The real-time Delphi method represents a refinement of the classical Delphi technique, designed to overcome limitations such as prolonged study duration and delayed feedback during consensus development. This article, building upon the classical Delphi foundation, systematically elaborates on the application process, advantages, and limitations of the real-time Delphi method. It further presents currently available websites or software capable of facilitating real-time Delphi exercises and offers considerations and recommendations for its application in guideline development, aiming to serve as a reference for relevant researchers.

Objective: To investigate associations of suicidal ideation with clinical features, inflammatory markers, and thyroid hormones in patients with schizophrenia. Methods: The subjects of this study were 203 schizophrenic patients, grouped on the basis of suicidal ideation. Clinical characteristics were assessed using multiple scales. Neutrophil to lymphocyte ratio(NLR), platelet to lymphocyte ratio(PLR), monocyte to lymphocyte ratio(MLR) and thyroid hormones were also detected. SPSS 23.0 was used for statistical analyses. Results : The prevalence of suicidal ideation was 21.7% in patients with schizophrenia. Logistic stepwise regression analyses showed that Calgary depression scale(CDSS) total score(OR=1.490, 95%CI=1.287-1.724,P<0.001), insomnia severity index scale(ISI) total score(OR=1.096, 95%CI=1.011-1.187,P=0.025), modified overt aggression scale(MOAS) total score(OR=1.111, 95%CI=1.016-1.215,P=0.021), MLR(Ln)(OR=15.123, 95%CI=3.868-59.125,P<0.001), and triiodothyronine(T3)(OR=0.037, 95%CI=0.003-0.388,P=0.006) were the independent influences of suicidal ideation. Additionally, receiver operating characteristic(ROC) curve analyses revealed that the five-item combination of CDSS total score, ISI total score, MOAS total score, MLR(Ln), and T3(AUC=0.908, 95%CI=0.867-0.949,P<0.001) had better ability to identify suicidal ideation. Conclusion The risk of suicidal ideation is relatively high in patients with schizophrenia, and there may be stronger associations between suicidal ideation and depression, insomnia, aggression, MLR, and T3.

ObjectiveTo study the relationship between qi stagnation constitution and suboptimal health status (SHS) or lifestyle.MethodsFrom 2012 to 2013, we conducted a cross-sectional survey of 24 159 Chinese individuals aged 12–80 years. The qi stagnation constitution was assessed using the Constitution in Chinese Medicine Questionnaire. Health status was evaluated through medical records and the Subhealth Measurement Scale V1.0 (SHMS V1.0). Health-promoting lifestyles were measured using the Health-Promoting Lifestyle Profile II (HPLP-II).ResultsOf the 24 159 participants, 16.1% and 15.2% were classified as “always” and “sometimes” having the qi stagnation constitution, respectively. Those classified as “rarely” having the qi stagnation constitution scored higher on both the HPLP-II and SHMS V1.0. The participants classified as “always” having the qi stagnation constitution showed a significant association with SHS or disease compared to other imbalanced constitutions. Those in the “always” category were approximately 21 times more likely to be classified as having SHS (odds ratio [OR]: 21.17, 95% confidence interval [CI]: 15.74–28.45), whereas those in the “sometimes” category were approximately six times more likely (OR: 5.89, 95% CI: 5.04–6.90). Accordingly, the qi stagnation constitution score was significantly associated with the diagnosis of SHS, with an area under the curve of 0.77 (P .001). A score of 18.75 yielded the highest Youden Index (0.407), with a sensitivity of 60.5% and a specificity of 80.3%. Significant associations were observed between health-promoting lifestyles and qi stagnation constitution severity in an ordinal regression analysis (P .001). Protective factors included stress management (OR: 1.59), self-actualization (OR: 1.57), and exercise (OR: 1.36). In contrast, poorer interpersonal relationships (OR: 0.79), greater health responsibilities (OR: 0.86), and poorer nutrition (OR: 0.91) were associated with increased severity.ConclusionModulating the qi stagnation constitution through lifestyle interventions may help prevent the progression of SHS to disease, which aligns with core preventive principles in traditional Chinese medicine.

