Objective:To construct a risk assessment model based on probabilistic hesitant fuzzy set(PHFS)for pressure-related injuries in medical equipment,and analyze its application value in control and management for risk of pressure-related injuries in medical equipment in the department of emergency.Methods:The frequency of events caused by pressure-related injuries of equipment was counted as statistical method.Combined with the risk assessment factors of pressure-related injuries,the technique for order preference by similarity to ideal solution(TOPSIS)based on PHFS was used to evaluate the risk level of pressure-related injuries of equipment,and formulate corresponding measures for risk management of pressure-related injuries.A total of 120 used medical equipment at the Department of Emergency of the First Affiliated Hospital of Xi'an Jiaotong University from January 2024 to December 2024 were selected.Using the random number table method,60 equipment were managed with the conventional risk management mode for pressure-related injuries(conventional management mode),and the other 60 equipment were managed with risk assessment model based on PHFS(model management mode)for pressure-related injuries in medical equipment.The incidence of pressure-related injuries of equipment,scores of operational quality of equipment,incidence of pressure-related injuries at different staging were compared between two kinds of management modes.A self-made questionnaire was used to investigate the satisfactions of emergency doctors,nurses,patients,and medical engineers in the department of equipment,who used and managed equipment.Results:The scores of operational standardization,pressure controllability,and diagnostic comfort in the model management mode were respectively(93.36±4.56),(90.54±3.69)and(93.65±4.69)points,which were significantly higher than those in the conventional management mode,while the score of material sensitivity was(30.23±3.26)points,which was significantly lower than that in the conventional management mode(t=15.941,11.896,11.511,17.200,P<0.05).The incidences of occurring pressure-related injuries in the referred logs of diagnosis and treatment of respiratory equipment,monitoring equipment,infusion equipment,and oxygen supply equipment in the model management mode were significantly lower than those in the conventional management mode(x2=9.924,9.493,9.796,8.075,P<0.05).The incidences of stage 1,2,3,and 4 of pressure-related injuries of equipment in the model management mode were significantly lower than those in the conventional management mode(x2=7.209,6.985,8.048,7.473,P<0.05).The satisfactions of emergency doctors,nurses,patients,and medical engineers in the department of equipment for the clinical use of equipment in the model management mode were significantly higher than those in the conventional management mode(t=12.499,13.200,14.410,9.226,P<0.05).Conclusion:The risk assessment model based on PHFS for pressure-related injury of medical equipment can reduce the incidences of pressure-related injuries of medical equipment in the department of emergency,and improve the safety of using medical equipment,and enhance the service quality of clinical equipment,and increase the satisfaction for equipment in clinical applications.

Objective:To investigate the effect of preoperative continuous fascia iliaca compartment block (FICB) on perioperative opioids dosage and quality of postoperative recovery in elderly patients with frail.Methods:A prospective study method was used. Sixty elderly frail patients underwent selective unilateral femoral head replacement surgery from November 2022 to October 2024 in Sihui People′s Hospital were selected. The patients were divided into control group and FICB group by random digits table method with 30 cases each. The patients in control group did not receive continuous FICB before surgery, and the patients in FICB group received continuous FICB 1 d before surgery. The perioperative use of opioids and analgesic effect, operative time, intraoperative blood loss, postoperative hospital stay, quality of recovery-40 (QoR-40) score at discharge and postoperative complications were compared between the two groups.Results:A total of 57 patients completed the study, with 29 cases in the FICB group and 28 cases in the control group. There were no statistical differences in operative time, intraoperative blood loss and postoperative hospital stay between the two groups ( P>0.05). The sufentanil dosage of patient-controlled analgesia (PCA), perioperative nalbuphine dosage, frequency of perioperative visual analog score (VAS)>4 scores, rate of preoperative rescue analgesia, rate of postoperative rescue analgesia and pressing frequency of PCA in FICB group were significantly lower than those in control group: (94.1 ± 5.4) μg vs. (102.1 ± 6.1) μg, 0 (0, 0) mg vs. 10.0 (0, 20.0) mg, 3.0 (2.0, 5.0) times vs. 5.0 (4.0, 6.0) times, 3.4% (1/29) vs. 32.1% (9/28), 13.8% (4/29) vs. 39.3% (11/28) and 2.0 (1.0, 3.0) times vs. 4.0 (3.0, 5.0) times, and there were statistical differences ( P<0.01 or <0.05). The total QoR-40 score and physical comfort, pain scores in FICB group were significantly higher than those in control group: 156(153, 161) scores vs. 153 (148, 159) scores, 47 (45, 50) scores vs. 45 (43, 47) scores and 30 (29, 31) scores vs. 28 (25, 30) scores, and there were statistical differences ( P<0.05 or <0.01); there were no statistical differences in emotional state, physical independence and psychological support scores between the two groups ( P>0.05). The incidences of dizziness and nausea vomiting in FICB group were significantly lower than those in control group: 13.8% (4/29) vs. 42.9% (12/28) and 10.3% (3/29) vs. 35.7% (10/28), and there were statistical differences ( P<0.05); there were no statistical difference in the incidences of delirium, pulmonary infection and deep vein thrombosis in the lower extremities between the two groups ( P>0.05). Conclusions:Preoperative continuous FICB can reduce perioperative opioids dosage in elderly patients with frail, and improve early stage postoperative recovery quality.

