Logistic Regression Analysis and Nursing Interventions for High-risk Factors for Pressure Sores in Patients in a Surgical Intensive Care Unit

Objective： To investigate the risk factors related to the development of pressure sores in critically ill surgical patients and to establish a basis for the formulation of effective precautions. Methods： A questionnaire regarding the factors for pressure sores in critically ill surgical patients was created using a case control study with reference to the pertinent literature. After being exam- ined and validated by experts, the questionnaire was used to collect data about critically ill surgical patients in a grade A tertiary hospital. Among the 47 patients enrolled into the study, the 14 who developed nosocomial pressure sores were allocated to the pressure sore group, and the remaining 33 patients who met the inclusion criteria and did not exhibit pressure sores were allocated to the control group. Univariate and multivariate logistic regression analyses were employed to examine the differences in 22 indicators between the two groups in an attempt to identify the risk factors for pressure sores. Results： According to the univariate analyses, the maximum value of lactic acid in the arterial blood, the number of days of norepinephrine use, the number of days of mechanical ventilation, the number of days of blood purification, and the number of days of bowel incontinence were statistically greater in the pressure sore group than in the control group （P〈0.05）. The multivariate logistic regression analysis revealed that the number of days of norepinephrine use and the level of lactic acid in the arterial blood were high risk-factors for pressure sores （P〈0.05）. Conclusions： The best method for preventing and control pressure sores in surgical critically ill patients is to strongly emphasize the duration of the critical status and to give special attention to patients in a continuous state of shock. The adoption of measures specific to high-risk patient groups and risk factors, including the active control of primary diseases and the application of decompression measures during the treatment of the patients, are helpful for improving the quality of care in the prevention and control of pressure sores in critically ill patients.

Hepatitis C risk assessment,testing and referral for treatment in urban primary care:Role of race and ethnicity

AIM: To determine rates of hepatitis C (HCV) risk factor ascertainment, testing, and referral in urban primary care practices, with particular attention to the effect of race and ethnicity. METHODS: Retrospective chart review from four primary care sites in Philadelphia; two academic primary care practices and two community clinics was performed. Demographics, HCV risk factors, and other risk exposure information were collected. RESULTS: Four thousand four hundred and seven charts were reviewed. Providers documented histories of injection drug use (IDU) and transfusion for less than 20% and 5% of patients, respectively. Only 55% of patients who admitted IDU were tested for HCV. Overall, minorities were more likely to have information regarding a risk factor documented than their white counterparts (79% vs 68%, P < 0.0001). Hispanics were less likely to have a risk factor history documented, compared to blacks and whites (P < 0.0001). Overall, minorities were less likely to be tested for HCV than whites in the presence of a known risk factor (23% vs 35%, P = 0.004). Among patients without documentation of risk factors, blacks and Hispanics were more likely to be tested than whites (20% and 24%, vs 13%, P < 0.005, respectively). CONCLUSION: (1) Documentation of an HCV risk factor history in urban primary care is uncommon, (2)Racial differences exist with respect to HCV risk factor ascertainment and testing, (3) Minority patients, positive for HCV, are less likely to be referred for subspecialty care and treatment. Overall, minorities are less likely to be tested for HCV than whites in the presence of a known risk factor.

Newborn Umbilical Cord Care in Parakou in 2013: Practices and Risks

Objective: The objective was to study umbilical care practices and risks in Parakou (North Benin). Patients and method: It was a cross-sectional and descriptive study carried out within a community from June 1 to August 31, 2013. It focused on all the infants born at the maternity of Parakou Health Center and their mothers. Results: Two hundred and ten newborns were included i.e. 101 boys and 109 girls. In 80.9% of cases, inappropriate substances had been applied to umbilical cord. Umbilical cord care quality was adjudged as poor, acceptable and good in 58.6%, 31.9% and 9.5% of cases respectively. A bacterial umbilical infection had been noted in 59.5% of newborns. Only 4.8% had sterile umbilical wound. The commonest bacteria were: Staphylococcus aureus (58.1%), Staphylococcus saprophiticus (53.3%), Escherichia coli (44.8%) and Pseudomonas aeruginosa (14.3%). The factors associated with umbilical infection were: low educational status of mother (p = 0.026), low-income occupation of mother (p = 0.021), customary practices to accelerate umbilical cord fall off (p = 0.007), short time to cord falling off lower than 6 days (p = 0.015). Conclusion: Umbilical cord care involves high risk for bacterial infection in our context. Strong actions must be taken within the community in order to reduce that risk.

