Evaluation of Clinical Laboratory Tests’ Turnaround Time in a Tertiary Hospital in Democratic Republic of the Congo

The delay in the delivery of laboratory results can be fatal and can even lead to the death of patients. This study was conducted at the clinical laboratory of the University Hospital of Kinshasa (UHK) from October 2020 to April 2021, aimed to evaluate the laboratory tests’ turnaround time (TAT) and to identify reasons for delay. TAT was quantified using a time and motion analysis approach. The evaluation of TAT consisted of comparing the overall intra-lab TAT with the suggested TAT using student t-test at 95% confidence intervals. Brainstorming was the root cause analysis tool used for identifying reasons for delay. In this study, the laboratory tests’ TATs were significantly higher (p < 0.001) comparing to international guidelines (60 minutes) and customers’ suggested TAT (120 minutes). Only 0.98% of the samples were reported within 60 minutes of patient reception and 1.47% within 120 minutes, i.e. an outlier rate of 98.5%. Root causes of delay related to Machinery, Management, Manpower, Materials, Method and Milieu. Because of many reasons, the laboratory is not meeting the established TAT. Preventive and curative measures must be undertaken to reduce the delay and improve the TAT.

Time Management of the Clinical Nurses at Public Hospital in Bangladesh

Nursing is a very intense and focused career, so picking the right time and its proper management can help to relieve personal stress, manage tasks properly and achieve patients and organizational outcome. Objective: This study aimed to explore perceived time management skill of the clinical nurses. Methods: This was a descriptive correlational study design using simple random sampling. A total of 77 clinical nurses working in Mugda Medical College Hospital, Dhaka, Bangladesh were selected as study participants. The data were collected through structure questionnaire which consisted of demographic questionnaire and five dimensions of Time Management Skill Questionnaire (TMSQ). Results: The overall mean score of time management skill was 2.63 (SD = 0.28) reflecting a medium level of nurses perceived time management skill. The results also revealed that nurses age (r = 0.39, p = 0.000), monthly income (r = 0.294, p = 0.017) and service experience (r = 0.248, p = 0.030) were statistically significant correlated with nurses’ perceived time management skill. Conclusion: The outcome of this research would add to develop a strategy for nurse administrators to take an initiative for how nurses could improve the time management and utilize their limited time effectively. It specifies that proper time management can influence to provide quality care and achieving organizational goal.

Improving Clinical Laboratory Quality through Reduction of Tests’ Turnaround Time in Democratic Republic of the Congo: Key Strategies

In Democratic Republic of the Congo (DRC), the laboratory TAT is significantly very long and do not comply with either international standards or the suggestions of customers. However, there is neither a national nor a local strategy to improve the laboratory TAT. The aim of the present study is to develop practical management strategies to shorten clinical laboratory tests’ TAT. This was a qualitative study conducted in Kinshasa. Focus groups and Lean tools were used respectively to generate a wide range of views from a variety of laboratory staff and to eliminate several form of waste in the laboratory flow process. Based on the identified root causes of delay, focus groups participants reported that there is a lot of scope for the improvement of TAT in DRC. Consistent attendance and punctuality are essential. The hospital management should implement the Laboratory Information Systems (LIS) and install Middleware. Total laboratory automation, inventory system for all reagents and supplies used in the laboratory, expansion of the sampling area, sufficient number of high-power machine and a clear job description are indispensable. LIS, 3.5 mL BD vacutainer BarricorTM tube and point-of-care testing (POCT) are necessary for workflow improvement. A reduction of 312 minutes was achieved by eliminating or decreasing non-value-added activities. Applying the suggested key strategies, and particularly the new workflow process, is a basis for improving the laboratory tests’ TAT. The algorithm presented can be easily implemented in other laboratories that face this type of problem.

