ObjectiveTo develop an intervention program based on a shared mental model to enhance the communication and collaboration skills of nurses in multidisciplinary teams in stroke rehabilitation wards. MethodsUsing the shared mental model as the theoretical framework, the intervention program was preliminarily drafted through literature review to establish a theoretical foundation and qualitative research to identify clinical needs. The Delphi method was then used to revise and refine the program. ResultsBased on literature review and qualitative research, intervention elements were extracted across four dimensions: equipment, tasks, team interaction and team members, forming the initial draft of the intervention program. Two rounds of consultations were conducted with 18 experts, achieving a 100% valid response rate in both rounds. The expert authority coefficients were 0.87 and 0.90, respectively. In the second round of consultation, the variation coefficients for the importance scores of each item ranged from 0 to 0.20 (overall Kendall's W = 0.272, P < 0.001), and the variation coefficients for feasibility scores ranged from 0 to 0.21 (overall Kendall's W = 0.275, P < 0.001). The final intervention program included five first-level indicators, eight second-level indicators, and 29 third-level indicators, aligning with the four dimensions of the shared mental model. ConclusionThe intervention program was developed to enhance the communication and collaboration skills of nurses in multidisciplinary teams in stroke rehabilitation wards based on the shared mental model.

Objective:To investigate the incidence of postoperative complications in Chinese patients with gastric or colorectal cancer, and to evaluate the risk factors for postoperative complications.Methods:This was a national, multicenter, prospective, registry-based, cohort study of data obtained from the database of the Prevalence of Abdominal Complications After Gastro- enterological Surgery (PACAGE) study sponsored by the China Gastrointestinal Cancer Surgical Union. The PACAGE database prospectively collected general demographic characteristics, protocols for perioperative treatment, and variables associated with postoperative complications in patients treated for gastric or colorectal cancer in 20 medical centers from December 2018 to December 2020. The patients were grouped according to the presence or absence of postoperative complications. Postoperative complications were categorized and graded in accordance with the expert consensus on postoperative complications in gastrointestinal oncology surgery and Clavien-Dindo grading criteria. The incidence of postoperative complications of different grades are presented as bar charts. Independent risk factors for occurrence of postoperative complications were identified by multifactorial unconditional logistic regression.Results:The study cohort comprised 3926 patients with gastric or colorectal cancer, 657 (16.7%) of whom had a total of 876 postoperative complications. Serious complications (Grade III and above) occurred in 4.0% of patients (156/3926). The rate of Grade V complications was 0.2% (7/3926). The cohort included 2271 patients with gastric cancer with a postoperative complication rate of 18.1% (412/2271) and serious complication rate of 4.7% (106/2271); and 1655 with colorectal cancer, with a postoperative complication rate of 14.8% (245/1655) and serious complication rate of 3.0% (50/1655). The incidences of anastomotic leakage in patients with gastric and colorectal cancer were 3.3% (74/2271) and 3.4% (56/1655), respectively. Abdominal infection was the most frequently occurring complication, accounting for 28.7% (164/572) and 39.5% (120/304) of postoperative complications in patients with gastric and colorectal cancer, respectively. The most frequently occurring grade of postoperative complication was Grade II, accounting for 65.4% (374/572) and 56.6% (172/304) of complications in patients with gastric and colorectal cancers, respectively. Multifactorial analysis identified (1) the following independent risk factors for postoperative complications in patients in the gastric cancer group: preoperative comorbidities (OR=2.54, 95%CI: 1.51-4.28, P<0.001), neoadjuvant therapy (OR=1.42, 95%CI:1.06-1.89, P=0.020), high American Society of Anesthesiologists (ASA) scores (ASA score 2 points:OR=1.60, 95% CI: 1.23-2.07, P<0.001, ASA score ≥3 points:OR=0.43, 95% CI: 0.25-0.73, P=0.002), operative time >180 minutes (OR=1.81, 95% CI: 1.42-2.31, P<0.001), intraoperative bleeding >50 mL (OR=1.29,95%CI: 1.01-1.63, P=0.038), and distal gastrectomy compared with total gastrectomy (OR=0.65,95%CI: 0.51-0.83, P<0.001); and (2) the following independent risk factors for postoperative complications in patients in the colorectal cancer group: female (OR=0.60, 95%CI: 0.44-0.80, P<0.001), preoperative comorbidities (OR=2.73, 95%CI: 1.25-5.99, P=0.030), neoadjuvant therapy (OR=1.83, 95%CI:1.23-2.72, P=0.008), laparoscopic surgery (OR=0.47, 95%CI: 0.30-0.72, P=0.022), and abdominoperineal resection compared with low anterior resection (OR=2.74, 95%CI: 1.71-4.41, P<0.001). Conclusion:Postoperative complications associated with various types of infection were the most frequent complications in patients with gastric or colorectal cancer. Although the risk factors for postoperative complications differed between patients with gastric cancer and those with colorectal cancer, the presence of preoperative comorbidities, administration of neoadjuvant therapy, and extent of surgical resection, were the commonest factors associated with postoperative complications in patients of both categories.

