OBJECTIVE: To develop a digital intelligent multimodal shift handover system for the intensive care unit (ICU) and evaluate its application effect in ICU shift handovers. METHODS: A research and development team was established, consisting of 1 department director, 1 head nurse, 3 information technology engineers, 3 nurses, and 2 doctors. Team members were assigned responsibilities including overall coordination and planning, platform design and maintenance, pre-application training, collection and organization of clinical feedback, and research investigation respectively. A digital intelligent multimodal shift handover system was developed for ICU based on the Shannon-Weaver linear transmission model. This innovative system integrated automated data collection, intelligent dynamic monitoring, multidimensional condition analysis and visual reporting functions. A cloud platform was used to gather data from multi-parameter vital signs monitors, infusion pumps, ventilators and other devices. Artificial intelligence algorithms were employed to standardize and analyze the data, providing personalized recommendations for healthcare professionals. A self-controlled before-after method was adopted. Before the application of the ICU digital intelligent multimodal shift handover system (from December 2023 to March 2024), the traditional verbal bedside handover was used; from June 2024 to March 2025, the ICU digital intelligent multimodal shift handover system was applied for shift handovers. Questionnaires before the application of the shift handover system were collected in April 2024, and those after the application were collected in April 2025. The shift handover time, handover quality (scored by the nursing handover evaluation scale), satisfaction with doctor-nurse communication (scored by the ICU doctor-nurse scale) before and after the application of the handover system were compared, and nurses' satisfaction with the shift handover system (scored by the clinical nursing information system effectiveness evaluation scale) was investigated. RESULTS: After the application of the ICU digital intelligent multimodal shift handover system, the shift handover time was significantly shorter than that before the application [minutes: 20 (15, 25) vs. 30 (22, 40)], the handover quality was significantly higher than that before the application [score: 84.0 (78.0, 88.5) vs. 71.0 (55.0, 79.0)], and the satisfaction with doctor-nurse communication was also significantly higher than that before the application (score: 84.58±6.79 vs. 74.50±11.30). All differences were statistically significant (all P < 0.05). In addition, the nurses' system effectiveness evaluation scale score was 102.30±10.56, which indicated that nurses had a very high level of satisfaction with the ICU digital intelligent multimodal shift handover system. CONCLUSIONS The application of the ICU digital intelligent multimodal shift handover system can shorten the shift handover time, improve the handover quality, and enhance the satisfaction with doctor-nurse communication. Nurses have a high level of satisfaction with this system.
Intensive Care Units ; Humans ; Patient Handoff ; Artificial Intelligence ; Algorithms

OBJECTIVE: To observe the effect of governor vessel moxibustion on improving cardiopulmonary fitness in patients with stable chronic obstructive pulmonary disease (COPD) of qi deficiency of lung and kidney. METHODS: A total of 40 patients with stable COPD of qi deficiency of lung and kidney were randomized into an observation group (20 cases) and a control group (20 cases). The routine basic treatment and nursing were adopted in the control group. In the observation group, on the basis of the treatment in the control group, governor vessel moxibustion was applied at the area from Dazhui (GV14) to Yaoshu (GV2) of the governor vessel, 1 hour a time, once a week. Both groups were treated for 8 weeks consecutively. The maximal oxygen uptake (VO₂max), 6-minute walking test (6MWT) and Borg score, pulmonary function indexes (forced expiratory volume in 1 second [FEV₁], forced vital capacity [FVC] and ratio of FEV₁ and FVC [FEV₁/FVC]), chronic obstructive pulmonary disease assessment test (CAT) score, and TCM syndrome score were observed in the two groups before and after treatment respectively. RESULTS: After treatment, the VO₂max, 6MWT, FEV₁, FVC and FEV₁/FVC were increased compared with those before treatment in the two groups (P<0.001, P<0.05), the above indexes in the observation group were higher than those in the control group (P<0.05, P<0.01). After treatment, the Borg, CAT and TCM syndrome scores were decreased compared with those before treatment in the two groups (P<0.05, P<0.001), the above indexes in the observation group were lower than those in the control group (P<0.05). CONCLUSION Governor vessel moxibustion can effectively improve the cardiopulmonary fitness, clinical symptoms and the quality of life in patients with stable COPD of qi deficiency of lung and kidney.
