Objective:To construct a core competency indicator system for prehospital emergency nursing staff in stroke.Methods:A preliminary draft of the core competency indicator system for prehospital emergency nursing staff in stroke was formulated through literature research and group discussions. From January to March 2023, 15 experts were selected, and after two rounds of Delphi expert consultations, the indicators at all levels were modified and improved to form the final version of the indicator system. The degree of expert enthusiasm was expressed as the effective response rate of the questionnaire, the degree of expert authority was expressed as the expert authority coefficient ( Cr), and the degree of expert opinion coordination was expressed as the Kendall harmony coefficient and coefficient of variation. Results:In two rounds of Delphi expert consultation, the effective response rates of the questionnaire were 100.00% and 93.33%, respectively, and the expert authority coefficients were 0.853 and 0.861. After the second round of expert consultation, the coefficient of variation for each item was from 0 to 0.23, and the Kendall's harmony coefficient was 0.185 ( P<0.01). The final constructed indicator system included four primary indicators, 14 secondary items, and 31 tertiary items. Conclusions:The constructed core competency indicator system for prehospital emergency nursing staff in stroke is scientific and reliable, and can provide reference for the training and assessment of prehospital emergency nursing staff.

Objective:To construct an evaluation index system for the core competence of emergency medical dispatchers, so as to provide a theoretical basis for the training, assessment and ability evaluation of emergency medical dispatchers.Methods:In September 2022, a research group was established to compile the first draft of the evaluation index system for the core competencies of emergency medical dispatchers through literature review, semi-structured interviews and group discussions. From October to November 2022, a total of 27 experts in related fields from nine provinces and municipalities directly under the Central Government in China were consulted by Delphi expert letters, items were screened and amended, and an evaluation index system for the core competence of emergency medical dispatchers was formed.Results:A total of two rounds of correspondence were conducted. The effective recovery rate of the questionnaire was 100%, and the authority coefficient of the experts was 0.856. Kendall's coordination coefficients were 0.402 and 0.414 ( P<0.01), respectively. Finally, a core competency evaluation index system for emergency medical dispatchers was constructed, which included seven primary indicators, 16 secondary indicators and 75 tertiary indicators. Conclusions:The core competence evaluation index system for emergency medical dispatchers is scientific, reliable and comprehensive, which can provide a theoretical basis for the training, assessment and ability evaluation of emergency medical dispatchers.

Objective:To investigate the prognostic value of N-terminal B-type brain natriuretic peptide precursor (NT-proBNP), cardiac troponin I (cTnI) and aVL lead T-wave changes in acute coronary syndrome (ACS).Methods:Clinical data of 162 patients with ACS admitted to the Emergency Chest Pain Center of the Affiliated Hospital of Jining Medical University from January 2020 to December 2021 were retrospectively collected, including 84 patients with unstable angina pectoris (UAP) and 46 patients with ST-segment elevation myocardial infarction (STEMI). 32 patients with non-ST elevation myocardial infarction (NSTEMI); There were 66 patients with single-vessel disease, 70 patients with double-vessel disease, 26 patients with multi-vessel disease, and 51 patients with major cardiovascular adverse events (MACE). The levels of NT-proBNP, cTnI and T-wave change ratio of aVL lead were compared in different patients.Results:The NT-proBNP and cTnI of UAP patients were 510.42(365.56, 630.54)pg/ml and 8.20(6.50, 10.50)ng/ml, respectively, which were significantly lower than those of STEMI and NSTEMI patients (all P<0.05). There was no significant difference in NT-proBNP and cTnI between STEMI and NSTEMI patients (all P>0.05). The T-wave change proportions of NT-proBNP, cTnI and aVL leads in patients with multi-vessel lesions were 804.90(680.87, 980.05)pg/ml, 13.90(10.12, 15.65)ng/ml and 88.46%(23/26), respectively. It was significantly higher than that in patients with single and double vessel lesions (all P<0.05). The T-wave change ratio of NT-proBNP, cTnI and aVL leads in patients with double-vessel disease was 680.84(525.50, 810.62)pg/ml, 10.40(8.92, 13.60)ng/ml and 67.14%(47/70), respectively, which was significantly higher than that in patients with single-vessel disease (all P<0.05). The proportions of T-wave changes of NT-proBNP, cTnI and aVL leads in MACE patients were 744.54(621.17, 905.54)pg/ml, 12.21(8.65, 15.54)ng/ml and 86.27%(44/51), respectively. It was significantly higher than those without MACE (all P<0.05). The area under receiver operating characteristic (ROC) curve of NT-proBNP, cTnI and aVL lead T-wave changes independently and jointly predicted the occurrence of MACE were 0.937, 0.677, 0.706 and 0.799, respectively, among which NT-proBNP had a higher value in predicting the occurrence of MACE. Conclusions:The T-wave changes of NT-proBNP, cTnI and aVL leads are related to the type of lesions, the number of lesions and the occurrence of MACE in ACS patients, and NT-proBNP has a high value in predicting prognosis.

