1
|
Tolera BD, Gebremedhin KB. Nurses' knowledge and practice regarding venous-thromboembolism prevention in tertiary hospitals of Addis Ababa, Ethiopia: A cross-sectional study. JOURNAL OF VASCULAR NURSING 2024; 42:123-130. [PMID: 38823972 DOI: 10.1016/j.jvn.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 01/19/2024] [Accepted: 02/19/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND The prevalence of venous thromboembolism is steadily increasing in developing nations including Ethiopia. Nurses play a vital role in the prevention of venous thromboembolism. However, the level of nurses' knowledge, practice, and associated factors in venous thromboembolism prevention is not well-known across Ethiopia. This study aimed to assess nurses' knowledge, practice, and associated factors regarding venous-thromboembolism prevention in tertiary Hospitals of Addis Ababa, Ethiopia METHODS: An institutional-based cross-sectional study was conducted among 339 randomly selected nurses working at tertiary hospitals in Addis Ababa, Ethiopia. A validated questionnaire was used to collect data. Data were analyzed with SPSS version 25. Both descriptive and inferential statistics were used to describe and test the association between selected variables. RESULTS Out of the total 339 participants, only (51.6%) and (45.4%) had adequate knowledge and practice towards venous thromboembolism prevention respectively. Attending in-service training (AOR=1.701, p = 0.044) was significantly associated with knowledge of VTE prevention. Educational level (AOR= 3.871, P = 0.048), work experience (AOR=5.207, P<0.001), work location (AOR= 0.507, P = 0.019), working department (AOR= 2.959, P = 0.048), knowledge level (AOR= 0.477, P=0.005) were significantly associated with better preventive practice. CONCLUSION This study suggests that nurses' level of knowledge and practice towards venous thromboembolism prevention was inadequate. Nurses' educational level, attending in-service training, work experience, work location, and working department were determinant factors associated with nurses' knowledge and practice towards venous thromboembolism prevention. Therefore, upgrading nurses' educational level and providing in-service training on venous thromboembolism prevention is crucial for positive patient outcomes.
Collapse
Affiliation(s)
- Boka Dugassa Tolera
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Ethiopia.
| | | |
Collapse
|
2
|
Elmahdi E, Yousif BA, Alotaibi MN, Rashikh MA, Alotaibi N, Alsaab S, Alruways AF, Aladhyani A, Aljuaid MM, Alotaibi EH, Alharthy MR, Alotaibi H, Alqahtani DS. Awareness and Knowledge of Venous Thromboembolism Among Saudi Adults in the Dawadmi Province: A Cross-Sectional Study. Cureus 2024; 16:e52742. [PMID: 38384618 PMCID: PMC10880873 DOI: 10.7759/cureus.52742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
Background Venous thromboembolism (VTE) significantly contributes to the global disease burden. The annual incidence of VTE is one to two per 1,000 adults worldwide. We aimed to evaluate the awareness and knowledge of VTE risk factors, manifestations, prevention, and treatment options among the general adult population of Dawadmi, Riyadh, Saudi Arabia. Methodology We conducted a cross-sectional study using the self-designed and validated VTE knowledge questionnaire. A survey was conducted online via Google Documents, composed of 12 questions. Participants included in the study were over 18 years old, regardless of their medical history. However, medical students and healthcare providers were excluded. Results A total of 384 participants (46.4% men and 53.6% women) completed the survey; most respondents were between 18 and 28 years of age. Majority of the participants recognized that immobility, obesity, complicated surgery, road traffic accidents, smoking, and old age are the most common risk factors for VTE. However, more than half of the elderly and lower-educated participants did not identify complicated surgery and consumption of oral contraceptive pills as risk factors for VTE. Awareness of VTE was significantly higher among those with a family history of VTE and a graduate degree (p<0.001). Results showed a deficit of awareness and information about VTE, especially among males, those with low education, and elderly participants. Conclusion This study demonstrates the need for more awareness of VTE among the Saudi adult population. The urge to spread awareness and knowledge about VTE among the public in Dawadmi province is required.
