Background Meteorological factors are among the key extrinsic triggers for the onset and exacerbation of cardiovascular and cerebrovascular diseases (CVD). Against the backdrop of sustained global warming, elucidating the impact of ambient temperature and atmospheric pressure on CVD, especially on pre-hospital CVD emergent events, has become imperative for evidence-based prevention and emergency preparedness. Objective To quantify the temporal trends of daily mean temperature and atmospheric pressure and their associations with pre-hospital CVD emergent events in Yantai, and to explore effect modification by demographic subgroups and geographic areas, thereby providing an empirical basis for the rational allocation of emergency medical resources. Methods Pre-hospital CVD emergency data from January 1, 2016 to December 31, 2022 were selected from the Yantai 120 Emergency Medical Command System. Synchronous meteorological factors and environmental pollutant data were obtained from the websites of the National Oceanic and Atmospheric Administration and the National Centers for Environmental Information of the United States. Time-series analysis combined with distributed lag non-linear model was used to analyze the association between daily temperature, atmospheric pressure, and pre-hospital CVD emergencies. Average annual percentage changes (AAPC) were calculated using Joinpoint (version 5.2.0.0) to reflect temporal trends. Spearman correlation analysis was employed to screen variables with low collinearity for inclusion in the multi-pollutant adjusted models. Results From 2016 to 2022, a total of 268275 pre-hospital CVD emergency cases were recorded in Yantai City, showing an increasing annual trend (AAPC=7.16%, P=0.002). Emergency volume, daily temperature, atmospheric pressure, and PM₁₀ displayed marked seasonal patterns, with summer bottoms and winter peaks for emergencies, daily temperature higher in summer and lower in winter, and the inverse for atmospheric pressure. Correlation analysis showed that both daily temperature and atmospheric pressure were positively correlated with O₃, with correlation coefficients of 0.745 and 0.723, respectively; negatively correlated with PM_2.5, with correlation coefficients of −0.246 and −0.235, respectively; and negatively correlated with PM₁₀, with correlation coefficients of −0.241 and −0.229, respectively (P < 0.05). A U-shaped correlation was revealed between daily temperature and pre-hospital CVD emergency risk. Using 24 °C as the reference, risk was elevated at both low and high daily temperatures, with the strongest cold effect at –11 ℃ (RR=1.53, 95%CI: 1.35, 1.73) and strongest heat effect at 30 ℃ (RR=1.06, 95%CI: 1.01, 1.11); cold effects were prolonged (lag0–14d) compared to heat effects. Atmospheric pressure exhibited a positive association with emergencies; using a median of 1012.2 hPa as the reference, the maximum risk occurred at 1037 hPa (RR=1.25, 95%CI: 1.03, 1.52), with a 0–5 d lag. In the subgroup analysis, the impact of low temperature was more pronounced among females (RR_{−9 ℃}=1.66), people over 60 years (RR_{−9 ℃}=1.91), and rural residents (RR_{−9 ℃}=1.76). High atmospheric pressure significantly increased the risk of pre-hospital CVD emergency among females (RR_{1035 hPa}=1.54), people under 18 years (RR_{1035 hPa}=3.62), and rural residents (RR_{1035 hPa}=1.46). The sensitivity analysis results indicated that, after excluding the impact of pandemic and the degrees of freedom for time variations, the effects of daily average temperature and atmospheric pressure on pre-hospital CVD emergency volume were consistent with the primary analysis findings. Conclusion Both non-optimal temperature and atmospheric pressure significantly increase the pre-hospital CVD emergency volume; therefore, emergency medical services should develop targeted response protocols, optimize resource allocation, and intensify public health education to mitigate the pre-hospital burden attributable to temperature and pressure fluctuations.

OBJECTIVE To improve the diagnosis and treatment level of critically ill infectious diseases， standardize the clinical application of nanopore sequencing and promote the sound development of the technology. METHODS Division of Therapeutic Drug Monitoring of Chinese Pharmacological Society and Expert Committee of Precision Medicine for Clinical Treatment of Guangdong Pharmaceutical Association initiated and organized multidisciplinary experts to discuss and determine the consensus writing outline by using the nominal group method， forming a preliminary consensus draft； expert consultation was performed by using Delphi method， and then experts’ opinions were analyzed and revised to form consensus. RESULTS & CONCLUSIONS Consensuses of Experts on the Application of Nanopore Sequencing Technology in the Detection of Pathogenic Microorganisms covers targeted sequencing， metagenomic sequencing and whole genome sequencing， and is standardized in terms of sample collection and storage， detection process， bioinformatics analysis and report interpretation； the recommendations are provided for the key issues.

