项目管理在降低呼吸重症监护室环境物品表面多重耐药菌检出率中的应用

目的:探讨项目管理在降低呼吸重症监护室(RICU)环境物品表面多重耐药菌检出率中的应用效果。方法:采用目的抽样方法,选取医院呼吸与危重症医学科RICU 17张编制床位、32处高频接触环境物品表面及42名工作人员为观察对象。2019年1月—2019年3月实施RICU常规管理,2019年4月—2019年6月实施项目管理。比较项目管理前后RICU各类别工作人员手卫生依从率、RICU环境物品表面清洁合格率及多重耐药菌检出率。结果:在项目管理后RICU各类别工作人员手卫生依从率均高于项目管理前(P<0.05);项目管理后RICU环境物品表面清洁合格率较项目管理前升高(P<0.05);项目管理后多重耐药菌(MDRO)病人床单位及病区办公区域环境物体表面的耐甲氧西林金黄色葡萄球菌(MRSA)和耐碳青霉烯鲍曼不动杆菌(CRAB)检出率均较项目管理前降低(P<0.05)。结论:项目管理可有效提高RICU各类别工作人员手卫生依从性及环境物品表面清洁合格率,降低RICU环境物品表面多重耐药菌检出率。     

Clinical characteristics of pediatric patients with COVID-19 between Omicron era vs. pre-Omicron era

IntroductionDetailed data on clinical characteristics in children with the omicron strain of SARS-COV-2 are limited.MethodsWe conducted a retrospective observational study of children with COVID-19 at the National Center for Child Health and Development to evaluate the clinical manifestations during and before the emergence of the omicron variant. Only symptomatic patients without underlying diseases were included. Participants were divided into two temporal groups: the “omicron era” (1/2022–2/2022) and the “pre-omicron era,” where the delta variant predominated (7/2021–11/2021). The patients were subclassified into an older vaccine-eligible group (aged 12–17 years), a younger vaccine-eligible group (aged 5–11 years), and a vaccine-ineligible group (aged 0–4 years).ResultsWe compared 113 patients in the omicron era with 106 in the pre-omicron era. Most patients in both eras had non-severe disease, and no patients required mechanical ventilation or died. Among patients aged 0–4 years, sore throat and hoarseness were more common during the omicron era than the pre-omicron era (11.1% vs. 0.0% and 11.1% vs. 1.5%, respectively). Croup syndrome was diagnosed in all patients with hoarseness. Among patients aged 5–11 years, vomiting was more frequent during the omicron era (47.2%) than during the pre-omicron era (21.7%). Cough and rhinorrhea were less common during the omicron era in patients aged 0–4 and 5–11 years, respectively, than during the pre-omicron era.ConclusionsIn children with COVID-19, clinical manifestations differed between the omicron and pre-omicron eras. In the Omicron era, croup syndrome was more frequent in vaccine-ineligible children.     

Practice developments supporting change implementation in Wellington,New Zealand (NZ) for ‘continuity of care when transitioning complex preterm infants from NICU to home’

The discussion paper will focus on continuity of care relating to previous NZ research, specifically to transitioning complex preterm infants from NICU to home based on parent experiences, and on the practice developments that have occurred, to ensure optimal health outcomes. Previous NZ research discovered parent desire a consistent service delivery for the entire transition journey from NICU and at home.An informative and comprehensive opportunity has occurred for reflective professional practice, evaluation, development and implementation which have transpired in positive change through innovative practice developments and support change implementation in Wellington, NZ. This has resulted in the articulation of a model of care that has both embraced and integrated parental desires for a continuity of care process for complex preterm infants. This has been achieved by having the same Discharge Facilitator/Key Case Manager present within the NICU and external to the NICU for Home-based infants for the entire transition journey.The paper will focus and emphasis additional practice development changes and furthermore, will present a real purpose, for other countries to learn of such practice developments that have exemplified a celebratory success for families of Wellington, NZ.     