Objective:To investigate the incidence of postoperative complications in Chinese patients with gastric or colorectal cancer, and to evaluate the risk factors for postoperative complications.Methods:This was a national, multicenter, prospective, registry-based, cohort study of data obtained from the database of the Prevalence of Abdominal Complications After Gastro- enterological Surgery (PACAGE) study sponsored by the China Gastrointestinal Cancer Surgical Union. The PACAGE database prospectively collected general demographic characteristics, protocols for perioperative treatment, and variables associated with postoperative complications in patients treated for gastric or colorectal cancer in 20 medical centers from December 2018 to December 2020. The patients were grouped according to the presence or absence of postoperative complications. Postoperative complications were categorized and graded in accordance with the expert consensus on postoperative complications in gastrointestinal oncology surgery and Clavien-Dindo grading criteria. The incidence of postoperative complications of different grades are presented as bar charts. Independent risk factors for occurrence of postoperative complications were identified by multifactorial unconditional logistic regression.Results:The study cohort comprised 3926 patients with gastric or colorectal cancer, 657 (16.7%) of whom had a total of 876 postoperative complications. Serious complications (Grade III and above) occurred in 4.0% of patients (156/3926). The rate of Grade V complications was 0.2% (7/3926). The cohort included 2271 patients with gastric cancer with a postoperative complication rate of 18.1% (412/2271) and serious complication rate of 4.7% (106/2271); and 1655 with colorectal cancer, with a postoperative complication rate of 14.8% (245/1655) and serious complication rate of 3.0% (50/1655). The incidences of anastomotic leakage in patients with gastric and colorectal cancer were 3.3% (74/2271) and 3.4% (56/1655), respectively. Abdominal infection was the most frequently occurring complication, accounting for 28.7% (164/572) and 39.5% (120/304) of postoperative complications in patients with gastric and colorectal cancer, respectively. The most frequently occurring grade of postoperative complication was Grade II, accounting for 65.4% (374/572) and 56.6% (172/304) of complications in patients with gastric and colorectal cancers, respectively. Multifactorial analysis identified (1) the following independent risk factors for postoperative complications in patients in the gastric cancer group: preoperative comorbidities (OR=2.54, 95%CI: 1.51-4.28, P<0.001), neoadjuvant therapy (OR=1.42, 95%CI:1.06-1.89, P=0.020), high American Society of Anesthesiologists (ASA) scores (ASA score 2 points:OR=1.60, 95% CI: 1.23-2.07, P<0.001, ASA score ≥3 points:OR=0.43, 95% CI: 0.25-0.73, P=0.002), operative time >180 minutes (OR=1.81, 95% CI: 1.42-2.31, P<0.001), intraoperative bleeding >50 mL (OR=1.29,95%CI: 1.01-1.63, P=0.038), and distal gastrectomy compared with total gastrectomy (OR=0.65,95%CI: 0.51-0.83, P<0.001); and (2) the following independent risk factors for postoperative complications in patients in the colorectal cancer group: female (OR=0.60, 95%CI: 0.44-0.80, P<0.001), preoperative comorbidities (OR=2.73, 95%CI: 1.25-5.99, P=0.030), neoadjuvant therapy (OR=1.83, 95%CI:1.23-2.72, P=0.008), laparoscopic surgery (OR=0.47, 95%CI: 0.30-0.72, P=0.022), and abdominoperineal resection compared with low anterior resection (OR=2.74, 95%CI: 1.71-4.41, P<0.001). Conclusion:Postoperative complications associated with various types of infection were the most frequent complications in patients with gastric or colorectal cancer. Although the risk factors for postoperative complications differed between patients with gastric cancer and those with colorectal cancer, the presence of preoperative comorbidities, administration of neoadjuvant therapy, and extent of surgical resection, were the commonest factors associated with postoperative complications in patients of both categories.

