Objective:To retrieve, evaluate and summarize the best evidence on the use of bedside ultrasound by ICU nurses to assess the lungs of adult critically ill patients, and to provide a reference for clinical practice and the construction of related processes and protocols.Methods:Based on the "6S" pyramid model, a computer-based search was conducted on relevant computer decision support system, guideline networks, professional associations, and domestic and international databases, the search time limit was from the establishment of the database to June 5, 2024. The panel members who had been trained in the evidence-based course evaluated the included literature with corresponding tools, extracted evidence according to the theme.Results:Twenty-five papers were finally included, including 6 guidelines, 8 expert consensus, 2 expert opinion, 3 clinical decision-making, 3 systematic evaluation, and 3 randomized controlled trials. A total of 35 pieces of evidence were formed from 4 aspects, including personnel training, operation specifications, clinical application (including dyspnea screening, intervention implementation, efficacy evaluation, diaphragm function evaluation) and precautions.Conclusions:The best evidence for lung assessment and intervention in adult critically ill patients based on bedside ultrasound can provide a reference for the adjustment and decision-making of nursing measures for adult critically ill patients. In the subsequent process of evidence transformation, attention should be paid to combining clinical practice and the joint cooperation of medical staff.

Objective:To retrieve, evaluate and summarize the best evidence on the use of bedside ultrasound by ICU nurses to assess the lungs of adult critically ill patients, and to provide a reference for clinical practice and the construction of related processes and protocols.Methods:Based on the "6S" pyramid model, a computer-based search was conducted on relevant computer decision support system, guideline networks, professional associations, and domestic and international databases, the search time limit was from the establishment of the database to June 5, 2024. The panel members who had been trained in the evidence-based course evaluated the included literature with corresponding tools, extracted evidence according to the theme.Results:Twenty-five papers were finally included, including 6 guidelines, 8 expert consensus, 2 expert opinion, 3 clinical decision-making, 3 systematic evaluation, and 3 randomized controlled trials. A total of 35 pieces of evidence were formed from 4 aspects, including personnel training, operation specifications, clinical application (including dyspnea screening, intervention implementation, efficacy evaluation, diaphragm function evaluation) and precautions.Conclusions:The best evidence for lung assessment and intervention in adult critically ill patients based on bedside ultrasound can provide a reference for the adjustment and decision-making of nursing measures for adult critically ill patients. In the subsequent process of evidence transformation, attention should be paid to combining clinical practice and the joint cooperation of medical staff.

Objective:To explore the long-term efficacy of virtual reality exposure therapy (VRET) for acrophobia.Method:Sixty patients with acrophobia who visited the Nanjing Brain Hospital Affiliated to Nanjing Medical University from October 2018 to January 2021 were selected and randomly divided into VRET group ( n=30) and imaginary exposure therapy (IET) group ( n=30) using a block random number table method. The VRET group received VRET treatment, while the IET group received IET treatment. Both groups received treatment twice a week for 3 weeks. At baseline and after treatment, the acrophobia questionnaire (AQ) and attitude towards high questionnaire (ATHQ) were used to assess the patients' acrophobia symptoms, and the behavioral avoidance test (BAT) was used to assess the patients' level of avoidance when facing high altitude situations. During the 2-year follow-up after treatment, AQ and ATHQ were used to evaluate the patients' acrophobia symptoms. The repeated measures ANOVA and covariance analysis were used to analyze the data using SPSS 27.0 software. Result:(1) Repeated measures ANOVA showed that there was no significant interaction effect of AQ-anxiety, AQ-avoidance, and ATHQ scores between the two groups before and after treatment ( F=1.37, 1.95, 0.21, all P>0.05), while the time main effect of AQ-anxiety ( F=43.29) and ATHQ score ( F=13.35) was significant (both P<0.05), and the time main effect and group main effect of AQ-avoidance score were significant ( Ftime=62.84, Fgroup=5.65, both P<0.05). The AQ-avoidance scores of the VRET group(6.19±3.60, 8.25±3.80) were significantly lower than those of the IET group (9.60±3.74, 12.00±4.57)after treatment and during the follow-up period (both P<0.05).(2)After controlling for the baseline initial values of BAT in the two groups, the VRET group had a lower corrected BAT score (1.51 ± 0.72) than the IET group (4.39 ± 0.75) ( F=55.81, P<0.001), indicating that the efficacy of the VRET group was significantly better than that of the IET group. Conclusion:VRET significantly reduces acrophobia symptoms and behavioral avoidance level in patients with acrophobia, demonstrating superior efficacy compared to IET in both immediate and long-term effects.

