Objective To establish the HPLC analysis method for ketoconazole related substances,and to provide technical support for the improvement of the quality standard and the purity of ketoconazole.Methods Gradient elution conditions were optimized based on the chromatographic parameters outlined in the 2024"British Pharmacopoeia"for ketoconazole cream.A C18 column(4.6 mm×150 mm,3 μm)was used to facilitate the elution process using a gradient of acetonitrile and acetate buffer,and detection performed at a wavelength of 230 nm.Results The known impurities and potentially genotoxic impurities in the material drugs of ketoconazole can be more effectively separated using the established methods,which are both robust and highly sensitive.The content of the two potentially geno toxic impurities,six known impurities and unknown impurities in the 21 batches of ketoconazole sourced from five raw material pharmaceutical companies is below the specified limit requirements.Conclusion This method contributes to improving the quality of ketoconazole ingredients,ensuring the safety of ketoconazole preparations,and better supporting the regulatory supervision.

Objective:To evaluate the clinical status of long-term oral anticoagulant management in patients with atrial fibrillation, and to analyze the obstacles and promoting factors in the implementation of evidence, so as to provide evidence for clinical transformation.Methods:This study was a cross-sectional study. Through the evidence-based nursing method, guided by the Ottawa Model, the review indicators and review methods were developed based on the best evidence. The clinical status review of 100 patients who met the inclusion criteria in the Department of Cardiology, Affiliated Hospital of Jiangsu University was conducted from August to November 2022 using a convenience sampling method, and based on the results of the review, an analysis of obstacles and promoting factors was carried out to develop a clinical response.Results:This study included 100 patients with atrial fibrillation, 60 males and 40 females, aged (70.14 ± 10.39) years. Totally 26 best items were included, and 24 review indicators were developed, among which only 4 indicators had a compliance rate of 100% , 2 indicators had a compliance rate of >60% , 5 indicators had a compliance rate of <60% , and 13 indicators had a compliance rate of 0. According to the results of the review, a comprehensive and systematic analysis was conducted from the three dimensions of system, practitioners, patients and family members. For each dimension, obstacles and promoting factors were analyzed in depth from evidence-based change, potential adopters and practical environment.Conclusions:There is a gap between the best evidence and clinical status of long-term oral anticoagulant management in patients with atrial fibrillation. In-depth analysis of obstacle factors, formulate countermeasures, and promote the efficient implementation of evidence in clinical practice.

Objective:Based on the best evidence, formulate the review indicators to promote the initiation and establishment of maternal lactation and carry out clinical review, analyze the barriers and promoting factors of the clinical application of evidence, and formulate countermeasures.Methods:Evidence-based nursing research was used to identify clinical problems, build evidence-based group, systematically search, evaluate and synthesize evidence. On September 1,2023 to December 31 in Affiliated Hospital of Jiangsu University document and delivery of maternal investigation, in Ottawa research application mode as a guide, based on the evidence to review indicators and review method, clear clinical status and evidence gap, combined with the stakeholders interview, using content analysis to analyze barriers and promoting factors, to formulate action countermeasures.Results:In this study, 140 pregnant women were finally included for clinical review, aged from 22 to 42 (30.13 ± 3.69) years. A total of 23 pieces of best evidence were incorporated, leading to the establishment of 29 review indicators. Among these, 20 review indicators showed compliance rates below 60%. The main obstacles based on the results of review and interviews with stakeholders: the evidence content covered perinatal stages but lacked specificity and practical applicability; nurses had insufficient knowledge and faced increased workloads; pregnant/postpartum women lacked essential knowledge and skills, with delayed resolution of lactation issues; the practice environment lacked evidence-based implementation protocols, specialized assessment tools, and professional lactation consultant teams, etc. Promoting factors: the project team had rich experience in evidence transformation; the reform aligned with national policies, high engagement from departmental leaders, and standardized management systems for evidence-based projects in the nursing department; strong motivation among pregnant/postpartum women; the hospital was an infant-friendly hospital with talents needed for evidence transformation.Conclusions:There is a big gap between the clinical status and the evidence of promoting the initiation and establishment of lactation, so nursing staff should make full use of the promoting factors and formulate countermeasures according to the obstacle factors, so as to provide reference for promoting the initiation of lactation and the establishment of relevant evidence to clinical transformation.