Objective:To explore the related prognostic factors in patients with aortic dissection (AD) after surgery or interventional therapy, and to construct a multi-factor Cox regression analysis nomogram prediction model.Methods:The clinical data of patients diagnosed with AD in the emergency department of Affiliated Hospital of Jining Medical University of Shandong Province from January 2019 to December 2021 were collected to analyze retrospectively. The survival time was followed up, the survival curve was drawn by Kaplan-Meier method, the difference of survival rate among different Stanford types was tested by Log-Rank test, and Cox regression univariate and multivariate survival analysis was used to screen the prognostic factors. According to the results of multivariate analysis, the death risk nomogram model after AD was established, the differentiation of the model was evaluated by C-index, the accuracy of the model was evaluated by calibration curve, and the clinical benefit of the model was evaluated by decision curve analysis (DCA).Results:A total of 256 patients with AD were included, the mortality rate was 4.45% (37/256), and the overall survival rates at 3 months, 6 months and 12 months after operation were 90.23%, 87.50% and 85.55%, respectively. There was no significant difference in postoperative survival rate among AD patients with different Stanford types (χ 2=2.30, P=0.13). Cox multivariate regression analysis showed that history of hypertension ( HR=3.791, 95% CI 1.150-12.501, P=0.029), number of branch vessels involved ( HR=1.210, 95% CI 1.029-1.422, P=0.021), preoperative left ventricular ejection fraction (LVEF) ( HR=0.936, 95% CI 0.880-0.996, P=0.038) and perioperative complications ( HR=4.024, 95% CI 1.839-8.807, P<0.001) were independent prognostic factors in patients with AD. Furthermore, the predictive nomogram model of 3-month, 6-month and 12-month survival rate in patients with AD was constructed, and the C-index was 0.778. The calibration curve indicated that the accuracy of the model was good, and the clinical benefit of the DCA model was good. Conclusions:Hypertension history, the number of branch vessels involved, preoperative LVEF and perioperative complications are independent risk factors of postoperative death in patients with AD. The nomogram prediction model based on the above factors can be used to evaluate the postoperative survival of patients with AD.

Objective:To develop a scientific and comprehensive job competency evaluation scale for pre hospital emergency nurses, and to test its reliability and validity.Methods:Based on the theory of nurse medical quality responsibility model, the first draft of the scale was formed through literature review, Delphi method, and other research methods. A questionnaire survey was conducted among 563 pre hospital nurses from 6 tertiary A hospitals in Shandong Province. SPSS 27.0 statistical software was used for factor analysis to test the reliability and validity of the scale.Results:The final competency evaluation scale for pre hospital emergency nurses included 6 dimensions and 40 items. Cronbach′s α coefficient of the total scale was 0.921, and the Spearman Brown split half reliability coefficient was 0.756. Conclusion:The job competency evaluation scale for pre hospital emergency nurses constructed in this study has good reliability and validity, and can be used to evaluate the job competency of pre hospital emergency nurses.