Humans ; Moxibustion ; Pulmonary Disease, Chronic Obstructive/physiopathology* ; Male ; Female ; Middle Aged ; Aged ; Qi ; Lung/physiopathology* ; Kidney/physiopathology* ; Acupuncture Points

Objective To understand the nursing practice of prone position ventilation for patients with moderate to severe acute respiratory distress syndrome(ARDS)in intensive care unit(ICU)in Shandong province,so as to provide basis for standardizing the nursing practice process of prone position ventilation and carrying out training for hospitals.Methods A self-made questionnaire was used,and convenience sampling was adopted.From September 15th to November 5th,2023,ICU nurses were selected from various hospital levels in Shandong province to investigate the obstructive factors of prone ventilation implementation,the weak links in nursing practice and status,and the occurrence of complications.Results A total of 1 188 questionnaires were collected,of which 991 were valid.92.8%(920/991)of nurses had performed prone position ventilation.The biggest obstacle to the implementation of prone position ventilation was the complexity of patient treatments and multiple devices involved[74.6%(686/920)].Regarding the status of training,90.5%(897/991)of nurses had received training on prone position ventilation and 77.0%(763/991)of nurses felt that training was needed.As for pre-operation assessment,more than 80.0%of nurses evaluated patients'vital signs,airway and secretions and so on,among which the evaluation awareness of analgesia was the worst[81.6%(751/920)].As for the main points of implementation,only 14.0%(129/920)of nurses chose the opposite side of the most important pipeline as the turning direction;48.6%(447/920)of nurses chose the anti-Trendelenburg position;36.3%(334/920)of nurses chose to ventilate≥12 hours.Facial edema[81.7%(752/920)],skin pressure injury[78.9%(726/920)]and eye complication[75.8%(697/920)]were the top 3 most frequent complications.Conclusions ICU nurses'prone position ventilation practices were generally line with the nursing team standard for prone position of adult mechanically ventilated patients and the best evidence recommendation,and needs to be further standardized in aspects of turning direction,position management,ventilation duration,and enteral nutrition management.It is recommended that nursing managers at all levels of hospitals further improve the quality of nursing practice of prone position ventilation according to relevant evidence-based evidence and the actual situation of hospitals.

Objective:To develop an economical,simple,and accessible method for early identification of high-risk pregnant women with gestational diabetes mellitus(GDM),this study developed and evaluated multiple machine learning models,identified the optimal prediction model,and constructed a clinical decision support sys-tem(CDSS)based on this model.Methods:A total of 464 pregnant women who visited the Second Affiliated Hospital of Dalian Medical University from January 1,2023 to December 30,2024 were included,of which 386 were used to establish a prediction model(231 in the training set and 155 in the testing set),and the remaining 78 were used as a validation.Adopting the methods of double-point sequence correlation and chi-square test,four machine learning models were constructed after selecting feature variables:Logistic Regression,Random Forest,Support Vector Machine,and eXtreme Gradient Boosting(XGBoost).Preliminary judgment of the maximum weight mod-el,further comparison of the discriminative ability,calibration ability,and clinical practicality of each model to evalu-ate and select the optimal model,develop its CDSS,and verify the accuracy of the model.Results:①Correlation analysis identified predictors of GDM:age,pre-pregnancy body mass index(BMI),systolic/diastolic blood pres-sure,white blood cell count,hemoglobin,lymphocyte ratio,fasting plasma glucose,uric acid,direct bilirubin,chronic hypertension complicating pregnancy,and assisted reproductive technology conception.②XGBoost dominated the ensemble model and demonstrated the best performance in discrimination(AUC 0.931,95%CI 0.910-0.967),cali-bration,and clinical utility among the four models.③The CDSS achieved an accuracy of 78.2%,sensitivity of 64.7%,and specificity of 82.0%in the XGBoost model.Conclusions:The XGBoost model has the highest ability to predict GDM in the early stage.Developing its CDSS not only facilitates doctors to quickly assess GDM risk,but also is suitable for promotion to remote areas,where high-risk population screening can be achieved through re-mote data.

