Objective To construct a risk prediction model for intraoperative acquired pressure injury(IAPI)during neurosurgery in pediatric patients,and verify the predictive effect of the model,to provide a reference for preventing IAPI during neurosurgery in pediatric patients.Methods The clinical data of 776 pediatric patients undergoing neurosurgery in a tertiary-level hospital in Chongqing from January to June 2023 were retrospectively collected.The risk factors for IAPI were explored through univariate analysis and binary Logistic regression analysis.The fitting degree and predictive effect of the model were verified by Hosmer-Lemeshow test and receiver operator characteristic(ROC)curve,respectively.The model was validated internally by Bootstrap.Results The incidence of IAPI during neurosurgery in pediatric patients was 7.99％.Logistic regression analysis showed that bleeding volume,anesthesia time,age,intraoperative use of instruments such as drills and milling cutters that increase external force,and surgical position were the factors influencing IAPI in neurosurgical children(all P＜0.05).The results of the Hosmer-Lemeshow test showed that x2=3.636,P=0.888.The results of internal verification showed that the sensitivity of the model was 0.59;the specificity was 0.81;the area under the ROC curve was 0.79.Conclusion This study analyzes the risk factors for IAPI during neurosurgery in pediatric patients and constructs a line chart prediction model with good predictive performance,which can provide a reference for individualized prediction of the risk of IAPI during neurosurgery in pediatric patients.It can provide a scientific basis for clinical nursing staff to identify high-risk children with IAPI early and take personalized preventive measures in time.

Objective To construct a risk prediction model for intraoperative acquired pressure injury(IAPI)during neurosurgery in pediatric patients,and verify the predictive effect of the model,to provide a reference for preventing IAPI during neurosurgery in pediatric patients.Methods The clinical data of 776 pediatric patients undergoing neurosurgery in a tertiary-level hospital in Chongqing from January to June 2023 were retrospectively collected.The risk factors for IAPI were explored through univariate analysis and binary Logistic regression analysis.The fitting degree and predictive effect of the model were verified by Hosmer-Lemeshow test and receiver operator characteristic(ROC)curve,respectively.The model was validated internally by Bootstrap.Results The incidence of IAPI during neurosurgery in pediatric patients was 7.99％.Logistic regression analysis showed that bleeding volume,anesthesia time,age,intraoperative use of instruments such as drills and milling cutters that increase external force,and surgical position were the factors influencing IAPI in neurosurgical children(all P＜0.05).The results of the Hosmer-Lemeshow test showed that x2=3.636,P=0.888.The results of internal verification showed that the sensitivity of the model was 0.59;the specificity was 0.81;the area under the ROC curve was 0.79.Conclusion This study analyzes the risk factors for IAPI during neurosurgery in pediatric patients and constructs a line chart prediction model with good predictive performance,which can provide a reference for individualized prediction of the risk of IAPI during neurosurgery in pediatric patients.It can provide a scientific basis for clinical nursing staff to identify high-risk children with IAPI early and take personalized preventive measures in time.

Objective:To investigate the status of continuous care for children with chronic diseases in public hospitals in Chongqing, so as to provide references for improving the quality of continuous care for children with chronic diseases.Methods:This study is a cross-sectional study. From April to May 2022, a total of 66 managers from 66 departments of 50 hospitals in Chongqing were selected as the research objects by the purposive sampling method. The Implementation of Transitional Care for Children's Chronic Diseases in Medical and Health Institutions Questionnaire was used to investigate the implementation, management status and managers' evaluation of continuous care for children with chronic diseases. A total of 66 questionnaires were distributed in this study, and 66 valid questionnaires were collected, with an effective recovery rate of 100.00% (66/66) .Results:Among 50 hospitals, 29 provided transitional care items for children with chronic diseases. The continuous care of children with chronic diseases had many problems, such as single content and form, low utilization rate of information platform, no standardized evaluation system and quality management program, and low satisfaction of continuous care for children with chronic diseases.Conclusions:Public hospitals in Chongqing have launched continuous care for children with chronic diseases, but the breadth and depth are limited, and there are still shortcomings in form, content, and effectiveness evaluation. In the future, it is necessary to further expand the content and form of continuous care for children with chronic diseases, establish standardized continuous care evaluation indicators, and improve the quality of continuous care for children with chronic diseases.