利用Time-lapse技术筛选早期胚胎对IVF-ET妊娠结局的影响

目的探索利用Time-lapse系统筛选早期胚胎的临床应用价值。方法回顾性分析本中心2016年7月至2017年12月,第一次新鲜或复苏周期D3卵裂期胚胎移植的患者资料,根据胚胎评估方法分为Time-lapse系统组(TLM组,n=74)和传统形态学评分组(CMA组,n=951),比较这两种不同胚胎筛选方法对临床结局的影响。结果患者的不孕年限、体重指数、基础FSH、基础LH、E2、AMH、窦卵泡数、内膜厚度和周期类型等一般情况,在TLM组和CMA组均无显著差异(P均>0.05);TLM组年龄显著高于CMA组[(31.8±4.2)vs.(30.8±4.4),P<0.05],而平均移植胚胎数显著少于CMA组[(1.7±0.5)vs.(1.9±0.3),P<0.05];患者的临床结局,包括临床妊娠率、种植率、流产率、宫外孕率、双胎率和移植两个胚胎的双胎率等在两组间均无显著差异(P均>0.05)。进一步按照年龄分层分析,在<35岁患者,患者的一般情况在两组间均无显著差异(P均>0.05),TML组的平均移植胚胎数显著少于CMA组[(1.7±0.5)vs.(1.9±0.3),P<0.05],而患者临床结局在两组间亦无显著差异(P>0.05);在≥35岁患者,TML组的平均移植胚胎数显著少于CMA组[(1.7±0.5)vs.(1.9±0.4),P<0.05],而患者的一般情况和临床结局在两组间亦无显著差异(P>0.05)。结论利用Time-lapse技术选择早期胚胎,可以在显著减少移植胚胎数的基础上,维持稳定的临床妊娠结局。因此,认为Time-lapse技术可以在一定程度上优选出更具发育潜能的胚胎,为早期胚胎单胚胎移植提供新方法。

使用time-lapse筛选早期IVF/ICSI胚胎及其临床结局

目的通过比较使用time-lapse（延迟摄像）和传统形态学方法筛选IVF/ICSI胚胎的临床结局,评价time-lapse用于早期胚胎观察和筛选的价值。方法回顾性分析139个IVF/ICSI周期的资料,根据胚胎的筛选方法,分为time-lapse monitoring组（TLM组）（n=68）和对照组（n=71）,比较两组间的βHCG阳性率、临床妊娠率和胚胎着床率,并根据女方年龄、受精方式进行亚组分析。结果 TLM组的βHCG阳性率、临床妊娠率、胚胎着床率分别为：66.2%、61.8%、47.1%;对照组的βHCG阳性率、临床妊娠率、胚胎着床率分别为：47.9%、43.7%、30.3%;TLM组的βHCG阳性率、临床妊娠率、胚胎着床率均高于对照组,且差异均有统计学意义（P〈0.05）。亚组分析显示：相较于年龄≤30岁的患者,年龄31~35岁的患者利用time-lapse更能明显改善临床结局;利用time-lapse能明显提高IVF周期的βHCG阳性率、临床妊娠率、胚胎着床率,但对于ICSI和TESA周期,效果则不理想。结论使用time-lapse动态监测胚胎并根据胚胎的形态动力学参数对胚胎进行评价和筛选,与传统方法相比,能获得更好的临床结局;年龄较大的（〉30岁）或者是进行IVF周期的患者更能从中获益。

Clinical effects of Xingnao Kaiqiao acupuncture on neurological impairment following cerebral infarction