Collapse
Affiliation(s)
- Essam Elmahdi
- Internal Medicine, College of Medicine, Shaqra University, Dawadmi, SAU
| | | | | | - Mohammad A Rashikh
- Pharmacology and Therapeutics, College of Medicine, Shaqra University, Dawadmi, SAU
| | - Nemer Alotaibi
- Pediatrics, College of Medicine, Shaqra University, Dawadmi, SAU
| | - Saad Alsaab
- Internal Medicine, College of Medicine, Shaqra University, Dawadmi, SAU
| | | | | | - Mohannad M Aljuaid
- Family and Community Medicine, College of Medicine, Shaqra University, Dawadmi, SAU
| | - Eid H Alotaibi
- Medicine, College of Medicine, Shaqra University, Dawadmi, SAU
| | | | - Hallal Alotaibi
- Internal Medicine, College of Medicine, Shaqra University, Dawadmi, SAU
| | | |
Collapse
|
3
|
Feng X, Luo H, Liu M, Jiang J, Li W, Li Y, Tian L. Development and validation of knowledge, attitude and practice questionnaire for pediatric nurses to prevent central venous device-related thrombosis in hospitalized children. Nurse Educ Pract 2023; 71:103694. [PMID: 37453368 DOI: 10.1016/j.nepr.2023.103694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023]
Abstract
AIM This study aimed to develop and validate a scientific and standardized knowledge, attitude and practice questionnaire of pediatric nurses' preventive care for central venous device-related thrombosis among hospitalized children. BACKGROUND Pediatric nurses play a significant role in the prevention of central venous device-related thrombosis for hospialized children. However, the status of pediatric nurses' knowledge, attitude and practice of central venous device-related thrombosis prevention has not been revealed due to the lack of assessment tools. METHODS This questionnaire was framed by the theory of knowledge, attitude and practice. The item pool was compiled through a literature review and a preliminary questionnaire was formed based on expert consultation. A total of 457 pediatric nurses from 10 tertiary class A general hospitals and specialized pediatric hospitals in China were selected for pre-survey. Item analysis, reliability and validity test were conducted to refine and evaluate the items to form a formal questionnaire. RESULTS A total of 54 items were proposed in three dimensions of knowledge, attitude and practice. In the exploratory factor analysis, five, three and three common factors were extracted for each dimension, accounting for 60.552%, 89.829% and 84.258% of the total variance, respectively. The content validity index of the three dimensions ranged from 0.968 to 1.000 at the scale level and from 0.833 to 1.000 at the item level. The Cronbach's α coefficients for the total questionnaire and each dimension were between 0.926 and 0.973. The retest reliability for the total questionnaire and each dimension was between 0.688 and 0.898. CONCLUSION The proposed questionnaire has good reliability and validity and it can be applied to evaluate pediatric nurses' knowledge, attitude and practice in preventing central venous device-related thrombosis for hospitalized children.
Collapse
Affiliation(s)
- Xinyu Feng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Hui Luo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Mengyuan Liu
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jing Jiang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Weijuan Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yinglan Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China; National Clinical Research Center of Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, Hunan, China; School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China.
| | - Lingyun Tian
- Department of Nursing, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
| |
Collapse
|
4
|
Tang X, Lyu WR, Jin Y, Wang R, Li XY, Li Y, Zhang CY, Zhao W, Tong ZH, Sun B. Modern thromboprophylaxis protocol based on guidelines applied in a respiratory intensive care unit: a single-center prospective cohort study. Thromb J 2022; 20:76. [PMID: 36510234 PMCID: PMC9746213 DOI: 10.1186/s12959-022-00439-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Critically ill patients in intensive care units (ICUs) are at high risk of venous thromboembolism (VTE). This study aimed to explore the prophylaxis effect under a guideline-based thromboprophylaxis protocol among critically ill patients in a respiratory ICU. METHODS For this single-center prospective cohort study, we followed the thromboprophylaxis protocol, which was drawn up based on relevant guidelines and Chinese experts' advice. Clinical data were entered into an electronic case report form and analyzed. Multivariate logistic regression was conducted to explore independent risk factors of VTE event under this protocol. RESULTS From August 1, 2014, to December 31, 2020, 884 patients underwent thromboprophylaxis according to this protocol; 10.5% of them received mechanical prophylaxis, 43.8% received pharmacological prophylaxis, and 45.7% received pharmacological combined with mechanical prophylaxis. The proportion of VTE events was 14.3% for patients who received the thromboprophylaxis protocol, of which 0.1% had pulmonary thromboembolism (PTE), 2.0% had proximal deep vein thrombosis (DVT), and 12.1% had isolated distal DVT. There was no significant difference between different thromboprophylaxis measures. Cirrhosis (OR 5.789, 95% CI [1.402, 23.894], P = 0.015), acute asthma exacerbation (OR 39.999, 95% CI [4.704, 340.083], P = 0.001), and extracorporeal membrane oxygenation treatment (OR 22.237, 95%CI [4.824, 102.502], P < 0.001) were independent risk factors for proximal DVT under thromboprophylaxis. CONCLUSIONS The thromboprophylaxis protocol based on guidelines applied in the ICU was practicable and could help decrease the proportion of PTE and proximal DVT events. The risk factors of VTE events happening under the thromboprophylaxis protocol require more attention. TRIAL REGISTRATION ClinicalTrials.gov: NCT02213978.
