Objective: To investigate the causes and characteristics of immune hemolytic transfusion reactions (HTRs) triggered by anti-E antibodies, so as to provide a scientific reference for guaranteeing clinical blood transfusion safety. Methods: Five patients who experienced HTRs in our hospital from November 2023 to October 2024 were selected as the research subjects. ABO/RhD blood grouping, antibody screening, antibody identification, and the direct antiglobulin test (DAT) were conducted using the column agglutination method. The causes of HTRs in these patients were investigated using multiple techniques such as the two-step enzyme method, polyethylene glycol (PEG), acid elution technique, and capillary centrifugation method. Results: All five patients tested negative for antibody screening prior to transfusion. However, after transfusion of E+ phenotyped blood, patients 1, 2, 3, and 5 developed delayed haemolytic transfusion reaction (DHTR), while patient 4 experienced acute haemolytic transfusion reaction (AHTR). Anti-E antibodies were detected in all blood samples from the patients after the hemolytic transfusion reaction, including the enzyme-only anti-E antibody in two cases. Conclusion: Anti-E antibody can trigger both intravascular and extravascular hemolysis. It is recommended to conduct ABO/RhD and RhE antigen-matched transfusions and establish a regional blood transfusion database to reduce immune hemolytic transfusion reactions caused by anti-E antibody.

Objective This study develops and evaluates a just-in-time adaptive intervention(JITAI)-based smart nursing protocol for interventional radiology preoperative waiting areas,assessing its impact on patient experience Methods A time-series design was employed.Patients in the waiting area of an interventional operating room at a tertiary hospital in Chengdu,Sichuan Province,were studied during April and August 2024.Participants were divided into an intervention group(n=766)and a control group(n=864).The intervention group received the newly developed management protocol,while the control group received conventional nursing care.Differences between the groups were compared regarding perceived waiting time,actual waiting time,preoperative anxiety levels,and satisfaction rates.Results Totally 13 participants were lost to follow-up in the intervention group and 11 in the control group,resulting in final analyzed cohorts of 753 and 853 patients,respectively.The median actual waiting time was significantly shorter in the intervention group with 50.03(23.92,76.38)min,compared to the control group with 65.62(35.77,104.32)min.A significant difference was observed between the 2 groups(P＜0.001).Similarly,the median perceived waiting time was significantly lower in the intervention group with 48.00(20.00,70.00)min than 73.00(38.00,105.00)min in the control group.A significant difference was observed between the 2 groups(P＜0.001).The anxiety score during the waiting period was lower in the experimental group than it in the control group,and the experimental group showed a significantly higher satisfaction level compared to the control group,with both dif ferences being statistically significant(P＜0.05).Conclusion The intelligent nursing program,developed based on the JIT AI theory,effectively reduces both the actual and perceived preoperative waiting time for patients in the in-terventional operating room,optimizing their preoperative waiting experience.

Objective To systematically evaluate and analyze qualitative studies of parental engagement in kangaroo mother care experiences for preterm infants in the NICU,aiming to provide references for promoting the early recovery of preterm infants in NICU and improving the quality of nursing services.Methods Relevant were searched for qualitative studies of parental engagement in kangaroo mother care for preterm infants in NICU.The search time limit was from the construction of the database to July 19,2024.The quality of the included literature was assessed using the Joanna Brigg Institute's(JBI)Australian Centre for Evidence-Based Health Care's Quality Assessment Criteria for Qualitative Research,and the results were integrated using the meta-integration methods.Results A total of 17 papers were included in the literature,and 61 findings were extracted,grouped into 10 new categories.These were further synthesized into 4 integrated findings:physical and psychological perceptions of participation in kangaroo mother care;challenges to participation in kangaroo mother care;facilitators of participation in kangaroo mother care;expectations and suggestions for kangaroo mother care.Conclusion Hospital administrators should further improve the management specifications of kangaroo mother care for preterm infants in NICU,optimize resource allocation and strengthen publicity.At the same time,healthcare professionals should actively promote the establishment of peer and family support systems and increase participation in kangaroo mother care to facilitate early recovery of preterm infants in NICU and to continuously promote the improvement of nursing service quality.

Objective Under the"Key Information Infrastructure Security Protection Requirements for Information Secu-rity Technology"(hereinafter referred to as"Security Protection Requirements"),this study aims to construct a security protec-tion system for medical information systems and improve their security protection capabilities.Methods Starting from the char-acteristics and security requirements of medical information systems,combined with the standard"Security Protection Require-ments",this study discusses and analyzes the construction of six aspects of security protection capabilities:identification,securi-ty protection,detection and evaluation,monitoring and warning,active defense,and event handling,and implements protection for key information infrastructure in medical institutions from both software and hardware aspects.Results A practical,system-atic,and normalized security protection system for medical information systems has been constructed to achieve comprehensive protection of medical information systems.Conclusion Under the requirements of"Security Protection Requirements",it is crucial to establish a comprehensive security protection system for medical information systems and implement the protection of key information infrastructure in medical institutions from both software and hardware aspects.This provides a scientific basis and practical guidance for network security protection in the medical industry.