Objective:To investigate the correlation between bronchial wall thickness that was determined by high-resolution computed tomography(HRCT)on lung,and pulmonary function and curative efficacy of patients with chronic obstructive pulmonary disease(COPD).Methods:From January 2020 to December 2022,a total of 154 COPD patients were retrospectively selected as the observation group.According to the indicator of the percentage of forced expiratory volume in the first second(FEV1%),the patients were divided into high-risk group(grade Ⅰ,n=51),mild group(grade Ⅱ,n=45),moderate group(grade Ⅲ,n=35)and severe group(grade Ⅳ,n=23)as the 2023 global initiative for chronic obstructive lung disease(GOLD)scale.At the same time,67 healthy subjects were selected as healthy control group.All of them underwent HRCT scan on their chest,and the thickness of the bronchial wall at the opening of the bronchus of bilateral lung apex was measured.The percentage of forced expiratory volume at the first second(FEV1%),forced expiratory volume at the first second(FEV1)and FEV1/forced vital capacity(FEV1/FVC%)(percentage of forced vital capacity)were measured by the pulmonary function apparatus.Pearson correlation analysis software was used to analyze the correlation between bronchial wall thickening and lung function and curative efficacy.Results:The left bronchial wall thickness(1.49±0.21)mm and the right bronchial wall thickness(1.52±0.24)mm in the observation group were higher than those in the healthy control group(t=18.041,15.504,P<0.05),respectively.In the observation group,the higher GOLD grading of the subgroup has higher thickness at the left and right sides of bronchial walls,and there were also significant differences at the thicknesses of bilateral bronchial walls among different grading groups(F=13.888,25.841,P<0.05),respectively.The FEV1(1.82±0.32),FEV1/FVC%(63.09±5.26)and FEV1%(63.36±6.03)in COPD patients of the each subgroup of observation group were lower than those of healthy control group,and the differences were statistically significant(t=6.693,15.392,7.944,P<0.05),respectively.In the observation group,patients with higher GOLD grade has lower decreasing level of the FEV1,FEV1/FVC%and FEV1%,and there were statistically significant differences in pulmonary function levels among the subgroups of the observation group(F=166.541,141.751,57.120,P<0.05),respectively.The results of Pearson correlation analysis showed that the left and right sides of bronchial wall thickening of HRCT scan on COPD patients were positively correlated with FEV1,FEV1/FVC%and FEV1%levels of pulmonary function in COPD patients(r=0.451,0.503,0.498,0.531,0.488.0.515,P<0.05),respectively.Conclusion:The thickness of bronchial wall of HRCT scan images on lung appears high expression in COPD patients,and its expression level can reflect the severity of patients'disease,and has a strong correlation with pulmonary function.