Collapse
Affiliation(s)
- Xiao Tang
- grid.24696.3f0000 0004 0369 153XDepartment of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang, Beijing, 100020 China
| | - Wen-Rui Lyu
- grid.24696.3f0000 0004 0369 153XDepartment of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang, Beijing, 100020 China
| | - Yu Jin
- grid.24696.3f0000 0004 0369 153XDepartment of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang, Beijing, 100020 China
| | - Rui Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang, Beijing, 100020 China
| | - Xu-Yan Li
- grid.24696.3f0000 0004 0369 153XDepartment of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang, Beijing, 100020 China
| | - Ying Li
- grid.24696.3f0000 0004 0369 153XDepartment of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang, Beijing, 100020 China
| | - Chun-Yan Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang, Beijing, 100020 China
| | - Wei Zhao
- grid.411607.5Department of Ultrasonic diagnosis, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhao-Hui Tong
- grid.24696.3f0000 0004 0369 153XDepartment of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang, Beijing, 100020 China
| | - Bing Sun
- grid.24696.3f0000 0004 0369 153XDepartment of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang, Beijing, 100020 China
| |
Collapse
|
5
|
Peng S, Kong X, Ma G, Hou J, Luo L, Xu R, Fan Y, Zhang J. Clinical Nurses’ Knowledge, Attitude and Practice of Catheter-Related Thrombosis and Its Influencing Factors: A Cross-Sectional Survey. Risk Manag Healthc Policy 2022; 15:2257-2268. [DOI: 10.2147/rmhp.s387124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
|
6
|
Assessment of knowledge, attitude, practice and associated factors of venous thromboembolism prophylaxis among health professionals. A cross sectional study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2021.100436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
7
|
Feng S, Li M, Wang K, Hang C, Xu D, Jiang Y, Jia Z. Knowledge, attitudes, and practices regarding venous thromboembolism prophylaxis: A survey of medical staff at a tertiary hospital in China. Medicine (Baltimore) 2021; 100:e28016. [PMID: 34889246 PMCID: PMC8663865 DOI: 10.1097/md.0000000000028016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
To assess the knowledge, attitudes, and practices regarding venous thromboembolism (VTE) prophylaxis among medical staff at a tertiary hospital in China.A self-administered web-based survey was completed by medical staff, and data about respondent knowledge, attitudes, and practices regarding VTE prophylaxis were gathered and analyzed with chi-square tests, using a 95% significance level.Of the 2079 medical staff invited to participate in the survey, a total of 2042 (including 921 clinicians and 1121 nurses) responded. The overall rate of correct responses to knowledge items was 57.6%; the rate was 60.1% for clinicians and 55.4% for nurses (P < .001). The median affirmative ("strongly agree"/"agree") rate for attitude items was 99.0% (range, 83.2%-99.4%). Medical staff members were most commonly concerned about the possibility of a financial penalty when a patient could not be treated with VTE prophylaxis (49.4%). Low levels of knowledge and participation of medical staff were identified most commonly as difficulties involved in VTE prophylaxis (48.5%). The median affirmative response rate for practice items was 58.2% (range, 51.1%-68.3%). All affirmative response rates for practice items were significantly higher for nurses than for clinicians (all P < .001).Although the overall attitude toward VTE prophylaxis was positive, the knowledge level was poor, especially among nurses, and the rate of affirmative responses regarding practices was low, especially among clinicians. Medical institutions should improve staff training regarding VTE prophylaxis, and medical staff should be encouraged to actively engage in VTE prophylaxis.
Collapse
Affiliation(s)
- Shangpeng Feng
- Department of Cardiology, Changzhou No. 2 People's Hospital, Changzhou, China
| | - Minhui Li
- Department of Obstetrics and Gynecology, Changzhou, China
- Department of Medical Division, Changzhou, China
| | - Kai Wang
- Department of Interventional and Vascular Surgery, Changzhou, China
| | | | - Dongmei Xu
- Department of Orthopedics, Changzhou No. 2 People's Hospital, Changzhou, China
| | - Ye Jiang
- Department of Cardiology, Changzhou No. 2 People's Hospital, Changzhou, China
| | - Zhongzhi Jia
- Department of Interventional and Vascular Surgery, Changzhou, China
| |
Collapse
|
8
|
Al Bshabshe A, Mousa WF, Alshehri MS, Saeed Alshahrani MM, Alamri OM, Alshehri FS, AlFlan MA, Alshehri AS. Awareness, knowledge, and attitude toward venous thromboembolism among Aseer Population, Saudi Arabia. J Family Med Prim Care 2021; 10:2411-2415. [PMID: 34322447 PMCID: PMC8284245 DOI: 10.4103/jfmpc.jfmpc_2430_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/21/2021] [Accepted: 02/23/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: Calls to carry efforts to increase awareness about venous thromboembolism (VTE) as a preventable major healthcare problem with serious consequences has been upraised. This study was planned to get an overview of the awareness, knowledge, and attitude toward VTE among Aseer population, Saudi Arabia and the need for an education plan. Materials and Methods: Questionnaire composed of 35 questions based cross-sectional study was conducted online via Google documents to public in Aseer that included both genders aged more than 18 years who agreed to be involved in the study, to assess knowledge and attitude toward VTE. The collected data were presented as numbers, percentages, and were analyzed using Statistical Package for Social Sciences version 24. Results: The results of the data showed that awareness knowledge and attitude toward VTE were lacking and unsatisfactory. Conclusion: Diligence to spread knowledge and awareness of VTE among public in Aseer is required. Further surveys involving other populations are warranted.
