OBJECTIVE To investigate the relationship between nurse-to-patient ratios and hospital-acquired infec-tions(HAIs)in the intensive care units,and to assess the impact of both average and maximum nurse-to-patient ratios on the risk of HAIs.METHODS Data were obtained from the hospital information system(including Hospi-tal Information System,nursing sensitive quality indicator monitoring system and hospital infection management system).Inpatients aged 18 years and older in ten intensive care units from 1 Jan.2022 to 31 Dec.2023 were in-cluded;data on the nurse-to-patient ratios during day shifts,night shifts and the overall period and HAIs cases were collected.Univariate test was conducted to compare differences between the infection group and the non-infection group.Logistic regression models were utilized to evaluate the association between various nurse-to-patient ratio indicators and the risk of HAIs while controlling the covariates.RESULTS A total of 2 742 patients were included,with an HAIs incidence rate of 18.23％.The average patient-to-nurse ratio was significantly low-er in the infection group than in the non-infection group(2.76±0.82 vs.3.27±1.16,P＜0.001),whereas the maximum nurse-to-patient ratios for the overall period,day and night shifts were 3.57±1.09(infected)vs.3.91±1.31(uninfected),3.30±1.12 vs.3.48±1.16,and 4.62±1.85 vs.5.10±2.08,respectively(all P＜0.001).Regression analysis showed that no significant association between the average nurse-to-patient ratios for the overall period,day and night shifts and the risk of HAIs;whereas the odds ratios(ORs)for the maximum patient-to-nurse ratio greater than 4 were 2.122(1.355-3.324)for the overall period,2.061(1.333-3.186)for the day shift and 1.495(1.055-2.118)for the night shifts(all nurse-to-patient ratios≤3 in the reference group).CONCLUSIONS The maximum nurse-to-patient ratios are important risk factors for HAIs in the intensive care u-nits,whereas the average nurse-to-patient ratios are not significantly associated with HAIs.It is suggested that in-sufficient nursing resources during peak hours may increase the risk of infection,and optimizing the allocation of nursing care during peak hours will help to reduce the incidence of HAIs.

Objective:To observe any effect of supplementing treatment according to the Early Start Denver model (ESDM) with repeated transcranial magnetic stimulation (rTMS) in the treatment of children with autism spectrum disorder (ASD).Methods:Sixty-seven children on the autism spectrum aged 2 or 3 years were randomly divided into a control group of 33 and an observation group of 34. Both groups were treated as specified by the ESDM for 24 weeks, but the observation group additionally received rTMS. At 12 and 24 weeks, both groups were evaluated using the Autism Behavior Checklist, the Childhood Autism Rating Scale (CARS), the revised version of the Repetitive Behavior Scale (RBS-R), Gesell Development Schedules, and the Autism Treatment Evaluation Checklist (ATEC).Results:The CARS, Gesell, RBS-R and ATEC results of both groups had improved significantly after 12 weeks, with further improvements observed another 12 weeks later, when the average Autism Behavior Checklist scores had also improved significantly. At that point the results of the observation group were significantly better than those of the control group, on average.Conclusions:Combining ESDM and rTMS can significantly relieve the main symptoms of autism and improve the comprehensive development of children on the autism spectrum 2 or 3 years old. Therefore, such combination is worthy of application in clinical practice.

The number of pertussis cases reported through hospital-based passive surveillance severely underestimated the actual disease incidence. This may be due to factors such as atypical symptoms in the vaccine era, limited diagnostic criteria, insufficient clinician awareness, poor access to diagnostic technologies, and problems in monitoring and reporting management. Atypical pertussis often lacks specific symptoms or signs, making it prone to underdiagnosis or missed diagnosis in clinical practice. As a result, patients are not managed or treated effectively. This enables the pathogen to continue spreading. This is an important reason for the difficulty in accurately assessing the actual prevalence of pertussis. This study reviews the global understanding and evolving perspectives of atypical pertussis. It also examines the challenges this condition poses to prevention and control efforts. These challenges include low consultation rates, frequent underdiagnosis or missed diagnoses, limited laboratory testing access, and insufficiently targeted prevention strategies. The study also proposes countermeasures to optimize diagnosis, surveillance, and overall prevention and control efforts.

Objective To explore the supportive care needs of heart transplant patients at different stages.Methods Purposive sampling method was used to select 15 heart transplant patients who were hospitalized in a tertiary A hospital in Guangdong Province from July 2023 to February 2024 as research subjects.According to the"Timing It Right"theory,5 semi-structured interviews were conducted with patients.Interpretive phenomenology was used to sort out and analyze the data.Results A total of 5 themes and 18 subthemes were extracted,including urgent desire for transplant information and psychological support during diagnosis,strong physiological and emotional needs during hospitalization,significant demand for health education in the preparation period for discharge,expectation of family support during the adjustment period,increasing demand for social support during the adaptation period.Conclusion The supportive care needs of heart transplant patients at different stages are dynamic.Medical staff should adopt the concept of dynamic and continuous care,and provide personalized care in stages,plans and continuance,in order to improve the quality of life of heart transplant patients.

