Objective To systematically evaluate the advance care planning readiness assessment tools applicable to the elderly and to provide a reliable assessment tool for the development of advance care planning.Methods PubMed,Web of Science,Cochrane Library,Embase,CINAHL,Yimaitong,Wanfang Database,China National Know-ledge Network,VIP Database,and China Biomedical Literature Database were systematically searched.The search time limit is from database establishment to April 30,2024.Pre-established medical care plan readiness assessment tools that meet the inclusion criteria were screened,and the"consensus based standards for the selection of health measurement instruments"was used to evaluate the methodological quality and measurement attributes of the inclusion assessment tools.The improved version of the evidence quality evaluation and recommendation strength grading method is used to grade the evidence of the assessment tool and form the final recommendation opinion.Results A total of 14 articles were included,including 10 advance care planning readiness assessment tools suitable for the elderly.None of the articles reported cross-cultural validity,measurement error,and responsiveness.The content validity and internal consistency of the Chinese Advance Care Planning Readiness Scale and the Advance Care Planning Readiness Scale for Chronic Disease Patients were both"adequate",with A-level recommendations,and the remaining assessment tools were all B-level recommendations.Conclusion There are various types of advance care planning readiness assessment tools for the elderly,but the methodological quality needs to be improved and the measurement properties need to be further evaluated.It is temporarily recommended to use the Chinese Advance Care Planning Readiness Scale and the Advance Care Planning Readiness Scale for Chronic Disease Patients.

The bacterial CBASS(cyclic-oligonucleotide-based anti-phage signaling system) represents a novel innate immune defense mechanism mediated by cyclic nucleotides.The system employs cGAS/DncV-like nucleotidyltransferases (CD-NTases) to recognize exogenous nucleic acids, catalyzing the production of second messenger molecules such as cyclic GMP-AMP (cGAMP) to activate effector proteins (e.g., nucleases), thereby triggering "cell suicide" to combat phage infection. The molecular mechanisms and evolutionary features of CBASS not only uncover the diversity of bacterial immune defenses but also provide critical insights into the conservation of prokaryotic-eukaryotic immune pathways. Notably, the bacterial CBASS system exhibits profound homology with the eukaryotic cGAS-STING (Cyclic GMP-AMP Synthase—Stimulator of Interferon Genes) pathway across multiple dimensions, including the catalytic domains of CD-NTase/cGAS and cyclic nucleotide signaling mechanisms. This finding supports the hypothesis that eukaryotic innate immunity may have originated from prokaryotic horizontal gene transfer and highlights an evolutionary shift in defense strategies from bacterial "population lysis" to "individual inflammatory activation" in higher organisms.This review systematically synthesizes the functional architecture and mechanisms of the CBASS system, with a deep exploration of its evolutionary connections to the eukaryotic cGAS-STING pathway. The insights gained herein offer fresh perspectives for understanding the origin and evolution of the innate immune system, and for driving advancements in biotechnological research and development.

Objective To investigate the antimicrobial resistance patterns of carbapenem-resistant Klebsiella pneumoniae(CRKP)strains isolated from children for better prevention,treatment,and control of CRKP infections in children.Methods A total of 182 clinical CRKP strains were collected between January 2018 and December 2020 in Hebei Children's Hospital.All CRKP strains were identified by matrix-assisted laser desorption ionization-time of flight(MALDI-TOF)mass spectrometry.The common carbapenemase genes(blaKPC,blaNDM,blaIMP,blaVIM,blaOXA-48)of CRKP isolates were studied by PCR.Multilocus sequence typing(MLST)was performed for homology analysis.Results The 182 children infected with CRKP were mainly infants(＞28 days to＜1 years),accounting for 49.45％(90/182),followed by newborns(≤28 days),accounting for 36.26％(66/182).The main source of the 182 CRKP isolates was sputum(50.55％,92/182),blood(15.93％,29/182),and urine(13.19％,24/182).The strains were mainly isolated from patients in neonatology(30.22％,55/182),general surgery(21.43％,39/182),cardiac surgery(13.19％,24/182),and intensive care unit(11.54％,21/182).Antimicrobial susceptibility testing showed that all of the 182 CRKP strains were resistant to cefepime,ceftazidime,piperacillin-tazobactam,and cefoperazone-sulbactam(100％).Overall,97.8％,71.4％,81.9％,75.8％,69.2％,and 2.7％of the strains were resistant to aztreonam,amikacin,ciprofloxacin,levofloxacin,doxycycline,and tigecycline,respectively.The prevalence of carbapenemase gene blaKPC-2 was the highest(73.63％,134/182),followed by blaNDM-5(15.38％,28/182),and blaNDM-1(11.54％,21/182).A total of 15 different sequence types(ST)were identified by MLST,of which ST11 was the most common type(72.53％,132/182),followed by ST17(11.54％,21/182).Conclusions CRKP isolates in Hebei Children's Hospital showed high level resistance to antimicrobial agents.Antimicrobial therapy should be prescribed cautiously according to the results of antimicrobial susceptibility testing to avoid the emergence of resistant strains.KPC-2-producing ST1 1 type CRKP strains may be prevalent in this hospital.Effective control measures should be taken to avoid further spread of such CRKP strains.