BACKGROUND： Although the curative effects of acupuncture have been confirmed by various treatments of cerebral infarction, few studies have investigated when acupuncture can attain the best clinical effect. OBJECTIVE： Four different time points were selected for acupuncture treatment of cerebral infarction to evaluate the appropriate time course for Xingnao Kaiqiao therapy in terms of improved neurological function. DESIGN： Controlled observation. SETTING： Department of Traditional Chinese Medicine Rehabilitation and Physiotherapy of the Affiliated Hospital of Medical College of Chinese Armed Police Forces. PARTICIPANTS： A total of 120 inpatients with cerebral infarction of different stages, including 75 males and 45 females, aged 41-75 years, were selected from November 2005 to December 2006 at the Department of Traditional Chinese Medicine Rehabilitation and Physiotherapy in Affiliated Hospital of Medical College of Chinese Armed Police Forces. Diagnostic criteria： in accordance with ＂main points of diagnosis on different cerebrovascular disease＂ secondly revised in the Second Cerebrovascular Disease Academic Meeting of Chinese Medicine Association in 1986. All accepted subjects provided confirmed consent, and the experiment received ethical permission from the hospital＇s ethics committee. METHODS： ① Experiment grouping： All inpatients were divided into four groups with non-stochastic concurrent control method according to the disease course： Group Ⅰ （onset within 7 hours）, group Ⅱ （onset from 7 hours to 3 days）, group Ⅲ （onset within 4-7 days）, and group IV （onset within 21-180 days）. On the basis of symptomatic treatment with western medicine, each group received Xingnao Kaiqiao therapy after onset within 7 hours, 7 hours to 3 days, 4 to 7days, and 21 to 180 days. ① The principal acupoints were Neiguan, Renzhong, and Sanyinfiao. ② The auxiliary acupoints were Jiquan, Chize, and Weizhong. ③Acupuncture manipulations： initially, Neiguan （PC6, bilateral） was needled at 0.5-1.0 cun vertically with a reducing technique achieved by rotating-swirling and lifting-inserting for l minute. Subsequently, Renzhong （GV26） was needled at 0.3-0.5 cun obliquely towards the nasal septum, with a heavy bird-pecking method until eyeballs were moist or shed tears. Sanyinjiao （SP6, affected limb） was needled at 1.0-1.5 cun obliquely along the medial border of the tibia with a 45° angle between the needle and skin. The technique of reinforcing was achieved by a lifting-inserting method until the affected lower limb twitched three times. The auxiliary acupoint, Jiquan, was selected when the patient extended the affected upper limb abduction. Jiquan was along the downward channel, l cun from the quondam Jiquan （HT1） acupoint; the armpit hair was avoided. Jiquan （affected limb） was needled vertically at 1.0-1.5 cun. The technique of reduction was achieved by lifting-inserting until the affected upper limb twitched three times. Chize （LU5） was selected when the patient flexed the elbow at 120°. Chize was vertically needled at l cun with a lifting-inserting reducing technique until the affected forearm and fingers twitched three times. Weizhong （BL40） was selected when the patient＇s leg was raised straight in a supine position. Weizhong was vertically needled at 0.5 1.0 cun with a lifting-inserting reducing technique until the affected lower limb twitched three times. ⑤ Acupuncture manipulations were achieved by the doctor who is an associate chief physician and doctor of acupuncture and moxibustion and has aptitude for the post＇s specification. ⑥One course of treatment lasted for 10 days and each group was treated for two courses of treatment. ⑦Experiment evaluation： To apply neurological impairment scores for evaluating clinical curative effects before and after treatment with Xingnao Kaiqiao therapy on day 7, 14, and 21（range of 0 45; decreasing score indicates functional improvement）.To evaluate clinical curative effect by clinical effective power： Basic recovery： equal to or more than 81%; significant improvement： 56% to 81% （including 56%）; Improvement： between 36% to 56% （including 36%）; Slight Improvement： 11% to 36% （including 11%）; No change： less than 11%; Aggravation （including death）： negative value. Total effective rate was computed at the same time. MAIN OUTCOME MEASURES： The total effective rate and amelioration of neurological impairment of the patients after treatment. RESULTS： All 120 patients with cerebral infarction were included in the final analysis, without deletion. ① Comparison of the total effective rate： the total effective rate of group Ⅰ, group Ⅱ, group Ⅲ and group IV was 97%, 93%, 93%, and 67%, respectively. There were significant differences of interclass synthetic curative effects （x^2 = 36.351 7, P 〈 0.01）. ② Amelioration of neurological impairment： A decreased neurological impairment score was observed in group Ⅰ on day 7, 14, and 21 after Xingnao Kaiqiao therapy. The differences between group Ⅳ and the remaining three groups were significant （P 〈 0.05）. CONCLUSION： Xingnao Kaiqiao therapy is helpful for amelioration of neurological impairment in patients during the acute stage cerebral infarction.