Risk Factors Associated with Acinetobacter baumannii Infections in Patients in an Intensive Care Unit of a Public Hospital in Paraná

To identify risk factors for A. baumannii infection in patients hospitalized in an Intensive Care Unit (ICU) of a tertiary public hospital in Paraná, Brazil, a retrospective paired case-control study (ratio 1:2) was conducted from January 2018 to December 2020. Patients in the case group were hospitalized in the ICU with A. baumanni (n = 68 cases) and were compared with patients in the control group, without infection by A. baumannii (n = 136). Both were matched by age (±10 years), sex, and ICU stay (±5 days). Conditional multiple logistic regression was used to determine statistically significant risk factors based on the results of bivariate analyses. Mortality was higher in infected (cases) than in non-infected patients (51.5% vs. 39.7%). The incidence and bacterial resistance increased annually. At bivariate analysis, cases had longer hospital stays (median 35 vs. 22 days, p A. baumannii and antimicrobial resistance. There is need for surveillance, and constant evaluation of control actions. Risk factors were colonization, previous hospitalization, and hospitalization time. This is essential for the decision-making of professionals and optimization of prevention, control, and therapeutic management actions.

Risk factors and antibiotic resistance of pneumonia caused by multidrug resistant Acinetobacter baumannii in pediatric intensive care unit

BACKGROUND:With beta-lactam drugs and immunosuppressants widely used,the infection caused by Acinetobacter baumannii(Ab) has become more and more serious with multidrug resistant Acinetobacter baumannii(MDRAb) emerging and worsening rapidly.Compared with other patients,the incidence and multidrug resistance of MDRAb are higher in children in pediatric intensive care unit(PICU) because of immune deficiency,severe basic diseases,prolonged hospitalization and invasive operations.Hence it is significant to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence of MDRAb in children.METHODS:A total 115 patients with MDRAb pneumonia and 45 patients with negative MDRAb(NMDRAb) pneumonia who had been treated from January 2009 to August 2011 were studied retrospectively at the PICU of Wuhan Children's Hospital.Clinical data were analyzed with univariate and multivariate Logistic regression.RESULTS:In 176 clinical strains of Acinetobacter baumannii isolated,there were 128 strains of MDRAb,accounting for 72.73%.Drug susceptibility tests showed that the resistance rates of β-lactam antibiotics were more than 70%except for cefoperazone sulbactam.The rates to carbapenems were higher than 90%.They were significantly higher than those of NMDRAb.Amikacin,levofloxacin,ciprofloxacin and minocycline had the lowest drug-resistance rates(<20%).Multivariate Logistic regression revealed that ICU stay,the time of mechanical ventilation,anemia,hypoproteinemia and the use of carbapenems were independent risk factors for MDRAb pneumonia.CONCLUSIONS:MDRAb is an important opportunistic pathogen to pneumonia in PICU,and its drug-resistance is severe.It increases significantly the mortality of patients.It is important to take the effective prevention measures for controlling it.