Collapse
Affiliation(s)
- Ali Al Bshabshe
- Department of Medicine/adult Critical Care Division, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | | | - Mohammed Sultan Alshehri
- Medical Student, Department of Medicine, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | | | - Omar Mohammed Alamri
- Medical Student, Department of Medicine, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Fayez Saeed Alshehri
- Medical Student, Department of Medicine, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Mohammed Ali AlFlan
- Medical Student, Department of Medicine, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Afnan Sultan Alshehri
- Medical Student, Department of Medicine, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| |
Collapse
|
9
|
Hebeshy MI, Hansen DM, Broome B, Abou Abdou S, Murrock C, Bernert D. Development of the Nurses' Intention to Use Deep Vein Thrombosis Preventive Measures Questionnaire. J Nurs Meas 2020; 28:E216-E232. [PMID: 33067374 DOI: 10.1891/jnm-d-19-00011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Deep vein thrombosis (DVT) is a serious condition resulting in poor patient outcomes. Therefore, methods to improve nurses' use of preventive measures for DVT are paramount. The purpose of this study was to develop and validate an instrument that captured nurses' intentions to use DVT preventive measures. METHODS Instrument development occurred in several stages stemming from the recommended formatted structure associated with theory of planned behavior (TPB). Content validity was established with a panel of experts, then the instrument was pilot tested with a sample of intensive care unit (ICU) nurses. RESULTS The final instrument consisted of four subscales, each subscale was tested with four items by content validity index (CVI) ranging between 0.8 and 1.0, and an overall S-CVI/Ave of 0.93. CONCLUSIONS The instrument demonstrated high content validity. Future research will test the instrument for psychometric properties.
Collapse
|
10
|
Xu Y, Wang W, Zhen K, Zhao J. Healthcare professionals' knowledge, attitudes, and practices regarding graduated compression stockings: a survey of China's big-data network. BMC Health Serv Res 2020; 20:1078. [PMID: 33238994 PMCID: PMC7690181 DOI: 10.1186/s12913-020-05933-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/17/2020] [Indexed: 11/11/2022] Open
Abstract
Background The accurate identification of venous thromboembolism prophylaxis implementation barriers is an important part of prophylaxis prevention. However, in China, data to help identify these barriers is limited. This study has two objectives: 1) to determine the knowledge, attitudes, and practices (KAPs) of healthcare professionals regarding graduated compression stockings (GCS) since the launch of the National Program for the Prevention and Management of Pulmonary Embolism (PE) and Deep Venous Thrombosis (DVT) in October 2018 and 2) to identify the obstacles and assist the program. Methods This was a cross-sectional study of 5070 healthcare professionals in China. We used exploratory factor and reliability analyses to evaluate the researcher-designed questionnaire’s reliability and validity. The formal questionnaire, which included demographic data, knowledge, attitudes, and clinical practice patterns, was distributed to healthcare professionals. Results Of the 5070 respondents, 32.5% had a good knowledge of GCS, 78.5% had a positive attitude towards their use, and 34.0% exhibited normative behavior when applying them. The KAPs of healthcare professionals towards GCS were significantly correlated with one another. Binary logistic regression suggested that the training received by healthcare professionals was an important factor affecting their knowledge regarding GCS usage. Conclusions The training provided for the use of GCS in China cannot meet medical staff needs and deserves more attention from policy makers. This represents an obstacle for venous thromboembolism prophylaxis, which restricts the effective implementation of the National Program for Prevention and Management of PE and DVT.