Objective:To explore the barriers to nurses applying the best evidence for non-pharmacologic prophylactic management of venous thromboembolism (VTE) in patients with multiple myeloma (MM), and to provide a basis for the development of clinical responses.Methods:A parallel mixed-methods study was conducted in January 2024 to facilitate the selection of nurses from the hematology department of Affiliated Hospital of Jiangsu University to conduct semi-structured in-depth interviews. Concurrently, convenience sampling was employed to select nursing staff from the same departineat for a quantitative questionnaire survey. The interview outlines based on the theoretical domains framework and the questionnaires based on the Barriers to the Application of the Evidence and Facilitators Scale. The questionnaire was developed based on the Barriers and Facilitators to Evidence Application Scale and combined with qualitative and quantitative analyses to derive barriers to nurses' implementation of best evidence.Results:The qualitative study conducted interviews with 9 female nurses in the hematology department, aged 25-49. The quantitative study surveyed 17 female nurses in the hematology department with an average age of (33.18 ± 9.09) years. Nurses scored high overall in evidence application (156.65 ± 20.09) points, with high scores on the organizational form dimension (34.47 ± 1.48) points, the evidence application leader dimension (44.24 ± 1.30) points, the nurses' team dimension (42.53 ± 1.41) points, and the implementation scenario dimension (11.18 ± 0.61) points, which suggests that nurses were process was well supported overall. Low scores on the evidence dimension (11.94 ± 0.91) points and patient dimension (12.41 ± 1.03) points indicated that nurses had barriers in knowledge acquisition and practical application. The results of qualitative interviews further revealed that nurses encourter multiple challenges when applying best evidence, including insufficient knowledge base, low professional identity within societym, absence of standardized departmental protocols, negative outcome expectations, and inadequate motivation coupled with ulcear objectives.Conclusions:There are multiple clinical factors affecting nurses' application of best evidence, and departments should propose targeted coping strategies based on the barrier factors to ensure the successful implementation of evidence-based practice changes, and thus advance the clinical application of best evidence for non-pharmacological prevention of VTE in MM patients.

Objective:To analyze the current situation of health-related quality of life (HRQOL) and its influencing factors among community-dwelling elderly with mild cognitive impairment (MCI) based on the health ecology model (HEM).Methods:From December 2023 to September 2024, a cross-sectional survey was conducted among 997 community-dwelling elderly in Beijing, Shandong, Chongqing and other regions. The EuroQol five-dimensional questionnaire 5 level (EQ-5D-5L), the Montreal cognitive assessment (MoCA), and the Pittsburgh sleep quality index (PSQI) were used to assess the subjects.Descriptive analysis, Mann-Whitney U test, Kruskal-Wallis test, and Tobit regression analysis were performed using Stata 18.0 software. Results:A total of 324 valid samples were finally obtained, and the health utility value of MCI elderly was 0.842(0.815, 0.951). Tobit regression analysis showed that ≥80 years old( β=-0.121, 95% CI=-0.193--0.050) in individual traits level, don't exercise( β=-0.196, 95% CI=-0.255--0.137) and poor quality of sleep ( β=-0.064, 95% CI=-0.116--0.013) in behavior characteristics level, and poor subjective economic status( β=-0.153, 95% CI=-0.261--0.045) in living and working conditions level were risk factors for the health utility value of the elderly with MCI. Drinking( β=0.096, 95% CI=0.022-0.171) in behavior characteristics level and participating in social activities( β=0.126, 95% CI=0.062-0.190) in interpersonal network level were protective factors for the health utility value of the elderly with MCI. Conclusions:The HRQOL of the community-dwelling elderly with MCI in China is low, and its influencing factors are multi-level. HEM should be combined to strengthen the intervention and management of the elderly with MCI from personal constitution to policy environment to improve their HRQOL.