AIM:To investigate the effect of drug-containing serum of oxytropis falcata extract on oxi-dative stress injury of podocyte induced by high glucose through PI3K/AKT/Nrf2 pathway.METH-ODS:The rat renal podocyte was cultured in vitro,and the concentration and time of D-glucose mod-elling and the optimal concentration and time of administration in the drug-containing serum of oxy-tropis falcata extract were screened.The cells were divided into normal group,high glucose group,high glucose+blank serum group,oxytropis falcata group,inhibitor group,oxytropis falcata+inhibitor group.Rhodamine staining and electron microsco-py were used to observe the morphological and pathological changes of podocyte,flow cytometry was used to detect apoptosis rate,and cell migra-tion ability was detected by scratch test.Immuno-fluorescence and fluorescence probe were used to detect the fluorescence expression of p-AKT and ROS level of cells,ELISA was used to detect the con-tent of MDA,NO,SOD and T-AOC in the superna-tant of cells,and Western Blot was used to detect the protein expression of p-PI3K/PI3K,p-AKT/AKT and Nrf2 in cells.The mRNA expressions of Nrf2,HO-1,GCLM and SOD were detected by RT-qPCR.RESULTS:It was selected that 45 mmol/LD-glucose induction for 48 hours was the best modeling con-dition,and the 1-fold dilution of the medicated se-rum of oxytropis falcata extract for 48 hours was the best concentration and intervention time.Com-pared with the normal group,the foot processes of the high glucose group were widely fused and ad-hered to each other,the apoptosis rate,migration ability and intracellular ROS level were significantly increased(P＜0.01),the fluorescence expression of p-AKT was markedly decreased(P＜0.01),the con-tents of MDA and NO were dramatically enhanced,and the contents of SOD and T-AOC were signifi-cantly downregulated(P＜0.01).The protein expres-sion of p-PI3K/PI3K,p-AKT/AKT,Nrf2 and the mRNA expression of Nrf2,HO-1,GCLM and SOD markedly declined(P＜0.01).Compared with high glucose group,foot process fusion and adhesion of podo-cytes in oxytropis falcata group and oxytropis falca-ta+inhibitor group were improved in varying de-grees,apoptosis rate,migration ability and intracel-lular ROS level significantly declined(P＜0.05,P＜0.01),p-AKT fluorescence expression increased(P＜0.01),NO content decreased,T-AOC level elevated(P＜0.01);the content of MDA decreased and the activity of SOD notably rose(P＜0.01),the protein expression of p-PI3K/PI3K,p-AKT/AKT,Nrf2 and the mRNA expression of Nrf2,HO-1,GCLM and SOD markedly increased in oxytropis falcata group(P＜0.05,P＜0.01);the level of ROS in podocytes im-proved(P＜0.01),the fluorescence expression of p-AKT decreased(P＜0.05),the content of NO upregu-lated,the content of T-AOC downregulated,and the expression of p-PI3K/PI3K,p-AKT/AKT,Nrf2 pro-tein and HO-1,GCLM,SOD mRNA decreased in in-hibitor group(P＜0.05,P＜0.01).Compared with oxy-tropis falcata group,the apoptosis rate,migration ability and intracellular ROS level of podocytes in oxytropis falcata+inhibitor group markedly in-creased(P＜0.05,P＜0.01),p-AKT fluorescence ex-pression declined(P＜0.01),MDA and NO content increased,SOD and T-AOC content decreased(P＜0.05,P＜0.01),p-PI3K/PI3K,p-AKT/AKT,Nrf2 protein and Nrf2,HO-1,GCLM,SOD mRNA expression all dramatically downregulated(P＜0.05,P＜0.01).CON-CLUSION:Oxytropis falcata extract may protect podocytes by activating the PI3K/AKT/Nrf2 signal-ing pathway,thereby improving the morphological,structural and functional changes of podocytes in-duced by high glucose and inhibiting oxidative stress response.

