Objective To explore the impact of multi-model adaptive statistical iterative reconstruction (ASiR-V) algorithm on radiation dose and image quality in children’s ultra-low-dose chest CT examination. Methods A total of 72 children who underwent chest CT scans at Qingdao Municipal Hospital with admissions between January 2024 and January 2025 were selected as subjects and divided into two groups using a random number table. In the control group (n = 36), the tube voltage was set at 100 kVp and the conventional filtered back projection algorithm was used. In the observation group (n = 36), the tube voltage was set at 80 kVp and images were reconstructed using 30% ASiR-V (observation group 1), 60% ASiR-V (observation group 2), and 90% ASiR-V (observation group 3), respectively. Radiation doses were recorded for each group, and both subjective and objective evaluations of image quality were conducted. Results Compared with the control group, the observation group demonstrated significantly lower volume CT dose index [(0.86 ± 0.09) mGy], dose length product [(25.90 ± 3.55) mGy·cm], and effective dose [(0.01 ± 0.001) mSv] (P < 0.05). There was no significant difference in subjective evaluation scores of image quality among the four groups (z = −2.206, P = 0.530). Additionally, Fisher’s exact test showed that the proportion of images scoring 4-5 points was higher in observation group 2 than in observation group 3 (P = 0.024). The noise value of the ascending aorta in the mediastinal window and the noise values of the right and left middle lung fields and the right and left upper lung fields in the lung window were lower in observation groups 2 and 3 than in the control group, and these values were lower in observation group 3 than in observation group 2 (P < 0.05). The signal-to-noise ratios of the ascending aorta and liver in observation groups 2 and 3 were higher than those in the control group, and the ratios were higher in observation group 3 than in observation group 2 (P < 0.05). Conclusion Reconstruction using the 60% ASiR-V algorithm for pediatric ultra-low-dose chest CT examination can ensure good image quality while reducing radiation dose and improving examination safety.

OBJECTIVE To know about the current status of medical order auditing in pharmacy intravenous admixture service （PIVAS） of medical institutions nationwide， further improve the management of medical orders in PIVAS， and reduce and eliminate the occurrence of intravenous medication administration errors. METHODS Through the questionnaire survey method， to address the problems and current situation of PIVAS medical order auditing in medical institutions nationwide， experts from each province （autonomous region， municipality directly under the central government） in the research group were responsible for organizing the PIVAS directors of relevant medical institutions in their provinces to fill in the questionnaires on medical order audit and inappropriate medical order interventions， and conduct a statistical analysis of the results. RESULTS A total of valid 751 responses were received to the PIVAS questionnaire on the review of medical prescriptions. Our PIVAS medical order audit is mainly carried out by a combination of manual and computer. The median number of medical orders were audited by PIVAS per day were 700.00-771.00； the median number of new medical orders were audited by PIVAS per day were 209.68-215.00； medical order auditing rates were 85.50%-92.44% averagely； the inappropriate doctor’s orders accounted for 1.82%-1.89% averagely； the intervention rates of inappropriate medical orders ranged 74.90%-79.41%， the success rates of intervention were 79.62%-87.28% averagely； the medication refund rates were 2.92%-3.08%. CONCLUSIONS Most of the PIVAS in China’s healthcare institutions use medical order review software to assist in the review of medical orders， and there are cases of individual PIVAS in which medical orders are not reviewed comprehensively and inappropriate orders are not intervened in， and the standards and processes of medical prescription review need to be improved. It is recommended to emphasize the pharmacist’s responsibility system， standardize the use of prescription review software； gradually expand the scope of medical order review， and adopt a multi-departmental collaborative approach so as to increase the success rate of intervention for inappropriate prescriptions and reduce the rate of PIVAS withdrawals.

