季节性指数平滑法在预测某院儿科门诊人次中的应用

目的应用季节性指数平滑法预测某院儿科门诊人次,为儿科合理调配医疗资源提供科学依据。方法基于2013年1月1日-2018年12月31日某院儿科门诊人次数据,使用SPSS22.0软件建立季节性指数平滑模型,采用2016年1月1日-2018年12月31日各季度儿科门诊人次数据进行验证,并对2019年1月1日-2020年12月31日儿科门诊人次进行预测。结果季节性指数平滑法的最优预测模型为Winters相加模型,该模型在Gamma(趋势)、Delta(季节)均有统计学意义,平稳的R^2分别为0.76,R^2值为0.79,标准化的BIC为20.69,模型残差为白噪声序列,平均相对误差为8.85%;2019年1月1日-2020年12月31日某院儿科门诊人次的预测仍呈现出持续上升的季节性和周期性趋势。结论季节性指数平滑法的Winters相加模型能够较好的拟合该院儿科门诊人次的实际值,可用于儿科门诊量及变化趋势的预测,值得推广应用。     

景德镇市三级医院儿科护理人员执业环境调查研究

目的 调查景德镇市全市三级医院儿科护理人员执业环境,为护理人员执业环境改善提供参考。方法 纳入2019 年4 月～2020 年4 月景德镇市全市三级医院儿科护理人员80 例,采用儿科临床护理人员一般情况调查表、儿科临床护士执业环境测评量表调查儿科护理人员执业环境情况,比较儿科护士执业环境各维度评分与磁性医院均分、儿科护士执业环境评分前5 位及后5 位条目。结果 与磁性医院均分相比,景德镇市全市三级医院儿科护理人员在护士参与医院事务、人力和物力配备、医护合作及薪酬待遇和社会地位几个维度评分明显较低,差异有统计学意义（P＜0.05）;护士执业环境评分前5 位条目分别为医院积极实施护士岗位培训和继续教育计划、护士长领导能力及管理能力强、护理团队能够针对患者护理问题进行日常讨论、科室的医护人员协同工作、医院实施护理质量持续改进;评分后5 位条目分别为有机会参与进修、成为医院护理委员会成员、参与医院管理决策、科室有充足护理人员完成护理工作、参与医院内部管理。结论 景德镇市全市三级医院儿科护理人员执业环境整体评分有待提升,应针对执业环境现状,积极促进护理人员参与医院管理决策,为其提供进修机会,改善执业环境。     

Radiofrequency Catheter Ablation for Dyssynchrony‐induced Dilated Cardiomyopathy in an Infant

The relationship between accessory pathway‐mediated ventricular preexcitation and left ventricular dyssynchrony‐induced dysfunction has been described in patients with Wolff–Parkinson–White (WPW) syndrome in the absence of sustained supraventricular tachycardia (SVT). Supraventricular tachycardia in infants is usually successfully suppressed with antiarrhythmic medications, but catheter ablation has ultimately been required as definitive treatment in medically resistant cases. Catheter ablation has not been described in young infants for dyssynchrony‐related dilated cardiomyopathy in the absence of SVT. We describe a case of an infant with WPW who did not have sustained supraventricular tachycardia, but who developed rapid progression of ventricular dysfunction after birth. Preexcitation could not be medically suppressed but was successfully ablated. This was followed by complete resolution of ventricular dysfunction within 2 months.     

The older patient with syncope: practicalities and controversies

Introduction

Corticosteroid administration in Kawasaki disease (KD) is controversial but accepted as treatment for patients who do not respond to initial treatment. The impact of corticosteroids on evolving coronary artery aneurysms (CAA) and future vascular remodelling is unknown.

Methods and results

The clinical history of 80 patients (73% male; median age at diagnosis 2.2 years) seen from 1990 to 2008 with CAAs after KD were reviewed, 19 (24%) of whom received systemic corticosteroids in the acute phase (14 for ≤ 3 days, 5 for 4+ days). CAA z-scores were assessed at baseline, 2-3 months, and 1 year after the acute phase. Linear regression models adjusted for repeated measures were used to determine the association between change in CAA z-score over time and corticosteroid use, adjusting for patient age at diagnosis, gender, intravenous immunoglobulin use, total days of fever, albumin level, hemoglobin level and platelet count.

Results

The corticosteroid treated group had longer duration of fever in the acute phase (median 17 vs. 11 days, p = 0.04). Adjusted CAA z-scores at diagnosis, 2-3 months and 1 year follow-up for CAA in the left anterior descending decreased (from + 5.5 to + 3.5 to + 1.9) in those not treated with corticosteroids, but progressed for those treated with corticosteroids (from + 7.4 to + 17.5 to + 15.8), regardless of duration of corticosteroid treatment. Similar results were noted for CAA of the right coronary artery and the left main coronary artery.

Conclusions

The use of corticosteroids in the acute phase of KD for patients with evolving CAAs may be associated with worsening involvement and impaired vascular remodelling and warrants further study.     

Continuous positive airway pressure and noninvasive ventilation adherence in children

BackgroundAdherence to continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) is crucial for the successful treatment of sleep-disordered breathing. The aim of our study was to analyze the adherence of children to long-term home CPAP/NIV treatment.MethodsWe analyzed data from all consecutive patients older than the age of 2 years, in whom CPAP/NIV treatment was initiated in a specialized pediatric NIV and in those who were receiving CPAP/NIV treatment at home for at least 1 month. Data of the memory cards of the ventilators and nocturnal gas exchange were analyzed during a routine CPAP/NIV overnight control in the hospital. CPAP/NIV adherence during the previous month was analyzed according to patient’s age, ventilatory mode, type of interface, nocturnal gas exchange, and duration of treatment.ResultsThe data of 62 children (mean age, 10 ± 5 years) with obstructive sleep apnea (n = 51) treated with CPAP and neuromuscular disease (n = 6) or lung diseases (n = 5) treated with NIV were analyzed. Mean adherence was 8:17 ± 2:30 h:min per night, and the results did not significantly differ between CPAP and NIV adherence. Seventy-two percent of the patients used their device >8 h per night. The mean number of nights of CPAP/NIV use during the last month was 26 ± 5 nights per month. Treatment adherence was not correlated to age, the type of underlying disease, the type of interface (nasal, facial mask, or nasal cannula), nocturnal gas exchange, and duration of CPAP/NIV treatment.ConclusionLong-term CPAP/NIV adherence at home was extremely high in this group of children followed in a pediatric NIV unit. This finding may explain the lack of effect of the interface, nocturnal gas exchange, and duration of CPAP/NIV treatment.