Collapse
Affiliation(s)
- Yaping Xu
- Department of Orthopedics, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Hepingli, Chaoyang District, Beijing, 100029, China. .,Bone Necrosis and Joint Preservation Reconstruction Center, China-Japan Friendship Hospital, Beijing, China. .,Department of Nursing, China-Japan Friendship Hospital, Beijing, China.
| | - Wei Wang
- Department of Nursing, China-Japan Friendship Hospital, Beijing, China
| | - Kaiyuan Zhen
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Jing Zhao
- Department of Nursing, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
11
|
Gao X, Qin H, Hang C, Wang K, Shi Y, Qian L, Zhou Y, Li Y, Jia Z. Knowledge, Behaviors, and Attitudes Regarding Venous Thromboembolism Prophylaxis: A Survey of Clinicians at a Tertiary Hospital of China. Ann Vasc Surg 2020; 72:365-372. [PMID: 32947000 DOI: 10.1016/j.avsg.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/19/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In this study, we sought to assess knowledge, attitudes, and behaviors regarding venous thromboembolism (VTE) prophylaxis among clinicians at a tertiary hospital of China. METHODS An electronic questionnaire was sent to clinicians to gather information regarding demographic data (5 items), knowledge about VTE prophylaxis (21 items), behaviors regarding VTE prophylaxis (8 items), and attitudes regarding VTE prophylaxis (7 items). Answers of "strongly agree" and "agree" on the behaviors and attitude items were defined as affirmative responses. Clinicians were also asked to provide suggestions regarding VTE prophylaxis. RESULTS A total of 867 clinicians were included in this study. The overall correct response rate for knowledge items was 60.9%. The median affirmative response rate for behavior items was 48.6% (range 29.5-80.3%), and the median affirmative response rate for attitude items was 98.7% (range 96.9-99.3%). Clinicians were most concerned about the adverse effects triggered by chemical VTE prophylaxis (79.5%) and possibility of a financial penalty when a patient could not be treated with VTE prophylaxis (72.3%). Low patient compliance and low level of clinician knowledge and participation were identified most commonly as difficulties involved in VTE prophylaxis. A total of 78 suggestions were collected; these suggestions generally focused on improving the quality and frequency of staff training (n = 24) and enhancing learning opportunities (n = 22). CONCLUSIONS Although the clinicians' overall attitude toward VTE prophylaxis was positive, the knowledge level was relatively poor, and the rate of affirmative responses regarding behaviors was low. Medical institutions should improve clinician training regarding VTE prophylaxis.
Collapse
Affiliation(s)
- Xueli Gao
- Department of Nursing, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, People's Republc of China
| | - Hui Qin
- Department of Medical Division, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, People's Republc of China
| | - Cheng Hang
- Department of Nursing, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, People's Republc of China
| | - Kai Wang
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, People's Republc of China
| | - Yixin Shi
- Department of Scientific Teaching Section, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, People's Republc of China
| | - Liulan Qian
- Department of Scientific Teaching Section, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, People's Republc of China
| | - Yi Zhou
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, People's Republc of China
| | - Yemei Li
- Department of Pulmonary and Critical Care, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, People's Republc of China.
| | - Zhongzhi Jia
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, People's Republc of China.
| |
Collapse
|
12
|
Brenner B, Arya R, Beyer-Westendorf J, Douketis J, Hull R, Elalamy I, Imberti D, Zhai Z. Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at-risk patient groups: pregnancy, elderly and obese patients. Thromb J 2019; 17:24. [PMID: 31889915 PMCID: PMC6935082 DOI: 10.1186/s12959-019-0214-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 12/13/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) accounts for an estimated 900,000 cases per year in the US alone and constitutes a considerable burden on healthcare systems across the globe. OBJECTIVE To understand why the burden is so high, qualitative and quantitative research was carried out to gain insights from experts, guidelines and published studies on the unmet clinical needs and therapeutic strategies in VTE prevention and treatment in three populations identified as being at increased risk of VTE and in whom VTE prevention and treatment were regarded as suboptimal: pregnant women, the elderly and obese patients. METHODOLOGY A gap analysis methodology was created to highlight unmet needs in VTE management and to discover the patient populations considered most at risk. A questionnaire was devised to guide qualitative interviews with 44 thrombosis and haemostasis experts, and a review of the literature on VTE in the specific patient groups from 2015 to 2017 was completed. This was followed by a Think Tank meeting where the results from the research were discussed. RESULTS This review highlights the insights gained and examines in detail the unmet needs with regard to VTE risk-assessment tools, biomarkers, patient stratification methods, and anticoagulant and dosing regimens in pregnant women, the elderly and obese patients. CONCLUSIONS Specifically, in pregnant women at high risk of VTE, low-molecular-weight heparin (LMWH) is the therapy of choice, but it remains unclear how to use anticoagulants when VTE risk is intermediate. In elderly patients, evaluation of the benefit of VTE prophylaxis against the bleeding risk is particularly important, and a head-to-head comparison of efficacy and safety of LMWH versus direct oral anticoagulants is needed. Finally, in obese patients, lack of guidance on anticoagulant dose adjustment to body weight has emerged as a major obstacle in effective prophylaxis and treatment of VTE.