Objective To summarize the best evidence of early rehabilitation management of hand function in patients with hand burn,and provide basis for medical personnel to carry out early rehabilitation management of hand burn.Methods According to the 5S model,all evidence on early rehabilitation management of hand function in patients with hand burns was retrieved from databases and websites including UpToDate,BMJ Best Practice,NICE,RNAO,GIN,and so on.The retrieved evidence included clinical decisions,guidelines,evidence summaries,expert consensuses,systematic reviews,Meta analysis.The search period of the summary of best evidence,expert concensus and guidelines are from the establishment of the database to December 20,2024,and the search period of the systematic reviews is from January 1,2019 to December 20,2024.Quality evaluation of literature,evidence extraction and summary were conducted.The evidence was graded according to JBI evidence pre-grading system 2014.Results Totally 17 pieces of the literature were included,including 1 clinical decision,4 guidelines,6 evidence summaries,3 expert consensus articles,and 3 systematic reviews.Totally pieces of best evidence were summarized,including 7 aspects of assessment,hand positioning,treatment of edema,dressing,use of orthotics,joint mobility training,and health education.Conclusion This study summarized the best evidence of early rehabilitation management of hand function in patients with hand burn,and provided evidence-based evidence for clinical rehabilitation management plan.According to the clinical situation,the medical staff can apply the evidence to clinical practice,so as to improve the hand function and quality of life of patients.

Objective:To analyze the current situation of health-related quality of life (HRQOL) and its influencing factors among community-dwelling elderly with mild cognitive impairment (MCI) based on the health ecology model (HEM).Methods:From December 2023 to September 2024, a cross-sectional survey was conducted among 997 community-dwelling elderly in Beijing, Shandong, Chongqing and other regions. The EuroQol five-dimensional questionnaire 5 level (EQ-5D-5L), the Montreal cognitive assessment (MoCA), and the Pittsburgh sleep quality index (PSQI) were used to assess the subjects.Descriptive analysis, Mann-Whitney U test, Kruskal-Wallis test, and Tobit regression analysis were performed using Stata 18.0 software. Results:A total of 324 valid samples were finally obtained, and the health utility value of MCI elderly was 0.842(0.815, 0.951). Tobit regression analysis showed that ≥80 years old( β=-0.121, 95% CI=-0.193--0.050) in individual traits level, don't exercise( β=-0.196, 95% CI=-0.255--0.137) and poor quality of sleep ( β=-0.064, 95% CI=-0.116--0.013) in behavior characteristics level, and poor subjective economic status( β=-0.153, 95% CI=-0.261--0.045) in living and working conditions level were risk factors for the health utility value of the elderly with MCI. Drinking( β=0.096, 95% CI=0.022-0.171) in behavior characteristics level and participating in social activities( β=0.126, 95% CI=0.062-0.190) in interpersonal network level were protective factors for the health utility value of the elderly with MCI. Conclusions:The HRQOL of the community-dwelling elderly with MCI in China is low, and its influencing factors are multi-level. HEM should be combined to strengthen the intervention and management of the elderly with MCI from personal constitution to policy environment to improve their HRQOL.

