Objective:To build a nursing care plan decision-making support system based on the hospital's nursing information system and evaluate its effects in newly hired nurses.Methods:This study adopted a non-synchronous pre-post control design. Totally 181 newly hired nurses recruited by Beijing Tiantan Hospital, Capital Medical University, were selected by convenience sampling. The control group consisted of 85 new nurses hired in August 2021, while the intervention group consisted of 96 new nurses hired in August 2022. The control group received traditional training methods, while the intervention group received training through the nursing care plan decision-making support system in addition to the traditional methods. The nursing decision-making ability and the quality of specialty nursing care were compared between the two groups.Results:Finally, 81 nurses were included in the control group, and 93 nurses were included in the intervention group. The nursing decision-making ability score in the intervention group was (80.15±4.59), which was significantly higher than the (78.62±5.13) in the control group ( t=-2.080, P=0.039). The intervention group also had a significantly higher qualified rate of specialty nursing care compared to the control group (χ 2=6.626, P=0.036) . Conclusions:The application of the nursing care plan decision-making support system in the standardized training of newly hired nurses can improve their nursing decision-making abilities and the quality of specialty nursing care.

To study the technical principles and case analysis of typical fault of fully automatic enzyme-linked immunosorbent assay(ELISA)analyzer,in order to improve the usage effect of the analyzer.The microparticle enzyme immunoassay(MEIA)analysis technique was used to complete the ELISA test.The main calibration,standard calibration,qualitative calibration and calibration solution correction were used as the calibration methods of the ELISA analyzer to improve the analytic precision of ELISA.By analyzing the cases of typical faults encountered during the use of the fully automatic ELISA analyzer,such as washing machine,startup initialization alarm,boot disk,sampling arm and filter,the corresponding solutions of fault were proposed to provide reference for the maintenance and management of the fully automatic ELISA analyzer at later stage.

Objective:To explore the risk factors of bortezomib-related peripheral neuropathy (BIPN) and the clinical and electrophysiological characteristics of patients in treatment of multiple myeloma (MM).Methods:The clinical data of 71 newly diagnosed MM patients treated with BD (bortezomib + dexamethasone) regimen in Yancheng First People's Hospital from March 2016 to December 2019 were retrospectively analyzed. The bone marrow morphology, immunology, cytogenetics, molecular biology (MICM), routine electrophysiological examination before and after treatment were performed. All patients were divided into the peripheral neuropathy (PN) group and the non-PN group according to the presence or not of BIPN, and the clinicopathological differences of both groups were also compared; a binary logistic regression model was used to analyze the factors affecting the occurrence of PN. The electrophysiological characteristics were summarized and fluorescence in situ hybridization (FISH) was used to detect karyotype of BIPN patients.Results:Among 71 MM patients, there were 40 cases (56.3%) of PN and 31 cases (43.7%) of non-PN. The proportion of patients at international staging system (ISS) staging Ⅲ, and the levels of IgA, IgG, IgM, serum creatinine, β 2-microglobulin (β 2-MG) in the PN group were higher than those in the non-PN group, and hemoglobin (Hb) level in the PN group was lower than that in the non-PN group, and the differences were statistically significant (both P < 0.05). Binary logistic regression analysis showed that increased IgA ( OR = 1.151, 95% CI 1.012-1.309, P = 0.033), increased IgG ( OR = 1.055, 95% CI 1.000~1.112, P = 0.049), increased IgM ( OR = 1.010, 95% CI 1.001-1.018, P = 0.022), increased serum creatinine ( OR = 1.037, 95% CI 1.011~1.065, P = 0.005), increased β 2-MG ( OR = 1.564, 95% CI 1.039-2.354, P = 0.032) were risk factors for BIPN. Among 40 patients with BIPN, 33 cases (82.5%) of sensory nerve conduction velocity (SCV) were abnormal, 23 cases (57.5%) of motor nerve conduction velocity (MCV) were abnormal; 31 cases (77.5%) showed demyelination damage, 9 cases (22.5%) had axonal damage. Among 40 patients with BIPN, 24 cases underwent FISH detection, including 19 cases (79.2%) with chromosomal mutations, of which 12 cases (50.0%) were mixed subtype abnormal. Conclusions:MM patients with high levels of β 2-MG, IgA, IgG, IgM and serum creatinine are more prone to PN when treated with bortezomib. The electrophysiology of patients with BIPN is mainly characterized by demyelination of sensory nerves.

