Humans ; Gastrointestinal Microbiome ; Constipation/therapy* ; Probiotics/therapeutic use* ; Patients

Objective To investigate the short-term efficacy of celiac plexus block combined with the interstitial permanent implantation of 125I seeds in the treatment of advanced pancreatic cancer(inoperable locally advanced and metastatic pancreatic cancers).Methods A total of 100 patients with advanced pancreatic cancer were selected and treated with celiac plexus block combined with the interstitial permanent implantation of 125I seeds under CT guidance.Pain relief and changes in the tumor marker CA19-9 were assessed on the seventh day,the first and third months after surgery.In the third month after surgery,tumor size was assessed by CT.Results Among the 100 patients with advanced pancreatic cancer,complete response(CR)was found in 12 cases,partial response(PR)in 78 cases,stable disease in five cases,and progression of disease in five cases three months after surgery.The CA19-9 level and the sum of short and long tumor diameters were significantly decreased(both P<0.01).A total of 100 patients had severe pain before treatment(visual analogue scale(VAS)):7-10 points),59 patients reported pain disappearance(VAS:0 points),35 patients had mild pain(VAS:1-3 points),and six patients experienced moderate pain(VAS:4-6 points)in the third month after treatment.The pain relief rate was 100%.Conclusion Celiac plexus block combined with the interstitial permanent implantation of 125I seeds has good short-term efficacy and can effectively improve short-term pain in patients with advanced pancreatic cancer.

Objective:To construct an evaluation system for clinical thinking ability of general practitioners in the treatment of multimorbidity.Methods:This was a cross-sectional study. The draft of evaluation indexes for clinical thinking ability of general practitioners in treatment of multimorbidity was preliminary developed through literature review, collation, analysis and discussion. Nineteen clinical and teaching experts of general practice were selected for consultation via anonymous convenient sampling. From January to June 2022, 2 rounds of expert consultation were conducted using the Delphi method. During the first round of consultation, according to the survey feedback, we modified and improved the evaluation system of general practitioners′ clinical thinking ability for multi-disease co-treatment. During the second round, experts were asked to assess the importance of each index, and to calculate the weight of each index accordingly. Questionnaires were sent to experts via letters. The content of the questionnaires encompasses the basic information of experts, evaluation for various indexes and relevant opinions. The mean value of importance assignment ≥3.5, coefficient of variation ≤0.25 and the full score frequency ≥30% were taken as the criteria. Indexes unsatisfying the criteria were removed, so that the final index system could be constructed.Results:The average age of 19 experts was 50.2 years old, 9 of them were male. A total of 2 rounds of expert consultation were conducted, 19 questionnaires were issued in each round, and 19 effective questionnaires were received afterwards. In the first round of consultation, 10 experts put forward revised opinions, and some indexes were adjusted according to the definition criteria and the discussion of the research group. In the second round of consultation, 3 experts put forward suggestions for modification. According to the definition criteria, no need to delete the indexes. After discussion by the research group, some indexes were adjusted, and finally an evaluation system of clinical thinking ability for multi-disease co-treatment of general practitioners was established, including 4 first-level indexes and 30 second-level indexes. The weights of the 4 first-level indexes in descending order were "overall thinking ability" (38.01%), "diagnostic thinking ability" (33.96%), "evidence-based thinking ability" (14.75%), and "critical thinking ability" (13.28%). Among the 30 secondary indexes, the top 5 were "ability to identify and handle priority emergency incidents" (5.04%), "risk assessment and critical illness identification ability" (4.63%), "emergency referral ability" (4.61%), "communication and expression ability" (4.57%), and "standardized diagnosis and treatment ability" (4.23%).Conclusion:This study successfully constructed an evaluation system for clinical thinking ability of general practitioners in the treatment of multimorbidity.

