Application of Quality Control Circle Activity in Improving Effectiveness of Drug Intervention in Lung Cancer Patients with Moderate to Severe Pain

Objective:Lung cancer has the highest incidence and mortality of all malignant tumors in China.Cancer pain dramatically affects patients’comfort level,causing insomnia,anorexia,anxiety,fear,depression,and a decline in the quality of life(QOL).The literature suggests a shortage of adequate cancer pain management for 59.1% of patients in China.The quality control circle(QCC)activity reflects the people-oriented core idea of management.This study aimed to assess the efficacy of QCC in enhancing the effectiveness of drug interventions in lung cancer patients with moderate to severe pain.Methods:From January 2019 to July 2019,lung cancer patients with moderate to severe pain were treated with drugs.The total number of drug interventions was 3072.A QCC activity was performed following the ten steps of the plan-do-check-act(PDCA)model.The reasons for the poor effectiveness of drug intervention in lung cancer patients with moderate to severe pain were analyzed.Countermeasures were designed to improve the effectiveness of drug intervention,including setting up a pain college,writing a medication education manual,and formulating operational rules for the administration of narcotic drugs.The effectiveness of drug intervention in lung cancer patients with moderate to severe pain and activity ability scores of QCC members were analyzed statistically before and after QCC activity.The effectiveness of drug intervention was investigated and compared before and after establishing the QCC.Results:After establishing the PDCA model,the effectiveness of drug intervention for moderate to severe pain in lung cancer patients increased from 56.28% to 85.29%.Members had significant improvement in problem-solving ability,responsibility,communication,coordination,self-confidence,team cohesion,enthusiasm,QCC skills,and harmony.Conclusion:QCC activity can significantly improve the efficiency of drug intervention in lung cancer patients with moderate to severe pain and their quality of life.

Inter-and intra-observer variability for the assessment of coronary artery tree description and lesion EvaluaTion(CatLet©)angiographic scoring system in patients with acute myocardial infarction

Background:Previously,we developed a novel Coronary Artery Tree description and Lesion EvaluaTion(CatLet©)angiographic scoring system,which was capable of accounting for the variability in the coronary anatomy and assisting in the risk-stratification of patients with acute myocardial infarction(AMI).Our preliminary study revealed that the CatLet score better predicted clinical outcomes for AMI patients than the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score.However,the reproducibility of the CatLet score in both inter-and intra-observer remains to be evaluated.Methods:A total of 30 consecutive AMI patients,admitted in September of 2015,were independently assessed by two experienced interventional cardiologists to evaluate the inter-observer reproducibility of the CatLet score.Another set of 49 consecutive AMI patients,admitted between September and October in 2014,were assessed by one of the two interventional cardiologists on two occasions 3 months apart to evaluate the intra-observer reproducibility of the CatLet score.The weighted kappa was used to express the degree of agreement.Results:The weighted kappa values(95%confidence interval)for the intra-and inter-observer reproducibility of the CatLet Score were 0.82(0.59-1.00,Z=7.23,P<0.001)and 0.86(0.54-1.00,Z=5.20,P<0.001),respectively,according to the tertile analysis(≤14,15-22,>22).Regarding the adverse characteristics pertinent to lesions and dominance parameters,the kappa values for the inter-observer variability were 0.80(0.56-1.00,Z=6.47,P<0.001)for total number of lesions,0.57(0.28-0.85,Z=3.03,P<0.001)for bifurcation,0.69(0.43-0.96,Z=5.06,P<0.001)for heavy calcification,1.00(0.72-1.00,Z=6.93,P<0.001)for tortuosity,0.54(0.26-0.82,Z=3.78,P<0.001)for thrombus,0.69(0.48-0.91,Z=6.29,P<0.001)for right coronary artery dominance,0.69(0.41-0.96,Z=4.91,P<0.001)for left anterior descending artery length,and 0.22(0.06-0.51,Z=1.56,P=0.06)for diagonal size.Equivalent values for the intra-observer variability were moderate to almost perfect(range 0.54-1.00).Conclusions:The reproducibility of the CatLet angiographic scoring system for evaluation of the coronary angiograms ranged from substantial to excellent.The high reproducibility of the CatLet angiographic scoring system will boost its clinical application to patients with AMI.