Association of Multimodal Pain Control with Patient-Reported Outcomes in Children Undergoing Surgery

IntroductionOur aim was to describe practices in multimodal pain management at US children's hospitals and evaluate the association between non-opioid pain management strategies and pediatric patient-reported outcomes (PROs).MethodsData were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial. Non-opioid pain management strategies included use of preoperative and postoperative non-opioid analgesics, regional anesthetic blocks, and a biobehavioral intervention. PROs included perioperative nervousness, pain-related functional disability, health-related quality of life (HRQoL). Associations were analyzed using multinomial logistic regression models.ResultsAmong 186 patients, 62 (33%) received preoperative analgesics, 186 (100%) postoperative analgesics, 81 (44%) regional anesthetic block, and 135 (73%) used a biobehavioral intervention. Patients were less likely to report worsened as compared to stable nervousness following regional anesthetic block (relative risk ratio [RRR]:0.31, 95% confidence interval [CI]:0.11–0.85), use of a biobehavioral technique (RRR:0.26, 95% CI:0.10–0.70), and both in combination (RRR:0.08, 95% CI:0.02–0.34). There were no associations of non-opioid pain control modalities with pain-related functional disability or HRQoL.ConclusionUse of postoperative non-opioid analgesics have been largely adopted, while preoperative non-opioid analgesics and regional anesthetic blocks are used less frequently. Regional anesthetic blocks and biobehavioral interventions may mitigate postoperative nervousness in children.Level of evidenceIII.     

The Optimal Primary Treatment for Pediatric Perianal Abscess and Anal Fistula: A Systemic Review and Meta-Analysis

BackgroundPerianal abscesses and anal fistulas are common. The principle of intention-to-treat has not been considered in previous systemic reviews. Thus, the comparison between primary and post-recurrence management was confused, and the recommendation of primary treatment is obscure. The current study aims to identify the optimal initial treatment for pediatric patients.MethodsUsing PRISMA guidelines, studies were identified from MEDLINE, EMBASE, PubMed, Cochrane Library, and Google Scholar without any language or study design restriction. The inclusion criteria include original articles or articles with original data, studies of management for a perianal abscess with or without anal fistula, and patient age of <18 years. Patients with local malignancy, Crohn's disease, or other underlying predisposing conditions were excluded. Studies without analyzing recurrence, case series of <5, and irrelevant articles were excluded in the screening stage. Of the 124 screened articles, 14 articles had no full texts or detailed information. Articles written in a language other than English or Mandarin were translated by Google Translation first and confirmed with native speakers. After the eligibility process, studies that compared identified primary managements were then included in the qualitative synthesis.ResultsThirty-one studies involving 2507 pediatric patients met the inclusion criteria. The study design consisted of two prospective case series of 47 patients and retrospective cohort studies. No randomized control trials were identified. Meta-analyses for recurrence after initial management were performed with a random-effects model. Conservative treatment and drainage revealed no difference (Odds ratio [OR], 1.222; 95% Confidential interval [CI]: 0.615–2.427, p = 0.567). Conservative management had a higher risk of recurrence than surgery without statistical significance (OR 0.278, 95% CI: 0.109–0.707, p = 0.007). Compared with incision/drainage, surgery can prevent recurrence remarkably (OR 4.360, 95% CI: 1.761–10.792, p = 0.001). Subgroup analysis of different approaches within conservative treatment and operation was not performed for lacking information.ConclusionStrong recommendations cannot be made due to the lack of prospective or randomized controlled studies. However, the current study based on real primary management supports initial surgical intervention for pediatric patients with perianal abscesses and anal fistula to prevent recurrence.Level of evidenceType of study: Systemic review; Evidence level: Level II.     

1401例超长住院日患者分布与影响因素分析

目的分析超长住院患者分布及影响因素,探讨减少超长住院日的措施。方法从江苏省某三甲医院病案管理系统中调取2020年1月1日-2020年12月31日134016例出院患者的住院病案首页资料,对住院时间≥30天的1401例超长住院患者的分布特征进行统计描述,采用Logistic回归模型分析超长住院日的影响因素。结果2020年全院平均住院日为7.13天,其中超长住院患者平均住院日为41.85天。超长住院患者以60岁以上年龄组最多(39.61%);出院科室主要分布在血液科(42.18%)、普通外科(11.85%)、骨科(7.49%)等;疾病类别主要为肿瘤(47.32%)、影响健康状态和与保健机构接触的因素(10.56%)、循环系统疾病(7.07%)等;多因素Logistic回归结果显示,男性(OR=1.188)、离院方式为非医嘱离院或其他(OR=2.046)和死亡病例(OR=3.362)是超长住院的危险因素。结论控制超长住院日对平均住院日影响显著,医院应加强重点人群、重点科室和重点病种管理提高诊疗管理水平,缩短平均住院日。     

A Pre-Protocol/Post-Protocol Quality Improvement Initiative Specific to One Hospital for Security of Pathologic Specimen

ObjectiveThe objective of this study was to reduce errors in a pathologic specimen with the help of a protocol systematizing the pathology specimen management process in the operating room.Materials and methodThis quasi-experimental study was carried out in the operating room unit of a research and training hospital. A protocol systematizing the process of specimen management in secure surgical pathology and prepared in light of the current literature was used as an intervention, and the effectiveness of the protocol was tested.ResultsIt was determined that the rate of adverse events decreased from .3226% (68 of 21,078) to .032% (6 of 18,706) after the protocol systematizing the surgical pathology specimen management process prepared by the researchers, and the protocol was found to be effective by 90% (P = .03).ConclusionBased on the data obtained in this study, we recommend the use of a pathologic specimen management protocol in the operating room.     