AIM:To investigate the effect of drug-containing serum of oxytropis falcata extract on oxi-dative stress injury of podocyte induced by high glucose through PI3K/AKT/Nrf2 pathway.METH-ODS:The rat renal podocyte was cultured in vitro,and the concentration and time of D-glucose mod-elling and the optimal concentration and time of administration in the drug-containing serum of oxy-tropis falcata extract were screened.The cells were divided into normal group,high glucose group,high glucose+blank serum group,oxytropis falcata group,inhibitor group,oxytropis falcata+inhibitor group.Rhodamine staining and electron microsco-py were used to observe the morphological and pathological changes of podocyte,flow cytometry was used to detect apoptosis rate,and cell migra-tion ability was detected by scratch test.Immuno-fluorescence and fluorescence probe were used to detect the fluorescence expression of p-AKT and ROS level of cells,ELISA was used to detect the con-tent of MDA,NO,SOD and T-AOC in the superna-tant of cells,and Western Blot was used to detect the protein expression of p-PI3K/PI3K,p-AKT/AKT and Nrf2 in cells.The mRNA expressions of Nrf2,HO-1,GCLM and SOD were detected by RT-qPCR.RESULTS:It was selected that 45 mmol/LD-glucose induction for 48 hours was the best modeling con-dition,and the 1-fold dilution of the medicated se-rum of oxytropis falcata extract for 48 hours was the best concentration and intervention time.Com-pared with the normal group,the foot processes of the high glucose group were widely fused and ad-hered to each other,the apoptosis rate,migration ability and intracellular ROS level were significantly increased(P＜0.01),the fluorescence expression of p-AKT was markedly decreased(P＜0.01),the con-tents of MDA and NO were dramatically enhanced,and the contents of SOD and T-AOC were signifi-cantly downregulated(P＜0.01).The protein expres-sion of p-PI3K/PI3K,p-AKT/AKT,Nrf2 and the mRNA expression of Nrf2,HO-1,GCLM and SOD markedly declined(P＜0.01).Compared with high glucose group,foot process fusion and adhesion of podo-cytes in oxytropis falcata group and oxytropis falca-ta+inhibitor group were improved in varying de-grees,apoptosis rate,migration ability and intracel-lular ROS level significantly declined(P＜0.05,P＜0.01),p-AKT fluorescence expression increased(P＜0.01),NO content decreased,T-AOC level elevated(P＜0.01);the content of MDA decreased and the activity of SOD notably rose(P＜0.01),the protein expression of p-PI3K/PI3K,p-AKT/AKT,Nrf2 and the mRNA expression of Nrf2,HO-1,GCLM and SOD markedly increased in oxytropis falcata group(P＜0.05,P＜0.01);the level of ROS in podocytes im-proved(P＜0.01),the fluorescence expression of p-AKT decreased(P＜0.05),the content of NO upregu-lated,the content of T-AOC downregulated,and the expression of p-PI3K/PI3K,p-AKT/AKT,Nrf2 pro-tein and HO-1,GCLM,SOD mRNA decreased in in-hibitor group(P＜0.05,P＜0.01).Compared with oxy-tropis falcata group,the apoptosis rate,migration ability and intracellular ROS level of podocytes in oxytropis falcata+inhibitor group markedly in-creased(P＜0.05,P＜0.01),p-AKT fluorescence ex-pression declined(P＜0.01),MDA and NO content increased,SOD and T-AOC content decreased(P＜0.05,P＜0.01),p-PI3K/PI3K,p-AKT/AKT,Nrf2 protein and Nrf2,HO-1,GCLM,SOD mRNA expression all dramatically downregulated(P＜0.05,P＜0.01).CON-CLUSION:Oxytropis falcata extract may protect podocytes by activating the PI3K/AKT/Nrf2 signal-ing pathway,thereby improving the morphological,structural and functional changes of podocytes in-duced by high glucose and inhibiting oxidative stress response.