Objective:To explore the effect of the hospital-community-family trinity linkage nursing model in patients with home pressure injury.Methods:From May 2018 to May 2019, convenience sampling was used to select 60 bedridden patients with stage 3 to 4 pressure injury at home in Dongcheng District, Beijing, as the research object. The patients were randomly divided into the observation group and the control group, with 30 cases in each group. The observation group conducted a hospital-community-family trinity linkage nursing model, while the control group carried out a traditional community-based routine dressing change and nursing management model. The pressure injury healing rate and healing time of the two groups of patients were compared.Results:The cure rate of patients in the observation group was 96.67% (29/30) , which was higher than 80.00% (24/30) in the control group, and the difference was statistically significant ( P<0.05) . The cure time of patients in the observation group was (42.20±4.97) days, which was shorter than (50.13±4.83) days in the control group, and the difference was statistically significant ( P<0.01) . Conclusions:The hospital-community-family trinity linkage nursing model can improve the treatment effect of home pressure injury, and can provide a practical basis for the rehabilitation of chronic wounds of patients with home pressure injury in the community.

Objective:To construct an evaluation indicator system of nursing quality in Ophthalmological Daytime Operation Room and provide a reference for objectively assessing the nursing quality in ophthalmological Daytime Operation Room.Methods:From January to August 2020, the evaluation indicator system of nursing quality in Ophthalmological Daytime Operation Room was constructed by literature retrieval, semi-structured interviews, Delphi's expert correspondence inquiries, and hierarchical analysis based on Donabedian's structure-process-outcome model.Results:The effective response rates of the questionnaires for the two rounds of expert correspondence inquiries were 100.0%; the expert authority coefficients were 0.851 and 0.858; and the expert coordination coefficients were 0.098-0.264. The evaluation indicator system of nursing quality in ophthalmological daytime operation room finally constructed included 3 primary indicators, 11 secondary indicators, and 57 tertiary indicators.Conclusions:The evaluation indicator system of nursing quality in Ophthalmological Daytime Operation Room constructed in this study is highly scientific and reliable, which can comprehensively and objectively assess and continuously improve the nursing quality of Ophthalmological Daytime Operation Room.

Objective:To explore the application of Bloom target teaching theory combined with PBL teaching mode in standardized residency training of respiratory.Methods:A total of 44 residents of Batch 2019 who had been in respiratory department of our hospital for 2 months on rotation were selected as the control group, and traditional teaching training was adopted in the group. In addition, 41 residents of Batch 2020 who were enrolled in the respiratory department of our hospital for a 2-month residency training rotation were selected as the research group, and Bloom target teaching theory combined with PBL teaching mode was applied in the group. After the residency training, the teaching effect of the two groups of training residents was evaluated by theoretical examination, practical skill operation examination and questionnaire survey. SPSS 22.0 was used to conduct t test. Results:The results of theoretical assessment and practical skills operation assessment of students in the study group were better than those in the control group, and the difference was statistically significant ( P<0.05). The subjective satisfaction of the training residents and the tutors were scored respectively. The results showed that the scores of residents in the study group were higher than those in the control group, the difference was statistically significant ( P<0.05). The subjective satisfaction score of residents on the assessment results of this stage showed that residents in the study group had higher scores than the control group, with statistical significance ( P<0.05). The tutor's subjective satisfaction score of the assessment results at this stage showed that the scores of the residents in the study group were higher than those in the control group, and the difference was statistically significant ( P<0.05). Conclusion:The combination of Bloom target teaching theory and PBL teaching mode can improve the theoretical and practical operation ability of students in respiratory department, improve their learning initiative, enthusiasm and teaching satisfaction, and then improve the teaching quality.