OBJECTIVE To investigate and analyze the operational costs and current charging policies of pharmacy intravenous admixture service （PIVAS） in China， and provide a reference for promoting high-quality and sustainable development of PIVAS. METHODS Questionnaires were distributed in 30 provinces， autonomous regions， and municipalities across the country through the “Wenjuanxing” platform from May 6th to July 1st， 2022. The operational costs， charging status and suggestions of PIVAS were investigated and analyzed. RESULTS A total of 761 PIVAS participated in the survey nationwide， including 666 tertiary medical institutions， 93 secondary medical institutions， and 2 primary medical institutions. Approximately 60.58% of PIVAS had implemented a charging system that allowed charges. Among them， most PIVAS required inspection and evaluation before charging. The annual operating cost of PIVAS in China was approximately 2 098 100 yuan， with the integrated operating cost comprising 89.36% of the total， while the dispensing cost accounted for only 10.64%. Human costs emerged as the highest annual consumption （74.20%）， followed by decoration and facility maintenance costs （4.77%） and equipment acquisition costs （3.44%）. Regarding charges for different drugs nationwide， common drugs had an average charge standard of 4.39 yuan per bag while antibacterial drugs averaged 5.01 yuan per bag； hazardous drugs had an average charge of 23.17 yuan per bag， whereas parenteral nutrition solutions averaged 38.75 yuan per bag. However， the recommended average charges of the four drugs mentioned above were 6.71， 9.63， 38.35 and 44.03 yuan per bag， respectively. CONCLUSIONS At present， there is no unified inspection and evaluation standard and charging standard in China. Moreover， the current charging standard is lower than the recommended standard. It is necessary to combine operational costs and develop more reasonable and fair charging standards.

Objective:To investigate the association between sleep status and the risk for coronary heart disease in adults in Suzhou.Methods:Using the baseline and follow up information of 53 269 local residents aged 30-79 years in China Kadoorie Biobank conducted in Wuzhong District, Suzhou, 51 929 subjects were included in this study after excluding those reporting coronary heart disease, stroke and cancer at the baseline survey. A Cox proportional hazards regression model was used to analyze the association of healthy sleep score (0-3 points) and sleep factors (snoring, insomnia, long sleep duration and nap) with the risk for coronary heart disease.Results:The median follow-up time was 11.12 years, and 1 304 individuals were diagnosed with coronary heart disease during the follow-up. After adjusting for potential confounders, occasional snoring ( HR=1.20, 95% CI: 1.04-1.38), usual snoring ( HR=1.17, 95% CI: 1.02-1.33), insomnia disorder ( HR=1.41, 95% CI: 1.12-1.78), daytime dysfunction ( HR=1.56, 95% CI: 1.20-2.03) and perennial nap ( HR=1.37, 95% CI: 1.19-1.59) were associated with increased risk of coronary heart disease. Compared with those with sleep score of 0 - 1 (low sleep quality), the people with sleep score of 3 had reduced risk of coronary heart disease by 26% ( HR=0.74, 95% CI: 0.63-0.87). Stratified analysis showed that the association of healthy sleep score 3 with risk of coronary heart disease was stronger in low physically active individuals (interaction P<0.05). Conclusions:Snoring, insomnia disorders, daytime dysfunction, and perennial napping were all associated with increased risk for coronary heart disease, and keep healthy sleep mode might reduce the risk for coronary heart disease in adults.

Objective:To explore the effect of health education based on symptom management strategy on the psychological status, self-management ability and quality of life of maintenance hemodialysis patients.Methods:A randomized controlled trial method was used. One hundred and fifty hemodialysis maintenance patients in the Blood Purification Center, Jinan People's Hospital from August 2019 to August 2020, were selected as the research subjects by convenience sampling. Patients were divided into a control group and observation group by random number table method, with 75 cases in each group. The control group was given routine health education, and the observation group was given health education based on symptom management strategies. Self-rating Anxiety Scale (SAS), self-rating Depression Scale (SDS), self-management ability scale of dialysis patients, and SF-36 quality of life scale were used to compare the improvement of negative emotion, self-management ability, and quality of life in the two groups.Results:There was no statistically significant difference between the control group and the observation group before the intervention (all P>0.05). After 3 months of intervention, the SAS and SDS scores of the patients in the observation group were (36.42 ± 4.09) and (35.74 ± 3.64) respectively, which were lower than those of the control group (46.37 ± 4.64) and (49.38 ± 2.49). The difference was statistically significant ( t=8.46, 9.42, P<0.05); the self-management score of patients in the observation group (80.11 ± 7.83) was higher than that in the control group (47.21 ± 6.62), with a statistically significant difference ( t=32.29, P<0.05); the total score of SF-36 quality of life in the observation group (594.32 ± 35.03) was higher than that in the control group (501.42 ± 32.78),with a statistically significant difference ( t=24.66, P<0.05). Conclusions:Health education based on symptom management strategy can improve the psychological status of maintenance hemodialysis patients, and has important value in improving their self-management ability and quality of life.