This article reported that clinical pharmacists participated in the anti-infection treatment process of a patient with fever after intracranial aneurysm operation.The initial fever in the patient caused by arachnoid hemorrhage was non-infectious fever.Then followed by intracranial infections,the intravenous regimen of vancomycin and meropenem was optimized according to clinically relevant guidelines and the blood-brain barrier permeability of antimicrobials.Later,Escherichia coli was reported via the cerebrospinal fluid culture,and the patient with intracranial infection was cured by step-down therapy with ceftazidime.During hospitalization,the patient experienced an adverse event of demyelinating myelitis,which was considered to be related to the excessive single dose of intrathecal gentamicin.The intrathecal administration was promptly discontinued,and eventually the patient recovered well in muscle power.Throughout the entire treatment process,clinical pharmacists assisted physicians in providing patient with an individualized treatment plan and provided reference for the safe,effective,and rational use of antibiotics.

ObjectiveTo explore the obstacles and causes of communication and cooperation among doctors, nurses and rehabilitation therapists in a stroke rehabilitation team. MethodsFrom July to October, 2022, twelve rehabilitation evaluation meetings were observed using ethnographic research, based on Shared Mental Model theory. Semi-structured interviews were held with five doctors, ten nurses and four rehabilitation therapists. ResultsFour themes and nine sub-themes were presented, namely equipment (poor interoperability of information system, limited knowledge of rehabilitation equipment for doctors and nurses), task (members were under time pressure to attend meeting, imperfect inter-discipline communication system), team interaction (insufficient information sharing, unfamiliar with roles/responsibilities, misunderstanding between specialties) and team member (less participation of nurses, limited multidisciplinary knowledge). ConclusionThe communication and cooperation among stroke rehabilitation team members is limited by many factors, such as equipment, task, team interaction and team members. It is suggested to improve interoperability of information systems, create a supportive environment, know each other's roles/responsibilities, strengthen interdisciplinary crossover, pay attention to and support the cultivation of nurses' ability, to promote efficient communication and cooperation among team members.

Objective To explore the role of clinical pharmacists in the treatment of drug poisoning by analyzing the clinical pharmacist's participation in the treatment of a patient with sodium valproate poisoning. Methods Clinical pharmacists measured the plasma concentration of sodium valproate to inform the doctor to diagnose illnesses. At the initial stage when the concentration is high, to eliminate the free drug by continuous venous-venous hemodialysis-filtration (CVVHDF). Then, the combined drug was cleared by hemoperfusion (HP). Results The blood concentration dropped by half at the first CVVHDF and decreased obviously after two HPs. After stable observation in five days’ course of disease, the blood concentration was maintained at a low level and the patient was cured and discharged. Conclusion The implementation of the blood purification program under the monitoring of the blood drug concentration with the participation of pharmacists is helpful for the rescue of drug overdose and is worthy of promotion.

Objective:To investigate the change of microalbuminuria (MA) in patients with RA and its clinical significance.Methods:From January 2018 to December 2019, data of 75 cases of RA patients were collected from outpatient and inpatient wardsof our hospital, and the data of 75 cases of physical examination wascollected as control. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) anti-cyclic citrullinated peptide (CCP) antibody, blood lipid, Homeostasis model assessment for insulin resistance (HOMA-IR), rheumatoid factor (RF), anti-CCP antibodyand MA levels were measured respectively. RA patients were obtained by ultrasound Carotid intima-media thickness (cIMT) and brachial artery flow mediated diastolic function (FMD) were measured. The statistical analysis was carried out with independent t-test, analysis of variance, Pearson correlation analysis and multiple stepwise regression. Results:The MA level of RA patients was significantly higher than that of the healthy control group [(31±5) mg/L vs (25±4) mg/L, t=5.982, P<0.05]. In RA patients, MA level was positively correlated with course of disease ( r=0.327, P=0.015), HOMA-IR ( r=0.576, P<0.01], CRP ( r=0.212, P=0.027), RF ( r=0.585, P<0.01), disease activity score in 28 joints (DAS28) ( r=0.472, P=0.013), cIMT ( r=0.611, P<0.01) and duration of nonsteroidal anti-inflammatory drugs (NSAIDs) use ( r=0.274, P<0.01), and urineMA level( OR=1.763, P<0.01) were independent correlation factors affecting cIMT. Conclusion:The level of MA in RA patients is significantly higher than that in normal controls, and is correlated with disease activity and subclinical atherosclerosis, which could be another important predictor of disease follow-up and early screening of subclinical atherosclerosis in RA patients.

