Prediction model establishment and validation for enteral nutrition aspiration during hospitalization in patients with acute pancreatitis

BACKGROUND Acute pancreatitis(AP)is a disease caused by abnormal activation of pancreatic enzymes and can lead to self-digestion of pancreatic tissues and dysfunction of other organs.Enteral nutrition plays a vital role in the treatment of AP because it can meet the nutritional needs of patients,promote the recovery of intestinal function,and maintain the barrier and immune functions of the intestine.However,the risk of aspiration during enteral nutrition is high;once aspiration occurs,it may cause serious complications,such as aspiration pneumonia,and suffocation,posing a threat to the patient’s life.This study aims to establish and validate a prediction model for enteral nutrition aspiration during hospitalization in patients with AP.AIM To establish and validate a predictive model for enteral nutrition aspiration during hospitalization in patients with AP.METHODS A retrospective review was conducted on 200 patients with AP admitted to Chengdu Shangjin Nanfu Hospital,West China Hospital of Sichuan University from January 2020 to February 2024.Clinical data were collected from the electronic medical record system.Patients were randomly divided into a validation group(n=40)and a modeling group(n=160)in a 1:4 ratio,matched with 200 patients from the same time period.The modeling group was further categorized into an aspiration group(n=25)and a non-aspiration group(n=175)based on the occurrence of enteral nutrition aspiration during hospitalization.Univariate and multivariate logistic regression analyses were performed to identify factors influencing enteral nutrition aspiration in patients with AP during hospitalization.A prediction model for enteral nutrition aspiration during hospitalization was constructed,and calibration curves were used for validation.Receiver operating characteristic curve analysis was conducted to evaluate the predictive value of the model.RESULTS There was no statistically significant difference in general data between the validation and modeling groups(P>0.05).The comparison of age,gender,body mass index,smoking history,hypertension history,and diabetes history showed no statistically significant difference between the two groups(P>0.05).However,patient position,consciousness status,nutritional risk,Acute Physiology and Chronic Health Evaluation(APACHE-II)score,and length of nasogastric tube placement showed statistically significant differences(P<0.05)between the two groups.Multivariate logistic regression analysis showed that patient position,consciousness status,nutritional risk,APACHE-II score,and length of nasogastric tube placement were independent factors influencing enteral nutrition aspiration in patients with AP during hospitalization(P<0.05).These factors were incorporated into the prediction model,which showed good consistency between the predicted and actual risks,as indicated by calibration curves with slopes close to 1 in the training and validation sets.Receiver operating characteristic analysis revealed an area under the curve(AUC)of 0.926(95%CI:0.8889-0.9675)in the training set.The optimal cutoff value is 0.73,with a sensitivity of 88.4 and specificity of 85.2.In the validation set,the AUC of the model for predicting enteral nutrition aspiration in patients with AP patients during hospitalization was 0.902,with a standard error of 0.040(95%CI:0.8284-0.9858),and the best cutoff value was 0.73,with a sensitivity of 91.9 and specificity of 81.8.CONCLUSION A prediction model for enteral nutrition aspiration during hospitalization in patients with AP was established and demonstrated high predictive value.Further clinical application of the model is warranted.

Study of Sound Environment Influenced by the Crowd in Waiting Areas in General Hospitals

In this study,the crowd has been investigated and analyzed in waiting areas in large general hospitals in China in order to find the rules the variations of sound environment with the change of crowd. The field investigation,questionnaire,field-testing and computer simulation have been adopted. The results show that: the social /demographic characteristics of staff and patients are not significantly related to the satisfaction evaluation of sound environment; there is a significant correlation between the population density and LAeq of the background noise in waiting areas; when population density is 0,the LAeq of background noise is not 0 in waiting areas; the loudspeaker should be set in the waiting areas. Loudspeaker arrangements should be integrated into the ceiling lamp or construct facilities along the depth direction of the layout,and the two adjacent speakers recommended distance should be controlled at about 4 m. If the population density is controlled in the reasonable range,and sound absorption,noise reduction processing and electronic queuing system are adopted,sound environment of waiting areas will be built with noise interference relatively small in different population densities.