Objective:To explore the reliability and validity of the Chinese version of Hammersmith Neonatal Neurological Examination (C-HNNE).Methods:A prospective cohort study.One hundred and fourteen neonates born in Longgang District Maternity & Child Healthcare Hospital of Shenzhen City between October 2022 and August 2023, who were hospitalized in the Neonatology or Obstetrics Department after birth and met the inclusion criteria, were enrolled as study subjects.They were divided into an early preterm group(34 cases), a mid-late preterm group(50 cases), and a full-term group(30 cases) based on gestational age.The first C-HNNE assessment was completed within 24 hours after birth, and 20 cases from each group were selected for inter-rater reliability assessment; 48 hours after the first C-HNNE assessment, 20 cases from each group were selected to undergo the C-HNNE assessment again for test-retest reliability assessment.At corrected 4 months of age, short-term neurodevelopmental outcomes were determined by pediatric rehabilitation physicians using clinical examination combined with general movements (GMs) assessment.Inter-rater reliability and test-retest reliability were assessed by calculating intra-class correlation coefficient (ICC). The optimal cutoff scores of the C-HNNE for each group were determined by plotting receiver operating characteristic(ROC) curves.Predictive validity was determined by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).Results:The highest sensitivity for predicting neonatal corrected neuromotor developmental outcome at 4 months of age was achieved when the optimal C-HNNE scores were taken as 22.25, 25.25, and 29.25 in the early preterm, mid-late preterm, and term groups, respectively.The ICCs for the inter-rater reliability of the total C-HNNE score and subscale scores in all 3 groups were above 0.7, indicating good reliability.The ICCs for test-retest reliability of some individual items were<0.6, indicating moderate reliability.In terms of validity, the correlation coefficients between the total C-HNNE scores and the GMs scores of the three groups were 0.550, 0.483, 0.473 (all P<0.01), and the sensitivity of the C-HNNE for predicting neurodevelopmental developmental outcomes in neonates corrected to 4 months of age was 82.9%, specificity was 70.4%, PPV was 58.0%, and NPV was 89.3%. Conclusions:C-HNNE demonstrates good reliability and validity and can be used as a routine bedside examination program for early neonatal life.

OBJECTIVE To investigate the relationship between nurse-to-patient ratios and hospital-acquired infec-tions(HAIs)in the intensive care units,and to assess the impact of both average and maximum nurse-to-patient ratios on the risk of HAIs.METHODS Data were obtained from the hospital information system(including Hospi-tal Information System,nursing sensitive quality indicator monitoring system and hospital infection management system).Inpatients aged 18 years and older in ten intensive care units from 1 Jan.2022 to 31 Dec.2023 were in-cluded;data on the nurse-to-patient ratios during day shifts,night shifts and the overall period and HAIs cases were collected.Univariate test was conducted to compare differences between the infection group and the non-infection group.Logistic regression models were utilized to evaluate the association between various nurse-to-patient ratio indicators and the risk of HAIs while controlling the covariates.RESULTS A total of 2 742 patients were included,with an HAIs incidence rate of 18.23％.The average patient-to-nurse ratio was significantly low-er in the infection group than in the non-infection group(2.76±0.82 vs.3.27±1.16,P＜0.001),whereas the maximum nurse-to-patient ratios for the overall period,day and night shifts were 3.57±1.09(infected)vs.3.91±1.31(uninfected),3.30±1.12 vs.3.48±1.16,and 4.62±1.85 vs.5.10±2.08,respectively(all P＜0.001).Regression analysis showed that no significant association between the average nurse-to-patient ratios for the overall period,day and night shifts and the risk of HAIs;whereas the odds ratios(ORs)for the maximum patient-to-nurse ratio greater than 4 were 2.122(1.355-3.324)for the overall period,2.061(1.333-3.186)for the day shift and 1.495(1.055-2.118)for the night shifts(all nurse-to-patient ratios≤3 in the reference group).CONCLUSIONS The maximum nurse-to-patient ratios are important risk factors for HAIs in the intensive care u-nits,whereas the average nurse-to-patient ratios are not significantly associated with HAIs.It is suggested that in-sufficient nursing resources during peak hours may increase the risk of infection,and optimizing the allocation of nursing care during peak hours will help to reduce the incidence of HAIs.