OB JECTIVE To conduct overview of the systematic revi ew（SR）/meta-analysis for the effectiveness and safety of pharmacological interventions for hospitalized neconatal pain ， and to provide evidence-based reference for neonatal pain management. METHODS CNKI，CBM，Wanfang，VIP，PubMed，Embase，the Cochrane Library ，Web of Science ，CINAHL and Google Scholar were searched for SR/meta-analysis of pharmacological interventions for hospitalized neonatal pain. The search period was from Nov. 1st，2016-Nov. 1st，2021. After literature screening and data extraction ，AMSTAR 2 scale was used to evaluate the methodological quality of the included literature ，and GRADE method was used to assess the evidence quality of the outcome of the include d literature . A su mmary analysis was then conducted. RESULTS Totally 36 outcome indexes of 7 SR/ meta-analysis were included. Five studies were of moderate quality，and two were very poor according to AMSTAR 2 scale. GRADE results showed that among 36 outcome indexes，there were 7 moderate-quality indexes （19.44％），low-quality indexes （61.11％），and 7 critically-low-quality indexes （19.44％）. The main reason for downgrading the quality of evidence was impr ecision of results （71.74％）. CONCLUSIONS Opioids c an significantly reduce t he pain score of mechanically ventilated neonates but may increase hypotension. Acetaminophen can significantly reduce pain scores during eye examinations and postoperative morphine consumption with no adverse reaction report. However ，its analgesic effect on procedural pain is less than glucose and sucrose. Lidocaine and prilocaine and tetracaine may relieve venipuncture and lumbar puncture pain but lidocaine and prilocaine may increase the risk of adverse reaction. Clonidine can reduce neonatal mechanical ventilation pain with no adverse reaction report. It is suggested that neonatal pediatricians should use analgesic drugs selectively based on clinical judgment and pain assessment results.

BACKGROUND: Massive bleeding is the main concern for the management of placenta percreta (PP). Intra-abdominal aortic balloon occlusion (IABO) is one method for pelvic devascularization, but the efficacy of IABO is uncertain. This study aims to investigate the outcomes of IABO in PP patients. METHODS: We retrospectively reviewed the clinical data of PP cases from six tertiary centers in China between January 2011 and December 2015. PP cases with/without the use of IABO were analyzed. Propensity score matching analysis was performed to reduce the effect of selection bias. Postpartum hemorrhage (PPH) and the rate of hysterectomy, as well as neonatal outcomes, were analyzed. RESULTS: One hundred and thirty-two matched pairs of patients were included in the final analysis. Compared with the control group, maternal outcomes, including PPH (68.9% vs. 87.9%, χ2 = 13.984, P < 0.001), hysterectomy (8.3% vs. 65.2%, χ2 = 91.672, P < 0.001), and repeated surgery (1.5% vs. 12.1%, χ2 = 11.686, P = 0.001) were significantly reduced in the IABO group. For neonatal outcomes, Apgar scores at 1 minute (8.67 ± 1.79 vs. 8.53 ± 1.68, t = -0.638, P = 0.947) and 5 minutes (9.43 ± 1.55 vs. 9.53 ± 1.26, t = 0.566, P = 0.293) were not significantly different between the two groups. CONCLUSIONS IABO can significantly reduce blood loss, hysterectomies, and repeated surgeries. This procedure has not shown harmful effects on neonatal outcomes.
Aorta ; Balloon Occlusion/methods* ; Blood Loss, Surgical ; Female ; Humans ; Hysterectomy ; Infant, Newborn ; Placenta Accreta/surgery* ; Placenta Previa/surgery* ; Postpartum Hemorrhage ; Pregnancy ; Retrospective Studies

Objective To compose a scientific, systematic and operative nursing quality evaluation system for neonatal blood exchange transfusion, and to provide a reference for quality control of clinical nursing practice. Methods Semi-structured interviews were conducted, the related literature was reviewed, and a preliminary Delphi enquiry questionnaire with the frame of structure quality, process quality and outcome quality was ultimately formed. Through Delphi enquiry questionnaires and analytic hierarchy processing method, all the indictors and the weights were affirmed. Results Totally 19 experts participated in the inquiry, the authority coefficients in the 2 rounds were 0.91 and 0.93 respectively, theχ2 test of Kendall′s W coefficients was significance with P<0.01. The nursing quality evaluation system for neonatal blood exchange transfusion was finalized with 3 level-1 indicators, 9 level-2 indicators and 39 level-3 indicators. Conclusions The nursing quality evaluation system developed through this study can provide practical reference to clinical nursing practice.