Objective:To investigate the effect of preoperative continuous fascia iliaca compartment block (FICB) on perioperative opioids dosage and quality of postoperative recovery in elderly patients with frail.Methods:A prospective study method was used. Sixty elderly frail patients underwent selective unilateral femoral head replacement surgery from November 2022 to October 2024 in Sihui People′s Hospital were selected. The patients were divided into control group and FICB group by random digits table method with 30 cases each. The patients in control group did not receive continuous FICB before surgery, and the patients in FICB group received continuous FICB 1 d before surgery. The perioperative use of opioids and analgesic effect, operative time, intraoperative blood loss, postoperative hospital stay, quality of recovery-40 (QoR-40) score at discharge and postoperative complications were compared between the two groups.Results:A total of 57 patients completed the study, with 29 cases in the FICB group and 28 cases in the control group. There were no statistical differences in operative time, intraoperative blood loss and postoperative hospital stay between the two groups ( P>0.05). The sufentanil dosage of patient-controlled analgesia (PCA), perioperative nalbuphine dosage, frequency of perioperative visual analog score (VAS)>4 scores, rate of preoperative rescue analgesia, rate of postoperative rescue analgesia and pressing frequency of PCA in FICB group were significantly lower than those in control group: (94.1 ± 5.4) μg vs. (102.1 ± 6.1) μg, 0 (0, 0) mg vs. 10.0 (0, 20.0) mg, 3.0 (2.0, 5.0) times vs. 5.0 (4.0, 6.0) times, 3.4% (1/29) vs. 32.1% (9/28), 13.8% (4/29) vs. 39.3% (11/28) and 2.0 (1.0, 3.0) times vs. 4.0 (3.0, 5.0) times, and there were statistical differences ( P<0.01 or <0.05). The total QoR-40 score and physical comfort, pain scores in FICB group were significantly higher than those in control group: 156(153, 161) scores vs. 153 (148, 159) scores, 47 (45, 50) scores vs. 45 (43, 47) scores and 30 (29, 31) scores vs. 28 (25, 30) scores, and there were statistical differences ( P<0.05 or <0.01); there were no statistical differences in emotional state, physical independence and psychological support scores between the two groups ( P>0.05). The incidences of dizziness and nausea vomiting in FICB group were significantly lower than those in control group: 13.8% (4/29) vs. 42.9% (12/28) and 10.3% (3/29) vs. 35.7% (10/28), and there were statistical differences ( P<0.05); there were no statistical difference in the incidences of delirium, pulmonary infection and deep vein thrombosis in the lower extremities between the two groups ( P>0.05). Conclusions:Preoperative continuous FICB can reduce perioperative opioids dosage in elderly patients with frail, and improve early stage postoperative recovery quality.