护理专案改善在临床手术Time-Out准确执行中效果研究

目的:探究护理专案改善在提升临床手术Time-Out准确执行中的应用效果。方法:将医院收治的60例患者随机分为对照组(实施常规基础护理,30例)和观察组(实施护理专案改善活动,30例),比较两组患者Time-Out执行准确率、不良反应发生率、焦虑SAS评分、护理满意程度VAS评分。结果:观察组Time-Out执行准确率和不良反应发生率优于对照组(P<0.05);观察组焦虑SAS评分和护理满意程度VAS评分优于对照组(P<0.05)。结论:护理专案改善在提升临床手术Time-Out准确执行中的应用效果显著,同时还可以减少不良反应的发生。

Clinical evaluation of timing of endovascular embolization treatment for intracranial aneurysm

Objective To evaluate the effects of endovascular embolization treatment for intracranial aneurysms in different time. Methods The clinical data of 165 cases of ruptured intracranial aneurysm treated by endovascular treatment were analysed retrospectively. The patients were divided into 3 groups accrodding to

The impact of operative timing on clinical outcomes in elderly hip fracture

Objective To study the effect of operative timing on clinical outcomes in elderly hip fracture.Methods Two hundred sixty-seven patients with hip fracture were treated from July 2006 to May 2008.The patients who had an operation within

The impact of a computerized care records service (CRS) on doctors’ work patterns in urological outpatient clinics

Objective: Government targets to reduce waiting times are putting enormous pressures on outpatient services. The implementation of an electronic care records service (CRS) at our hospital in 2008 has led to widespread press coverage of ensuing chaos in clinical administration. We wanted to know how this new electronic system impacted on our working patterns in outpatient clinics and – more specifically – on the time actually spent with the patients. Material & methods: This study was performed 4 and 12 months after implementation of CRS to assess its impact on the time distribution in clinic. Senior doctors were monitored with a stop clock during consultations. Timings for pre- and post-consultation administration, and the actual consultation with the patient were recorded. A total of 170 consultations were evaluated in this way. Results: The key findings were that the total time needed to spend on a urological outpatient of 16 minutes remains unchanged from the pre-CRS era, but a majority (57%) of this time is spent in administration on the computer without the patient involved. Conclusion: No more than 15 patients should be seen in a 4 hour outpatient clinic per doctor. This recommendation drawn up by BAUS before CRS remains still valid. Patient administration related to the consultation that has previously been done by administrative aides is now to be done by the doctors on the computer in the same consultation session. Intended to streamline patient pathways, this does reduce the quality interaction-time between doctor and patients significantly.

常规出凝血检验自动审核规则的建立与验证

目的:建立常规出凝血检验项目结果自动审核规则,为临床实验室提高检验结果审核质量和效率提供参考。方法:收集2020年1-3月期间解放军总医院第一医学中心等8家医院检验科的24510份枸橼酸钠抗凝常规出凝血检测标本,根据随机抽样法将其分为规则建立组和规则验证组,规则建立组血标本6670份,其中差值检查2056份;规则验证组血标本17840份,其中差值检查3210份。使用StagoSTARMax全自动血凝分析仪及配套试剂检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、凝血酶时间(TT)、D-二聚体(DD)和(或)抗凝血酶(AT)活性。以人工审核结果为标准,计算两组自动审核与人工假阴性率(无效审核)、假阳性率(无效拦截)、通过率、阳性符合率、阴性符合率、审核一致率和标本周转时间(TAT)。结果:建立的自动审核规则及规则应用流程,涉及室内质量控制、报警信息、自动审核范围、危急值和差值检查。规则建立组单个项目通过率为82.6%~92.4%,总体通过率为73.8%,自动审核与人工审核结果一致率为98.2%,阳性符合率和阴性符合率分别为24.4%和73.8%。规则验证组单个项目通过率为86.4%~91.5%,总体审核通过率为71.5%。模拟应用自动审核规则,8家医院中两家医院单位的平均TAT分别缩短1.5 h和2.1 h。结论:应用常规出凝血自动审核规则能够使人工审核工作量减少,明显缩短TAT,提高实验室工作效率。