Objective:To develop the Perceived Nurse-Patient Relationship Scale and test its reliability and validity.Methods:Based on literature review, qualitative interviews, and expert consultation, a preliminary draft of the Perceived Nurse-Patient Relationship Scale was developed. From June to August 2020, convenience sampling was used to select 2 578 clinical nurses from 49 ClassⅢ hospitals in Hubei Province as research subjects, and reliability and validity testing were conducted on the scale.Results:Exploratory factor analysis extracted three common factors, including 18 items, with a cumulative variance contribution rate of 74.702%. Confirmatory factor analysis showed that the model fitted well. The scale-content validity index was 0.983, and the item-content validity index was 0.900 to 1.000. The Cronbach's α coefficient of the scale was 0.955, with a split-half reliability of 0.883.Conclusions:The Perceived Nurse-Patient Relationship Scale has good reliability and validity, and can be used to measure the nurse-patient relationship perceived by nurses.

Objective:To develop a Self-neglect Questionnaire for the aged in China and to test its reliability and validity so as to provide an effective assessment tool for differentiating self-neglect for the aged.Methods:The initial questionnaire was developed based on former results of qualitative research, literature review and the method of Delphi expert consultation. From April to May 2018, a total of 71 elderly inpatients were selected by convenience sampling at a ClassⅢ Grade A hospital in Wuhan to investigation with item analysis. From June to October 2018, by convenience sampling a total of 314 elderly inpatients were investigated formally at a Class Ⅲ Grade A hospital in Wuhan, and the questionnaire was tested in terms of reliability and validity.Results:Finally, the Self-neglect Questionnaire induding 7 common factors and 24 items was formed. The Cronbach's α of the questionnaire was 0.875, the split-half reliability coefficient was 0.709. In content validity, the item-content validity index (I- CVI) ranged from 0.895 to 1, and the average scale-content validity index (S- CVI/Ave) was 0.987. Exploratory factor analysis extracted 7 common factors with 69.391% for the cumulative variance contribution. Conclusions:The Self-neglect Questionnaire for the aged has good reliability and validity which can be an assessment tool for self-neglect of the aged.

Coronavirus disease 2019 (COVID-19) can cause great damage to the elderly patients and lead to high mortality. The clinical presentations and auxiliary examinations of the elderly patients with COVID-19 are atypical, due to the physiological ageing deterioration and basal pathological state. The treatment strategy for the elderly patients has its own characteristics and treatment protocol should be considered accordingly. To improve the diagnosis, treatment, and prevention of COVID-19 in the elderly, the Expert Committee of Geriatric Respiratory and Critical Care Medicine, China Society of Geriatrics established the "Expert consensus for the diagnosis, treatment, and prevention of coronavirus disease 2019 in the elderly" . We focused on the clinical characteristics and key points for better treatment and prevention of COVID-19 in the elderly. (1) For diagnosis, atypical clinical presentation of COVID-19 in the elderly should be emphasized, which may be complicated by underlying disease. (2) For treatment, strategy of multiple disciplinary team (mainly the respiratory and critical care medicine) should be adopted and multiple systemic functions should be considered. (3) For prevention, health care model about integrated management of acute and chronic diseases, in and out of hospital should be applied.

Purpose: Elder self-neglect is a global public health issue and should be taken seriously at large. Nurses,usually working directly with elderly patients, have a better understanding of what factors may causeelder self-neglect. In this qualitative study, we explored the influencing factors of elder self-neglect fromthe perception of nurses in the context of Chinese culture. Methods: Face-to-face, in-depth interviews were conducted from November 2018 to December 2018.Purposive sampling was used. Twenty one participants recruited from eight geriatric wards of a generalhospital located in Wuhan were interviewed. A content analysis of qualitative nature was performed toanalyze the data. Results: Our conceptual model illustrated the findings based on the three themes of the conflict betweenpersonal recognition and social judgment, the choice between current needs and individual beliefs, aswell as the compromise between insufficient abilities and limited resources. Conclusion Nurses together with family members and social workers can help older adults improvetheir awareness of self-neglect to bridge the gap with social judgment, learn to focus on their own needs,as well as seek as much support as possible. Nurses should also respect the autonomy and selfdeterminationof elder self-neglecters because self-neglect is related to older adults' values. Furthermore,larger studies are needed to quantitatively test and refine the model.

Purpose: Elder self-neglect is a global public health issue and should be taken seriously at large. Nurses,usually working directly with elderly patients, have a better understanding of what factors may causeelder self-neglect. In this qualitative study, we explored the influencing factors of elder self-neglect fromthe perception of nurses in the context of Chinese culture. Methods: Face-to-face, in-depth interviews were conducted from November 2018 to December 2018.Purposive sampling was used. Twenty one participants recruited from eight geriatric wards of a generalhospital located in Wuhan were interviewed. A content analysis of qualitative nature was performed toanalyze the data. Results: Our conceptual model illustrated the findings based on the three themes of the conflict betweenpersonal recognition and social judgment, the choice between current needs and individual beliefs, aswell as the compromise between insufficient abilities and limited resources. Conclusion Nurses together with family members and social workers can help older adults improvetheir awareness of self-neglect to bridge the gap with social judgment, learn to focus on their own needs,as well as seek as much support as possible. Nurses should also respect the autonomy and selfdeterminationof elder self-neglecters because self-neglect is related to older adults' values. Furthermore,larger studies are needed to quantitatively test and refine the model.