一体化管理的老年综合评估护理模式对前列腺癌患者心理因素和生活质量的影响

目的探讨对前列腺癌患者采用一体化管理老年综合评估(CGA)护理模式对其心理因素和生活质量的影响。方法选取2020年3月至2021年3月在南京市第一医院就诊,确诊为前列腺癌,且首次行腹腔镜下前列腺癌根治术的患者96例,随机分为对照组、观察1组、观察2组,各32例。对照组为住院后采用常规护理模式进行护理,观察1组为入院后行CGA干预组,观察2组为一体化管理的CGA干预组。三组患者分别在干预前、出院时,进行焦虑自评量表(SAS)、抑郁自评量表(SDS)测评;在干预前、术后30 d,进行生活质量核心量表QLQ-C30(V3.0)和前列腺癌特异性补充量表QLQ-PR25测评。结果出院时,观察2组SAS、SDS评分显著优于对照组及观察1组(P<0.05);术后30 d,观察2组生活质量QLQ-C30、QLQ-PR25评分显著优于对照组及观察1组(P<0.05)。结论一体化管理CGA护理模式可有效改善前列腺癌患者的心理状态,提高其术后生活质量。     

集束化干预联合闭环管理对ICU多重耐药菌感染的防控效果

目的 探讨集束化干预策略联合闭环管理模式对ICU多重耐药菌感染的防控效果。方法选取2020年1~12月EICU住院患者275例作为对照组，实施常规管理；2021年1~10月EICU住院患者239例作为观察组，在常规管理基础上实施集束化干预策略联合闭环管理。结果实施后，观察组多重耐药菌感染发生率明显低于对照组；患者住院日显著低于对照组，4项护理措施执行率(隔离标识、手卫生、环境消毒、医务人员相关知识知晓)、病原学送检率显著高于对照组（均P<0.05）。结论集束化干预联合信息化闭环管理可有效降低EICU多重耐药菌感染发生率。     

医院信息化平台住院陪护人员管理功能的开发与应用

目的 探讨医院信息系统中增加住院陪护管理功能的应用效果。方法 基于互联网医院、智慧医院等信息系统，开发信息化住院陪护管理功能，包括流行病学史调查、免费核酸申请、电子陪护证办理、体温监测登记及上报和统计查询。该功能与医院智慧护理链接后全院应用。比较功能应用前和应用后的遵医嘱一患一陪达标率、有效陪护证达标率、体温监测并登记日上报达标率和陪护证使用追溯率，评价护士和管理者疫情防控管理的人均耗时以及对该管理功能的满意度。结果 应用信息化陪护管理功能后，一患一陪达标率、有效陪护证达标率、体温监测并登记日上报达标率和陪护证使用追溯率显著高于应用前（均P＜0.05）；护士陪护管理人均耗时从（554.13±30.77）s降至（311.67±21.54）s（P＜0.05）；护士和管理者对该信息化陪护管理功能的满意度显著提高（均P＜0.05）。结论 信息化住院陪护管理功能的应用有效提升了疫情期间陪护的管理质量和管理效率，提高了一线护士和管理者的满意度。     

风险管理在儿科急诊护理工作中的应用研究

目的研究风险管理在儿科急诊护理工作中的应用。方法选取2021年10月至12月间来我科室就诊的100例患儿作为研究对象,将其分为研究组、对照组两组,每组各50例患儿。运用常规护理模式护理对照组患儿,运用风险管理模式,为研究组患儿给予护理干预,分析二组发生不良护理事故的情况并统计护理满意度。结果研究期间,研究组不良护理事件发生率为2.0%,对照组不良护理事件发生率为12.0%；研究组对护理工作的满意度为98.0%,对照组对护理工作的满意度为84.0%,P<0.05,组间差异具统计学意义。结论将风险管理应用于儿科急诊护理工作,可降低不良事件发生几率,保障患儿安全,具有推广应用价值。     

连续性血液净化治疗患儿静脉留置导管感染风险预测体系的构建及应用

目的:探讨连续性血液净化治疗患儿静脉留置导管感染风险因素,据此构建风险预测体系,并检验其实际应用效果,以期为临床预防护理提供依据。方法:选取医院2018年4月—2020年4月收治的400例连续性血液净化治疗患儿,按两组基础资料具有匹配性原则将其分为构建组300例、验证组100例,统计构建组中静脉留置导管感染患儿例数,通过单因素分析、多因素Logistic回归分析筛选静脉留置导管感染的独立危险因素,据此构建风险预测体系,并检验其在验证组中的应用效果。结果:经统计得到,构建组中静脉留置导管感染患儿共66例,感染发生率为22.00%;单因素分析得到,连续性血液净化治疗患儿静脉留置导管感染风险因素有穿刺部位、导管留置时间、插管次数、血流速度、血红蛋白、遵医依从性、抗生素使用时间、操作人员手卫生(P<0.05);多因素Logistic回归分析得到,连续性血液净化治疗患儿静脉留置导管感染独立风险因素有股静脉置管、导管留置时间>7 d、血流速度>180 mL/min、血红蛋白<100 g/L、遵医依从性差、抗生素使用时间>7 d(P<0.05);构建得到连续性血液净化治疗患儿静脉留置导管感染风险预测体系为P=1/[1+e^(-(-1.935+1.635×股静脉置管+1.740×导管留置时间>7 d+1.725×血流速度>180 mL/min+2.241×血红蛋白<100 g/L+2.089×遵医依从性差+1.331×抗生素使用时间>7 d))],ROC曲线分析显示,曲线下面积AUC=0.881,灵敏度为86.67%,特异性为97.14%,准确率为94.00%。结论:连续性血液净化治疗患儿静脉留置导管感染风险大,且风险因素复杂,研究构建的静脉留置导管感染风险预测体系灵敏度高、特异性强,评估准确率高。