Objective To understand the molecular epidemiological characteristics of Norovirus outbreaks and the genome evolution of Norovirus epidemic strains in Hainan Province from 2020 to 2022.Methods The information and samples have been collected from the norovirus outbreaks from 2020 to 2022.Norovirus was detected by using the real-time PCR in these samples,then the detected sequences were amplified the analyzed.The Norovirus se-quences of 8 strains had been amplified and analyzed.Results From 2020 to 2022,39 gastroenteritis outbreaks were reported,and 25 outbreaks caused by Norovirus which mainly occurred in childcare institutions and schools(20/25,80％).The Norovirus outbreaks were mainly concentrated in counties around Haikou(northeast),which including Ding'an(5 cases),Wenchang(4 cases),Chengmai(4 cases),and Lingao(3 cases);following by western regions which included Baisha(2 cases),Ledong(2 cases),and Dongfang(3 cases).1 case was in Wanning in the southeast.Among individuals aged 2-17,the positive proportion of Norovirus in males was higher than that in females.Among individuals aged over 55,the proportion of Norovirus positive in females was higher than that in males.The gender of positive samples among individuals aged 18-40 was related to their profession.According to RT-PCR typing and sequencing,GⅡ group Norovirus were classified in13 outbreaks.There were 4 genotypes detected.GⅡ.2[P1 6]was the main epidemic strain with 60％(9/13),and the other three genotypes were GⅡ.4 Sydney[P31](15.4％,2/13)GⅡ.4 Sydney[P16](7.7％,1/13)and GⅡ.3[P12](7.7％,1/13).Further genic analysis of 8 Norovirus strains showed that all of them were still in the same branch as the previ-ous strain,and all exhibited a certain amount of amino acid variation.Conclusion Norovirus is the main pathogen of gastroenteritis outbreaks in Hainan province,and the main epidemic strain is GⅡ.2[P16].It is necessary to continue to strengthen the monitoring that provides scientific evidence for the prevention and control of norovirus out-breaks in Hainan region.

BACKGROUND:Atlantoaxial dislocation,because of its high difficulty and high risk of surgery,has been regarded as the"surgical restricted area"by the international orthopedic community.However,with the rapid development of intelligent digitization in orthopedics,robot-assisted navigation screw placement technology has been widely used in clinical practice,which significantly reduces the difficulty and risk of surgery and improves the safety of surgery.However,there are few reports on the application of this technique in the treatment of atlantoaxial dislocation. OBJECTIVE:To explore the application value of robot-assisted pedicle screw internal fixation in the treatment of atlantoaxial dislocation. METHODS:The medical records of five patients with atlantoaxial dislocation treated with C1-C2 pedicle screw fixation under robot-assisted navigation in Zhuhai Hospital of Guangdong Provincial Hospital of Chinese Medicine from October 2021 to July 2022 were retrospectively analyzed.Operation time,length of neck incision,blood loss,postoperative drainage volume,and length of hospital stay were recorded.Attention should be paid to cerebrospinal fluid leakage,vertebral artery injury,nerve injury,operative area infection and other complications.The visual analog scale score of neck pain,the spinal cord injury grade of the American Spinal Injury Association,the cervical spine score of the Japanese Orthopaedic Association,and the imaging indicators were collected before surgery and at the last follow-up.Screw placement accuracy was assessed. RESULTS AND CONCLUSION:(1)Five patients were successfully completed surgery,without vascular,nerve injury or other complications,and were followed up for 12-20 months.(2)A total of 20 cervical pedicle screws were placed in 5 patients,including 9 type A screws,10 type B screws,and 1 type C screw.The accuracy of screw placement was 95%.(3)At the last follow-up,the visual analog scale score was(0.80±0.71)points,which was significantly lower than that before operation(4.00±2.83)points;the Japanese Orthopaedic Association score was(14.80±0.84)points,which was significantly higher than that before operation(8.00±0.71)points.Anterior atlantodental interval decreased from(7.86±3.25)mm to(2.82±0.93)mm;space available of the spinal cord increased from(6.74±1.99)mm to(12.10±3.51)mm;cervicomedullary angle increased from(133.32±13.55)° to(153.44±9.53)°;clivus-canal angle increased from(128.02±9.92)° to(143.25±12.99)°.The results of the last follow-up indexes were improved compared with those before operation,and the differences were significant(all P<0.05).(4)Postoperative imaging follow-up showed that all patients had bone fusion in the bone graft area,and no internal fixation loosening,fracture or pull-out occurred.(5)This method can avoid relying on the doctor's experience and hand feeling,ensure the accuracy of upper cervical screw placement,reduce the risk of surgery,and obtain satisfactory results in mid-term follow-up.