Objective Under the"Key Information Infrastructure Security Protection Requirements for Information Secu-rity Technology"(hereinafter referred to as"Security Protection Requirements"),this study aims to construct a security protec-tion system for medical information systems and improve their security protection capabilities.Methods Starting from the char-acteristics and security requirements of medical information systems,combined with the standard"Security Protection Require-ments",this study discusses and analyzes the construction of six aspects of security protection capabilities:identification,securi-ty protection,detection and evaluation,monitoring and warning,active defense,and event handling,and implements protection for key information infrastructure in medical institutions from both software and hardware aspects.Results A practical,system-atic,and normalized security protection system for medical information systems has been constructed to achieve comprehensive protection of medical information systems.Conclusion Under the requirements of"Security Protection Requirements",it is crucial to establish a comprehensive security protection system for medical information systems and implement the protection of key information infrastructure in medical institutions from both software and hardware aspects.This provides a scientific basis and practical guidance for network security protection in the medical industry.

Objective This study develops and evaluates a just-in-time adaptive intervention(JITAI)-based smart nursing protocol for interventional radiology preoperative waiting areas,assessing its impact on patient experience Methods A time-series design was employed.Patients in the waiting area of an interventional operating room at a tertiary hospital in Chengdu,Sichuan Province,were studied during April and August 2024.Participants were divided into an intervention group(n=766)and a control group(n=864).The intervention group received the newly developed management protocol,while the control group received conventional nursing care.Differences between the groups were compared regarding perceived waiting time,actual waiting time,preoperative anxiety levels,and satisfaction rates.Results Totally 13 participants were lost to follow-up in the intervention group and 11 in the control group,resulting in final analyzed cohorts of 753 and 853 patients,respectively.The median actual waiting time was significantly shorter in the intervention group with 50.03(23.92,76.38)min,compared to the control group with 65.62(35.77,104.32)min.A significant difference was observed between the 2 groups(P＜0.001).Similarly,the median perceived waiting time was significantly lower in the intervention group with 48.00(20.00,70.00)min than 73.00(38.00,105.00)min in the control group.A significant difference was observed between the 2 groups(P＜0.001).The anxiety score during the waiting period was lower in the experimental group than it in the control group,and the experimental group showed a significantly higher satisfaction level compared to the control group,with both dif ferences being statistically significant(P＜0.05).Conclusion The intelligent nursing program,developed based on the JIT AI theory,effectively reduces both the actual and perceived preoperative waiting time for patients in the in-terventional operating room,optimizing their preoperative waiting experience.

Objective To systematically evaluate and analyze qualitative studies of parental engagement in kangaroo mother care experiences for preterm infants in the NICU,aiming to provide references for promoting the early recovery of preterm infants in NICU and improving the quality of nursing services.Methods Relevant were searched for qualitative studies of parental engagement in kangaroo mother care for preterm infants in NICU.The search time limit was from the construction of the database to July 19,2024.The quality of the included literature was assessed using the Joanna Brigg Institute's(JBI)Australian Centre for Evidence-Based Health Care's Quality Assessment Criteria for Qualitative Research,and the results were integrated using the meta-integration methods.Results A total of 17 papers were included in the literature,and 61 findings were extracted,grouped into 10 new categories.These were further synthesized into 4 integrated findings:physical and psychological perceptions of participation in kangaroo mother care;challenges to participation in kangaroo mother care;facilitators of participation in kangaroo mother care;expectations and suggestions for kangaroo mother care.Conclusion Hospital administrators should further improve the management specifications of kangaroo mother care for preterm infants in NICU,optimize resource allocation and strengthen publicity.At the same time,healthcare professionals should actively promote the establishment of peer and family support systems and increase participation in kangaroo mother care to facilitate early recovery of preterm infants in NICU and to continuously promote the improvement of nursing service quality.