新入职护士时间管理倾向与临床实践行为的调查研究

目的探讨新入职护士时间管理倾向与临床实践行为的现状、相关性及影响因素。方法于2022年1月选取九江市的市级、县级5家医院的145名新入职护士作为调查对象,采用问卷调查的方式,对护士进行一般人口学特征6项,时间管理倾向量表3个维度及临床实践行为3个维度的调查,比较不同人口学特征护士的时间管理倾向、临床实践行为,采用Pearson检验分析护士时间管理倾向与临床实践行为的相关性,采用多元线性回归分析临床实践行为的影响因素。结果145名护士的时间管理倾向量表总分为(3.74±0.62)分,其中时间价值感、时间监控观、时间效能感得分较高。临床实践行为评分总分为(4.15±0.64)分,其中认知、情感、操作技能得分较高。不同学历、生源地、所在医院级别、是否担任班干部的护士时间管理倾向评分比较,不同学历、生源地、所在医院级别的护士临床实践行为评分比较,差异有统计学意义(P<0.05)。时间管理倾向量表3个维度评分及总分,与临床实践行为3个维度评分及总分呈正相关(P<0.05)。多元线性回归分析显示,护士的学历、生源地、医院级别、时间管理倾向3个维度评分及总分为临床实践行为的影响因素(P<0.05)。结论新入职护士时间管理倾向与临床实践行为处于较高水平,而且呈现正相关,其中生源地、市级医院、时间管理倾向为临床实践行为的影响因素,因此需加强时间管理技巧的培训,提高护士的临床实践行为,研究价值较高。

89例细菌性肝脓肿的临床特征及抗感染治疗分析

目的分析探讨细菌性肝脓肿的临床特征、抗菌药物合理使用情况和疗程。方法回顾青岛市第八人民医院2020年1月1日至2022年12月31日诊断为“细菌性肝脓肿”患者的临床资料,总结临床特征,制定评价标准对抗菌药物合理性进行评价,统计不同治疗结局抗菌药物的使用疗程。结果共89例患者纳入分析,平均年龄(62.0±15.6)岁,男性占61.8%,最常见合并症为糖尿病,占53.9%。59例(66.3%)脓液或血培养阳性患者中,肺炎克雷伯菌51例(57.3%)。经验和目标抗感染治疗中,分别有45例(50.6%)和17例(28.8%)抗菌药物使用不合理。痊愈抗感染疗程(17.0±7.6)d,临床实际抗感染疗程(21.1±7.3)d。结论糖尿病为细菌性肝脓肿的高危因素,以肺炎克雷伯菌感染为主。应加强抗菌药物的管理,探索适宜抗感染疗程,减少抗菌药物的过度使用。

妊娠期口腔急症的临床考量

妊娠期是口腔疾病患病和治疗的特殊时期,妊娠期发生的口腔急症需得到恰当的处置。一方面,孕妇生理环境、个人习惯的改变增加了部分口腔疾病的易患性;另一方面,为了保证孕妇和胎儿安全,临床治疗策略局限。孕妇应掌握口腔健康知识、增强口腔保健意识。口腔医生应在“孕前预防,孕期治标,孕后治本”的原则下,根据不同的妊娠时期制定合适的治疗方案,以最安全、简单、有效的手段控制急症、防止疾病进展,避免对孕妇和胎儿的不良影响。防治结合,让孕妇和口腔医生共同维护妊娠期口腔健康。本文围绕妊娠期治疗原则,对妊娠期口腔急症治疗的时机选择、临床管理和不同疾病的治疗策略等进行了总结。

Value of Real-Time Bedside Ultrasonography in the Etiologic Diagnosis of Acute Dyspnea