Collapse
Affiliation(s)
- Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Roopen Arya
- King’s Thrombosis Centre, Department of Haematological Medicine, King’s College Hospital Foundation NHS Trust, London, UK
| | - Jan Beyer-Westendorf
- Thrombosis Research Unit, Department of Medicine I, Division Hematology, University Hospital ‘Carl Gustav Carus’ Dresden, Dresden, Germany
- King’s Thrombosis Service, Department of Haematology, King’s College London, London, UK
| | - James Douketis
- Department of Medicine, McMaster University, Hamilton, Ontario Canada
- Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario Canada
| | - Russell Hull
- Foothills Medical Centre and Thrombosis Research Unit, University of Calgary, Calgary, Canada
| | - Ismail Elalamy
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
- Hematology and Thrombosis Center, Tenon University Hospital, Sorbonne University, INSERM U938, Sorbonne University, Paris, France
| | | | - Zhenguo Zhai
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| |
Collapse
|
13
|
Xu Y, Wang W, Zhao J, Wang J, Zhao T. Knowledge, attitude, and practice of healthcare professionals toward clinically applying graduated compression stockings: results of a Chinese web-based survey. J Thromb Thrombolysis 2019; 47:102-108. [PMID: 30293224 PMCID: PMC6336747 DOI: 10.1007/s11239-018-1749-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study had three objectives: (1) to investigate healthcare professionals’ knowledge, attitude, and practice toward clinically applying graduated compression stockings, (2) to analyze the influencing factors, and (3) to provide data to support departments that develop health policies. A self-administered web-based survey was completed by 1,444 healthcare professionals, including physicians and nurses from 15tertiary hospitals and four secondary hospitals from 10 provinces in China. Reliability analysis and exploratory factor analysis were used to evaluate the researcher-designed questionnaire’s reliability and validity. The formal questionnaire, which included demographic data (eight items), knowledge (ten items), attitudes (four items), and clinical practice patterns (six items), was distributed among healthcare professionals. The relationships and mechanisms among the variables were explored using descriptive statistical analysis, Pearson’s correlation coefficients, and multiple linear regression analysis. Of the 1,444 respondents, 31.2% had good knowledge of clinically applying graduated compression stockings, 83.5% had a positive attitude toward clinically applying them, and 30.4% of respondents exhibited normative behavior when applying them. The multiple linear regression analysis indicated that training was an important factor influencing the knowledge, attitude, and practice toward clinically applying graduated compression stockings. The healthcare professionals’ attitude toward clinically applying graduated compression stockings was positive, but the related knowledge was poor, and the code of behavior was deficient. Medical institutions should improve training for clinically applying graduated compression stockings among healthcare professionals and standardize the use of graduated compression stockings to facilitate the prevention of hospital-acquired venous thromboembolism.
Collapse
Affiliation(s)
- Yaping Xu
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing, China. .,Bone Necrosis and Joint Preservation Reconstruction Center, China-Japan Friendship Hospital, Beijing, China. .,Department of Bone and Joint Surgery, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Hepingli, Chaoyang District, Beijing, 100029, China.
| | - Wei Wang
- Department of Nursing, China-Japan Friendship Hospital, Beijing, China
| | - Jing Zhao
- Department of Nursing, China-Japan Friendship Hospital, Beijing, China
| | - Jiahuan Wang
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing, China.,Bone Necrosis and Joint Preservation Reconstruction Center, China-Japan Friendship Hospital, Beijing, China
| | - Tingting Zhao
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing, China.,Bone Necrosis and Joint Preservation Reconstruction Center, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
14
|
Zhou WH, He JQ, Guo SG, Walline J, Liu XY, Tian LY, Zhu HD, Yu XZ, Li Y. Venous thromboembolism in the emergency department: A survey of current best practice awareness in physicians and nurses in China. World J Emerg Med 2019; 10:5-13. [PMID: 30598712 DOI: 10.5847/wjem.j.1920-8642.2019.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND For emergency department (ED) patients, risk assessment, prophylaxis, early diagnosis and appropriate treatment of venous thromboembolism (VTE) are essential for preventing morbidity and mortality. This study aimes to investigate knowledge amongst emergency medical staff in the management of VTE. METHODS We designed a questionnaire based on multiple scales. The questionnaire was distributed to the medical and nursing clinical staff in the large urban ED of a medical center in Northern China. Data was described with percentages and the Kruskal-Wallis test was used to compare ranked data between different groups. The statistical analysis was done using the SPSS 22.0 software. RESULTS In this survey, 180 questionnaires were distributed and 174 valid responses (response rate of 96.67%) were collected and analyzed. In scores of VTE knowledge, no significant differences were found with respect to job (doctor vs. nurse), the number of years working in clinical medicine, education level, and current position, previous hospital experience and nurses' current work location within the ED. However, in pair wise comparison, we found participants who worked in ED for more than 5 years (n=83) scored significantly higher on the questionnaire than those under 5 years (n=91) (95.75 vs. 79.97, P=0.039). There was a significant difference in some questions based on gender, age, job, and nurse work location, number of working years, education level, and different ED working lifetime. CONCLUSION Our survey has shown deficiencies among ED medical staff in knowledge and awareness of the management of VTE. We recommend several changes be considered, such as the introduction of an interdisciplinary workshop for medical staff; the introduction of a standardized VTE protocol; a mandatory study module on VTE for new physicians and nurses; the introduction of a mandatory reporting system for adverse events (including VTE).