Restoration of energy level in the early phase of acute pediatric pancreatitis

Acute pancreatitis (AP) is a serious inflammatory disease with rising incidence both in the adult and pediatric populations. It has been shown that mitochondrial injury and energy depletion are the earliest intracellular events in the early phase of AP. Moreover, it has been revealed that restoration of intracellular ATP level restores cellular functions and defends the cells from death. We have recently shown in a systematic review and meta-analysis that early enteral feeding is beneficial in adults; however, no reviews are available concerning the effect of early enteral feeding in pediatric AP. In this minireview, our aim was to systematically analyse the literature on the treatmentof acute pediatric pancreatitis. The preferred reporting items for systematic review(PRISMA-P) were followed, and the question was drafted based on participants, intervention, comparison and outcomes: P: patients under the age of twenty-one suffering from acute pancreatitis; I: early enteral nutrition (per os and nasogastric- or nasojejunal tube started within 48 h); C: nil per os therapy; O: length of hospitalization, need for treatment at an intensive care unit, development of severe AP, lung injury (including lung oedema and pleural effusion), white blood cell count and pain score on admission. Altogether, 632 articles (Pub Med: 131; EMBASE: 501) were found. After detailed screening of eligible papers, five of them met inclusion criteria. Only retrospective clinical trials were available. Due to insufficient information from the authors, it was only possible to address length of hospitalization as an outcome of the study. Our mini-meta-analysis showed that early enteral nutrition significantly(SD = 0.806, P = 0.034) decreases length of hospitalization compared with nil per os diet in acute pediatric pancreatitis. In this minireview, we clearly show that early enteral nutrition, started within 24-48 h, is beneficial in acute pediatric pancreatitis. Prospective studies and better presentation of research are crucially needed to achieve a higher level of evidence.

Impact of Early Postoperative Enteral Feeding on Hospital Length of Stay in Patients Undergoing Colonic Surgery: Results of a Prospective Randomized Trial

Introduction: Early feeding within 24 hours of intestinal surgery seems advantageous in terms of reduction of wound infection, pneumonia and length of hospital stay. The aim of the study is to evaluate the impact of early enteral nutrition in length of hospital stay in comparison to traditional postoperative feeding regimen. Method: This prospective study enrolled 95 patients randomized in two groups: control group patients receive enteral feeding in absence of nausea or vomiting, abdominal distension and after passage of flatus or stools, while patients in experimental group were fed a liquid diet within 12 hours of surgery, followed by a regular diet at the next meal. The primary endpoint was the impact of early oral feeding on hospital length of stay. The secondary endpoint was to measure the impact of the diet reintroduction modality on the incidence of early postoperative morbidity and return of bowel function. Result: Length of hospital stay was slightly diminished in the experimental group compared to control (8.78 ± 3.85 versus 9.41 ± 5.22), but the difference was not statistically significant. Postoperative nausea and vomiting were reported in 24 (51.0%) patients in experimental group and 30 (62.5%) in control group. Only one patient required nasogastric tube insertion. The majority of patients did not demonstrate any postoperative morbidity in both groups. Conclusion: Early enteral nutrition is safe after intestinal surgery. However we did not demonstrate that early enteral feeding diminished length of hospital stay or hastened the return of bowel function.

PDCA循环在缩短日间手术术前等待时间中的效果评价

目的探讨运用PDCA程序缩短日间手术患者术前准备等待时间,进而符合院感防控的管理模式。方法采用PDCA循环管理方法,以建立多学科合作机制、精准安排患者入院时间、合理规划术前等待区域等改进方案。2022年1月8日—21日的日间手术患者316例为对照组,2022年3月26日—5月8日,实施PDCA改善后的日间手术患者为PDCA组。对2组患者术前等待时间、患者术前等候期满意度进行比较。结果日间手术患者平均等待时间由对照组的184.36 min,降低至PDCA组的47.64 min,满意度由81.01%提升至96.11%,前后比较差异有统计学意义(P<0.001)。结论日间手术短平快的运作方式与感染控制理念相融合,需要各医院根据业务区域特点及患者需求做有效的患者术前分流措施,对于提升患者就医体验、降低院感发生率、护患满意度具有重要意义。