Why Are Risk-Pooling and Risk-Sharing Arrangements Necessary for Financing Healthcare and Improving Health Outcomes in Low and Lower Middle-Income Countries

Health is important to economic development, and economic development has an important impact on health outcomes. Health Expenditure makes up a substantial part of the global economy. In the world, the costs of healthcare are increasing;patients are compelled to pay more for treatment, and that makes a lot of people faced to Catastrophic Health Expenditures (CHE) and in long run fall below the poverty line. One of the most urgent and vexing challenges faced by many low- and middle-income countries is how to provide health care for the more than two billion poor people who live in these areas (developing countries). As much as more than 65% (in 2014) of total private health care expenditure in low-income countries comes from out-of-pocket payment by patients. In addition, according to World Bank report (2007), in low and lower middle-income countries was speared nearly 13% of global health spending with 87% the global disease burden. The WHO considers health financing models with high risk pooled, such as health insurance and prepaid schemes, a promising means for achieving universal health-care coverage and promotion health care. A crucial concept in health financing is that of pooling. The WHO defines risk-pooling as the “accumulation and management of revenues in such a way as to ensure that the risk of having to pay for health care is borne by all members of the pool and not by each contributor individually”. The larger degree of pooling, the less people will have to bear the health financial risks. Furthermore, adopting and operating financing policies based on greeter risk pooling/sharing (prepayments) are recommended to all countries (especially in low and lower-middle income countries). It means risk sharing/pooling plays a key role in all financing systems for achieving effectiveness and efficiency health systems.

Prevention of stress-related ulcer bleeding at the intensive care unit: Risks and benefits of stress ulcer prophylaxis

Stress-related mucosal disease is a typical complication of critically ill patients in the intensive care unit(ICU). It poses a risk of clinically relevant upper gastrointestinal(GI) bleeding. Therefore, stress ulcer prophylaxis(SUP)is recommended in high-risk patients, especially those mechanically ventilated > 48 h and those with a manifest coagulopathy. Proton pump inhibitors(PPI) and, less effectively, histamine 2 receptor antagonists(H2RA) prevent GI bleeding in critically ill patients in the ICU. However, the routine use of pharmacological SUP does not reduce overall mortality in ICU patients. Moreover, recent studies revealed that SUP in the ICU might be associated with potential harm such as an increased risk of infectious complications, especially nosocomial pneumonia and Clostridium difficile-associated diarrhea. Additionally, special populations such as patients with liver cirrhosis may even have an increased mortality rate if treated with PPI. Likewise, PPI can be toxic for both the liver and the bone marrow, and some PPI show clinically relevant interactions with important other drugs like clopidogrel. Therefore, the agent of choice, the specific balance of risks and benefits for individual patients as well as the possible dose of PPI has to be chosen carefully. Alternatives to PPI prophylaxis include H2 RA and/or sucralfate. Instead of routine SUP, further trials should investigate risk-adjusted algorithms, balancing benefits and threats of SUP medication in the ICU.

移动CT在重症患者风险管控中的临床应用价值

目的探讨重症监护室(ICU)患者行移动CT头部扫描的时效性、经济性、辐射剂量及临床价值。方法回顾性收集2022年9—12月我院临床怀疑进展性颅内出血需移动CT头部检查的ICU患者40例(移动CT组),因移动式CT维修需要转运至放射科CT室行头部检查的ICU患者40例(常规CT组)。记录两组患者完成检查的绝对风险时间、辐射剂量及检查流程,并由2位高年资影像医师对两组患者出血区的图像质量进行评分评价,并对结果进行统计学分析。结果移动CT组完成检查的平均绝对风险时间为(9.21±2.13)min,显著低于常规CT组的(47.43±7.10)min,差异有统计学意义(Z=30.542,P<0.05);移动CT组的容积CT剂量指数为(41.26±0.00)mGy·cm、剂量长度乘积为(660.16±0.00)mGy·mA^(-1)·s^(-1)以及有效辐射剂量为(1.52±0.00)mSv,均低于常规CT组的(55.41±10.75)mGy·cm、(824.88±174.63)mGy·mA^(-1)·s^(-1)、(1.90±0.40)mSv,差异有统计学意义(Z=49.543,P<0.05;Z=164.002,P<0.05;Z=9.500,P<0.05)。两组出血区的图像质量比较差异无统计学意义(Z=0.028,P>0.05)。移动CT组检查流程较常规CT组减少3个环节和3位医务人员。结论重症监护患者行CT头部扫描时,移动CT检查具有更高的时效性、降低了风险,节约了人力成本、降低了辐射剂量,能更好地服务于ICU需行头部CT检查的患者。

