Objectives To explore the establishment and effects of a multilevel and inter-disciplinary management scheme for specialist nurses.Methods The multilevel and inter-disciplinary management scheme included establishing the pyramid hierarchical training model,exploring superimposed training mechanism for specialist nurses with horizontal expansion,vertical extension,and deep development,and constructing stereoscopic clinical evaluation and quantitative assessment system.Four hundred-forty two specialized nurses have been recruited to join the multilevel and inter-disciplinary management scheme from July 2021 to August 2023.The core competencies of specialized nurses were compared before and after the implementation of management scheme.Results The quality development of specialized nursing have been improved,and the total scores and the scores of 3 dimensions(research innovation,management,and professional development)in core competencies of specialized nurses after the intervention of multilevel and inter-disciplinary management scheme were higher than those before(P＜0.05).Conclusion The multilevel and inter-disciplinary management scheme can effectively improve the core competencies of specialized nurses,and promote the high-quality development of specialized nursing.

Objective:To explore the correlation between cardiometabolic index(CMI) and the severity of coronary artery stenosis and long-term prognosis in patients with acute myocardial infarction(AMI).Methods:A total of 712 patients with AMI who were admitted to the Xinjiang Uygur Autonomous Region People′s Hospital from January 2018 to December 2019 were included as the subjects. According to the tertile of CMI, the subjects were divided into high, medium, and low value groups. Gensini score was used to quantitatively assess the degree of coronary artery stenosis. The endpoint event was defined as the occurrence of major cardiovascular adverse events(MACEs). Spearman correlation analysis was conduceted to explore the correlation between CMI and Gensini score. Multivariate Cox regression was utilized to analyze the independent influencing factors of MACEs. A restricted cubic spline plot was employed to analyze the nonlinear relationship between CMI and the risk of MACEs. Kaplan- Meier curve was used to analyze survival differences between groups. Subgroup analysis was performed to evaluate the consistency of the predictive value of CMI for MACEs. Results:Spearman correlation analysis showed that CMI was positively correlated with Gensini score( r=0.13, P<0.001). After adjusting for confounding, multivariate Cox regression analysis showed that CMI was an independent risk factor for MACEs( HR=1.709, 95% CI 1.052-2.778, P=0.031). The restricted cubic spline analysis revealed an L-shaped nonlinear effect relationship between CMI and MACEs risk( P=0.024). Kaplan- Meier survival curve analysis demonstrated that the cumulative incidence of MACEs in AMI patients increased significantly with the increase of CMI( P<0.05). Subgroup analysis indicated that CMI independently predicted the occurrence of MACEs across different subgroups, and had higher predictive value in patients with normal lipids and normal body weight. Conclusion:CMI is closely associated with the severity of coronary stenosis in AMI patients, and is an independent predictor of the risk of long-term MACEs.

Objective To investigate the current status of frailty in patients on maintenance hemodialysis(MHD),and explore the correlation of frailty with anxiety and depression.Methods General information,clinical data and blood biochemical data of 101 cases who underwent MHD in Department of Nephrology,Shunde Hospital Affiliated to Jinan University from January 2023 to January 2024 were collected.FRAIL scale was applied to evaluate the frailty of the patients,and they were accordingly classified into frailty group and non-frailty group(including pre-frail and non-frail participants).Anxiety and depression were evaluated by GAD-7 and PHQ-9 scale.Univariate analysis and logistic regression were used to explore the association of frailty with anxiety,depression and other possible influencing factors.Results Among the 101 cases,29 cases(28.71%)were includedin frailty group and 72 cases(71.29%)in non-frailty group.There were 42 patients with depression(41.58%)and 25 with anxiety(24.75%).In the frailty group,the prevalence of depression was 65.52%and that of anxiety 55.17%.There were significant differences in age,grip strength,exercise,stroke and coronary heart disease,anxiety and depression,ferritin and CRP between the two groups(P＜0.01).Multivariate regression analysis showed that depression,anxi-ety,no exercise,stroke and high ferritin concentration were independent risk factors for frailty in MHD patients(P＜0.05).Conclusion In patients on MHD,frailty is closely associated with depression,anxiety,and lack of exercise,and stroke as well as high ferritin concentration are independent risk factors for frailty.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To investigate the clinical efficacy of mitral valve repair technique in the treatment of rheumatic mitral valve lesions. Methods The clinical data of patients diagnosed with rheumatic mitral valve lesions and undergoing mitral valve repair under extracorporeal circulation in our department from 2021 to 2022 were retrospectively analyzed. Results A total of 100 patients were collected, including 78 females and 22 males with an average age of 52 years. There were no secondary open heart or death in the whole group. Extracorporeal circulation time was 136.3±33.1 min, aortic cross-clamping time was 107.6±27.5 min, ventilator use time was 12.9±5.9 h, ICU stay was 2.6±1.4 d, and vasoactive medication use was 823.4±584.4 mg. Before and after the surgery, there were statistical differences in the left ventricular end diastolic diameter, left atrial end systolic diameter, effective mitral valve orifice area, shortening rate of left ventricular short axis, mitral E-peak blood flow velocity, mean mitral transvalvular pressure difference, mitral pressure half-time, and cardiac function graded by New York Heart Association (P＜0.05). While there was no statistical difference in left ventricular ejection fraction or left ventricular end-diastolic volume (P>0.05). Conclusion Overall repair of rheumatic mitral valve lesions can significantly improve the cardiac function and hemodynamics of the patients, and is a good choice for patients with rheumatic mitral valve lesions.