候床管理系统在提高分化型甲状腺癌患者住院收治率中的作用

目的探讨核医学科分化型甲状腺癌患者候床管理系统构建方法及在提高住院收治率中的作用。方法选择2021年3月—2023年1月广西医科大学第一附属医院核医学科收治的960例分化型甲状腺癌患者为对象,随机数字表法分为2组,各480例。对照组采用常规方法管理,观察组构建候床管理系统。2组均完成3个月干预,比较2组自我管理水平、住院时间、不良反应发生率、住院收治率及满意度。结果观察组干预3个月后自我概念、自护技能、自护意识及健康知识评分高于对照组(P<0.05);观察组干预3个月后住院时间≥7 d病例数和治疗过程中乏力、辐射损伤、放射性炎症、消瘦及恶心呕吐总发生率低于对照组(P<0.05);观察组干预3个月期间住院收治率为64.58%,高于对照组的43.75%;干预方法、服务态度、干预效果及干预形式方面满意度高于对照组(P<0.05)。结论构建核医学科分化型甲状腺癌患者候床管理系统,有助于提高患者自我管理水平,缩短住院时间,降低不良反应发生率,提高住院收治率及满意度。

高龄住院老年患者肠内营养支持的效果分析

目的 分析高龄住院老年患者肠内营养支持的效果。方法 回顾性选取2022年2月—2023年2月北京市垂杨柳医院老年医学科的66例高龄老年患者的临床资料,根据治疗方式分为观察组和对照组,各33例。对照组采用静脉途径提供营养支持,观察组采用肠内营养干预,对比两组的治疗效果。结果 观察组的血白蛋白(28.12±5.63)g/L、前白蛋白(0.18±0.02)g/L、转铁蛋白(1.62±0.28)g/L、血红蛋白(128.69±15.75)g/L高于对照组,差异有统计学意义(P均<0.05)。观察组的谷丙转氨酶(29.96±6.56)U/L、谷草转氨酶(25.52±7.65)U/L、总胆红素(15.12±1.89)μmol/L、血肌酐(100.47±15.64)μmol/L低于对照组,差异有统计学意义(P均<0.05)。观察组胃肠道反应发生率高于对照组,感染并发症发生率低于对照组,差异有统计学意义(P均<0.05)。结论高龄住院老年患者营养支持中应用肠内营养的效果突出。

不同时间建立肠道营养对极低出生体重儿T淋巴细胞亚群的影响研究

目的探讨不同时期建立肠道营养对极低出生体重(VLBW)儿的免疫功能(T淋巴细胞亚群)的数值变化。方法选取南宁市第二人民医院2021—2023年新生儿重症监护病房(NICU)收治的符合纳入标准的VLBW儿90例作为研究对象,依据建立肠道营养时间分为试验组(出生后3 d内)、对照1组(出生后3~7 d)、对照2组(出生后7 d后),每组各30例。统计分析三组T淋巴细胞亚群、感染性疾病发生情况、住院时间、住院费用。结果出生后第20天,试验组患儿CD3^(+)、CD4^(+)水平以及CD4^(+)/CD8^(+)值均高于对照1、2组,差异有统计学意义(P<0.05)。试验组患儿感染性疾病发生率低于对照1、2组,差异有统计学意义(P<0.05)。试验组患儿住院时间短于对照1、2组,且对照1组患儿住院时间短于对照2组,差异有统计学意义(P<0.05);试验组患儿住院费用低于对照1、2组,差异有统计学意义(P<0.05)。结论早期建立VLBW儿肠道营养预期可提高新生儿的细胞免疫功能,降低VLBW儿感染性疾病的感染率及降低感染程度,缩短住院时间,减少住院费用,为提供早期建立肠道营养可提高新生儿细胞免疫力提供理论依据。

互联网医院建设实践与效果研究

目的:探究互联网医院在优化患者就医流程、增强患者就医体验以及有效降低再入院率等方面的积极效应。方法:收集2020年10月至2022年2月互联网医院线上门诊、处方开具等数据,绘制门诊分布与趋势图,探索互联网医院重点服务的变化趋势。同时对互联网医院建成前后的候诊时间、用户满意度、再入院次数等数据进行调查分析。结果:研究发现,患者使用网络门诊、线上处方开具、检查开单和配药订单频次较低,使用在线预约、在线支付和报告查询频次较高。互联网医院建成前后门诊平均候诊时间由45分钟缩短至33.9分钟,患者就医体验显著提升。开设互联网医院线上线下服务的科室再入院率明显下降,除老年病科外,其他各科室前后对比具有统计学意义(P <0.05)。结论:互联网医院有助于降低再入院率,提升患者就医体验。

