Objective To formulate standardized procedure of incontinence-associated dermatitis (IAD) in ICU and evaluate the outcomes.Methods The standardized procedure of IAD,including training program,risk assessment workflow,grading intervention process and physician-nurse communication style,was formulated based on the best evidences combined with the experience of clinical team and patients needs.Then,IAD standardized procedure was applied to the quality improvement project of ICU,and the incidence and severity degrees of IAD were evaluated.Results The total incidence of IAD was on the decline before,during and after improvement,22.43％(96/428),16.06％(71/442),13.90％(51/367),the difference was statistically significant (x2=11.06,P＜ 0.01).The incidence of severe IAD was 2.57％ (11/428),0.45％ (2/442),0.27％(1/367) before,during and after improvement,the difference was statistically significant (x2=11.67,P＜0.01).The incidence of fungal infection was 5.14％ (22/428),2.04％ (9/442),1.63％ (6/367) before,during and after improvement,the difference was statistically significant (x2=10.53,P ＜ 0.01).Conclusions Application of evidence-based practice with specification of IAD,can improve nursing quality and promote patient safety.

Objective To evaluate imaging diagnosis, differential diagnosis, surgery and interventional therapy of hepatic angiomyolipoma associated with tuberous sclerosis.Methods Clinical features, imaging appearances and interventional therapy for 2 cases of HAML in TS were retrospectrively analyzed. Results The features of HAML in TS are as following:(1) Two cases were female with no history of hepatitis and hepatocirrhosis, liver function test and alpha feto protein were normal. (2) the tumor was shown as a multiple hyperechoic mass with sharp margin on ultrasonography; well defined, fat density and intensity mass on computerized tomography (CT); hypervascular mass with early drainage of hepatic vein and tumor staining on angiography. (3) One case underwent interventional therapy. After 42 month follow up, the tumor was found to be diminished in size. Another case was under monitored with only the enucleating of left renal mass. The hepatic tumor showed no change after 10 months.Conclusions The imaging appearances of HAML in TS are relatively characteristic. Superselective arterial embolization is an effective treatment for HAML in TS.

Objective To analyze the effect of Fufang Xueshuantong capsule on glaucomatous optic atrophy and its influence on ocular hemodynamics.Methods 124 cases of patients with glaucomatous optic atrophy from April 2014 to December 2016 in our hospital were selected,and randomly divided into experimental group and control group according to the order of hospital admission , with 62 cases in each group.The control group was treated with nerve growth factor plus vitamin needling,the experimental group was treated with nerve growth factor and vitamin and compound Xueshuantong capsule.Observation and comparison the total effective rate, visual function (visual acuity, total gray value) improvement of the two groups of patients, as well as the changes of ocular hemodynamic parameters (systolic peak velocity, diastolic End-stage blood flow velocity, resistance index, pulsatility index).Results The total effective rate of the experimental group was 93.55%(58/62), the total effective rate of the control group was 70.97%(44/62), the total effective rate of the experimental group was higher than the control group (P <0.05)).After treatment, the visual acuity of the experimental group was significantly higher than the control group, the total gray value of the experimental group was significantly lower than the control group (P<0.05).The peak systolic velocity and end diastolic velocity in the experimental group were significantly higher than those in the control group (P<0.05).The resistance index and pulsatility index in the experimental group were lower than those in the control group (P<0.05). Conclusion Compound Xueshuantong capsule is effective in the treatment of glaucomatous optic atrophy , can improve the ocular hemodynamics and improve the visual function.

Objective This paper summarizes the safety management of 13 ARDS patients resulting from influenza A (H7N9) virus infection with daily awakening during analgesia and sedation treatment.Methods Safety management was given to 13 ARDS patients with influenza A (H7N9) virus infection during analgesia and sedation treatment.Results No serious complications or adverse events occurred during interruption period of analgesia and sedation.Conclusions To give safety management of daily awakening to patients with influenza A (H7N9) virus infection during analgesia and sedation treatment can increase treatment effect and facilitate early recovery of patients.

Objective:To explore the effect of nursery-led multidisciplinary evidence-based intervention in the management of anticoagulation in inpatients with oral warfarin.Methods:In this study, Quasi-experimental research was adopted. 478 patients were selected as the baseline review group on August 1st, 2019 and December 31th, 2019, and 494 patients were selected as the after-effect evaluation group on February 1st, 2020 and May 31th, 2020 in cardiovascular surgery and cardiovascular medicine. Established a multidisciplinary team, according to theoretical framework basing on the evidence of continuous quality improvement model, combining with evidence and clinical practice to develop evidence-based solutions, the comparison of international normalized ratio (INR) before and after the intervention in the percentage of time in therapeutic range (TTR) and anticoagulant related the incidence of complications.Results:Before and after the multidisciplinary evidence-based intervention, the mean TTR of the patients were (51.67±31.04)% and (64.34±26.37)%, with statistically significant differences ( tvalue was 6.958, P<0.01); the incidence of bleeding and embolization was not statistically significant ( χ 2values were 0.294 and 0.268, P>0.05). Conclusion:Nursing-led multidisciplinary evidence-based interventions can improve the intensity and stability of oral warfarin anticoagulant therapy in inpatients.