Objective To systematically evaluate the advance care planning readiness assessment tools applicable to the elderly and to provide a reliable assessment tool for the development of advance care planning.Methods PubMed,Web of Science,Cochrane Library,Embase,CINAHL,Yimaitong,Wanfang Database,China National Know-ledge Network,VIP Database,and China Biomedical Literature Database were systematically searched.The search time limit is from database establishment to April 30,2024.Pre-established medical care plan readiness assessment tools that meet the inclusion criteria were screened,and the"consensus based standards for the selection of health measurement instruments"was used to evaluate the methodological quality and measurement attributes of the inclusion assessment tools.The improved version of the evidence quality evaluation and recommendation strength grading method is used to grade the evidence of the assessment tool and form the final recommendation opinion.Results A total of 14 articles were included,including 10 advance care planning readiness assessment tools suitable for the elderly.None of the articles reported cross-cultural validity,measurement error,and responsiveness.The content validity and internal consistency of the Chinese Advance Care Planning Readiness Scale and the Advance Care Planning Readiness Scale for Chronic Disease Patients were both"adequate",with A-level recommendations,and the remaining assessment tools were all B-level recommendations.Conclusion There are various types of advance care planning readiness assessment tools for the elderly,but the methodological quality needs to be improved and the measurement properties need to be further evaluated.It is temporarily recommended to use the Chinese Advance Care Planning Readiness Scale and the Advance Care Planning Readiness Scale for Chronic Disease Patients.

Objective To investigate the antimicrobial resistance patterns of carbapenem-resistant Klebsiella pneumoniae(CRKP)strains isolated from children for better prevention,treatment,and control of CRKP infections in children.Methods A total of 182 clinical CRKP strains were collected between January 2018 and December 2020 in Hebei Children's Hospital.All CRKP strains were identified by matrix-assisted laser desorption ionization-time of flight(MALDI-TOF)mass spectrometry.The common carbapenemase genes(blaKPC,blaNDM,blaIMP,blaVIM,blaOXA-48)of CRKP isolates were studied by PCR.Multilocus sequence typing(MLST)was performed for homology analysis.Results The 182 children infected with CRKP were mainly infants(＞28 days to＜1 years),accounting for 49.45％(90/182),followed by newborns(≤28 days),accounting for 36.26％(66/182).The main source of the 182 CRKP isolates was sputum(50.55％,92/182),blood(15.93％,29/182),and urine(13.19％,24/182).The strains were mainly isolated from patients in neonatology(30.22％,55/182),general surgery(21.43％,39/182),cardiac surgery(13.19％,24/182),and intensive care unit(11.54％,21/182).Antimicrobial susceptibility testing showed that all of the 182 CRKP strains were resistant to cefepime,ceftazidime,piperacillin-tazobactam,and cefoperazone-sulbactam(100％).Overall,97.8％,71.4％,81.9％,75.8％,69.2％,and 2.7％of the strains were resistant to aztreonam,amikacin,ciprofloxacin,levofloxacin,doxycycline,and tigecycline,respectively.The prevalence of carbapenemase gene blaKPC-2 was the highest(73.63％,134/182),followed by blaNDM-5(15.38％,28/182),and blaNDM-1(11.54％,21/182).A total of 15 different sequence types(ST)were identified by MLST,of which ST11 was the most common type(72.53％,132/182),followed by ST17(11.54％,21/182).Conclusions CRKP isolates in Hebei Children's Hospital showed high level resistance to antimicrobial agents.Antimicrobial therapy should be prescribed cautiously according to the results of antimicrobial susceptibility testing to avoid the emergence of resistant strains.KPC-2-producing ST1 1 type CRKP strains may be prevalent in this hospital.Effective control measures should be taken to avoid further spread of such CRKP strains.