Objective: To explore the value of real-time bedside ultrasonography in the etiologic diagnosis of acute dyspnea. Methods: Sixty-two patients with acute dyspnea who were treated in our hospital from January 2016 to December 2020 were randomly selected and their clinical data were retrospectively analyzed. All patients were randomly divided into a control group for routine examinations (n = 31) and an observation group for real-time beside ultrasonography (n = 31). The costs of medical examinations, examination duration, and diagnostic results of severe pneumonia, acute cardiogenic pulmonary edema, pulmonary embolism, chronic obstructive pulmonary disease, and pneumothorax (including sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy) of the two groups of patients were compared and analyzed. Results: Compared with the control group, the observation group had significantly shorter examinations (P < 0.05). Although the cost of medical examinations of the observation group tended to be higher, the difference between groups was not significant (P > 0.05). Moreover, there were no significant differences in left ventricular ejection fraction, left ventricular end-diastolic diameter, or brain natriuretic peptide between the two groups (P > 0.05). Comparison of the etiologic diagnosis results between the two groups showed that the observation group had significantly higher diagnostic sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for various causes compared with the control group (P < 0.05). Conclusion: Real-time bedside ultrasonography for the etiologic diagnosis of patients with acute dyspnea was quicker and had higher diagnostic accuracy;thus providing accurate guidance for the disease treatment, and having a higher promotional value in clinical practice compared with routine examinations.

时差成像培养系统对IVF和ICSI卵裂期胚胎移植患者临床结局的影响

目的探讨时差成像(TL)培养和常规培养对体外受精(IVF)和卵胞质内单精子注射(ICSI)卵裂期胚胎移植(ET)患者妊娠结局、新生儿结局的影响。方法纳入淮安市妇幼保健院生殖医学科2018年1月至2022年3月间行IVF-ET/ICSI-ET助孕的1148对夫妇作为研究对象,共计1200个周期。其中,TL培养550周期为TL培养组(n=550),常规培养650周期为常规培养组(n=650)。比较两组患者基线资料、妊娠结局和新生儿结局的差异。结果TL培养组患者临床妊娠率、着床率、活产率均显著高于常规培养组(χ^(2)=13.776,P<0.001;χ^(2)=23.663,P<0.001;χ^(2)=6.886,P=0.011),移植胚胎数显著低于常规培养组(χ^(2)=2.845,P=0.005)。两组患者早产率、不良新生儿结局、新生儿体重、畸形率、新生儿性别比均无显著性差异(χ^(2)=0.190,P=0.738;χ^(2)=0.663,P=0.024;t=0.221,P=0.878;χ^(2)=0.615,P=1.148;χ^(2)=0.335,P=0.284)。结论TL培养系统可显著改善IVF-ET/ICSI-ET患者临床妊娠率、着床率和活产率,对新生儿出生结局无不良影响。

青海省临床实验室临床基础检验专业急诊标本TAT的调查分析

目的调查青海省临床实验室临床基础检验专业急诊标本检验前和实验室内周转时间(TAT)现状,分析TAT超时的影响因素,为实验室质量改进提供依据。方法通过检验医学信息网网络平台向参加2022年青海省临床检验中心室间质量评价的临床实验室发放《2023年临床检验医疗质量控制指标室间质量评价(全年)质评上报表》,要求各实验室统计上报2022年1-12月不同专业急诊标本检验前TAT、实验室内TAT的年中位数和年第90百分位数(P_(90)),根据国家卫生健康委临床基础检验中心和青海省临床检验中心提供的《临检专业2023年临床检验医疗质量控制指标室间质评报告》摘取数据,采用SPSS22.0软件对回报数据的全血、尿液、粪便常规(简称三大常规)和凝血TAT相关信息进行统计分析,统计TAT在不同时间段内的实验室比率及超出阈外值的实验室比率。结果青海省参加该次调查的临床实验室共159家,实验室填报率为100.00%。其中,三级医院、二级医院及二级以下医院分别占16.35%、45.28%、38.36%。调查结果显示青海省临床实验室三大常规急诊标本检验前TAT年中位数、年(P_(90))小于30 min的实验室分别约占72.98%、56.61%,超出阈外值(≥30 min)的实验室占27.02%;实验室内TAT年中位数、年(P_(90))小于30 min的实验室分别约占53.46%、39.00%,超出阈外值(≥30 min)的实验室占46.54%。临床基础检验专业凝血急诊标本检验前TAT年中位数、年(P_(90))小于30 min的实验室分别约占68.35%、52.52%,超出阈外值(≥30 min)的实验室占31.65%;临床基础检验专业凝血急诊标本实验室内TAT年中位数、年(P_(90))小于60 min的实验室分别约占89.21%、74.10%,超出阈外值(≥60 min)的实验室占10.79%。结论青海省临床实验室临床基础检验专业急诊标本检验前和实验室内TAT超出阈外值的实验室较多,部分实验室需要优化标本周转环节,缩短标本TAT,应根据自己实验室的情况,建立自己的目标TAT。

