Objective To explore the application efficacy of dabigatran etexilate in anticoagulation for patients with nonvalvular atrial fibrillation after percutaneous coronary intervention(PCI).Methods A total of 103 AF patients undergoing PCI in our hospital from February 2021 to Janu-ary 2023 were recruited,and based on different anticoagulation regimens,they were divided into routine group(warfarin,52 cases)and dabigatran etexilate group(dabigatran etexilate,51 cases).The coagulation function indicators[prothrombin time(PT),active partial thromboplasting time(APTT),thrombin time(TT),fibrinogen(FIB)].cardiac function[left ventricular ejection frac-tion(LVEF),cardiac index,cardiac output],vascular endothelial function[nitric oxide(NO),en-dothelin-1(ET-1)],serum tissue-type plasminogen activator(t-PA),plasminogen activator inhib-itor-1(PAI-1)and Rac-related protein(Rac1)levels before and after treatment,and the incidences of adverse cardiovascular events(acute myocardial infarction,sudden cardiac death,ischemic stroke,pulmonary embolism,lower extremity deep venous thrombosis)and bleeding events in 1 year after surgery were compared between the two groups.Results After 2 months of treatment,LVEF,cardiac index,cardiac output,PT,APTT,TT and NO level were significantly increased while the FIB,ET-1,t-PA,PAI-1 and Rac1 levels were significantly decreased in the two groups(P＜0.05).At the moment,the dabigatran etexilate group had obviously higher LVEF,cardiac in-dex,cardiac output,longer PT,APTT and TT,and elevated NO level,while remarkably lower FIB,ET-1,t-PA,PAI-1 and Rac1 levels than the routine group(P＜0.05,P＜0.01).The incidence of bleeding events was significantly lower in the dabigatran etexilate group than the routine group(5.9％vs 19.2％,P＜0.05).Conclusion Dabigatran etexilate can effectively improve the coagula-tion function of AF patients after PCI,has a certain protective effect on vascular endothelial func-tion and cardiac function,and can reduce the risk of bleeding,which provides a reference for the selection of clinical anticoagulation regimen.

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 explore the application efficacy of dabigatran etexilate in anticoagulation for patients with nonvalvular atrial fibrillation after percutaneous coronary intervention(PCI).Methods A total of 103 AF patients undergoing PCI in our hospital from February 2021 to Janu-ary 2023 were recruited,and based on different anticoagulation regimens,they were divided into routine group(warfarin,52 cases)and dabigatran etexilate group(dabigatran etexilate,51 cases).The coagulation function indicators[prothrombin time(PT),active partial thromboplasting time(APTT),thrombin time(TT),fibrinogen(FIB)].cardiac function[left ventricular ejection frac-tion(LVEF),cardiac index,cardiac output],vascular endothelial function[nitric oxide(NO),en-dothelin-1(ET-1)],serum tissue-type plasminogen activator(t-PA),plasminogen activator inhib-itor-1(PAI-1)and Rac-related protein(Rac1)levels before and after treatment,and the incidences of adverse cardiovascular events(acute myocardial infarction,sudden cardiac death,ischemic stroke,pulmonary embolism,lower extremity deep venous thrombosis)and bleeding events in 1 year after surgery were compared between the two groups.Results After 2 months of treatment,LVEF,cardiac index,cardiac output,PT,APTT,TT and NO level were significantly increased while the FIB,ET-1,t-PA,PAI-1 and Rac1 levels were significantly decreased in the two groups(P＜0.05).At the moment,the dabigatran etexilate group had obviously higher LVEF,cardiac in-dex,cardiac output,longer PT,APTT and TT,and elevated NO level,while remarkably lower FIB,ET-1,t-PA,PAI-1 and Rac1 levels than the routine group(P＜0.05,P＜0.01).The incidence of bleeding events was significantly lower in the dabigatran etexilate group than the routine group(5.9％vs 19.2％,P＜0.05).Conclusion Dabigatran etexilate can effectively improve the coagula-tion function of AF patients after PCI,has a certain protective effect on vascular endothelial func-tion and cardiac function,and can reduce the risk of bleeding,which provides a reference for the selection of clinical anticoagulation regimen.

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 establish a prediction model for 3-years recurrence after initial ischemic stroke by Cox proportional hazards regression and individual prognostic Index(PI)equation, and to evaluate its application value and external reality. Methods The inpatients with cerebral ischemic stroke hospitalized in Neurology Department in North China University of Science and Technology Affiliated Hospital were finally internalized between January 2013 and December 2013.Follow-up study on recurrence was carried out between January 2016 and December 2016.The recurrence prediction model was constructed by the Cox proportional hazards regression model.During January 2016 and December 2016,data of patients with ischemic stroke were prospectively continuously collected.And PI equation was used to verify its external reality in ischemic stroke patients. Results A total of 184 cases had stroke recurrence during the follow-up period.The Cox proportional hazards regression model analysis showed that age(RR=1.303,95% CI:1.019-1.666),history of heart disease(RR=1.788,95% CI:1.127-2.836),hypertension(RR=1.897,95% CI:1.097-3.280),diabetes(RR= 1.674,95% CI:1.015-2.760)and total cholesterol(RR= 2.136,95% CI:1.396-3.266)were the independent risk factors for stroke recurrence.The established recurrence model was correlated with individual PI equation,which was PI = 0.265X1+ 0.581X2+ 0.640X3+ 0.515X4+0.759X5.By the validation study of PI equation to predict stroke recurrence among patients admitted later, the sensitivity was 0.719,specificity was 0.769,and accuracy was 0.800. Conclusions Age,history of heart disease,hypertension,diabetes,and total cholesterol are independent risk factors for recurrence of ischemic stroke.And the PI for predicting stroke recurrence within 3 years after initial stroke is successfully established,which is good and helpful for predicting ischemic stroke recurrence.

One hundred and sixteen cases of vertebral artery type of cervical spondylopathy were treated by electroacupuncture on Fengchi (GB 20) and Jiaji (Ex-B 2, C2-5), cupping plus manipulation of pulling the rotated neck. The result showed 89 cases were cured, 21 cases were improved and 6 cases failed with the total effective rate of 94.8%.