预住院病人入院前护理管理方案的构建及应用

目的:构建预住院病人入院前(即等待住院期间)的护理管理方案,并评价其应用效果。方法:通过文献回顾、焦点小组讨论及专家论证构建预住院病人入院前护理管理方案;选取2022年2月1日—5月31日于云南省某三级甲等医院办理预住院的病人为对照组(141例),采用常规护理方案;2022年6月1日—9月30日办理预住院的病人为试验组(126例),采用预住院病人入院前护理管理方案,比较两组病人入院前等待时间、住院时长、住院费用、入院准备评价得分及住院病人满意度的差异。结果:试验组入院前等待时间、住院时长低于对照组,差异有统计学意义(P<0.05);入院准备评价得分及病人满意度高于对照组,差异有统计学意义(P<0.05);住院费用两组比较差异无统计学意义(P>0.05),但试验组住院费用少于对照组。结论:预住院病人入院前护理管理方案有助于减少入院前等待时间、降低住院时长及住院费用,提高入院准备评价得分及住院病人满意度。

安徽省某三甲医院门诊患者候诊时间的影响因素分析

目的 分析安徽省某三甲医院门诊患者候诊时间影响因素,提出改进策略,提升患者就医感受。方法 通过医院信息系统调取2023年6月门诊患者就诊数据,并对当月就诊的405例门诊患者进行问卷调查,通过单因素及多因素分析候诊时间影响因素。结果 14岁及以下患者平均候诊时间最长,为15.2(5.1,39.5)min,预约挂号患者的平均候诊时间为9.2(3.9,19.5)min,短于非预约挂号的13.1(3.8,34.3)min;普通号患者平均候诊时间为9.5(2.8,25.1)min,短于专家的13.7(4.6,35.4)min;上午就诊患者平均候诊时间为10.1(3.3,26.7)min,短于下午就诊患者的15.7(5.0,37.1)min(P<0.001)。多元线性回归显示,年龄、就诊方式、就诊类型、就诊时间、医生半日接诊量对候诊时间的影响差异有统计学意义(P <0.05)。结论 通过对影响候诊时间的主要因素进行分析,提示医院管理部门要加强医患沟通,充分保证患者的就诊时间,要改变患者就诊习惯,持续提升分时段预约就诊的精确度,缩短门诊候诊时间。

西北某三甲医院移动支付对门诊质量影响

目的 通过移动支付流程改造,改善就医体验,促进门诊质量提升。方法 以西北某三甲医院门诊部作为研究对象,利用质量管理工具,结合信息化移动支付流程改造,对门诊患者等待时间和门诊患者满意度等进行系统分析。结果 信息化移动支付流程改造后,患者的等待时间和满意度与上一年相比都具有显著性差异(t=3.207,P=0.003;t=-6.047,P=0.010)。结论 医院门诊医疗中采用信息化移动支付能够减少门诊患者等待时间,改善门诊患者满意度。

基于环境心理学的高校医院等候空间设计研究

承载师生医疗保健的高校医院往往备受关注,但许多位于老校区的高校医院已无法应对扩招带来的学生压力,亟待改造升级。其中,等候空间在高校医院公共空间中是停留时间最长,互动行为主要发生的区域,因此文章以北京某高校医院为研究对象,通过实地测绘、问卷访谈等调研方法,对其等候空间的使用情况进行针对性地研究,同时提出相对应的优化策略,期望为高校医院等候空间环境品质的提升提供设计参考。

解决医院病床安排问题的线性规划方法

本文研究了医院病床安排问题,在综合考虑病人等待入院和等待手术期间产生费用的前提下,建立了病床安排问题的线性规划模型。利用该模型,可以得到使病人平均等待费用最低的入院顺序。通过实例计算显示,利用本文模型得到的结果与利用传统的先到先服务原则安排的结果相比,病人等待手术的平均时间大约缩短了50%,等待费用大约降低了50%。

大型医院门诊候诊环节管理的实践探讨

分析大型医院门诊候诊现状,提示门诊候诊环节管理在优化门诊服务流程中起到重要作用。首都医科大学宣武医院本着公平透明、人员流向均衡、尊重关爱和安全至上的候诊管理原则,采取分诊叫号系统、排队叫号系统、导诊和咨询服务、多种形式温馨提示、分时段就诊和检查、提高门诊工作效率、便民服务、诊间健康宣教、志愿者服务、院内就诊急救系统等措施,及时分流,缩短等候时间,改善候诊感受,提高门诊整体服务水平。