Objective:To construct a risk assessment model based on probabilistic hesitant fuzzy set(PHFS)for pressure-related injuries in medical equipment,and analyze its application value in control and management for risk of pressure-related injuries in medical equipment in the department of emergency.Methods:The frequency of events caused by pressure-related injuries of equipment was counted as statistical method.Combined with the risk assessment factors of pressure-related injuries,the technique for order preference by similarity to ideal solution(TOPSIS)based on PHFS was used to evaluate the risk level of pressure-related injuries of equipment,and formulate corresponding measures for risk management of pressure-related injuries.A total of 120 used medical equipment at the Department of Emergency of the First Affiliated Hospital of Xi'an Jiaotong University from January 2024 to December 2024 were selected.Using the random number table method,60 equipment were managed with the conventional risk management mode for pressure-related injuries(conventional management mode),and the other 60 equipment were managed with risk assessment model based on PHFS(model management mode)for pressure-related injuries in medical equipment.The incidence of pressure-related injuries of equipment,scores of operational quality of equipment,incidence of pressure-related injuries at different staging were compared between two kinds of management modes.A self-made questionnaire was used to investigate the satisfactions of emergency doctors,nurses,patients,and medical engineers in the department of equipment,who used and managed equipment.Results:The scores of operational standardization,pressure controllability,and diagnostic comfort in the model management mode were respectively(93.36±4.56),(90.54±3.69)and(93.65±4.69)points,which were significantly higher than those in the conventional management mode,while the score of material sensitivity was(30.23±3.26)points,which was significantly lower than that in the conventional management mode(t=15.941,11.896,11.511,17.200,P<0.05).The incidences of occurring pressure-related injuries in the referred logs of diagnosis and treatment of respiratory equipment,monitoring equipment,infusion equipment,and oxygen supply equipment in the model management mode were significantly lower than those in the conventional management mode(x2=9.924,9.493,9.796,8.075,P<0.05).The incidences of stage 1,2,3,and 4 of pressure-related injuries of equipment in the model management mode were significantly lower than those in the conventional management mode(x2=7.209,6.985,8.048,7.473,P<0.05).The satisfactions of emergency doctors,nurses,patients,and medical engineers in the department of equipment for the clinical use of equipment in the model management mode were significantly higher than those in the conventional management mode(t=12.499,13.200,14.410,9.226,P<0.05).Conclusion:The risk assessment model based on PHFS for pressure-related injury of medical equipment can reduce the incidences of pressure-related injuries of medical equipment in the department of emergency,and improve the safety of using medical equipment,and enhance the service quality of clinical equipment,and increase the satisfaction for equipment in clinical applications.

Objective:To investigate the application effects of a two-way six-step nursing teaching model based on the Kolb's learning cycle in the teaching of nurse interns in an emergency department.Methods:We assigned 52 undergraduate nursing students interning at the department of emergency from February 2020 to February 2022 to receive conventional teaching (control group) and 50 nurse interns from March 2022 to February 2023 to receive two-way six-step nursing teaching based on the Kolb's model (observation group). We evaluated the changes in core competencies before and after learning using the Competency Inventory for Registered Nurses (CIRN); assessed self-learning abilities using a nursing student self-learning ability assessment scale; recorded the incidence rates of related errors in the emergency department after learning; and assessed the level of satisfaction with nursing using the Patient Satisfaction Questionnaire (PSQ-18). SPSS 22.0 was used to perform the chi-square test and t-test. Results:After learning, the scores of CIRN dimensions and self-learning ability dimensions were all increased in both groups, and these scores were significantly higher in the observation group [(31.78±2.34), (50.22±4.33), (28.56±2.09), (19.22±3.11), (22.34±2.78); (30.07±3.14), (24.11±2.99), (30.11±3.41), (33.33±3.09)] than in the control group [(30.88±2.22), (48.34±3.88), (27.59±2.52), (17.77±3.08), (20.88±2.55); (28.67±2.09), (22.56±2.44), (27.99±3.03), (31.33±3.44)]. Compared with the control group, the observation group showed significantly lower incidence rates of errors in the execution of medical orders (19.23% vs. 2.00%, P=0.008) and errors in practice in accordance with standards (15.38% vs. 0.00%, P=0.006). There were no significant differences in the incidence rates of poor response on the spot, medical record errors, and medical dispute errors between the observation group and the control group (all P>0.05). The PSQ-18 scores in all dimensions of the observation group were significantly higher than those of the control group ( P=0.002, 0.001, 0.014, 0.008, <0.001). Conclusions:The two-way six-step nursing teaching model based on the Kolb's model can significantly improve the core competencies and self-learning abilities of nursing students in the department of emergency, and reduce errors in the execution of medical orders and practice in accordance with standards, thus improving their nursing service levels.