Objective:To investigate the familial inheritances, clinical features, treatments and outcomes of familial Waldenstrom macroglobulinemia (WM) patients.Methods:The clinical manifestations, laboratory examinations, diagnosis and treatments, and follow-up data of 6 familial WM patients who were admitted to Yancheng No.1 People's Hospital from June 2002 to July 2019 were retrospectively analyzed, and the literature was reviewed.Results:Among 6 WM patients, 4 patients had dizziness and fatigue at the onset, 1 patient had recurrent low-grade fever and abnormal sweating as the first manifestations, 1 patient was hospitalized due to pulmonary infection, and WM was found later. Two brothers of the patients were diagnosed with WM, another 2 brothers of the patients had IgM-type monoclonal gammopathy of undetermined significance (MGUS) during the physical examination. All the 6 patients were middle-aged/elderly men, with a median age of 63 years old (51-70 years old). The median follow-up time were 71.5 months (4-217 months), and by the end of the follow-up (June 2020), 2 cases died of pulmonary infection, and 1 of them developed acute myeloid leukemia; the other 4 cases were in regular chemotherapy. Two IgM-MGUS patients were followed up without symptoms.Conclusions:WM patients have familial aggregation, and their clinical manifestations are highly heterogeneous. Patients with family history may have poor prognosis. It is necessary to strengthen the awareness of WM and family history screening.

Objective:To investigate the expression of Toll-like receptor 8 (TLR8) in diffuse large B-cell lymphoma (DLBCL) and its correlation with clinicopathological characteristics and prognosis of patients.Methods:The data in the Oncomine database was used to analyze the difference of TLR8 mRNA expression between DLBCL tumor tissues and normal lymphocytes, and the result was verified in two independent subsets GSE 25638 and GSE 32018 of the NCBI-GEO database. The OSDLBCL online survival analysis tool was used to analyze the correlation of TLR8 mRNA relative expression level with overall survival (OS) and progression-free survival (PFS) of DLBCL patients. Gene ontology bioprocess (GO_BP) enrichment analysis was performed by using GSEA software. The correlation of TLR8 mRNA expression with tumor immune cell infiltration degree and immune checkpoint-related molecule expression was analyzed by TIMER online tool website. A total of 53 DLBCL patients who underwent lymph node biopsy in Yancheng No. 1 People's Hospital from June 2020 to June 2021 were selected. Immunohistochemistry was used to detect the expression of TLR8 protein, and its relationship with the clinicopathological characteristics of patients was analyzed.Results:The analysis result of data from Oncomine and GEO databases showed that the relative expression levels of TLR8 mRNA in tumor tissues of patients with DLBCL or activated B cell-like DLCBL were higher than those in normal lymphocytes (all P < 0.001). The results of OSDLBCL online survival analysis indicated that the OS ( P = 0.020) and PFS ( P = 0.004) in DLBCL patients with high TLR8 mRNA expression were worse than those in patients with low TLR8 mRNA expression. The level of TLR8 was related to the abnormal function of immune response, cytokine metabolism and DNA damage monitoring; the result of TIMER online analysis showed that the expression level of TLR8 mRNA was positively related to the degree of neutrophil infiltration ( r = 0.78, P < 0.001) and the expression of immunosuppressive molecules [HAVCR2 ( r = 0.85, P < 0.001), LAG3 ( r = 0.63, P < 0.001), CD274 ( r = 0.77, P < 0.001), TIGIT ( r = 0.32, P = 0.037), and C10ORF54 ( r = 0.34, P = 0.029)]. Among 53 DLBCL patients, 29 patients (54.7%) had low expression of TLR8 protein and 24 patients (45.3%) had high expression of TLR8 protein. There were statistical differences in the expressions of TLR8 protein in DLBCL patients with different serum lactate dehydrogenase and β 2-microglobulin levels (both P < 0.05). Conclusions:TLR8 is highly expressed in DLBCL patients, and TLR8 may be a prognostic marker of DLBCL.

Objective:To investigate the clinicopathological features, diagnosis, differential diagnosis and treatment of nodal marginal zone lymphoma (NMZL) with elevated monoclonal IgM.Methods:The clinical data of one NMZL patient with elevated monoclonal IgM treated at Yancheng No.1 People's Hospital in July 2020 were retrospectively analyzed, and the related literature was analyzed.Results:The patient was a 57-year-old female and the main clinical manifestations were fatigue and bone pain in left rib. Serum immunofixation electrophoresis showed IgM-κ type M proteinemia, bone marrow cytology showed a few plasmacytoid lymphocytes, bone marrow biopsy and immunohistochemistry showed B-cell non-Hodgkin lymphoma, bone marrow genetic testing showed MYD88 L265p and CXCR4 were both negative, postoperative pathology result of retroperitoneal lymph node biopsy was marginal zone lymphoma (mature small B type, prone to NMZL),and immunohistochemistry results: CD3, CD5, CD138, κ, λ, CD10, Cyclin D1 were negative, CD20, Pax-5, CD23 (FDC), bcl-2 were positive; Ki-67 positive index < 5%. The final diagnosis was NMZL with elevated monoclonal IgM. Partial remission was achieved after 8 cycles of reduced-dose CHOP regimen; thalidomide was used in the maintenance treatment, the disease condition was stable until August in 2021 and the follow-up was continuing.Conclusions:NMZL with elevated monoclonal IgM is relatively rare. Its diagnosis should be differentiated from Waldenstr?m macroglobulinemia and other inert B-cell lymphomas. Currently, there is no standard treatment and following the principle of individualized treatment can improve the prognosis of patients.