Acute pancreatitis(AP),one of the most common acute abdominal conditions in clinical practice,is typically self-limiting.However,approximately 20%of cases progress to severe acute pancreatitis,characterized by persistent systemic inflammatory response syndrome and multiple-organ dysfunction syndrome,with a high mortality rates.The pathogenesis of AP involves complex pathophysiological processes,and in recent years,the role of oxidative stress(OS)in AP has garnered increasing attention.OS refers to an imbalance between reactive oxygen species production and antioxidant capacity following endogenous or exogenous stimuli,which can lead to pancreatic cell injury,exacerbation of inflammatory responses,and organ dysfunction.Notably,antioxidants have demonstrated efficacy in reducing OS-induced pancreatic damage and multi-organ dysfunction in animal models.This article reviews current molecular mechanisms of OS in AP,its role in disease progression and recent advances in antioxidant-based therapeutic strategies for AP.

Objective:To explore the reliability and validity of the Chinese version of Hammersmith Neonatal Neurological Examination (C-HNNE).Methods:A prospective cohort study.One hundred and fourteen neonates born in Longgang District Maternity & Child Healthcare Hospital of Shenzhen City between October 2022 and August 2023, who were hospitalized in the Neonatology or Obstetrics Department after birth and met the inclusion criteria, were enrolled as study subjects.They were divided into an early preterm group(34 cases), a mid-late preterm group(50 cases), and a full-term group(30 cases) based on gestational age.The first C-HNNE assessment was completed within 24 hours after birth, and 20 cases from each group were selected for inter-rater reliability assessment; 48 hours after the first C-HNNE assessment, 20 cases from each group were selected to undergo the C-HNNE assessment again for test-retest reliability assessment.At corrected 4 months of age, short-term neurodevelopmental outcomes were determined by pediatric rehabilitation physicians using clinical examination combined with general movements (GMs) assessment.Inter-rater reliability and test-retest reliability were assessed by calculating intra-class correlation coefficient (ICC). The optimal cutoff scores of the C-HNNE for each group were determined by plotting receiver operating characteristic(ROC) curves.Predictive validity was determined by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).Results:The highest sensitivity for predicting neonatal corrected neuromotor developmental outcome at 4 months of age was achieved when the optimal C-HNNE scores were taken as 22.25, 25.25, and 29.25 in the early preterm, mid-late preterm, and term groups, respectively.The ICCs for the inter-rater reliability of the total C-HNNE score and subscale scores in all 3 groups were above 0.7, indicating good reliability.The ICCs for test-retest reliability of some individual items were<0.6, indicating moderate reliability.In terms of validity, the correlation coefficients between the total C-HNNE scores and the GMs scores of the three groups were 0.550, 0.483, 0.473 (all P<0.01), and the sensitivity of the C-HNNE for predicting neurodevelopmental developmental outcomes in neonates corrected to 4 months of age was 82.9%, specificity was 70.4%, PPV was 58.0%, and NPV was 89.3%. Conclusions:C-HNNE demonstrates good reliability and validity and can be used as a routine bedside examination program for early neonatal life.

Objective:To observe any effect of supplementing treatment according to the Early Start Denver model (ESDM) with repeated transcranial magnetic stimulation (rTMS) in the treatment of children with autism spectrum disorder (ASD).Methods:Sixty-seven children on the autism spectrum aged 2 or 3 years were randomly divided into a control group of 33 and an observation group of 34. Both groups were treated as specified by the ESDM for 24 weeks, but the observation group additionally received rTMS. At 12 and 24 weeks, both groups were evaluated using the Autism Behavior Checklist, the Childhood Autism Rating Scale (CARS), the revised version of the Repetitive Behavior Scale (RBS-R), Gesell Development Schedules, and the Autism Treatment Evaluation Checklist (ATEC).Results:The CARS, Gesell, RBS-R and ATEC results of both groups had improved significantly after 12 weeks, with further improvements observed another 12 weeks later, when the average Autism Behavior Checklist scores had also improved significantly. At that point the results of the observation group were significantly better than those of the control group, on average.Conclusions:Combining ESDM and rTMS can significantly relieve the main symptoms of autism and improve the comprehensive development of children on the autism spectrum 2 or 3 years old. Therefore, such combination is worthy of application in clinical practice.

Acute pancreatitis(AP),one of the most common acute abdominal conditions in clinical practice,is typically self-limiting.However,approximately 20%of cases progress to severe acute pancreatitis,characterized by persistent systemic inflammatory response syndrome and multiple-organ dysfunction syndrome,with a high mortality rates.The pathogenesis of AP involves complex pathophysiological processes,and in recent years,the role of oxidative stress(OS)in AP has garnered increasing attention.OS refers to an imbalance between reactive oxygen species production and antioxidant capacity following endogenous or exogenous stimuli,which can lead to pancreatic cell injury,exacerbation of inflammatory responses,and organ dysfunction.Notably,antioxidants have demonstrated efficacy in reducing OS-induced pancreatic damage and multi-organ dysfunction in animal models.This article reviews current molecular mechanisms of OS in AP,its role in disease progression and recent advances in antioxidant-based therapeutic strategies for AP.