Objective To understand the nursing practice of prone position ventilation for patients with moderate to severe acute respiratory distress syndrome(ARDS)in intensive care unit(ICU)in Shandong province,so as to provide basis for standardizing the nursing practice process of prone position ventilation and carrying out training for hospitals.Methods A self-made questionnaire was used,and convenience sampling was adopted.From September 15th to November 5th,2023,ICU nurses were selected from various hospital levels in Shandong province to investigate the obstructive factors of prone ventilation implementation,the weak links in nursing practice and status,and the occurrence of complications.Results A total of 1 188 questionnaires were collected,of which 991 were valid.92.8%(920/991)of nurses had performed prone position ventilation.The biggest obstacle to the implementation of prone position ventilation was the complexity of patient treatments and multiple devices involved[74.6%(686/920)].Regarding the status of training,90.5%(897/991)of nurses had received training on prone position ventilation and 77.0%(763/991)of nurses felt that training was needed.As for pre-operation assessment,more than 80.0%of nurses evaluated patients'vital signs,airway and secretions and so on,among which the evaluation awareness of analgesia was the worst[81.6%(751/920)].As for the main points of implementation,only 14.0%(129/920)of nurses chose the opposite side of the most important pipeline as the turning direction;48.6%(447/920)of nurses chose the anti-Trendelenburg position;36.3%(334/920)of nurses chose to ventilate≥12 hours.Facial edema[81.7%(752/920)],skin pressure injury[78.9%(726/920)]and eye complication[75.8%(697/920)]were the top 3 most frequent complications.Conclusions ICU nurses'prone position ventilation practices were generally line with the nursing team standard for prone position of adult mechanically ventilated patients and the best evidence recommendation,and needs to be further standardized in aspects of turning direction,position management,ventilation duration,and enteral nutrition management.It is recommended that nursing managers at all levels of hospitals further improve the quality of nursing practice of prone position ventilation according to relevant evidence-based evidence and the actual situation of hospitals.

Objective:To develop an economical,simple,and accessible method for early identification of high-risk pregnant women with gestational diabetes mellitus(GDM),this study developed and evaluated multiple machine learning models,identified the optimal prediction model,and constructed a clinical decision support sys-tem(CDSS)based on this model.Methods:A total of 464 pregnant women who visited the Second Affiliated Hospital of Dalian Medical University from January 1,2023 to December 30,2024 were included,of which 386 were used to establish a prediction model(231 in the training set and 155 in the testing set),and the remaining 78 were used as a validation.Adopting the methods of double-point sequence correlation and chi-square test,four machine learning models were constructed after selecting feature variables:Logistic Regression,Random Forest,Support Vector Machine,and eXtreme Gradient Boosting(XGBoost).Preliminary judgment of the maximum weight mod-el,further comparison of the discriminative ability,calibration ability,and clinical practicality of each model to evalu-ate and select the optimal model,develop its CDSS,and verify the accuracy of the model.Results:①Correlation analysis identified predictors of GDM:age,pre-pregnancy body mass index(BMI),systolic/diastolic blood pres-sure,white blood cell count,hemoglobin,lymphocyte ratio,fasting plasma glucose,uric acid,direct bilirubin,chronic hypertension complicating pregnancy,and assisted reproductive technology conception.②XGBoost dominated the ensemble model and demonstrated the best performance in discrimination(AUC 0.931,95%CI 0.910-0.967),cali-bration,and clinical utility among the four models.③The CDSS achieved an accuracy of 78.2%,sensitivity of 64.7%,and specificity of 82.0%in the XGBoost model.Conclusions:The XGBoost model has the highest ability to predict GDM in the early stage.Developing its CDSS not only facilitates doctors to quickly assess GDM risk,but also is suitable for promotion to remote areas,where high-risk population screening can be achieved through re-mote data.