Objective To investigate the value of abdominal aortic balloon combined homeostasis in the cesarean section with invasive completeplacenta previa. Methods Data of 47 cases of completeplacenta previa with placenta accrete from March 2007 to August 2018 were analyzed retrospectively. Seventeen cases (study group) were treated with abdominal aortic balloon combined homeostasis before cesarean, and 30 cases (control group) did not receive balloon occlusion. The operation time, intra-operative blood loss, intra-operative blood transfusion volume, disseminated or diffuse intravascular coagulation (DIC) rate, hysterectomy rate and post operative complications, time of postoperative hospital stay were compared. Also, the blood coagulation parameters 24 h after operation, including activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer werecompared between the two groups. Results Significant difference was observed in the blood loss [1 000 (800—2 000) ml vs. 2 200 (1 000-4 100) ml, Z=-2.272, P=0.023] and blood transfusion volume [400 (0-2 450) ml vs. 2 460 (200-4 460) ml, Z =- 2.02, P = 0.03], 16 cases of the study group still bled after releasing the balloon.Fifteen cases of them received uterine artery ligation. Bleeding stopped after uterine balloon compression in 1 case. Eleven cases of the 15 cases received uterine balloon compression at the same time. One case of 28 weeks gestation underwent subtotal hysterectomy due to hemorrhagic shock combined with DIC caused by placenta accretion of the bladder. While in control group, 7 cases underwent total hysterectomy because hemorrhagic shock combined with DIC and 3 cases underwent subtotal hysterectomy due to heavy bleeding, and there was statistical significance between two groups [1/17 vs. 33.3%(10/30), P=0.039]. Conclusions Temporary balloon occlusion of the abdominal aorta combined with conventional homeostasis can reduce blood loss, blood transfusion and hysterectomy rate in the cesarean section complicated with invasive complete placenta previa.

Objective To compare the surgical effect of gasless endoscopic thyroidectomy and CO2- insufflation endoscopic thyroidectomy, and evaluate the safety and applicability of gasless endoscopic thyroidectomy. Methods A prospective randomized controlled study was carried out.Sixty patients who were scheduled for bilateral thyroid surgery under endoscope were divided into 2 groups by sortition method: gasless group (30 patients, treated with gasless endoscopic thyroidectomy) and CO2-insufflation group (30 patients, treated with CO2-insufflation endoscopic thyroidectomy). The data of arterial partial pressure of carbon dioxide (PaCO2) and pH value before operation and 60 min after operation were detected. The operation time, intraoperative bleeding, time of putting the drain, hospitalization time after operation and postoperative complications were recorded. Results All the 60 patients completed endoscopic surgery,and no case was converted to the conventional procedure.There were no statistical differences in PaCO2and pH value before operation between 2 groups(P>0.05).The PaCO260 min after beginning of operation in gasless group was significantly lower than that in CO2-insufflation group:(36.43 ± 1.98)mmHg(1 mmHg=0.133 kPa)vs.(37.93 ± 3.27)mmHg,the pH value 60 min after beginning of operation was significantly higher than that in CO2-insufflation group:7.42 ± 0.02 vs. 7.37 ± 0.01, and there were statistical differences (P<0.05 or <0.01). There were no statistical difference in operation time, intraoperative bleeding, time of putting the drain, hospitalization time after operation and incidence of hoarseness between 2 groups (P>0.05). There were no complications related with trachea, parathyroid gland and superior laryngeal nerve in 2 groups. The incidence of CO2retention related complications in gasless group was significantly lower than that in CO2-insufflation group: 6.7% (2/30) vs. 43.3% (13/30), and there was statistical difference (P<0.01). Conclusions The modified spring suspension gasless endoscopic thyroidectomy not only acquires the equivalent surgical effect and indication,compared with the CO2-insufflation endoscopic surgery,but also is safer and has lower incidence rate of CO2retention related complications.