应用品管圈减少新入院患者病区等候时间的实践效果

目的 :分析探讨品管圈活动减少新入院患者病区等候时间的实践效果。方法 :采用品管圈的方法,对新入院患者病区等候时间进行调查统计和分析,并采取措施降低新入院患者病区等候时间。结果 :改善前新入院患者病区等候时间合计为4209分钟,平均每位患者等候时间为135.77分钟。通过采取措施,新入院患者的病区等候时间缩短到1497分钟,平均33.27分钟,下降了74.0%。结论 :采用品管圈活动减少了患者等候安置床位时间及辅班护士接诊时间,使患者可及早接受治疗,提高了护士工作效率及医院床位使用率。

急性脑卒中伴吞咽障碍患者不同时期肠内营养支持的疗效比较

目的探讨不同时期肠内营养对急性脑卒中后吞咽障碍患者的综合疗效。方法将184例急性脑卒中后吞咽障碍患者随机分为入院24 h内鼻饲肠内营养液的观察组(92例)和入院第4天开始鼻饲肠内营养液的对照组(92例)。比较治疗前和治疗后免疫功能、营养状况、并发症及鼻饲时间、住院时间、住院费用等。结果治疗后,观察组患者总淋巴细胞计数(TLC)、IgA、IgG、白蛋白和血红蛋白下降幅度较小,两组比较差异有统计学意义(P<0.05);观察组患者电解质紊乱、消化道溃疡、胃肠道反应及低蛋白血症发生率与对照组比较差异有统计学意义(P<0.05);观察组患者鼻饲时间、住院时间和住院费用较对照组明显缩短或减少,差异有统计学意义(P<0.05)。结论急性脑卒中后吞咽障碍患者早期肠内营养可以更好地改善患者免疫功能和营养状态,减少并发症,同时减少鼻饲时间和住院时间,并降低住院费用。

大型综合医院超声检查诊间自动预约平台建立及应用探讨

目的:建立基于信息化的医技检查诊间自动预约平台,优化检查流程,缩短患者等候时间,提升服务效能。方法:通过基于HIS系统的诊间自动预约系统,实现分时段预约服务,配合已实现的自助缴费系统及自助报到系统,建立医技检查诊间自动预约平台。同时比较流程再造前后患者预约排队等候时间、缴费排队等候时间、检查等候时间及满意度等指标,评估平台运行成效。结果:流程改造后有效减少了患者排队次数,预约排队等候时间平均缩短24.8分钟,患者满意度及临床科室对医技科室满意度均明显提高。结论:诊间超声自动预约平台的建立,实现了一站式、分时段精准预约,缩短了患者等候时间,提升了医技科室工作效率,实现了临床及患者的满意度双提升。

肺癌手术患者健康教育提前至候床期实施效果探讨

目的利用入院前候床期实施健康教育,以缩短住院时间和提高健康教育效果。方法将120例肺癌手术患者按时间段分为对照组和实验组60例。对照组按常规待患者入院后实施责任制整体护理,实验组于门诊确定住院手术后即建立档案实施健康教育,包括疾病知识、呼吸功能锻炼、手术相关事项告知等,并与入院后的教育相衡接至患者出院。结果实验组术后肺部并发症发生率显著低于对照组、健康知识掌握程度及满意度显著优于对照组、住院时间显著短于对照组(均P<0.01)。结论对肺癌手术患者将健康教育提前至候床期间实施,可提高患者健康知识掌握度、有助于降低手术并发症、缩短住院时间及提高患者满意度。

基于居民健康卡的预约诊疗流程优化

针对患者预约服务及候诊排队拥挤的问题,讨论了基于手机短信的院外候诊服务流程和基于专家问诊时间的分时就诊流程。首先介绍了预约诊疗的几种模式,并讨论了预约就诊数据交换的流程,然后讨论了基于手机短信的院外候诊服务流程和基于专家问诊时间的分时就诊流程,完全改变了传统取号后直接候诊的就医流程。文章主要从院外候诊、分时就诊以及服务质量评价等方面对预约诊疗服务流程进行优化,对有效解决医院"三长一短"的问题、缓解医院拥挤的现状、减少患者感染几率具有非常重要的作用。