Objective:To construct a competency evaluation indicator system for infection prevention and control nurses in Operating Rooms (hereinafter referred to as "IPC") and provide an objective basis for the management of IPC nurses.Methods:From June to November 2022, an initial competency evaluation indicator system for IPC nurses was developed through literature review and semi-structured interviews. The Delphi method was employed to consult 20 experts from 11 provinces and municipalities across the country. Analytical Hierarchy Process (AHP) and mean distribution method were applied to quantify and determine the weight of each level of indicators within the system.Results:Nineteen experts were finally included, with two rounds of questionnaire recovery rates of 95.00% (19/20) and 100.00% (19/19), respectively. The authority coefficients of the experts were 0.858 and 0.861, familiarity coefficients were 0.850 and 0.853, and coefficients of judgment basis were 0.865 and 0.868, respectively. The Kendall's W coefficient of concordance for the two rounds of inquiries were 0.139 and 0.202 ( P<0.05), respectively. The final IPC nurse competency evaluation indicator system included six primary indicators, 22 secondary indicators, and 66 tertiary indicators. Conclusions:The constructed IPC nurse competency evaluation indicator system is scientific, reasonable, objective, and comprehensive, providing a valuable reference for the capability training, assessment, entry standards, and qualification certification of IPC nurses.

Abstract: Objective　To analyze the genotype of carbapenemase resistance genes and their genetic homology in multidrug-resistant Acinetobacter baumannii, and to provide a theoretical basis for guiding the rational use of antibiotics and controlling the prevalence of nosocomial infections. Methods A total of 83 multidrug-resistant Acinetobacter baumannii isolated from patients in the intensive care unit (ICU) and environmental specimens in the Sixth People's Hospital of Nantong from July 2020 to December 2021 were collected. The bacteria were identified and subjected to drug sensitivity tests using the BioMérieux DL96-Ⅱ automatic bacterial identification susceptibility system. The carbapenemase-related drug resistance gene types were detected using the polymerase chain reaction (PCR) method, and clones were analyzed by pulsed field gel electrophoresis (PFGE). Results The types of 83 ICU Acinetobacter baumannii specimens include sputum (43 strains), broncholavage fluid (20 strains), and surfaces of objects such as ventilators (20 strains). The resistance rates of all strains to imipenem, tetracycline, gentamicin, amikacin and ciprofloxacin were 100%, 32.5%, 38.6%, 41.0% and 77.1% respecitively, while the resistance rates to others such as ticarcillin and clavulanate were greater than 95%. All strains carried were detected to carry OXA-23 and OXA-51 genes, while OXA-24, OXA-58, IMP-1, VIM, IMP-4, SIM and NDM-1 resistance genes were all negative. PFGE homology analysis confirmed that 83 strains of Acinetobacter baumannii, with counts of 12, 18, 12, 13, 10, 6, 7, 5 respectively, mainly A, B, C, D, E clones, the rest were sporadic clones. Conclusions The carbapenem resistant Acinetobacter baumannii isolated from our ICU are widely drug-resistant to commonly used antimicrobial drugs, with B clone strain being the major prevalent strain. Carrying OXA-23 and OXA-51 genes may be an important reason for the resistance of Acinetobacter baumannii to carbapenem antibiotics in our ICU. Rational use of antimicrobial drugs, enhanced monitoring of bacterial resistance, and effective control of the generation and further spread of drug-resistant strains should be emphasized.