Objective:To explore the application effect of the P-SAFE (Protection-Soothe, Antithrombotic,Foodstuff,Eudipsia) nursing model based on enhanced recovery after surgery (ERAS) in patients with hemifacial spasm after microvascular decompression surgery, and provide a protocol for the rapid recovery of patients.Methods:A non-randomized quasi-experimental study was used to conveniently select patients with hemifacial spasm who underwent microvascular decompression in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2022 to December 2023. Among them, 80 patients treated with the traditional nursing management model from January to December 2022 were selected as the control group, while 94 patients treated with the P-SAFE nursing model under the ERAS concept from January to December 2023 were selected as the experimental group. The two groups were compared in terms of incidence of perioperative hunger and thirst, nausea and vomiting, thrombus, pain, adverse events as well as length of hospital stay, hospital costs, and pre-discharge nursing satisfaction.Results:Among the 80 patients in the control group, there were 19 males and 61 females, with an age of (54.98 ± 7.44) years. Among 94 patients in the experimental group, there were 15 males and 79 females, aged (54.93 ± 8.71) years. The incidences of perioperative hunger, thirst, nausea and vomiting, thrombosis and adverse events in the experimental group were 29.79%(28/94), 29.79%(28/94), 7.45%(7/94), 0 and 0, respectively, all of which were better than those in the control group, which were 45.00%(36/80), 47.50%(38/80), 23.75%(19/80), 8.75%(7/80), and 5.00%(4/80), respectively, pain score in the experimental group was 0(0, 1.25) points, lower than 0(0, 3.00) points in the control group, the differences were statistically significant ( χ2 values were 4.30 to 9.04, Z=-2.96, all P<0.05). The hospital stays, hospital costs and nursing satisfaction in the experimental group were 9(7, 10) days, 3.97(3.91, 4.31) ten thousand yuan, and 98.00(92.75, 100.00) points, respectively, compared to the control group′s 11 (10, 12) days, 4.90(4.36, 5.08) ten thousand yuan, and 80.00(79.00, 100.00) points. These differences were also statistically significant ( Z=-7.84, -8.57, -5.79, all P<0.05). Conclusions:The P-SAFE nursing mode for patients with hemifacial spasm undergoing microvascular decompression under the concept of ERAS can reduce their perioperative discomfort, reduce the incidence of postoperative complications, improve the prognosis of patients, and help accelerate the recovery of patients.

The construction of a medication safety culture is important for medication safety management and rational drug use.The construction of medication safety culture standards is formulated based on relevant national policies and regulations,accreditation standards for hospitals,expert opinions,the current situation,and the development trend of the healthcare industry.With scientificity,general applicability,instructive guidance,and practicality,they standardized basic requirements,management processes,and improvement of the construction of medication safety culture.To facilitate understanding and the implementation of the standards,we describe the process of standards formulation and explain the key points of the standards.