Objective To compare the clinical efficacy between single and double volume exchange transfusion for neonatal hyperbilirubinemia,and to verify whether single volume exchange transfusion had advantages in maintaining homeostasis and reducing blood transfusion related complications.Methods Clinical materials of 86 neonates with neonatal hyperbilirubinemia who received blood exchange transfusion,from December 2013 to December 2014,in the diagnosis and treatment center of our hospital were retrospectively analyzed.Cases were divided into the single volume group (35 cases,with a blood volume 80-110 mL/kg) and double volume group (51 cases,with a blood volume 150-180 mL/kg) based on blood volume per kilogram of body weight.Comparisons of the homeostasis changes between pre-transfusion and post-transfusion were performed for each group,and the incidence rate of major adverse events were compared between the two groups.Results (1)In the single volume group and double volume group,the average blood exchange transfusion volumes were (98.16 ± 10.75) mL/kg and (157.78 ± 7.37) mL/kg,the exchange rate of bilirubin were (41.68± 8.52) ％ and (50.22 ± 13.14) ％,and the average time for blood transfusion were (85.60 ±18.66) min and(1 1B.22± 24.81)min respectively,and there were statistically significant differences in the exchange rate of bilirubin and average time for blood transfusion between the two groups (P＜0.05).(2)Compared with pre-transfusion,WBC and platelet (PLT)count,levels of serum total bilirubin (TBIL),albumin,serum potassium,serum sodium,serum chlorine,serum calcium and HCO3-,and pH value were significantly decreased after blood exchange transfusion,while RBC count,PT,APTT and blood glucose were significantly increased in the two groups (P＜0.01).Moreover,the changes of blood glucose,PLT and TBIL in the double volume group were more significantly than those in the single volume group,there were statistically significant differences (P＜0.05).No statistically significant difference was found in the rate of major adverse events between the two groups (P＞0.05).Conclusion Compared with double blood exchange transfusion therapy,single volume exchange transfusion can significantly decrease plasmic bilirubin level with less change of homeostasis,less blood volume for transfusion and less human resources consumption,its value in clinical application is recognized.

Objective To explore the construction and application effects of extended care form for children with epilepsy based on Omaha System.Methods Based on Omaha System,the form was established by referring medical records,literature review and three rounds of focus group discussion.From February to June,2016,48 children with epilepsy were selected as the observation group and received routine care as well as management using the form based on Omaha System;from August to December,2015,48 children with epilepsy were selected as the control group and received routine care and follow-up.The effects of intervention and scores of Family Management Measure were compared between two groups.Results Nursing issues in all domains for the observation group 3 months after intervention were lower than those during hospitalization except financial situation (P＜0.05);there was statistically significant difference in scores of knowledge-behavior-status of main nursing issues before and after intervention except cognition and mental health items (P＜0.05).Duration of hospitalization,expenditure,readmission rate,EEG results and scores of FAMM in the observation group were better than those in the control group (P＜0.05).Conclusion The construction and application of the form based on Omaha System can provide references for longterm management for children.

Objective To discuss the efficacy of applying management-by-objectives(MBO) in the hospital-level nursing quality control group.Methods Goals of objective management and assessment details were set by leaders of quality control groups along with the nursing department at the beginning of the year.The nine subordinate groups performed upon the required criteria,completed the quality inspection on time and recorded group activities.At the end of the year,group leaders reported to the hospital-level nursing quality committee and head nurses about their performances,where several major honors were rewarded to the best performing groups.SPSS 17.0 software was used for data statistics.The measurement data were analyzed by paired t test data while enumeration data by chi-square test.Results Scores of assessment items were significantly raised after implementing MBO(P＜0.05).Scores of key items,such as high quality care,emergency management,nursing skill,were increased to (98.1 ± 2.2),(97.7 ±2.7),(99.6±0.6),(96.1 ±2.1)from (93.6 ±2.5)(P=0.009),(93.0 ± 2.6) (P=0.009),(96.2 ± 1.3) (P=0.000) and (89.3 ± 4.5) (P--0.000),respectively.Care complaints were sharply dropped for all inpatient wards while numbers of management innovationand process reengineering were greatly increased (x2=8.884,P=0.031).Condusion Introduction of MBO in the hospital-level nursing quality control group does facilitate the continuous improvement of care quality.

Objective To assess the efficiency and safety of the ureteroscope pneumatic lithotripsy (UBSL) and extracorporeal shock-wave lithotripsy (ESWL) for urinary tract calculi,and to guide the clinical practice.Methods Through searching the electronic bibliographic databases,including CNKI,VIPand WANFANG database,and searching published articles by hand to assemble the random clinical trial of ureteroscope pneumatic lithotripsy and extracorporeal shock-wave lithotripsy for urinary tract calculi.The retrieval articles were all Chinese,and the time was from January 1990 to September 2012.The retrieval results were systematically evaluated.Results Three randomized clinical trials involving 124 patients were analyzed.The results of meta-analysis demonstrated:the clearance rote at one time,the rote of efficiency,the rote of operation one more time all had statistically significant difference between two methods.The incidence of renal pain,and the incidence of hematourine had no significant difference between two methods.Conclusions Ureteroscope pneumatic lithotripsy and extracorporeal shock-wave lithotripsy for urinary tract calculi can improve the clearance rote and efficiency rote as well as decrease the rate of operation one more time.However,it can not reduce the rate of complication of the operation.