Objective:To explore the long-term efficacy of virtual reality exposure therapy (VRET) for acrophobia.Method:Sixty patients with acrophobia who visited the Nanjing Brain Hospital Affiliated to Nanjing Medical University from October 2018 to January 2021 were selected and randomly divided into VRET group ( n=30) and imaginary exposure therapy (IET) group ( n=30) using a block random number table method. The VRET group received VRET treatment, while the IET group received IET treatment. Both groups received treatment twice a week for 3 weeks. At baseline and after treatment, the acrophobia questionnaire (AQ) and attitude towards high questionnaire (ATHQ) were used to assess the patients' acrophobia symptoms, and the behavioral avoidance test (BAT) was used to assess the patients' level of avoidance when facing high altitude situations. During the 2-year follow-up after treatment, AQ and ATHQ were used to evaluate the patients' acrophobia symptoms. The repeated measures ANOVA and covariance analysis were used to analyze the data using SPSS 27.0 software. Result:(1) Repeated measures ANOVA showed that there was no significant interaction effect of AQ-anxiety, AQ-avoidance, and ATHQ scores between the two groups before and after treatment ( F=1.37, 1.95, 0.21, all P>0.05), while the time main effect of AQ-anxiety ( F=43.29) and ATHQ score ( F=13.35) was significant (both P<0.05), and the time main effect and group main effect of AQ-avoidance score were significant ( Ftime=62.84, Fgroup=5.65, both P<0.05). The AQ-avoidance scores of the VRET group(6.19±3.60, 8.25±3.80) were significantly lower than those of the IET group (9.60±3.74, 12.00±4.57)after treatment and during the follow-up period (both P<0.05).(2)After controlling for the baseline initial values of BAT in the two groups, the VRET group had a lower corrected BAT score (1.51 ± 0.72) than the IET group (4.39 ± 0.75) ( F=55.81, P<0.001), indicating that the efficacy of the VRET group was significantly better than that of the IET group. Conclusion:VRET significantly reduces acrophobia symptoms and behavioral avoidance level in patients with acrophobia, demonstrating superior efficacy compared to IET in both immediate and long-term effects.

Objective To systematically evaluate the risk factors associated with the occurrence of nosocomial infections(NI)in patients undergoing extracorporeal membrane oxygenation(ECMO)support.Methods A computerized systematic search was performed aross the Chinese databases including CNKI,Wanfang Database,China Biomedical Literature Database(CBMdisc),and Weipu,as well as the English databases such as PubMed,EMBase,Web of Science,and the Cochrane Library for case-control or cohort studies on the risk factors of hospital-acquired infections in patients undergoing ECMO support from the time of database construction to February 2023.The relevant literatures were screened by two researchers independently.Meta-analysis was performed using RevMan 5.4 software.Results A total of 20 papers,including 2 746 patients and 16 risk factors,were included.Meta-analysis results showed that older age[>50 years:odds ratio(OR)= 2.87,95％ confidence interval(95％ CI)was 1.24-6.63,P = 0.01;>65 years:OR = 1.66,95％ CI was 1.22-2.26,P = 0.001],combined hypertension(OR = 1.48,95％ CI was 1.01-2.15,P = 0.04),combined diabetes mellitus(OR = 1.40,95％ CI was 1.02-1.94,P = 0.04),sequential organ failure assessment(SOFA)was higher(OR = 1.06,95％ CI was 1.02-1.10,P = 0.000 7),the installation of ECMO in the intensive care unit(ICU,OR=1.48,95％ Ciwas 1.11-1.99,P=0.008),ECMO course(OR=1.27,95％ Ciwas 1.05-1.54,P = 0.01),ventilator-assistance for >48 hours(OR = 4.91,95％ CI was 2.40-10.05,P<0.000 1),and tracheotomy(OR = 9.56,95％ CI was 3.60-25.35,P<0.000 01)were identified as ECMO risk factors for hospital-acquired infections in patients.Conclusion Older age,combined hypertension,diabetes mellitus,higher SOFA,ECMO installation site in ICU,ECMO course,ventilator assistance>48 hours,tracheotomy are the risk factors for the occurrence of hospital-acquired infections in patients with ECMO,healthcare professionals should promptly identify the risk factors related to hospital-acquired infections,and take active and effective measures against controllable risk factors,including early intervention to prevent the occurrence of NI in ECMO patients.