Predictive risk factors for prolonged stay in intensive care unit in patients undergoing coronary artery bypass grafting surgery

Objective To describe the preoperative factors of prolonged intensive care unit length of stay after coronary artery bypass grafting. Methods From 1997 to 2009, 1318 patients underwent isolated CABG in our hospital. Retrospective analysis was performed on these cases. Univariate and multivariate analyses

基于“安全-支持-合作”模式的高危跌倒护理方案在神经内科中的应用效果

目的 探讨基于“安全-支持-合作”模式的高危跌倒护理方案在神经内科的应用效果。方法 选取2022年3月至2023年3月在钦州市第二人民医院神经内科接受治疗的患者200例,随机分为对照组和观察组,每组100例,给予对照组常规护理,观察组于对照组基础上行基于“安全-支持-合作”模式的高危跌倒护理方案,对比2组护理方法对患者跌倒预防自我管理能力(《预防跌倒自我管理行为调查问卷》评价)、跌倒风险(Morese跌倒评估量表评估)、跌倒发生率、护理满意度(纽卡斯尔护理服务满意度量表评价)的影响。结果 2组护理前的《预防跌倒自我管理行为调查问卷》、跌倒风险比较,差异无统计学意义(P>0.05);2组护理后的《预防跌倒自我管理行为调查问卷》高于护理前,且观察组高于对照组;跌倒风险则低于护理前,且观察组低于对照组(P<0.05)。观察组跌倒发生率低于对照组(P<0.05)。观察组护理满意度高于对照组(P<0.05)。结论 基于“安全-支持-合作”模式的高危跌倒护理方案应用于神经内科中可有效改善患者跌倒预防自我管理能力,降低跌倒风险,减少跌倒的发生,并提高患者护理满意度。

Predictive risk factors associated with prolonged stay in the intensive care unit for patients undergoing coronary artery bypass grafting surgery

Objective The rate of post-operative complications has been increased with the changes in patients’age,prolonged duration,more severe and diffused lesions,and more patients with complications in recent years. We try to identify the risk factors associated with prolonged stay in the intensive care unit (ICU) after coronary artery bypass graft surgery (CABG) . Methods 1623 patients who received CABG surgery in Beijing Anzhen Hospital

某三甲医院急诊患者安全管理与对策研究

目的应用医疗失效模式与效应分析(healthcare failure mode and effect analysis,HFMEA)对急诊患者进行安全管理,保障急诊患者安全。方法成立HFMEA小组,选择急诊急救案例,绘制急诊急救流程,找出失效原因,计算危害指数。决策树分析后找出需要重点改善的失效原因,利用鱼骨图找出系统原因,拟定改善方案,包括加强信息化管控、以制度规范流程、组建快速反应小组、加强员工培训。结果实施改善方案后,危害指数明显下降。结论HFMEA强调事前干预,对急诊患者急救等高危流程有重大指导意义,可有效减少潜在风险点,提升急诊医疗质量与安全。

老年脓毒症患者重症监护室内发生下肢深静脉血栓的危险因素

目的探讨老年脓毒症患者重症监护室(ICU)内发生下肢深静脉血栓(DVT)的危险因素。方法收集2020年4月至2021年9月首都医科大学附属北京天坛医院收治的83例老年脓毒症患者的临床资料,根据ICU住院期间是否发生下肢DVT将患者分为DVT组(n=25)和对照组(n=58)。收集所有患者入住ICU的临床资料,包括年龄、性别、主要疾病、既往病史、化验结果、检查结果、ICU住院期间治疗情况及ICU住院结局等。比较两组患者的临床特征和住院期间治疗情况,采用多因素Logistic回归模型分析老年脓毒症患者ICU内发生下肢深静脉血栓(DVT)的危险因素。结果DVT组患者的糖尿病比例、下肢功能障碍比例、入院时D-二聚体水平升高比例及使用呼吸机的比例均高于对照组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,糖尿病、下肢功能障碍、入院时D-二聚体水平升高及使用呼吸机均是老年脓毒症患者ICU住院期间发生下肢DVT的危险因素(P﹤0.05)。结论糖尿病、下肢功能障碍、入院时D-二聚体水平升高及使用呼吸机均会增加老年脓毒症患者ICU住院期间发生下肢DVT的风险,临床中应对这些患者强化预防和监测。