Objective:To investigate the awareness and implementation of swallowing training for laryngectomy patients among nurses of Otolaryngology Department in ClassⅢ Grade A hospitals of China so as to provide a basis for standardizing the swallowing training for laryngectomy patients and training for nurses.Methods:From September 2019 to October 2019, this study selected 274 nurses of Otolaryngology Department from 46 hospitals in 26 provinces or cities of China as subjects by convenience sampling. All of nurses were investigated with the self-designed awareness of swallowing training for laryngectomy patients questionnaires among nurses of Otolaryngology Department. SPSS 19.0 was used for data analysis, and enumeration data were expressed as the frequency, percentage or constituent ratio.Results:A total of 274 questionnaires were sent out and 268 valid questionnaires were collected. Among 268 nurses, there were 4.10% (11/268) of them completely understood the swallowing function training knowledge. Departments with the swallowing function training standard for the laryngectomy patients accounted for 43.66% (117/268) . A total of 95.52% (256/268) of nurses thought that it was necessary to unify the swallowing function training standard for the laryngectomy patients, and 93.28% (250/268) of nurses agreed to carry out swallowing function taining for patients. However, there were only 30.22% (81/268) of nurses carrying out swallowing assessment by scales.Conclusions:In China, nurses of Otolaryngology Department in ClassⅢ Grade A hospitals have inadequate knowledge of swallowing function training for laryngectomy patients, and the swallowing function training lacks unified standard. Swallowing training and standardized nursing practice needs to be further improved.

Objective? To summarize and describe the experience of breast cancer postoperative rehabilitation patients with upper limb lymphedema so as to provide a basis for medical staff to formulate effective nursing intervention. Methods? Qualitative descriptive study was used to carry out individual in-depth interview in lymphedema patients, and content analysis method was used to data analysis. Results? Among 11 breast cancer postoperative rehabilitation patients, 4 categories of experience were refined by content analysis for interview data including lack of experience and different ways of lymphedema self-management, complex emotional experience as well as daily life affected. Conclusions? This study summarizes and describes the experience of breast cancer postoperative rehabilitation patients with upper limb lymphedema which helps medical staff to understand the real experience of lymphedema patients and provides information for medical staff to provide targeted intervention.

Objective: To investigation HER2 status in gastric adenocarcinoma of Chinese and contributing factors to the HER2 expression. Methods: HER2 status of 40 842 gastric adenocarcinomas and clinical data were retrospectively collected from 23 hospitals dated from 2013 to 2016. The association between HER2 positivity and clinicopathologic features was analyzed. Results: Of the 40 842 patients the median age was 62 years, the male female ratio was 2.6∶1.0. The rate of HER2 positivity was 8.8% (3 577/40 842). HER2 expression was related to the tissue type, tumor location, Lauren classification and tumor differentiation (P values: 0.009, 0.001, <0.01 and <0.01, respectively). Different HER2 expression status was observed between primary and recurrent tumors in 7.6% (48/635) cases. The rates of HER2 positivity ranged from 2% to 10% among different institutions. The rates of HER2 FISH amplification were dramatically different among the 23 hospitals (0-100%) with an average rate of 10% (810/8 156) in patients with HER2 IHC 2+ . Conclusions HER2 expression is associated with clinicopathologic characteristics. HER2 re-assessment of tumor tissue and use of in situ hybridization techniques increase HER2 positivity. The current retrospective study should reflect the HER2 status in gastric adenocarcinoma of Chinese patients.

Objective To investigate the incidence of genotypes related to analgesia and muscle relax effects,and to review the genetic polymorphism of OPRM1,CYP3A4 * 1G,SLCO1B1 and ABCB1 in Han population in North-western China.Methods The genotypes of OPRM1,CYP3A4 * 1G,SLCO1B1 and ABCB1 in patients born in North-western China between September,2016 and May,2017 were reviewed.North-western China was defined as Shaanxi,Gansu,Ningxia,Qinghai and Xinjiang Provinces.The distribution of genotypes was recorded.And the differences between male and female patients were compared.Results The frequency was 42.11％ for AG genotype and 12.14％ for GG genotype of OPRM1 (118A＞G).For CYP3A4 * 1G,the frequencies of CC,TT,TC and CT were 29.69％,4.17％,65.67％ and 0.47％,respectively.For ABCB1,the frequencies of CC,TT,TC and CT were 13.07％,44.60％,0.28％ and 42.05％,respectivsly.For SLCO1B1,AG genotype appeared in 37.44 ％ of the patients,GG genotype appeared in 55.21％ of the patients.There was no difference between the male and the female patients.Conclusion Genotypes related to change of susceptibility to opioids including fentanyl and rocuronium were detected in high percentage of patients in North-western China,indicating that SNP assay for instruction of anesthetic practice be of value.