糖皮质激素对川崎病患儿急性期治疗效果的影响

目的研究糖皮质激素对川崎病患儿急性期治疗效果的影响。方法纳入2018年1月—2023年1月期间孝感市中心医院收治的92例川崎病(KD)患儿,随机分为常规组与联合组各46例,常规组实施人免疫球蛋白+阿司匹林治疗,联合组在常规组基础上联合糖皮质激素治疗,两组患者均治疗两周。比较两组KD患儿用药后临床症状消失时间[发热、黏膜充血、四肢肿胀]。比较两组KD患儿治疗前后抗血小板聚集相关因子水平[血小板计数(PLT)、白细胞计数(WBC)、红细胞沉降率(ESR)]、炎症因子[生长分化因子-15(GDF-15)、巨噬细胞移动抑制因子(MIF)、血清高迁移率族蛋白B1(HMGB1)]、免疫功能[CD4^(+)、CD8^(+)]、冠状动脉内径。比较两组KD患儿治疗期间药物不良反应发生情况。结果联合组KD患儿发热、黏膜充血、四肢肿胀等临床症状消失时间显著低于常规组(P<0.05)。治疗两周后,两组患儿PLT、WBC、ESR、GDF-15、MIF、HMGB1、CD4^(+)水平显著低于治疗前,且联合组显著低于常规组(P<0.05);两组KD患儿CD8^(+)水平显著高于治疗前,且联合组显著高于常规组(P<0.05)。治疗后两组患儿冠状动脉内径较治疗前显著减小,但两组间冠状动脉内径比较差异无统计学意义(P>0.05)。两组患儿不良反应总发生率比较差异无统计学意义(P>0.05)。结论糖皮质激素联合人免疫球蛋白治疗KD患儿可促进其临床症状消失,并有利于提高其抗血小板聚集能力,降低炎症反应。

甲泼尼龙结合临床干预路径治疗小儿哮喘性支气管炎的临床疗效

目的:分析甲泼尼龙与临床干预路径治疗小儿哮喘性支气管炎的疗效。方法:选取2020年3月—2023年3月东台市人民医院收治的80例哮喘性支气管炎患儿作为研究对象,以随机数表法分为对照组和观察组,每组各40例。对照组患儿接受注射用甲泼尼龙琥珀酸钠治疗,观察组患儿接受甲泼尼龙结合临床干预路径治疗,分析临床疗效及对症状改善时间的影响。结果:观察组临床总有效率高于对照组,差异有统计学意义(P<0.05);观察组症状消失时间短于对照组,差异有统计学意义(P<0.05);观察组治疗后血清白细胞介素-4(IL-4)、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平低于对照组,差异有统计学意义(P<0.05)。结论:甲泼尼龙结合临床干预路径治疗小儿哮喘性支气管炎有助于提高临床疗效,缩短症状改善时间,促进炎症反应消退。

品管圈护理在儿科复诊患者中的应用效果

目的:分析品管圈护理在儿科复诊患者中的应用效果。方法:选取2023年7—11月泰安市妇幼保健院儿科门诊收治的复诊患儿140例作为研究对象,按照随机数字表法分为对照组和试验组,各70例。对照组进行常规护理,试验组进行品管圈护理。观察两组患儿复诊等候时间及护理满意度。结果:试验组个人信息登记时间、等候区等待复诊时间、医生就诊时间、就诊结束至结账缴费时间均短于对照组,差异有统计学意义(P<0.001)。试验组护理满意度高于对照组,差异有统计学意义(P=0.003)。结论:品管圈护理在儿科复诊患者中的应用效果较好,能够缩短患儿及家属复诊等候时间,提高医院的就诊效率和家属的复诊护理满意度。