基于改良Caprini风险评估的预见性护理对不同程度创面烧伤患者静脉血栓栓塞症的预防效果

目的探讨基于改良Caprini风险评估的预见性护理对不同程度创面烧伤患者静脉血栓栓塞症(VTE)的预防效果。方法将2022年1月至2023年9月浙江省金华市中心医院烧伤科就诊的334例烧伤患者作为研究对象,按非同期队列研究方法将其分为对照组和观察组,对照组(186例)接受Caprini风险评估的常规VTE护理,观察组(148例)接受改良Caprini风险评估的预见性护理。干预后,比较两组VTE发生率、VTE中高危识别率和凝血功能。结果干预后,观察组VTE发生率低于对照组,差异有统计学意义(P<0.05);干预后,观察组VTE中高危识别率高于对照组,差异有统计学意义(P<0.05)。干预后,两组凝血酶原时间(PT)、活化部分凝血酶时间(APTT)短于干预前,纤维蛋白原(FIB)高于干预前,且观察组PT、APTT短于对照组,观察组FIB高于对照组,差异有统计学意义(P<0.05)。结论对于烧伤患者而言,相对于Caprini风险评估的常规VTE护理,改良Caprini风险评估的预见性护理能够更好地预防VTE的发生,改善患者的凝血功能,值得推广使用。

长期护理政策的国际经验与中国探索

随着老龄化程度加深和家庭功能弱化,完善长期护理政策是未来社保体制和养老服务体系优化的重要一环。本文分类总结了世界主要国家和地区长期护理政策的特征以及制度选择的可能成因,并基于我国目前长期护理政策发展情况以及我国目前大力推进长期护理保险发展的背景,提出未来完善长期护理保险的政策思考。本文认为,首先应当确立我国未来长期护理保险的底层逻辑和基础,明确政策目标、政策定位及运行模式,整体设计应与国家战略及未来趋势相协调;其次完善筹资、评估和待遇方案,推进制度衔接和资源优化配置,提升长护险运行效率;然后在公共服务均等化的基础上平衡区域和人群受益水平,促进长护险制度公平发展;最后完善长护险配套资源建设,实现长期护理保险持续稳步发展的目标。

全麻患者术后麻醉重症监护室中新发下肢深静脉血栓的危险因素

目的筛选全麻术后转入麻醉重症监护室(AICU)的患者新发下肢深静脉血栓(DVT)的危险因素。方法回顾性收集2022年5—8月择期行全麻下手术后带气管插管转入AICU的患者192例,男105例,女87例,年龄18~85岁,BMI 18~31 kg/m^(2),ASAⅡ或Ⅲ级。收集患者基线资料、麻醉手术资料及实验室检查资料。根据入AICU 6 h内的超声结果是否有新发DVT将患者分为两组:DVT组和非DVT组。采用多因素Logistic回归分析筛选AICU中患者术后6 h内新发DVT的危险因素及其95%可信区间(CI)。结果全麻术后在AICU新发DVT的患者有64例(33.3%),均为小腿肌间静脉血栓(CMVT)。多因素Logistic回归分析结果显示,术前心律失常(OR=2.236,95%CI 1.011~4.943,P=0.047)、术前血小板计数高(OR=1.006,95%CI 1.002~1.010,P=0.007)、术前D⁃二聚体浓度高(OR=1.203,95%CI 1.046~1.383,P=0.010)、术中低血压(OR=1.010,95%CI 1.002~1.019,P=0.020)和术中应用去甲肾上腺素(OR=3.796,95%CI 1.697~8.492,P=0.001)是全麻术后AICU中患者新发DVT的危险因素;阿司匹林规律服用史(OR=0.176,95%CI 0.060~0.518,P=0.002)是其保护因素。结论术前心律失常、术前血小板计数高、术前D⁃二聚体浓度高、术中低血压及术中应用去甲肾上腺素是全麻手术后AICU患者6 h内新发DVT的危险因素。