A total of 231 patients aged>60 years who underwent orthopedic surgery in Department of Orthopedics of Emergency General Hospital from November 2019 to June 2022, were enrolled. All patients received a comprehensive geriatric assessment before surgery. The demographic characteristics, medical history of patients were collected, the geriatric syndrome, postoperative complications were analyzed. The risk factors of postoperative complications were analyzed with Logistic regression. The preoperative comprehensive geriatric assessment showed that the most common geriatric syndrome was cognitive impairment (29.9%, n=69), followed by frailty (14.3%, n=33), nutritional risk (10.4%, n=24), functional dependence (7.8%, n=18), depression and anxiety (3.9%, n=9). Postoperative complications occurred in 38 cases, including delirium in 18 cases (7.8%), respiratory infection in 15 cases (6.5%), heart failure in 9 cases (3.9%) and death in 1 case (0.4%). The Logistic regression analysis showed that anemia ( OR=5.278, 95% CI:1.237-22.518), frailty ( OR=2.865, 95% CI:1.049-7.829) and cognitive impairment ( OR=3.796, 95% CI:1.526-9.442) were independent risk factors for adverse postoperative outcomes ( P<0.05). The study indicates that incidence of preoperative geriatric syndrome in patients undergoing evaluation is common; and anemia, frailty and cognitive impairment may be related to adverse clinical outcomes in elderly patients after surgery.

Objective:To explore the effect of family empowerment program combined with deglutition exercises in patients with deglutition disorders.Methods:From February 2019 to February 2021, a total of 107 patients with deglutition disorders admitted to Xinxiang Central Hospital were enrolled by convenience sampling method and divided into the observation group (54 cases) and the control group (53 cases) using random number table method. The control group received routine nursing and deglutition intervention, and the observation group received family empowerment program combined with deglutition intervention on the basis of routine nursing. The standardized swallowing assessment (SSA) , mini nutritional assessment short-form (MNA-SF) , swallowing quality of life questionnaire (SWAL-QOL) scores and the incidence of adverse events of the two groups were compared before and after intervention.Results:After intervention, MNA-SF score and SWAL-QOL score of the observation group were higher than those of the control group, while SSA score, incidence of respiratory aspiration and aspiration pneumonia of the observation group were lower than those of the control group , the differences were statistically significant ( P<0.05) . Conclusions:The family empowerment program combined with deglutition exercises can improve patients' deglutition function and nutrition status, reduce the risk of respiratory aspiration and aspiration pneumonia, and improve patients' quality of life.

Objective:To explore the early warning value of carbapenem-resistant Klebsiella pneumoniae (CRKP) positivity in liver transplantation recipients with rectal swabs, examine the risk factors of CRKP bloodstream infection and provide the relevant treatments.Methods:From June 2018 to December 2019 in Organ Transplantation Research Institute Affiliated Tongji Hospital Tongji Medical College Huazhong University of Science & Technology, 148 cases of liver transplantation recipients with positive CRKP rectal swabbing were recruited. Clinical data were retrospectively analyzed. And the risk factors of CRKP bloodstream infections were examined for intervention and non-intervention groups to observe the effect of interventions of CRKP bloodstream infections.Results:Among them, 23 cases (15.5%) were positive for CRKP and 5 cases (21.7%) were infected with CRKP bloodstream. Rectal swab culture was negative in 125 cases and no bloodstream infection occurred. Long-term use of broad-spectrum antimicrobial agents, severe basic diseases (severe hepatitis), postoperative delayed graft liver function recovery, acute renal failure requiring renal replacement therapy (RRT) and postoperative anti-thymocyte globulin (ATG) induction were risk factors. In intervention group, there were 2 cases (11.1%) of 18 patients with positive CRKP in rectal swab culture in late stage. Among 5 CRKP-positive recipients without intervention, 3 cases (60%) developed later CRKP bloodstream infection. The incidence of bloodstream infection was significantly lower in intervention group than that in non-intervention group ( P<0.05). Conclusions:Rectal swab culture for liver transplantation recipients provides early warning for CRKP bloodstream infection. Interventions for CRKP positive high-risk recipients with rectal swab culture may reduce the occurrence of CRKP bloodstream infection and lower the risk of CRKP bloodstream infection in liver transplantation recipients.