Objective:To explore the effect of quality improvement based on action research study to reduce unplanned interruption during continuous renal replacement therapy.Methods:From June 2020 to December 2021, 175 patients who were treated CRRT in SICU of Beijing Chaoyang Hospital Affiliated to Capital Medical University were selected as research objects. The objects were divided into control group, observation group 1 and observation group 2 according to the time of admission. Routine nursing was used in the control group (55 cases), the first cycle of plan-action-observation-reflection according to the problems of unplanned interruption was used in the observation group 1(62 cases), the quality improvement was carried out on the basis of the first cycle, and then formulated the second cycle used in the observation group 2(58 cases). The incidence of unplanned interruption of CRRT, the duration of hemofiltration line and the ability of nurses to prevent unplanned interruption of CRRT were compared before and after implementation.Results:The baseline data of CRRT patients in the three groups were comparable ( P>0.05). After cycle quality improvement, the alarm frequencies of unplanned interruption in the observation group 1 and 2 was (8.87 ± 2.66) times and (8.07 ± 2.80) times respectively, which was significant lower than the (12.04 ± 4.23) times in the control group ( t = 3.17 and 3.97, both P<0.01). The cases of coagulation filter≥Ⅱ in the observation group 1 and 2 were 25 cases and 20 cases, which were significant lower than the 32 cases in the control group ( χ2 = 3.72, 6.38, both P<0.05). The duration of blood purification line use was (15.04 ± 7.51) h and (18.16 ± 7.67) h in the observation group 1 and 2, which were significant better than the (11.75 ± 6.84) h in the control group ( t = 3.29 and 6.41, both P<0.01). The ability of nurse to prevent unplanned interruption of CRRT in the control group, the observation group 1 and 2 were (72.62 ± 6.03), (84.77 ± 5.59) and (89.64 ± 4.54), the difference was sigaificant ( F = 146.97, P<0.001). Conclusions:The application of action research study in CRRT quality improvement could reduce the occurrence of unplanned interruption of CRRT and related complications, prolong the use time of hemofiltration line, improve the therapeutic effect of CRRT, improve the quality of nursing, and is worthy of clinical promotion.

Objective:To systematically search and summarize the best evidence for the implementation and management of parenteral nutrition in critically ill patients.Methods:Based on the evidence-based medicine evidence structure, relevant evidence on the implementation and management of parenteral nutrition in critically ill patients was searched from top to bottom in Chinese and English databases such as China National Knowledge Infrastructure (CNKI) , VIP, British Medical Journal (BMJ) Best Practice, UpToDate and so on. The search period was from January 1, 2017 to July 31, 2022. Using the quality level of evidence and grade of recommendation system of the Joanna Briggs Institute (JBI) Evidence-Based Health Care Center in Australia, two researchers conducted literature quality evaluation and evidence summary.Results:A total of 19 articles were included, including 2 clinical decisions, 3 clinical practice guidelines, 11 expert consensuses, 2 systematic reviews, and 1 retrospective case-control study. A total of 9 themes were summarized, including the establishment of a multidisciplinary team, indications for parenteral nutrition, nutritional assessment, parenteral nutrition start time, parenteral nutrition stop time, selection and evaluation of vascular pathways, selection of infusion devices, observation of infusion processes and complications, with a total of 29 best evidences.Conclusions:The safe implementation and management of parenteral nutrition support for critically ill patients is of great significance for improving patient health outcomes. Medical and nursing staff should establish a standardized evidence-based parenteral nutrition support process to improve the safety of parenteral nutrition implementation in critically ill patients.