Objective:To explore non-pharmacological prevention and management methods for venous thromboembolism (VTE) in ischemic stroke (IS) patients based on the best evidence and evaluate the effectiveness of their application.Methods:Based on evidence acquisition, this study was guided by the Ottawa model of research use to dissect the barriers and facilitators of evidence application through clinical review, and to implement intervention strategies and effect evaluation. Convenience sampling method was used to select inpatients and nurses in the Department of Neurology of Affiliated Hospital of Jiangsu University before and after evidence application as study subjects. The baseline review period was from March 1 to May 31, 2023, and the review subjects were 100 patients hospitalised in the Department of Neurology and 32 nurses working in the Department of Neurology during this period, and the evidence application review period was from December 1, 2023 to February 29, 2024, and the review subjects were 100 patients hospitalised in the Department of Neurology and 32 nurses working in the Department of Neurology during this period. Nurses and patients knowledge of non-pharmacological prevention of VTE, implementation of the review indicators, and the incidence of VTE in patients were compared before and after the application of the evidence.Results:After evidence application, most of the evidence implementation rates were higher than those before evidence application, and the differences were statistically significant ( P<0.05). The VTE non-pharmacological prevention knowledge scores of IS patients and nurses were higher than those before evidence application, and the differences were statistically significant ( P<0.05) ; the VTE incidence rate of IS patients was lower than that before evidence application, and the differences were statistically significant ( P<0.05) . Conclusions:Evidence-based practice of non-pharmacological prevention and management of VTE in patients with IS, guided by the Ottawa model of research use, can effectively improve nurses evidence-based adherence to non-pharmacological prevention and management of VTE, as well as enhance patients knowledge of non-pharmacological prevention of VTE, thereby reducing the incidence of VTE.

Objective To evaluate the quality of cisatracurium besilate injection produced by domestic manufacturers.Methods A comprehensive evaluation of 104 batches of samples was carried out using statutory testing methods combined withexploratory research,including related substances,1,5-pentanediol diacrylate,residual solvents,genotoxic impurities of benzenesulfonate esters,infrared spectrum,and endotoxin examination.The quality of domestic products and the controllability of current specifications were comprehensively evaluated.Results According to the statutory tests,the qualified rate of 104 batches of samples was 100.0％.The exploratory research showed that the results of related substances in the samples produced by 6 manufacturers were far below the limit,and no genotoxic impurities of benzenesulfonate esters were detected.However,the results showed that there was variability in 1,5-pentanediol diacrylate,as well as residual solvents.Conclusions The quality of the cisatracurium besilate injection is good,and the current specifications should be further improved and unified.It was proposed that the infrared spectrum,related substance,and 1,5-pentanediol diacrylate method be added or revised,and the limit of endotoxin strictly controlled.It was proposed that manufacturers pay attention to the quality of API and control injection production.

Sepsis is a systemic inflammatory response syndrome caused by the invasion of pathogenic microorganisms such as bacteria. In addition to the manifestations of systemic inflammatory response syndrome and primary infection lesions， critical cases often have manifestations of organ hypoperfusion. The morbidity and mortality of sepsis have remained high in recent years， which seriously affect the quality of life of the patients. The pathogenesis of sepsis is complicated， in which uncontrollable inflammation is a key mechanism. The phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt） signaling pathway plays a key role in mediating inflammation in sepsis. The available therapies of sepsis mainly include resuscitation， anti-infection， vasoactive drugs， intensive insulin therapy， and organ support， which show limited effects of reducing the mortality. Therefore， finding new therapeutic drugs is a key problem to be solved in the clinical treatment of sepsis. In recent years， studies have shown that traditional Chinese medicine （TCM） can regulate the PI3K/Akt pathway via multiple pathways， multiple effects， and multiple targets to inhibit inflammation and curb the occurrence and development of sepsis， which has gradually become a hot spot in the prevention and treatment of sepsis. Moreover， studies have suggested that TCM has unique advantages in the treatment of sepsis. TCM can regulate the PI3K/Akt signaling pathway to inhibit inflammation， reduce oxidative stress， and control apoptosis in the prevention and treatment of sepsis. Despite the research progress， a systematic review remains to be performed regarding the TCM treatment of sepsis by regulating the PI3K/Akt signaling pathway. After reviewing relevant papers published in recent years， this study systematically summarizes the relationship between PI3K/Akt pathway and sepsis and the role of TCM in the treatment of sepsis， aiming to provide new ideas for the potential treatment of sepsis and the development of new drugs.