Objective:To investigate the incidence and risk factors of hypertensive disorders in pregnancy (HDP) in high altitude areas and their influence on maternal and infant outcomes.Methods:This was a retrospective case-control study. A total of 220 newborns were selected as the high altitude group, who were born to 216 mothers with HDP and admitted to the Neonatal Intensive Care Unit of the Lhasa People's Hospital from June 1, 2018, to June 1, 2020. The low altitude group consisted of 235 newborns born to 231 mothers with HDP and admitted to the Department of Neonatology of the Children's Hospital Affiliated to Beijing Capital Institute of Pediatrics from January 1, 2018, to December 31, 2021. Differences in the types of HDP between the two groups and the risk factors for the high incidence of preeclampsia-eclampsia and early-onset preeclampsia in high altitude area were analyzed. The influences of HDP in high and low altitude areas on maternal and infant outcomes were compared. Statistical analysis was performed using t-test, Mann-Whitney U test, Pearson Chi-square test, or continuous correction Chi-square test, and univariate and multivariate logistic regression analysis. Results:Maternal age and the proportions of primiparae and women of advanced age or having irregular prenatal examination were greater in the high altitude group than those in the low altitude group (all P<0.05). Besides, the incidence of early-onset preeclampsia, eclampsia, preeclampsia-eclampsia, and chronic hypertension complicated by preeclampsia were also higher in the high altitude group (all P<0.05). Multivariate logistic regression analysis showed that high altitude was a risk factor for the development of preeclampsia-eclampsia ( OR=4.437, 95% CI:2.582-7.626). Adverse pregnancy history ( OR=2.576, 95% CI:1.217-5.452) and irregular prenatal examination ( OR=2.862, 95% CI:1.412-5.800) were independent risk factors for early-onset preeclampsia in pregnant women in high altitude areas. Twin-pregnancy was a protective factor for early-onset preeclampsia in pregnant women in high altitude areas ( OR=0.183, 95% CI: 0.054-0.623). The incidence of maternal heart failure [7.9% (17/216) vs 0.4% (1/231), χ2=15.98], placental abruption [7.9% (17/216) vs 3.5% (8/231), χ2=4.11], hemolysis, elevated liver function and low platelet count syndrome [14.4% (31/216) vs 1.7% (4/231), χ2=24.64], premature delivery [86.1% (118/216) vs 73.6% (170/231), χ2=10.79], fetal growth restriction [52.3% (115/220) vs 18.7% (44/235), χ2=56.26], fetal distress [18.2% (40/220) vs 8.1% (19/235), χ2=10.26], neonatal asphyxia [29.5% (65/220) vs 11.1% (26/235), χ2=24.26], severe asphyxia [8.6% (19/220) vs 2.6% (6/235), χ2=8.10] and the proportion of neonates requiring mechanical ventilation within 24 h after birth [69.5% (153/220) vs 42.6% (100/235), χ2=33.54] as well as neonatal death within 7 d after birth [5.5% (12/220) vs 1.3% (3/235), χ2=6.22] in the high altitude group were significantly higher than those in the low altitude group (all P<0.05). Conclusion:High altitude is a risk factor for preeclampsia-eclampsia, and the adverse effects of HDP on mothers and infants are more severe in high altitude areas.