Objective:To investigate the effect of ICU nurses-led procedural sedation and analgesia (PSA) regimen in critically ill patients after liver transplantation.Methods:Using the convenient sampling method, a total of 140 critically ill patients after liver transplantation who were admitted to the surgical ICU of Beijing Chaoyang Hospital from January to December 2019 were selected as the research objects. According to the random number table method, the patients were divided into the experimental group and the control group, with 70 cases in each group. The control group was given routine analgesia and sedation, while the experimental group was given a self-designed PSA program on the basis of the control group. The dosage of analgesic and sedative drugs, incidence of complications, length of mechanical ventilation and length of ICU stay in 2 groups were recorded and compared.Results:The per capita dose of analgesic and sedative drugs in the experimental group was lower than that in the control group, and the difference was statistically significant ( P<0.01) . The duration of mechanical ventilation, the duration of ICU stay and the incidence of delirium in the experimental group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The use of PSA in critically ill patients after liver transplantation can reduce the dosage of sedative and analgesic drugs, shorten the duration of mechanical ventilation and ICU stay and reduce the incidence of delirium.

Objective:To investigate the association between occupational hazard exposures and small airway function among middle-aged and elderly people.Methods:From July to December in 2015, a multistage cluster random sampling method was used to select 3 600 residents aged 40 years old and above from 6 chronic obstructive pulmonary disease surveillance points in Jiangsu province. A cross-sectional survey was conducted to collect relevant information. Multivariable linear regression model was performed to determine the relationship between occupational hazard exposures and small airway function.Results:A total of 3 347 participants were included in the final analysis, and 44.6% of participants had been exposed to occupational hazard exposures. Compared with participants without the exposure history of occupational hazards, the significantly lower post-bronchodilator FEF 50%, FEF 75% and MMEF levels were observed in those with the exposure history of occupational hazards (β=-82.74, -55.43 and -91.57, respectively). Post-bronchodilator FEF 75% and MMEF (β=-51.78 and -79.47, respectively) in the participants with the exposure history of occupational dust and post-bronchodilator FEF 50%, FEF 75% and MMEF (β=-96.84, -32.87 and -75.72, respectively) in the participants with the exposure history of occupational harmful gas all showed a lower level. Post-bronchodilator FEF 75% was negatively associated with occupational hazard exposures in males (β male=-91.65 vs. β female=-27.21, P for interaction=0.022). Conclusions:The small airway function is worse in the middle-aged and elderly population with the exposure history of occupational hazards, and it is more significant in the male population.

Objective:To investigate the association between occupational hazard exposures and small airway function among middle-aged and elderly people.Methods:From July to December in 2015, a multistage cluster random sampling method was used to select 3 600 residents aged 40 years old and above from 6 chronic obstructive pulmonary disease surveillance points in Jiangsu province. A cross-sectional survey was conducted to collect relevant information. Multivariable linear regression model was performed to determine the relationship between occupational hazard exposures and small airway function.Results:A total of 3 347 participants were included in the final analysis, and 44.6% of participants had been exposed to occupational hazard exposures. Compared with participants without the exposure history of occupational hazards, the significantly lower post-bronchodilator FEF 50%, FEF 75% and MMEF levels were observed in those with the exposure history of occupational hazards (β=-82.74, -55.43 and -91.57, respectively). Post-bronchodilator FEF 75% and MMEF (β=-51.78 and -79.47, respectively) in the participants with the exposure history of occupational dust and post-bronchodilator FEF 50%, FEF 75% and MMEF (β=-96.84, -32.87 and -75.72, respectively) in the participants with the exposure history of occupational harmful gas all showed a lower level. Post-bronchodilator FEF 75% was negatively associated with occupational hazard exposures in males (β male=-91.65 vs. β female=-27.21, P for interaction=0.022). Conclusions:The small airway function is worse in the middle-aged and elderly population with the exposure history of occupational hazards, and it is more significant in the male population.