Objective:To investigate the survival status of patients with acute aortic dissection (AD) treated by different methods, and evaluate the factors affecting the survival of AD patients.Methods:According to the retrospective research method, the patients diagnosed with AD in the Affiliated Hospital of Jining Medical University from January 1, 2019 to December 31, 2020 were collected. The treatment data and follow-up of patients were counted, the survival of patients was analyzed by Kaplan-Meier survival curve, and the factors affecting the survival of patients were analyzed by Cox regression model.Results:A total of 251 patients were included in this study, including 169 patients in the surgical treatment group and 82 patients in the conservative treatment group. The in-hospital fatality rate in the surgical treatment group and the conservative treatment group were 8.88%(15/169) and 43.90%(36/82), respectively, and the difference were statistically significant ( P<0.05). The survival time of surgical treatment group and conservative treatment group was (328.08±8.17)d and (194.43±19.80)d, respectively, and the difference was statistically significant ( P<0.05). Surgery ( RR=5.424, 95% CI: 2.821-10.428, P<0.05), acute myocardial infarction ( RR=0.448, 95% CI: 0.221-0.906, P<0.05), and shock ( RR=0.266, 95% CI: 0.102-0.693, P<0.05) and stroke ( RR=0.277, 95% CI: 0.127-0.604, P<0.05) were the factors affecting 1-year survival in AD patients. Conclusions:Active surgical treatment is recommended for AD patients with surgical indication as soon as possible.

Objective:To observe the effect of theophylline intravenous drip combined with high flow respiratory humidifier on serum pro Calcitonin (PCT) and lactate clearance rate (LCR) in elderly patients with chronic obstructive pulmonary disease (COPD) secondary to type II respiratory failure.Methods:We prospectively selected 120 elderly patients with COPD secondary to type II respiratory failure who were admitted to the Affiliated Hospital of Jining Medical University from March 2020 to March 2022. They were randomly divided into the control group ( n=60) and the observation group ( n=60). The control group was treated with non-invasive positive pressure ventilation combined with theophylline intravenous drip, and the observation group was treated with high flow respiratory humidification therapy apparatus combined with theophylline intravenous drip. The sputum viscosity of the two groups was counted, and the pulmonary function [forced vital capacity (FVC), forced expiratory volume in 1 s (FEV 1), FEV 1/FVC], blood gas analysis, respiratory mechanics, oxygen metabolism, and serum index levels, as well as the difference between acute physiology and chronic health assessment Ⅱ (APACHE Ⅱ) scores after treatment were compared between the two groups. Results:The overall sputum viscosity of the observation group was better than that of the control group ( P<0.05). Before treatment, there was no statistically significant difference in lung function and blood gas analysis indicators between the two groups (all P>0.05); After treatment, the lung function indicators, arterial partial pressure of oxygen (PaO 2), and oxygenation index (PaO 2/FiO 2) of both groups were significantly increased compared to before treatment (all P<0.05), while arterial partial pressure of carbon dioxide (PaCO 2) was significantly decreased compared to before treatment (all P<0.05), and the values of each indicator in the observation group after increasing or decreasing were significantly better than those in the control group (all P<0.05). Before treatment, there was no statistically significant difference in respiratory mechanics and oxygen metabolism indicators between the two groups (all P>0.05); After treatment, the arterial blood oxygen content (CaO 2) in the two groups was significantly higher than that before treatment (all P<0.05), while the oxygen uptake rate (ERO 2) in the two groups and the VO 2 max (VO 2Max), airway peak value, and respiratory resistance in the observation group were significantly lower than those before treatment (all P<0.05), and the values of each index in the observation group after rising or falling were significantly better than those in the control group (all P<0.05). Before treatment, there was no statistically significant difference in serum indicators and APACHE Ⅱ scores between the two groups (all P>0.05); After treatment, LCR and C-reactive protein (CRP) in the observation group were significantly higher than those before treatment ( P<0.05), while the scores of PCT, Interleukin 6 (IL-6), CRP and APACHE Ⅱ were significantly lower than those before treatment (all P<0.05), and the values of each index in the observation group after increase or decrease were significantly better than those in the control group (all P<0.05). Conclusions:Theophylline intravenous drip combined with high flow respiratory humidifier can improve respiratory mechanics, oxygen metabolism, reduce inflammatory reaction, and reduce the impact of disease on life in elderly patients with COPD secondary to type II Respiratory failure.

