dimensions of physiological,psychological,spiritual and social domain with accumulation contribution of 75.478％.ConclusionsNew scale has good reliability and validity,and more easily for patients to complete.It has feasibility and practicability.