Atopic dermatitis (AD) is a chronic, relapsable and pruritic skin disease, commonly found in children and adolescents. The prevalence of AD is increasing worldwide. It is reported that AD is related to many factors such as genetic inheritance, environment, immunity and skin barrier dysfunction, suggesting a very complex pathogenesis. In recent years, high-throughput technologies in the field of genomics and metabolomics have opened up new perspectives on the pathogenesis of AD, and shown potential application prospects in microbiome transplantation therapies for AD. This review summarized the current advances in the relationship between skin microecology and skin health, the pathogenesis and microbiomic characteristics of AD, features of pathogenic microorganisms, and microbiome transplantation therapies for AD. Based on our own practical experience, we put forward a culturomics research protocol to study the human skin microbiome and a method for quantitative microbiological examination, aiming to provide reference for the prevention, clinical treatment and therapeutic monitoring of AD.

Objective: To identify and characterize the 4 strains of Prototheca isolated from the clinical samples of skin or ascites samples in China. Methods: The taxonomic position of 4 yeast-like organisms was revealed by polyphasic taxonomic approach, i.e., cultural and morphologic characteristics, commercial biochemical systems of Vitek 2 (YST kit) and Vitek matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometry (MS) systems in combination with phylogenetic analysis based on the gene sequences of 16S and 28S rRNA. Results: The 4 strains of Prototheca were characterized as cream-white, smooth, moist yeast-like colonies on Sabouraud gentamicin chloramph agar after incubation for 3 days. However, round, oval-shaped or elliptical sporangiums with mulberry-like or strawberry-like endospores were observed by optical microscope, which showed distinct differences from the general yeast species. The 4 isolates were identified as Prototheca wickerhamii with Vitek YST kits by Vitek 2 systems and Vitek MALDI-TOF MS systems. The genome for the 4 isolates was characterized with the existence of the prokaryotic 16S rRNA gene and eukaryotic 28S rRNA gene. The 16S rRNA gene sequence of the 4 strains showed more than 99.7% similarity to that of P. wickerhamii. Sequence analysis of 28S rRNA gene showed that the organisms included multiple copies of different sequences, which showed sequence similarities of 91.9% to 100% even in the same strain. The phylogenetic dendrogram based on 16S rRNA and 28S rRNA gene sequences showed that the 4 strains of Prototheca formed a cluster along with P. wickerhamii. Conclusion The 4 yeast-like organisms could be identified as P. wickerhamii, and 16S rRNA gene should be the suitable molecular target for the identification.

Objective:To establish a calculation model of drug preparation difficulty coefficient for outpatient pharmacy intrave -nous admixture center ( OUIVA) in a children's hospital, and construct the performance model .Methods: All the prescriptions in a week in OUIVA of Shanghai children's medical center were randomly selected .According to the actual difficulty level in the process of outpatient and emergency drug preparation , a basic drug difficulty coefficient and difficulty coefficient addition method was constructed . The difficulty index of every prescription was calculated .All the prescriptions in a week were randomly selected , and according to the difficulty coefficient analysis method , the daily difficulty coefficient of the prescriptions was calculated in order to build a performance model for OUIVA in the hospital .Results:The difficulty coefficient of medicine mainly included four basic difficulty coefficients and nine difficulty addition coefficients .According to the statistics , the average difficulty coefficient of daily prescriptions was (3.83 ± 2.86 )with the highest difficulty coefficient of 35, and the prescription data showed that there was significant difference between outpa -tient and emergency prescriptions and daytime blood tumor prescriptions .Conclusion:A performance model based on the difficulty co-efficient for OUIVA in children ' s hospital is a more scientific reflection to the daily work .

Objective:To analyze the dosage distribution and the frequency of each dosage of high-risk tablets in the hospitalized patients in a children's hospital,and study whether the existing specifications of high-risk tablets meet the pediatrics clinical needs. Methods:All the prescriptions including high risk tablets were analyzed from 2014 to 2016 in Shanghai children's medical center. The frequency of every dosage of every drug was analyzed,and the current specifications were judged according to the frequency. New specifications were proposed when the existing specifications did not match the clinical needs. The new frequency of the proposed speci-fications was re-accounted for all the three-year prescriptions in order to evaluate whether the proposed new specifications met the clini-cal needs. Results:Among the five kinds of high-risk oral tablets,methotrexate tablets and vitamin A acid tablets were in accordance with the actual clinical requirements. Mercaptopurine tablets should add two specifications including 12.5 mg and 17 mg,and warfarin sodium tablets should add one specification(1.25 mg). Hydroxyurea tablets(250 mg) and warfarin sodium tablets(1 mg) were rec-ommended used in the children's hospital. Conclusion:The existing specifications of high-risk oral tablets can't fully meet the clini-cal needs,therefore,specifications still needs to be adjusted.