Objective:To investigate the effects of survival status in Stanford type A aortic dissection (TAAD) patients over 70 years old by different treatment methods.Methods:The clinical data of 151 TAAD patients over 70 years old from January 2012 to January 2022 in the Affiliated Hospital of Jining Medical University were retrospectively analyzed. Among them, 60 patients were treated with surgery (surgical treatment group), and 91 patients with conservative method (conservative treatment group). The duration of hospitalization and complications (including pericardial effusion, acute myocardial infarction, pericardial tamponade, shock, stroke, mesenteric ischemia and acute renal failure) were recorded. The patients were followed up within 30 d after the onset of illness. The survival status was recorded. The multivariate Cox regression analysis was used to analyze the independent risk factors of death in TAAD patients over 70 years old.Results:The duration of hospitalization in surgical treatment group was significantly longer than that in conservative treatment group: 14.00 (7.00, 19.75) d vs. 5.00 (2.00, 10.00) d. The incidences of pericardial tamponade, shock and acute renal failure: 1.7% (1/60) vs. 13.2% (12/91), 8.3% (5/60) vs. 24.2% (22/91) and 0 vs. 9.9% (9/91), with statistical differences ( P<0.01 or <0.05), but no statistical differences in the incidences of pericardial effusion, acute myocardial infarction, stroke, mesenteric ischemia between two groups ( P>0.05). Patient follow-up for 30 d, the mortality rate in surgical treatment group was significantly lower than that in conservative treatment group: 15.0% (9/60) vs. 46.2% (42/91), with statistical difference ( χ2 = 15.69, P<0.01). The multivariate Cox regression analysis result showed that conservative treatment, female, increased aortic root diameter and concomitant stroke were the independent risk factors of death in TAAD patients over 70 years old ( RR = 2.311, 2.135, 1.051 and 3.737; 95% CI 1.056 to 5.057, 1.083 to 4.212, 1.004 to 1.100 and 1.393 to 10.026; P<0.05 or <0.01). Conclusions:The early surgical treatment is recommended in TAAD patients over 70 years old with surgical indications.