Objective:To analyze the risk factors and clinical features of premature infants with bronchopulmonary dysplasia(BPD)at high altitude in Tibet and low altitude in Beijing.Methods:A retrospective case-control study was conducted.The clinical data of children with gestational age ≤32 weeks admitted to the Department of Neonatology of Lhasa People′s Hospital(altitude of 3 600 m)and the Department of Neonatology of Children′s Hospital Affiliated to Capital Institute of Pediatrics(altitude of 50 m)from January 1, 2018 to December 31, 2021 were collected.Cases were divided into BPD group and non-BPD group.Premature infants with BPD were divided into high altitude group and low altitude group according to different altitudes.The clinical characteristics and high risk factors of BPD were analyzed.Results:There were 379 premature infants with gestational age ≤32 weeks, 351 were included in the study, including 110 cases in group and 241 cases in non-BPD group.There were 48 cases in high altitude group and 62 cases in low altitude group.The incidence of BPD in high altitude areas(Lhasa)was 38.7%(48/124), among which mild, moderate and severe BPD accounted for 75.0%(36 cases), 18.8%(9 cases)and 6.3%(3 cases), respectively.The incidence rates of BPD were 100%(2/2), 86.7%(13/15)and 38.7%(33/107) in gestational age <28 weeks, 28 to 29 + 6 weeks and 30 to 32 weeks, respectively.There was a statistically significant difference among different gestational age groups( χ2=19.696, P<0.001). The incidence of BPD in low altitude areas(Beijing)was 27.3%(62/227), among which mild, moderate and severe BPD accounted for 74.2%(46 cases), 4.8%(3 cases)and 21.0%(13 cases), respectively.The incidence rates of BPD in gestational age<28 weeks, 28 to 29 + 6 weeks and 30 to 32 weeks were 100%(15/15), 45.6%(36/79)and 8.3%(11/133), respectively.There was a statistically significant difference among different gestational age groups( χ2=77.474, P<0.001). The incidence of BPD in high altitude areas was significantly higher than that in low altitude areas( χ2=4.841, P=0.028). Multivariate regression analysis showed that high altitude( OR 146.893, 95% CI 19.044-1 133.064), birth weight( OR 0.996, 95% CI 0.993-0.999), asphyxia( OR 4.187, 95% CI 3.020-21.670), non-invasive mechanical ventilation( OR 1.171, 95% CI 1.106-1.240)and invasive mechanical ventilation( OR 1.198, 95% CI 1.065-1.347)were significantly correlated with the occurrence of BPD.The gestational age at birth, small for gestational age infant, the fraction of inspired oxygen and the incidence of pregnancy induced hypertension in pregnant women in high altitude group were higher than those in low altitude group( P<0.05). The incidence of patent ductus arteriosus, the use time of noninvasive and invasive mechanical ventilation, the length of hospital stay, the age of mother, the application of prenatal hormone and the twin ratio in high altitude group were significantly lower than those in low altitude group( P<0.05). Conclusion:High altitude in Tibet is a high-risk factor for the occurrence of BPD in preterm infants.Strengthening maternal health care in high altitude areas of Tibet and doing a good job in asphyxia resuscitation in delivery room may be important measures to reduce BPD in preterm infants.

Objective:To explore the effect of small private blended teaching combined with guided feedback in the training of specialist nurses in Operating Room.Methods:The cluster sampling was used to select 62 trainees who participated in the training of specialist nurses in Operating Room of the First Affiliated Hospital of Zhengzhou University in 2019 and 2020 as the research object. The trainees in 2019 and 2020 were divided into the control group ( n=32) and the experimental group ( n=30) . The experimental group adopted the small private online course (SPOC) teaching method combined with guided feedback, and the control group adopted the traditional teaching method. After the training, the two teaching methods were evaluated by theoretical assessment, operational assessment and self-designed questionnaires. Results:The theoretical knowledge, surgical safety verification, and surgical position placement scores of the specialist nurses in Operating Room of the experimental group were (89.90±3.92) , (91.37±3.57) , (92.03±2.98) , and the scores of the control group were (87.44±3.06) , (88.53±4.23) , (87.28±3.10) respectively, and the differences between the two groups were statistically significant ( P<0.05) . The students in the experimental group had a good evaluation of the effect of the SPOC teaching method combined with guided feedback, and their satisfaction was over 90%. Conclusions:The SPOC teaching method combined with guided feedback can improve the theoretical knowledge and operational ability of specialist nurses in Operating Room, and enhance the enthusiasm of students to learn, cultivate clinical thinking ability and humanistic care consciousness. The training effect is better than traditional teaching method, which is helpful to improve the teaching quality of specialized nursing in Operating Room.