Collapse
Affiliation(s)
- Wen-Hua Zhou
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| | - Jian-Qiang He
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| | - Shi-Gong Guo
- Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford, UK
| | - Joseph Walline
- Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiao-Ying Liu
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| | - Li-Yuan Tian
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| | - Hua-Dong Zhu
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| | - Xue-Zhong Yu
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| | - Yi Li
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| |
Collapse
|
15
|
Xu Y, Zhao J, Chen Y. Prevention of venous thromboembolism in patients undergoing major orthopedic surgery in China: a qualitative study of patients' perceptions. J Orthop Surg Res 2018; 13:98. [PMID: 29690898 PMCID: PMC5937805 DOI: 10.1186/s13018-018-0813-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/17/2018] [Indexed: 01/08/2023] Open
Abstract
Background Venous thromboembolism (VTE) is the third leading cause of cardiovascular-associated death worldwide, and VTE prevention is one of the top patient safety strategies that hospitals can adopt. This study aimed to understand patients’ perceptions of VTE prevention related to major orthopedic surgery in order to guide the clinical practice of medical staff and improve patient quality of life. Patients undergoing major orthopedic surgery should receive interventions to prevent VTE. To encourage patient participation, these interventions should be patient-centered. However, few studies have examined the perceptions of VTE prevention among patients undergoing major orthopedic surgery. Methods Participants were purposively selected from among patients undergoing major orthopedic surgery in the orthopedic department of a level-three, class-A hospital in Beijing, China. Data were collected through in-depth semi-structured interviews, and findings were based on a thematic content analysis. All interviews were held during each patient’s hospital stay. Results From eight patients who participated, the following themes were identified: (1) unclear understanding of VTE, (2) poor understanding of the severity of postoperative VTE, and (3) poor understanding of VTE prevention. Conclusions There are weak links in clinical care related to VTE prevention. We should aim to more completely understand patients’ needs, strengthen the health education provided to patients, and improve patient adherence to preventative measures.
Collapse
Affiliation(s)
- Yaping Xu
- Department of Bone and Joint Surgery, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Hepingli, Chaoyang District, Beijing, 100029, China. .,Department of Trauma Orthopedics, China-Japan Friendship Hospital, Beijing, China. .,Bone Necrosis and Joint Preservation Reconstruction Center, China-Japan Friendship Hospital, Beijing, China.
| | - Jing Zhao
- Department of Nursing, China-Japan Friendship Hospital, Beijing, China
| | - Yuzhao Chen
- Department of Nursing, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
16
|
MA YF, XU Y, Chen YP, Wang XJ, Deng HB, He Y, WU XJ. Nurses' objective knowledge regarding venous thromboembolism prophylaxis: A national survey study. Medicine (Baltimore) 2018; 97:e0338. [PMID: 29620660 PMCID: PMC5902296 DOI: 10.1097/md.0000000000010338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Venous thromboembolism (VTE) is a common vascular disorder with high mortality and morbidity. Clinical nurses are a pivotal group that can serve as first-line health care providers. Lack of knowledge about VTE is an important barrier to effective nursing performance. This study aimed to determine nurses' knowledge of VTE prophylaxis through a nationwide survey across China, to understand gaps between current knowledge, and guidelines, and to help improve clinical nursing.The survey included 5 topics with 68 items on VTE, including basic knowledge, risk assessment, basic prophylaxis, physical prophylaxis, and pharmacological prophylaxis.The survey was distributed to 106 AAA-grade hospitals throughout China; 5218 valid questionnaires were submitted for analysis. There were 5097 women and 121 men respondents, with average age 30.29 ± 8.60 years. The average rate of correct responses regarding VTE knowledge was 59.90 ± 15.63%; 77.81% of subjects answered more than half of the survey items correctly. Better knowledge about thromboprophylaxis was observed among nurses who were more highly educated, more experienced, had received continuing education, intensive care unit (ICU), and lead nurses. Correct response rates were 68.39 ± 17.03%, 60.35 ± 21.01%, 75.51 ± 22.85%, 41.72 ± 17.47%, and 46.01 ± 21.22% for basic knowledge, risk assessment, basic prophylaxis, physical prophylaxis, and pharmacological prophylaxis, respectively.Respondents showed satisfactory results regarding basic prophylaxis, basic knowledge, and risk assessment for VTE; respondents had poorer knowledge regarding physical and pharmacological prophylaxis. Better mastery of knowledge about thromboprophylaxis was observed among nurses who were more highly educated, more experienced, had received continuous education, ICU, and lead nurses.This study suggested that nurse trainers should develop comprehensive educational programs that focus on low correct rate aspects. Higher-level continuous education could improve nurses' knowledge of thromboprophylaxis.
