Objective To construct and implement a swallowing disorder assessment and management program for tracheal intubated patients after extubation based on the 4R crisis management theory,providing standardized and scientific interventions for oral feeding.Methods Utilizing the expert meeting method with the 4R crisis management theory framework,a swallowing disorder assessment and management program was developed for post-extubation tracheal intubated patients.A convenience sampling method was employed to select patients with tracheal intubations treated from July to December 2023 in the emergency ICU,central ICU,and cardiovascular surgery ICU of a tertiary hospital in Zhejiang Province.The patients treated from October to December were assigned to an experimental group(n=68),while those treated from July to September were designated as a control group(n=58).The experimental group received the 4R crisis management-based intervention,whereas the control group received standard ICU assessment and management.Outcomes indicators included the incidence of post-extubation swallowing disorders,time to first oral intake,incidence of aspiration during initial feeding,nasogastric and nasointestinal tube placement duration,incidence of aspiration pneumonia during hospitalization,re-intubation rates,ICU readmission rates,ICU stay duration,and total hospitalization days.Results Of the initially recruited subjects,68 in the experimental group and 54 in the control group were included in the final analysis.After the intervention,the experimental group exhibited significantly lower rates of post-extubation swallowing disorders,shorter time to first liquid oral intake,aspiration incidence during first feeding,shorter durations of nasogastric and nasointestinal tube placement,aspiration pneumonia,ICU readmission compared to the control group(P＜0.05).No significant differences were observed between the groups in time to first regular oral intake,re-intubation rates(P＞0.05).Conclusion The risk management program for dysphagia following tracheal extubation based on the 4R crisis management theory is scientifically robust and safe,offering a valuable reference for clinical assessments and management of swallowing and eating post-extubation in tracheal intubated patients.

Objective To construct and implement a swallowing disorder assessment and management program for tracheal intubated patients after extubation based on the 4R crisis management theory,providing standardized and scientific interventions for oral feeding.Methods Utilizing the expert meeting method with the 4R crisis management theory framework,a swallowing disorder assessment and management program was developed for post-extubation tracheal intubated patients.A convenience sampling method was employed to select patients with tracheal intubations treated from July to December 2023 in the emergency ICU,central ICU,and cardiovascular surgery ICU of a tertiary hospital in Zhejiang Province.The patients treated from October to December were assigned to an experimental group(n=68),while those treated from July to September were designated as a control group(n=58).The experimental group received the 4R crisis management-based intervention,whereas the control group received standard ICU assessment and management.Outcomes indicators included the incidence of post-extubation swallowing disorders,time to first oral intake,incidence of aspiration during initial feeding,nasogastric and nasointestinal tube placement duration,incidence of aspiration pneumonia during hospitalization,re-intubation rates,ICU readmission rates,ICU stay duration,and total hospitalization days.Results Of the initially recruited subjects,68 in the experimental group and 54 in the control group were included in the final analysis.After the intervention,the experimental group exhibited significantly lower rates of post-extubation swallowing disorders,shorter time to first liquid oral intake,aspiration incidence during first feeding,shorter durations of nasogastric and nasointestinal tube placement,aspiration pneumonia,ICU readmission compared to the control group(P＜0.05).No significant differences were observed between the groups in time to first regular oral intake,re-intubation rates(P＞0.05).Conclusion The risk management program for dysphagia following tracheal extubation based on the 4R crisis management theory is scientifically robust and safe,offering a valuable reference for clinical assessments and management of swallowing and eating post-extubation in tracheal intubated patients.

Objective:To establish and apply the electronic further modified early warning score system (e-fMEWS), and explore its role in the condition evaluation and early warning of inpatients in non-critical units, so as to provide clinical nurses with an early and dynamic method to identify the potential deterioration risk of patients' condition.Methods:A retrospective analysis of 262 805 inpatients in multiple non-critical units of the Second Affiliated Hospital of Zhejiang University School of Medicine from January to December 2018 and January to December 2020 was performed. The patients who were hospitalized from January to December 2018 were used as the control group, and the responsible nurse used the traditional single evaluation index to start the emergency response system; the patients from January to December 2020 were used as the research group, and the emergency response system was started using e-fMEWS. The inclusion criteria were as follows: (1) hospitalization time ≥24 h; (2) patient ≥14 years old. Exclusion criteria were as follows: (1) patients had cardiopulmonary resuscitation before admission; (2) patients discontinued treatment or were transferred to another hospital during treatment; (3) patients received palliative care; (4) patients were admitted to non-critical wards in grade I of emergency pre-examination and triage. The activation of the rapid response team (RRT), the activation of the cardiorespiratory arrest team, the incidence of cardiac and respiratory arrest, the number of cases of invasive mechanical ventilation, the number of cases admitted to the intensive care unit, the length of hospital stay and the prognosis were compared. Statistical software SPSS 22.0 was used for data analysis.Results:Under the e-fMEWS assessment, compared with the control group, the rate of initiation of the research group decreased by 0.03%. For patients who initiated RRT, the average length of hospital stay was shortened, and the number of in-hospital respiratory cardiac arrest decreased (12.2% vs. 13.2%) and the number of cases transferred to the intensive care unit was less (42.8% vs. 50.6%), the rate of improvement and recovary increased (58.4% vs. 56.1%).Conclusions:The application of e-fMEWS can help clinical nurses to quickly and accurately identify the potential risk of deterioration of the patient's condition. Through early identification of potentially critically ill patients in non-critical units, early intervention and timely treatment can avoid adverse events and improve the patient prognosis.

Due to the availability of 18F-FDG in PET centers, this article aims to advocate and promote the standardization of 18F-FDG PET brain imaging in dementia in order to improve the reliability, repeatability and comparison of the imaging process and results. It is also provided to guide the PET imaging operation standard and to give suggestions on image interpretation.

Essential palatal tremor is relatively rare in clinical practice, which manifests involuntary and rhythmic contraction of soft-palate along with auditory click. The cause is unknown and there is no specific treatment at present. This article reports a female patient with essential palatine tremor, who presented with involuntarily beating of soft palate, disappeared during sleep, had sensory tricks, and gradually developed mental and psychological problems such as anxiety disorders. After treatment with integrated traditional Chinese and Western medicine, the symptoms improved. The clinical features of the case were analyzed, relevant literature was reviewed, and the possible etiology and characteristics of the disease were explored, so as to provide reference for clinical diagnosis and treatment.

OBJECTIVETo study the hypolipidemic active compounds from Crataegus pinnatifida and mechanism of action of those.

METHODGuided by the inhibitory activity to HMG-CoA reductase, the active compounds were separated and purified with macroporous resin and silica gel.

RESULTFour active compounds were obtained, which were quercetin, hyperoside, rutin and chlorogenic acid, the sum of their inhibitory rate was 50.01%, and the total inhibitory rate of the mixture of four active compounds matched was 79.48%.

CONCLUSIONQuercetin and hyperoside were the principle active components inhibiting HMG-CoA reductase in Hawthorn fruit, and there were synergistic action among them.

Crataegus ; chemistry ; Fruit ; chemistry ; Hydroxymethylglutaryl CoA Reductases ; analysis ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; pharmacology ; Plant Extracts ; pharmacology