Motivational interviewing for maternal Immunizations: Intervention development

Background and ObjectiveVaccine uptake during pregnancy remains low. Our objectives were to describe 1) development and adaptation of a clinician communication training intervention for maternal immunizations and 2) obstetrics and gynecology (ob-gyn) clinician and staff perspectives on the intervention and fit for the prenatal care context.MethodsDesign of the Motivational Interviewing for Maternal Immunizations (MI4MI) intervention was based on similar communication training interventions for pediatric settings and included presumptive initiation of vaccine recommendations (“You’re due for two vaccines today”) combined with motivational interviewing (MI) for hesitant patients. Interviews and focus group discussions were conducted with ob-gyn clinicians and staff in five Colorado clinics including settings with obstetric physicians, certified nurse midwives (CNMs), and clinician-trainees. Participants were asked about adapting training to the ob-gyn setting and their implementation experiences. Feedback was incorporated through iterative changes to training components.ResultsInterview and focus group discussion results from participants before (n = 3), during (n = 11) and after (n = 25) implementation guided intervention development and adaptation. Three virtual, asynchronous training components were created: a video and two interactive modules. This virtual format was favored due to challenges attending group meetings; however, participants noted opportunities to practice skills through role-play were lacking. Training modules were adapted to include common challenging vaccine conversations and live-action videos. Participants liked interactive training components and use of adult learning strategies. Some participants initially resisted the presumptive approach but later found it useful after applying it in their practices. Overall, participants reported that MI4MI training fit well with the prenatal context and recommended more inclusion of non-clinician staff.ConclusionsMI4MI training was viewed as relevant and useful for ob-gyn clinicians and staff. Suggestions included making training more interactive, and including more complex scenarios and non-clinician staff.     

Health-related quality of life after isolated limb perfusion compared to extended resection,or amputation for locally advanced extremity sarcoma: Is a limb salvage strategy worth the effort?

IntroductionThe aim of this study was to compare long-term patient reported outcomes (PROs) in patients with locally advanced extremity soft tissue sarcoma (eSTS) after isolated limb perfusion followed by resection (IR), compared to extended resection (ER), primary amputation (A) or secondary amputation after IR (IR-A).MethodsPatients were selected from the respondents of a multi-institutional cross-sectional cohort survivorship study (SURVSARC) conducted among sarcoma survivors registered in the Netherlands Cancer Registry (NCR), 2–10 years after diagnosis. Used PROs were the EORTC QLQ-C30, the Cancer worry scale (CWS), the Hospital Anxiety and Depression Scale (HADS), and the Toronto Extremity Salvage Score (TESS).ResultsWe identified 97 eSTS survivors: IR = 20, ER = 49, A = 20, IR-A = 8. While there were no differences in PROs between IR and ER, results showed better functioning and functionality in both groups versus the amputation groups. The amputation groups scored significantly lower on physical functioning (A = 62.7, IR-A = 65.7 versus IR = 78.0, ER = 82.7, p = 0.001) and role functioning (A = 67.5, IR-A = 52.8 versus IR = 79.2, ER = 80.6, p = 0.039), both EORTC QLQ-C30 scales. Also for the TESS, the scores were significantly lower for the amputation groups compared to the limb sparing groups (upper extremity p = 0.007 with A = 68.9, IR-A = 71.6 versus IR = 93.3, ER = 91.1; lower extremity p < 0.001 with A = 72.2, IR-A50.9 versus IR = 84.5 and ER = 85.5). There were no significant differences between the groups on cancer worry, anxiety and depression.ConclusionHRQoL in eSTS survivors treated with IR or ER is equal; for maintenance of physical functioning and functionality IR and ER outperform an amputation.     

Survival analysis of crown margin repair: A retrospective study in a dental school setting

BackgroundRepairing crowns with defective margins is minimally invasive and cost-effective compared with replacement. The authors’ objectives were to examine the survival trajectory of crown margin repairs and to determine the factors associated with survival.MethodsRecords of adult patients from January 2008 through August 2019 were reviewed for crown margin repairs completed at University of Iowa College of Dentistry. A total of 1,002 crown margin repairs were found. Each repair was followed through the end of study in 2019 or until an event (for example, additional repair, endodontic treatment, crown replacement, or extraction). A Cox proportional hazards model was used to study the relationship between selected covariates and time to event.ResultsDuring the follow-up period, 32.8% of the repairs needed reintervention. In the final model, repair material was the only significant covariate. No difference was found between the survival of repairs done with resin-modified glass ionomer and amalgam. However, the repairs done with resin-based composite and conventional glass ionomer were more likely (1.5 times: 95% CI, 1.02 to 2.10 times; and 2 times: 95% CI, 1.40 to 2.73 times, respectively) to need reintervention than were those done with amalgam.ConclusionsMedian survival time of crown margin repairs was 5.1 years (95% CI, 4.48 to 5.72 years). Median survival times for amalgam, resin-modified glass ionomer, resin-based composite, and glass ionomer repair materials were 5.7 years (95% CI, 4.80 to 6.25 years), 5.3 years (95% CI, 4.73 to 6.34 years), 3.2 years (95% CI, 2.51 to 6.19 years), and 3.0 years (95% CI, 2.53 to 3.62 years), respectively.Practical ImplicationsWhen considering crown margin repairs, resin-modified glass ionomer or amalgam is preferable to resin-based composite or glass ionomer.