Objective To design quality improvement checklist of catheter-related blood stream infection (CRBSI),in order to improve the nursing quality of ICU and ensure nursing safety.Methods A new ICU quality improvement checklist of CRBSI was designed and applied for the quality control of the patients with central venous catheter from April to June 2012.The using rate of central venous catheter and incidence of CRBSI were observed.Results After application of the checklists,the using rate of central venous catheter was decreased and the incidence of CRBSI was decreased.Conclusions The checklist may help improve the prevention and control of CRBSI in ICU.

ObjectiveTo study the clinical features and pathogenesis of ophthalmoplegia in senile patients with diabetes, and access the possibility of its development.MethodsBesides routine ophthalmologic and ocular muscle examination, general and laboratory examinations were also done. Some patients were diagnosed also with the help of image processing.ResultsMonocular involvement happened in all 21 patients. 12 patients suffered from oculomotor nerve paralysis, 5 abducent nerve paralysis, 3 trochlearis nerve paralysis, and 1 compound nerve paralysis. Among these patients with complete oculomotor nerve panalysis, no papillary change appeared.Conclusions Microvascular pathologic change may be the pathogenetic basis of ophthalmoplegia for senile diabetic patients. Its prognosis is favorable if reasonable treatment is made.

Objective To evaluate the effects of exercise therapy for patients with difficult weaning using mechanical ventilation.Methods A total of 63 patients with difficult weaning using mechanical ventilation were randomly divided into the experimental group(33 cases) and the control group(30 cases).The patients in the control group received routine respiratory care,however,the patients in the experimental group received gradual and individualized exercise therapy according to patients' condition and physical strength.The items such as the tidal volume,respiratory rate,PaO2/FiO2 were compared between two groups.Results Compared with the control group,the tidal volume,respiratory rate,PaO2/FiO2 and the score of APACHE Ⅱ were better in the experimental group on the 21th and 28th day after mechanical ventilation,the heart rate was better in the experimental group on the 28th day after mechanical ventilation.In addition,the duration of mechanical ventilation and ICU hospitalization was shorter in the experimental group.But the rate of complications showed no significant difference.Conclusions Exercise therapy has a positive effect on patients with difficult weaning using mechanical ventilation.

Objective:To establish an index system for the construction of cardiovascular nursing discipline based on the internal and external integration model of organ system, and to provide reference for the construction of cardiovascular nursing discipline with patients as the center and circulatory system as the core.Methods:Based on the health science cluster system theory, embodying the integrated nursing concept and the characteristics of cardiovascular discipline, the content of the cardiovascular nursing discipline construction index system and the weight of each index were determined through literature review, semi-structured interview and expert consultation. SPSS 23.0 was used to statistically analyze the obtained consultation data.Results:The positive coefficient of the experts was 92.308%, the authority coefficient was 0.812, and the coordination coefficients of the first-, second- and third-level indicators were 0.412, 0.421 and 0.347, respectively. The final indicator system consisted of 4 first-level indicators, 17 second-level indicators and 66 third-level indicators.Conclusion:The index system of cardiovascular nursing discipline construction is scientific and reliable, which has certain guiding significance to the construction of cardiovascular nursing discipline and the cultivation of talents under the integrated medical model.

Purpose To explore the application value of combining 18F-FDG PET images with interpretable deep learning radiomics(IDLR)models in the differential diagnosis of primary Parkinson's disease(IPD)and atypical Parkinson's syndrome.Materials and Methods This cross-sectional study was conducted using the Parkinson's Disease PET Imaging Benchmark Database from Huashan Hospital,Fudan University from March 2015 to February 2023.A total of 330 Parkinson's disease patients underwent 18F-FDG PET imaging,both 18F-FDG PET imaging and clinical scale information were collected for all subjects.The study included two cohorts,a training group(n=270)and a testing group(n=60),with a total of 211 cases in the IPD group,59 cases in the progressive supranuclear palsy(PSP)group,and a group of 60 patients with multiple system atrophy(MSA).The clinical information between different groups were compared.An IDLR model was developed to extract feature indicators.Under the supervision of radiomics features,IDLR features were selected from the features collected by neural network extractors,and a binary support vector machine model was constructed for the selected features in images of in testing group.The constructed IDLR model,traditional radiomics model and standard uptake ratio model were separately used to calculate the performance metrics and area under curve values of deep learning models for pairwise classification between IPD/PSP/MSA groups.The study conducted independent classification and testing in two cohorts using 100 10-fold cross-validation tests.Brain-related regions of interest were displayed through feature mapping,using gradient weighted class activation maps to highlight and visualize the most relevant information in the brain.The output heatmaps of different disease groups were examined and compared with clinical diagnostic locations.Results The IDLR model showed promising results for differentiating between Parkinson's syndrome patients.It achieved the best classification performance and had the highest area under the curve values compared to other comparative models such as the standard uptake ratio model(Z=1.22-3.23,all P<0.05),and radiomics model(Z=1.31-2.96,all P<0.05).The area under the curve values for the IDLR model in differentiating MSA and IPD were 0.935 7,for MSA and PSP were 0.975 4,for IPD and PSP were 0.982 5 in the test set.The IDLR model also showed consistency between its filtered feature maps and the visualization of gradient-weighted class activation mapping slice thermal maps in the radiomics regions of interest.Conclusion The IDLR model has the potential for differential diagnosis between IPD and atypical Parkinson's syndrome in 18F-FDG PET images.