肺泡蛋白沉积症患者全肺灌洗术中的风险管理

总结12例肺泡蛋白沉积症患者行全肺灌洗术中应用霍尔三维模型进行风险管理的护理经验。针对疾病特殊性及全肺灌洗术的多重风险,对患者风险分级管控,提前预警;引入霍尔三维模型,以全肺灌洗术围手术期为线轴,以专科知识及思辨逻辑能力系统排查及处理风险隐患,提升安全护理效能。该组患者住院治疗护理4~29 d,症状好转出院。

NT-proBNP对有创机械通气小儿急性呼吸衰竭28 d内死亡的预测价值研究

目的:研究氧合指数(OI)和N末端B型钠尿肽前体(NT-proBNP)在儿童重症监护病房(PICU)需要有创机械通气的急性呼吸衰竭(ARF)患儿28 d内死亡的预测价值。方法:选取2017—2019年入住本院PICU的需要有创机械通气的111例ARF患儿,收集并分析患儿临床资料,包括儿童机械通气死亡风险评分Ⅲ(PRISMⅢ)、OI、NT-proBNP、机械通气后28 d内生存情况等。采用单因素和多因素logistic回归分析评估ARF患儿28 d内死亡的危险因素。采用受试者工作特征(ROC)曲线评估NT-proBNP、OI和年龄预测28 d生存情况的效果。结果:患儿中位年龄12个月(4.5~66个月),28 d内79例存活(71.17%),32例死亡(28.83%)。与存活组相比,死亡组OI显著升高,NT-proBNP水平显著降低(均P<0.05),两组24 h内PRISMⅢ评分无显著差异(P>0.05)。多因素logistic回归分析结果显示,年龄、OI、NT-proBNP均为ARF患儿28 d内死亡的独立危险因素(P<0.05)。年龄、OI、NT-proBNP及三者联合的ROC曲线下面积(AUC)分别为0.625 0、0.603 6、0.602 8和0.657 2,年龄+OI+NT-proBNP联合具有更好的预测效果。结论:在ARF需机械通气患儿中,最初24 h的年龄、OI和NT-proBNP水平与28 d死亡风险相关;年龄、OI和NT-proBNP三者联合有助于早期识别ARF插管患儿死亡风险。

ICU患者静脉血栓栓塞风险评估模型的研究进展

ICU患者是发生静脉血栓栓塞(VTE)的高危人群,早期识别VTE发生风险至关重要。但目前专门用于ICU患者的VTE风险评估模型非常有限。本文主要针对可应用于ICU患者的VTE风险评估模型进行综述,旨在为临床选择适合的风险评估模型及构建适合我国ICU患者的VTE风险评估模型提供参考。

基层糖尿病微血管疾病筛查与防治专家共识(2024)

糖尿病微血管疾病(DMiVD)是糖尿病常见的慢性并发症,早期识别及有效干预可以显著提高患者生活质量,改善预后。中国微循环学会糖尿病与微循环专业委员会和中华医学会内分泌学分会基层内分泌代谢病学组组织领域内专家,以2021年版为基础,结合最新研究进展,特别针对基层临床实际需求,修订《基层糖尿病微血管疾病筛查与防治专家共识(2024)》。该共识详尽阐述了DMiVD(糖尿病视网膜病变、糖尿病肾脏病、远端对称性多发性神经病变和糖尿病心肌病)的筛查方法、综合管理及防治策略,明确分级诊疗及转诊流程,强化防治DMiVD重要性,为广大医师特别是基层医生及全科医生提供指导和建议,降低DMiVD的发生率、恶化率以及致残致死率。