Objective:An early diagnosis model of acute aortic dissection (AAD) was established based on chest pain center database.Methods:The clinical data of patients who attended Chest Pain Center of Department of Emergency in Affiliated Hospital of Jining Medical University of Shandong Province from January 2020 to December 2020 were retrospectively collected. Patients were divided into AAD and non-AAD groups according to whether or not AAD was diagnosed. The clinical related indicators of the two groups were compared. The research indicators with statistical differences between the two groups were included in multivariate Logistic regression analysis, and the early diagnosis of AAD nomogram model was established. The receiver operating characteristic (ROC) curve of the model was used to evaluate the prediction accuracy, and the Homser-Lemeshow statistics were used to test the goodness of fit for the model. A total of 630 patients with chest pain who visited the hospital from January 2021 to March 2021 were also collected for external validation of the model. The t-test of independent samples was used to compare the measurement data of normal distribution, nonparametric test was used to compare the measurement data of skewness distribution, and χ 2 test was used to compare the counting data between groups. Results:A total of 2 738 patients were included, of which 4.09% (112/2 738) were AAD patients. Univariate analysis showed that in AAD group, male morbidity (74.11%(83/112)), hypertension history (70.54%(79/112)), aortic disease history (10.71%(12/112)), family history of aortic disease (4.46%(5/112)), sudden onset of symptoms (76.79%(86/112)), percentage of patients with laceration pain (38.39%(43/112)), patients with back pain (66.07%(74/112)), patients with abdominal pain (16.96%(19/112)), systolic blood pressure ((159.44±30.94) mmHg), bilateral blood pressure/pulse asymmetry (23.21% (26/112)), incidence of complicated neurological signs (7.14%(8/112)) and D-dimer (3.57(2.10, 6.62) mg/L) were significantly higher than those in non-AAD group (59.56%(1 564/2 626), 46.23%(1 214/2 626), 0.23%(6/2 626), 0.08%(2/2 626), 35.99%(945/2 626), 0.08%(2/2 626), 3.08%(81/2 626), 3.81%(100/2 626), (142.46±27.90) mmHg, 0.15%(4/2 626), 0.27%(7/2 626), 0.31(0.20, 0.50) mg/L). Age ((57.95±14.35) years old) and CK-MB (1.50(0.90, 3.25) μg/L) were significantly lower than those in the non-AAD group ((61.94±15.77) years, 2.50(1.24, 4.81) μg/L). The differences were statistically significant (the statistical values were χ 2=9.47, χ 2=25.46, χ 2=180.80, χ 2=81.11, χ 2=76.17, χ 2=975.60, χ 2=798.00, χ 2=44.72, t=6.28, χ 2=527.20, χ 2=93.22, Z=14.09, t=2.61, and Z=3.51, respectively; P values were 0.002, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, 0.009, and <0.001, respectively). Multivariate analysis showed that history of hypertension ( OR=3.088, 95% CI:1.294-7.374), history of aortic disease ( OR=20.771, 95% CI:2.132-202.361), family history of aortic disease ( OR=266.425, 95% CI:17.610-4 030.851), sudden onset of symptoms ( OR=3.538, 95% CI:1.643-7.619), laceration pain ( OR=1 771.971, 95% CI:204.048-15 387.935), back pain ( OR=61.550,95% CI:27.987-135.367), abdominal pain ( OR=12.325, 95% CI:4.201-36.161), systolic blood pressure ( OR=1.026, 95% CI:1.013-1.039), bilateral blood pressure/pulse asymmetry ( OR=338.357, 95% CI:60.704-1 885.949) and D-dimer ( OR=1.241, 95% CI:1.176-1.309) were independent factors for the diagnosis of AAD in patients with chest pain (P values were 0.011, 0.009, <0.001, 0.001, <0.001, <0.001, <0.001, <0.001, <0.001, and <0.001, respectively). Furthermore, the nomogram model was constructed. ROC curve analysis showed that the area under the curve was 0.976 ( P<0.01), the specificity was 94.52%, and the sensitivity was 91.96%. The statistics of Homser-lemeshow was used to test the goodness of fit, which shows that the model can be fitted well (χ 2=2.928, P=0.939). The prediction model was verified by external validation data, and the area under the ROC curve was 0.934 ( P<0.01), indicating that the model had good prediction performance. Conclusions:History of hypertension, history of aortic disease, family history of aortic disease, sudden onset of symptoms, laceration pain, back pain, abdominal pain, systolic blood pressure, bilateral blood pressure/pulse asymmetry and D-dimer were independent factors for the diagnosis of AAD in patients with acute chest pain. The AAD early diagnosis nomogram model based on the above factors has good predictive performance.

Objective:To explore the application value of evaluation and management of patients with acute chest pain in China (EMPACT) score in risk stratification for patients with acute chest pain.Methods:According to the methods of prospective cohort study, 548 patients with chest pain in the Affiliated Hospital of Jining Medical University from February to April 2021 were selected. The risk stratification was performed according to EMPACT score. The primary endpoint was the major adverse events (MAE) within 30 d, including death from all causes, acute myocardial infarction (AMI), emergency revascularization, cardiac arrest, cardiogenic shock and other life-threatening situations that need urgent attention. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of EMPACT score for MAE.Results:Among the 548 patients, 75 cases had MAE within 30 d (MAE group), and the incidence of MAE was 13.7%; 473 cases did not occur MAE (non-MAE group). The EMPACT score in MAE group was significantly higher than that in non-MAE group: 8 (12, 18) scores vs. 5 (2, 8) scores, and there was statistical difference ( Z = 8.94, P<0.01). Spearman correlation analysis result showed that EMPACT score was positively correlated with MAE ( r = 0.38, P<0.01). ROC curve analysis result showed that the area under the curve of EMPACT score in prediction within 30 d MAE was 0.820 (95% CI 0.770 to 0.871), the cut-off value was 9.5 scores (since all the scoring systems were integers, the cut-off value was 10 scores), the sensitivity was 88.6%, and the specificity was 60.0%. Conclusions:The EMPACT score has a good risk stratification capability to achieve safe and effective triage of acute chest pain.