PURPOSE: As midwives witness and attend the whole process of childbirth, they have a better understanding of which factors may cause traumatic childbirth. However, because most of the studies paid their attention on mothers, little is known about psychological birth trauma from the perspective of midwives. This study aims to gain a full understanding of which factors may contribute to psychological traumatic childbirth from the perspective of midwives.METHODS: A qualitative research was conducted using in-depth interviews, which involved fourteen midwives from the maternal ward of a tertiary hospital. The interviews were recorded and transcribed, and then, Colaizzi's method was used to analyze the contents of the interviews.RESULTS: We proposed four themes and eight subthemes on the influencing factors of psychological traumatic childbirth from the perspective of midwives: low perceived social support (lack of support from family and lack of support from medical staff), hard times (protracted labor in the first stage and futile efforts during the second stage), poor birth outcomes (poor birth outcomes of the mother and poor birth outcomes of the baby), and excruciating pain (unbearable pain of uterine contraction and labor pain was incongruent with the mother's expectations).CONCLUSION: Medical staff should pay attention to psychological traumatic childbirth and its effects, and emphasis on the screening and assessment of birthing women with negative feelings so that their psychological traumatic childbirth can be prevented and decreased.
Female ; Humans ; Labor Pain ; Mass Screening ; Medical Staff ; Methods ; Midwifery ; Mothers ; Natural Childbirth ; Parturition ; Pregnancy ; Psychological Trauma ; Qualitative Research ; Tertiary Care Centers ; Uterine Contraction

ObjectiveTo explore the relationship among clinical nursing students＇ humanistic care ability, locus of control and meaning in life, and to provide scientific theoretical basis for improving their humanistic care ability. MethodsFrom November to December 2018, a questionnaire survey was conducted on 358 school nursing students selected by convenience sampling from a college in Liaoning Province using the Caring Ability Inventory(CAI), Internality, Powerful Others,and Chance Scale(IPC), and Chinese version of Meaning in Life Questionnaire(C-MLQ). ResultsThe 358 nursing students achieved the total score of (177.84±23.56)in CAI ; in IPC, the total score of "Internity" was (30.80±6.03), the total score of "Powerful Others" was (21.61±9.81)and the total score of "Chance" was (21.88±8.73); the total score of C-MLQ was (44.48±8.06). The "meaning in life", "powerful others" and "internity" could explain 51.5% of variations of the humanistic care ability. ConclusionsThe humanistic care ability of school nursing students is low and closely related to their locus of control and meaning in life. Intervention research on locus of control and meaning in life based on this theory should be strengthened so as to improve the clinical nursing students＇ humanistic care ability.

Objective To observe the efficacy and adverse reaction of intrapleural hyperthermic perfusion and intrapleural chemotherapy for patients with malignant pleural effusion (MPE) caused by lung cancer.Methods A total of 103 patients with MPE caused by lung cancer were assigned into one of two groups:intrapleural hyperthermic perfusion group (n =65) and intrapleural chemotherapy group (n =38).The disease control rate,MPE progress free survival,the relationship between vascular endothelial growth factor (VEGF) concentration in pleural effusion and curative effect and adverse reactions were observed.Results The overall disease control rate in intrapleural hyperthermic perfusion group and intrapleural chemotherapy group was 81.5％ and 52.6％ respectively,with a significant difference (x2 =9.834,P =0.002).The median MPE progress free survival of the two groups was 3.10 and 2.15 months respectively,with a significant difference (x2 =10.512,P =0.001).A significant difference of the median MPE progress free survival was observed in low VEGF concentration subgroup between intrapleural hyperthermic perfusion and intrapleural chemotherapy (3.34 months vs.2.20 months;x2 =9.409,P =0.002),but no difference was observed in high VEGF expression subgroup (2.85 months vs.2.10 months;x2 =2.429,P =0.119).The main adverse reactions included gastrointestinal adverse reaction,fatigue and hematotoxicity.Fatigue occurred in intrapleural hyperthermic perfusion group more commonly compared with intrapleural chemotherapy group (67.7％ vs.13.2％;x2 =28.595,P ＜ 0.001).Conclusion Compared with intrapleural chemotherapy,intrapleural hyperthermic perfusion can better improve disease control rate and MPE progress free survival in MPE patients caused by lung cancer,and it's adverse reactions are tolerated easily.The MPE progress free survival prolonging is observed especially in VEGF low expression subgroup.VEGF level in pleural effusions maybe could predict efficacy of intrapleural hyperthermic perfusion.