Objective To obtain the monitoring measurement range of quality indicators of red blood cells,plasma and derivatives and leukocyte-reduced apheresis platelets provided by blood stations in Hebei province,explore the distribution of monitoring values and the change of monitoring level,so as to further strengthen the homogenization construction of quality control laboratories in blood stations in Hebei.Methods In 2023,the sampling data of 12 blood stations in Hebei from 2015 to 2022 were collected,scatter plots were made and the range markers were set,and the"mean±SD"line was taken as the upper limit and lower limit of the measurement range.In 2024,the monitoring values in 2023 were added,and the changes of two measurement ranges were compared to analyze the stability and overall level.Results Comparison of the measurement range from 2015 to 2022 and the measurement range from 2015 to 2023 showed that the standard deviation of the content of deleukocyte suspension of red blood cells-hemoglobin,washed erythrocyte-hemoglobin,washed erythrocyte-su-pernatant protein,cryoprecipitate coagulation factor-FⅧ,fresh frozen plasma-FⅧ,leukocyte-reduced apheresis platelets-leukocyte residue and leukocyte-reduced apheresis platelet-red blood cell concentration decreased from 8.132 to 7.993,6.252 to 6.104,0.273 to 0.267,57.506 to 56.276,0.920 to 0.892,0.653 to 0.644 and 2.653 to 2.603,respectively.The narrowing of the standard deviation range of the above items led to more concentrated monitoring values and reduced disper-sion.Comparison of the measurement range from 2015 to 2022 and the measurement range from 2015 to 2023 showed that the mean value of leukocyte residue of the deleukocyte suspension of red blood cells,hemoglobin content of the wash eryth-rocyte,protein content of supernatant of the wash erythrocyte,hemolysis rate of the wash erythrocyte,FⅧ content of the cryoprecipitate coagulation factor,plasma protein content of the fresh frozen plasma,FⅧ content of the fresh frozen plasma,platelet content of the leukocyte-reduced apheresis platelets changed from 0.362 to 0.476,44.915 to 44.861,0.280 to 0.283,0.137 to 0.142,133.989 to 133.271,60.262 to 60.208,1.301 to 1.277 and 3.036 to 3.033,respectively,and was closer to the national standard line,which reflects an increase in the number of unqualified monitoring values or values close to the national standard line in 2023.The long-term qualified rate of coagulation items was low,and no improvement has been ob-served.The stability of biochemical items has been enhanced but overall deviation has occurred,with the average value close to the national standard line.The possibility of subsequent testing failure has increased.The counting items showed no obvi-ous common characteristics.Conclusion The use of"mean±SD"in the analysis can visually display the distribution of mo-nitoring values of different items in Hebei,forming an indicator measurement range covering the past nine years.It shows the characteristics of each item,and provides reference for subsequent quality control laboratory data analysis of each blood sta-tions to takes active measures to improve the monitoring level.

β-blocker is one of the commonly used anti-hypertensive drugs， and there are obvious differences in the selection of this class of drugs. Nebivolol is a third-generation β-blocker with a unique mechanism of action. This article summarizes the clinical application of nebivolol in anti-hypertensive treatment in recent years， and it is found that compared with other β-blockers， nebivolol has certain clinical treatment advantages. In addition to having a significant antihypertensive effect， it also has little impact on sexual function and heart rate of patients， and does not affect the blood glucose and lipid metabolism， so the drug is more suitable for some special groups of patients， including sexually active male hypertensive patients， hypertensive patients with complications such as type 2 diabetes mellitus and metabolic syndrome.