Objective: To understand the epidemiologic features of the rabies in Xishuang banna prefecture of Yunnan province, China in 2008-2017 and the viral molecular-evolution characteristics. Methods: The data of rabies case questionnaire were collected. The brain tissue samples from mad dogs, suspicious sick dogs and human brain tissue, saliva and cerebrospinal fluid samples from rabies patients were collected in Xishuangbanna. Coding region of nucleoprotein and glycoprotein genes were amplified by RT-PCR and sequenced. Homology and phylogenetic analysis were performed using the relevant bioinformatics software. Results: A total of 62 cases of human rabies were occurred in 28 districts of the 3 counties, Xishuangbanna prefecture in 2008-2017. Of them, 37 cases in Jinghong county, 15 in Menghai county and 10 in Mengla county. In which 48 cases were bitten by domestic dogs (77.42%), 11 cases were bitten by wild dogs (17.74%). Rabies case was occurred every year in the past decade. The seasonal incidence was not obvious. The majority of patients were aged from 30 to 59 years-old, with the youngest 1 year-old and the eldest 91 year-old. The male to female ratio was 1.70∶1, most cases were farmers. The nucleotide sequences of nucleoprotein gene of 9 virus strains (7 from Jinghong, 1 from Menghai and 1 from Mengla) were obtained from the samples of dogs and patients. Homology and phylogenetic analyses indicated that the 5 strains belonged to clade China-Ⅰ, 3 clade China-Ⅱ and 1 clade China-Ⅵ. The nucleotide sequences of glycoprotein gene of 5 virus strains (3 from Jinghong, 1 from Menghai and 1 from Mengla) were obtained from these positive samples, and all were clade China-Ⅰ, it is same with nucleoprotein genes analysis result from these 5 virus strains. These China-Ⅰ and China-Ⅱ strains from Xishuangbanna have a closer genetic relationship with same clade strains isolated from Pu’er and other prefectures of Yunnan province as well as Sichuan, Guizhou and Guangxi. The China-Ⅵ strain from Xishuangbanna share high homology and genetic relationship with China-Ⅵ strains isolated from southwestern Yunnan and neighbouring countries such as Myanmar, Laos and Vietnam in recent years. Conclusions In Xishuangbanna, rabies mainly occurred in rural area and domestic dog was the main source of transmission. These RABV clades China-Ⅰ, China-Ⅱ and China-Ⅵ were found in this region and the China-Ⅰ was principal clade. The transmission source of China-Ⅰ and China-Ⅱ were from adjacent areas in the province and China-Ⅵ was from Myanmar and Laos.

Objective To investigate the knowledge and attitude of nurses on the prevention and nursing of common complications among bedridden patients in Wuhan City, and provide scientific basis for the implementation of targeted training in improving clinical nursing quality. Methods A total of 748 clinical nurses from 4 hospitals in Wuhan City were selected in November 2016 using convenient sampling method. A self-designed questionnaire was applied to investigate the common complications nursing knowledge and attitude of nurses on bedridden patients. Results The accuracy of nurses' knowledge on the prevention and nursing of common complications among bedridden patients were listed as follows: deep vein thrombosis (DVT) (77.44%), pneumonia (73.88%), urinary tract inflammation (70.63%), and pressure ulcers (61.44%). The scores of nurses' attitude were listed successively: pressure ulcers (88.21%), urinary tract inflammation (86.81%), pneumonia (86.66%), and DVT (85.92%). There were positive correlation between the scores of knowledge and attitude of nurses on four kinds of complications (P< 0.05). Conclusions Nursing administrators should improve the training and update of common complications knowledge on nurses, and promote their positive attitude to the prevention of common complication to increase the quality of nursing.