Objective:To investigate the rates of low disease activity and clinical remission in patients with systemic lupus erythematosus(SLE)in a real-world setting,and to analyze the related factors of low disease activity and clinical remission.Methods:One thousand patients with SLE were enrolled from 11 teaching hospitals.Demographic,clinical and laboratory data,as well as treatment regimes were collec-ted by self-completed questionnaire.The rates of low disease activity and remission were calculated based on the lupus low disease activity state(LLDAS)and definitions of remission in SLE(DORIS).Charac-teristics of patients with LLDAS and DORIS were analyzed.Multivariate Logistic regression analysis was used to evaluate the related factors of LLDAS and DORIS remission.Results:20.7％of patients met the criteria of LLDAS,while 10.4％of patients achieved remission defined by DORIS.Patients who met LLDAS or DORIS remission had significantly higher proportion of patients with high income and longer disease duration,compared with non-remission group.Moreover,the rates of anemia,creatinine eleva-tion,increased erythrocyte sedimentation rate(ESR)and hypoalbuminemia was significantly lower in the LLDAS or DORIS group than in the non-remission group.Patients who received hydroxychloroquine for more than 12 months or immunosuppressant therapy for no less than 6 months earned higher rates of LLDAS and DORIS remission.The results of Logistic regression analysis showed that increased ESR,positive anti-dsDNA antibodies,low level of complement(C3 and C4),proteinuria,low household in-come were negatively related with LLDAS and DORIS remission.However,hydroxychloroquine usage for longer than 12 months were positively related with LLDAS and DORIS remission.Conclusion:LLDAS and DORIS remission of SLE patients remain to be improved.Treatment-to-target strategy and standar-dized application of hydroxychloroquine and immunosuppressants in SLE are recommended.

Objective To analyze the current situation of healthcare-associated infection (HCAI) management of fever clinics among different levels of medical institutions in Wuhan, and to provide a scientific basis for improving hospital infection management. Methods In January 2023, a network questionnaire survey was conducted on medical institutions with fever clinics in Wuhan. Results A total of 72 medical institutions were investigated, of which 58.33% had CT, and 48.61% had fever clinics for children. The total qualified rate of HCAI management was 78.28%. The qualified rates of four primary indicators, including hospital management, diagnosis and treatment environment protection, training and education, and implementation of infection control measures, were 82.27%, 71.49%, 75.93%, and 81.31%, respectively. There were statistical differences among different levels of medical institutions (all P<0.01). Among the 13 secondary indicators, the qualified rates of 7 indicators were more than 80%, with the highest being medical item management (93.06%), medical waste disposal (89.72%), and personnel management (83.33%), and the lowest being facilities and equipment (66.32%), and patients and accompanying personnel education (66.67%). Among the 65 tertiary indicators, 30 had a pass rate great than 80%. Conclusion Wuhan actively promotes the construction of fever clinics in medical institutions, and the overall situation of HCAI management is good. However, there are still some problems to varying degrees, especially in the layout procedures, hand hygiene, and staff training of fever clinics in secondary and lower medical institutions, which should be further strengthened.

Objective To monitor the antifungal resistance of clinical isolates of Candida spp.in the East China region.Methods MALDI-TOF MS or molecular methods were used to re-identify the strains collected from January 2018 to December 2022.Antifungal susceptibility testing was performed using the broth microdilution method.The susceptibility test results were interpreted according to the breakpoints of 2022 Clinical and Laboratory Standards Institute(CLSI)documents M27 M44s-Ed3 and M57s-Ed4.Results A total of 3 026 strains of Candida were collected,65.33％of which were isolated from sterile body sites,mainly from blood(38.86％)and pleural effusion/ascites(10.21％).The predominant species of Candida were Candida albicans(44.51％),followed by Candida parapsilosis complex(19.46％),Candida tropicalis(13.98％),Candida glabrata(10.34％),and other Candida species(0.79％).Candida albicans showed overall high susceptibility rates to the 10 antifungal drugs tested(the lowest rate being 93.62％).Only 2.97％of the strains showed dose-dependent susceptibility(SDD)to fluconazole.Candida parapsilosis complex had a SDD rate of 2.61％and a resistance rate of 9.42％to fluconazole,and susceptibility rates above 90％to other drugs.Candida glabrata had a SDD rate of 92.01％and a resistance rate of 7.99％to fluconazole,resistance rates of 32.27％and 48.24％to posaconazole and voriconazole non-wild-type strains(NWT),respectively,and susceptibility rates above 90％to other drugs.Candida tropicalis had resistance rates of 29.55％and 26.24％to fluconazole and voriconazole,respectively,resistance rates of 76.60％and 21.99％to posaconazole and echinocandins non-wild-type strains(NWT),and a resistance rate of 2.36％to echinocandins.Conclusions The prevalence and species distribution of Candida spp.in the East China region are consistent with previous domestic and international reports.Candida glabrata exhibits certain degree of resistance to fluconazole,while Candida tropicalis demonstrates higher resistance to triazole drugs.Additionally,echinocandins resistance has emerged in Candida albicans,Candida glabrata,Candida tropicalis,and Candida parapsilosis.