Collapse
|
17
|
Sun B, Tang X, Liang L, Tong Z. A survey of knowledge and application of mechanical thromboprophylaxis among the medical staff of intensive care units in North China. CLINICAL RESPIRATORY JOURNAL 2017; 12:1591-1597. [PMID: 28960850 DOI: 10.1111/crj.12715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 09/17/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Mechanical prophylaxis with graduated compression stockings (GCS) or intermittent pneumatic compression (IPC) is suggested for patients who are bleeding or at high risk for major bleeding. OBJECTIVES To explore how intensive care unit (ICU) medical staff in North China comprehend and practice mechanical thromboprophylaxis. METHODS Questionnaires comprising 39 questions including 4 dimensions of thromboprophylaxis were administered in ICUs in North China. RESULTS Fifty-two ICUs were surveyed from September 2014 to January 2015. A total of 2500 questionnaires were sent and 1861 were returned, corresponding to approximately 74.4%. Approximately 52.30% of all surveyed medical staff indicated they often practiced mechanical thromboprophylaxis. Twenty-five percentage of them never used or had never heard of mechanical thromboprophylaxis. Thirty-eight percent and twenty-four percent of them doubted the effectiveness of GCS and IPC respectively. Regarding the use of GCS, 50.2% of them were concerned about skin injury, 57.4% were concerned about difficulty with removal and 57.6% were anxious about discomfort. Thirty-five percent of the medical staff feared the ease of thrombus release during IPC thromboprophylaxis. CONCLUSIONS A wide gap exists with regards to the knowledge and application of mechanical thromboprophylaxis for venous thromboembolism (VTE) between the medical staff of our country and abroad. Strengthened standardized training may help medical staff improve their understanding and application of mechanical thromboprophylaxis. Amelioration of concerns regarding IPC and GCS could help increase the rate of mechanical thromboprophylaxis for VTE, reduce the occurrence of VTE in ICUs and improve the prognosis of these critically ill patients.
Collapse
Affiliation(s)
- Bing Sun
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Chaoyang, Beijing 100020, China.,Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Chaoyang, Beijing 100020, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Chaoyang, Beijing 100020, China.,Beijing Engineering Research Center for Diagnosis and Treatment of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Chaoyang, Beijing 100020, China
| | - Xiao Tang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Chaoyang, Beijing 100020, China.,Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Chaoyang, Beijing 100020, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Chaoyang, Beijing 100020, China.,Beijing Engineering Research Center for Diagnosis and Treatment of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Chaoyang, Beijing 100020, China
| | - Lirong Liang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Chaoyang, Beijing 100020, China.,Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Chaoyang, Beijing 100020, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Chaoyang, Beijing 100020, China.,Beijing Engineering Research Center for Diagnosis and Treatment of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Chaoyang, Beijing 100020, China
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Chaoyang, Beijing 100020, China.,Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Chaoyang, Beijing 100020, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Chaoyang, Beijing 100020, China.,Beijing Engineering Research Center for Diagnosis and Treatment of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Chaoyang, Beijing 100020, China
| |
Collapse
|
18
|
Gong JN, Yang YH. Current Clinical Management Status of Pulmonary Embolism in China. Chin Med J (Engl) 2017; 130:379-381. [PMID: 28218208 PMCID: PMC5324371 DOI: 10.4103/0366-6999.199841] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Indexed: 12/15/2022] Open
Affiliation(s)
- Juan-Ni Gong
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing 100020, China
| | - Yuan-Hua Yang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing 100020, China
| |
Collapse
|