Objective:To understand the current situation of robot-assisted patient rehabilitation training in neurological disease-related departments of ClassⅢ medical institutions across the country, so as to provide guidance and basis for promoting the improvement of robot-assisted training.Methods:In September 2021, convenience sampling was used to select neurological disease-related departments in Class Ⅲ hospitals from all provinces and cities across the country to conduct a survey on the status of robot-assisted rehabilitation training. A self-designed Hospital Robot-Assisted Training Questionnaire was used for investigation. The survey was conducted using an electronic questionnaire. A total of 250 questionnaires were distributed, and 236 valid questionnaires were recovered, with a valid recovery rate of 94.4%.Results:Among the 236 neurological disease-related departments, a total of 93 (39.4%) departments used robot-assisted rehabilitation training. The robot type was mainly wearable robot, which was mainly used to train lower limb motor function, upper limb motor function, gait ability and so on. A total of 55.9% (52/93) of departments believed that robot-assisted rehabilitation training was more effective than conventional rehabilitation training. Hospital type, department bed turnover times, and daily training time were the main factors affecting the effectiveness of robot-assisted training, and the differences were statistically significant ( P<0.05) . Among the 93 departments that had used robots, 22.6% (21/93) of the departments had not experienced any negative events in the robot-assisted rehabilitation training. The 143 departments that had not yet used robots had a positive attitude towards robots, and the main reasons for not using robots were that robots were too expensive, lacked the guidance of technicians, and were afraid to use them without professional training. Conclusions:Robot-assisted training has been concerned and tried to use by neurological disease-related departments, but the safety still needs to be further enhanced. Medical institutions should formulate robot-assisted rehabilitation training guidelines as soon as possible to guide the application and development of robot-assisted training.

Objective:To summarize the best evidence for the prevention and management of aspiration pneumonia in elderly patients to provide a basis for clinical nursing work.Methods:We systematically searched the domestic and foreign guide nets, websites of relevant institutions and databases on the relevant evidence for the prevention and management of aspiration pneumonia, including guidelines, expert consensus, systematic reviews, randomized controlled trials (RCT) , and the search time limit was from January 1, 2010, to June 30, 2020, and the language was not limited. Two researchers evaluated the quality of the included literature, and extracted, analyzed, and integrated evidence that met the quality evaluation criteria.Results:A total of 8 guidelines, 5 expert consensus, 10 systematic reviews, and 19 RCTs were included. The evidence was collected and extracted to form a prevention and management strategy for elderly patients with aspiration pneumonia including 11 first-level indicators and 32 second-level indicators.Conclusions:Medical and nursing staff should take effective measures in risk assessment, posture management, oral management, airway management, medication management, functional exercise and so on to reduce the risk of aspiration. Medical and nursing staff should also strengthen training for their own, elderly patients and main caregivers, and reduce the incidence of aspiration in elderly patients by applying the best evidence, so as to reduce the incidence of aspiration pneumonia.

Objective:To summarize the best evidence for prevention and management of aspiration in neurosurgical ICU patients and provide evidence for clinical nursing work.Methods:Relevant evidence on prevention and management of aspiration in neurosurgical ICU patients, including guidelines, consensus, system reviews, and randomized controlled trials (RCTs) which were published from 1st January, 2010 to 30th June, 2019 in any language was retrieved from guideline websites, relevant websites and databases. Two researchers evaluated the quality of the included literature and performed evidence extraction on those literatures that met the quality standards.Results:Totally 9 clinical practice guidelines, 8 expert consensus, 13 Meta analysis / systematic reviews and 10 RCTs were included, which were collected and extracted to form the final version of best evidence for aspiration prevention and management including 10 primary indicators and 29 secondary indicators.Conclusions:Medical staff should take effective measures in early assessment of aspiration risks, artificial airway management, position management, enteral nutrition management, sedation and analgesia management, etc., and reduce the incidence of aspiration in neurosurgical ICU patients by applying the best evidence. In addition, hospitals should provide various forms of education and training to medical staff, form transdisciplinary cooperation teams, and strengthen the prevention and management of aspiration.

Objective? To explore the effects of the electronic transfer system on emergency surgery patients. Methods? The electronic transfer system for emergency surgery patients were established. Totally 98 patients who were transferred from the emergency service into the Operation Room using the electronic surgery system were included into the observation group from January to December 2017, while 88 patients who were transferred from the emergency service into the Operation Room using oral and printed transfer records were included into the control group form January to December 2016. The success rate of transfer, patient's and nurse's satisfaction were compared between the two groups. Results? The success rate of transfer using the electronic transfer system for emergency surgery patients was 95.92%, while that of the control group was 77.27% (χ2=14.343,P＜ 0.05). Patient's satisfaction of the observation group was 92.86%, while that of the control group was 59.09% (χ2=29.743,P＜ 0.05). The nurse's satisfaction of the observation group was 95.92%, while that of the control group was 87.50%(χ2=4.432,P＜0.05). Conclusions? The establishment of the electronic transfer system for emergency surgery patients further clarifies the content of transfer, enhances nurses' responsibility and shortens the time of transfer, which plays a preventative and control role in risk management and safety management in emergency surgery patients.