Objective:To explore the application effect of the P-SAFE (Protection-Soothe, Antithrombotic,Foodstuff,Eudipsia) nursing model based on enhanced recovery after surgery (ERAS) in patients with hemifacial spasm after microvascular decompression surgery, and provide a protocol for the rapid recovery of patients.Methods:A non-randomized quasi-experimental study was used to conveniently select patients with hemifacial spasm who underwent microvascular decompression in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2022 to December 2023. Among them, 80 patients treated with the traditional nursing management model from January to December 2022 were selected as the control group, while 94 patients treated with the P-SAFE nursing model under the ERAS concept from January to December 2023 were selected as the experimental group. The two groups were compared in terms of incidence of perioperative hunger and thirst, nausea and vomiting, thrombus, pain, adverse events as well as length of hospital stay, hospital costs, and pre-discharge nursing satisfaction.Results:Among the 80 patients in the control group, there were 19 males and 61 females, with an age of (54.98 ± 7.44) years. Among 94 patients in the experimental group, there were 15 males and 79 females, aged (54.93 ± 8.71) years. The incidences of perioperative hunger, thirst, nausea and vomiting, thrombosis and adverse events in the experimental group were 29.79%(28/94), 29.79%(28/94), 7.45%(7/94), 0 and 0, respectively, all of which were better than those in the control group, which were 45.00%(36/80), 47.50%(38/80), 23.75%(19/80), 8.75%(7/80), and 5.00%(4/80), respectively, pain score in the experimental group was 0(0, 1.25) points, lower than 0(0, 3.00) points in the control group, the differences were statistically significant ( χ2 values were 4.30 to 9.04, Z=-2.96, all P<0.05). The hospital stays, hospital costs and nursing satisfaction in the experimental group were 9(7, 10) days, 3.97(3.91, 4.31) ten thousand yuan, and 98.00(92.75, 100.00) points, respectively, compared to the control group′s 11 (10, 12) days, 4.90(4.36, 5.08) ten thousand yuan, and 80.00(79.00, 100.00) points. These differences were also statistically significant ( Z=-7.84, -8.57, -5.79, all P<0.05). Conclusions:The P-SAFE nursing mode for patients with hemifacial spasm undergoing microvascular decompression under the concept of ERAS can reduce their perioperative discomfort, reduce the incidence of postoperative complications, improve the prognosis of patients, and help accelerate the recovery of patients.

OBJECTIVE To analyze the influential factors for potentially inappropriate medication （PIM） in elderly cancer patients. METHODS The data of elderly cancer patients hospitalized in a hospital from January to December 2021 were collected. According to the Beers standard of the American Geriatrics Society in 2019 （hereinafter referred to as the “2019 version of Beers standard”） and Criteria for Potentially Inappropriate Drug Use in Chinese Elderly （2017 version） （hereinafter referred to as the “Chinese PIM standard”）， the PIM status of elderly cancer patients was retrospectively analyzed. Multivariate Logistic regression analysis was used to identify influential factors for PIM. RESULTS A total of 293 patients were included in the study. According to the 2019 version of Beers standard， 211 patients （72.01%） had PIM， of which 204 （69.62%） had PIM related to drugs， 6 （2.05%） had PIM related to diseases or symptoms， 46 （15.70%） had PIM that should be used with caution， 32 （10.92%） had PIM with drug-drug interaction that should be avoided， and 11 （3.75%） had PIM based on renal function； the top 5 drugs in the list of incidence were proton pump inhibitors， metoclopramide， the first-generation antihistamines as promethazine， analgesics as ibuprofen and megestrol. According to the Chinese PIM standard， there were 132 patients （45.05%） with PIM， of which 119 （40.61%） had PIM related to drugs， involving 25 drugs （included 7 high-risk drugs and 18 low-risk drugs）， and 24 （8.19%） with PIM in disease status； top 4 drugs in the list of incidence were promethazine， megestrol， ibuprofen and cimetidine. Multivariate Logistic regression analysis showed that compared with patients with hospital stay≤10 days， patients with hospital 20054） stay between 11 and 30 days had a higher risk of PIM [odds ratio （OR）＝8.836 8， 95% confidence interval （CI） （3.217 8， 31.940 9）， P＝0.000 1]； compared with the patients with the 65895198。E-mail：fjman@cmpt.ac.cn number of clinical disease diagnosed≤5， patients with the number of clinical disease diagnosed≥11 had a higher risk of PIM [OR＝10.930 1， 95%CI （3.000 9， 70.922 9）， P＝0.001 8]； compared with surgical treatment， patients receiving antineoplastic drugs had a higher risk of PIM [OR＝2.209 5， 95%CI （1.180 2， 4.176 9）， P＝0.013 6]. CONCLUSIONS Elderly cancer patients have multiple diseases， complicated medication， and a high incidence of PIM. The length of hospital stay （11-30 d）， the number of clinical disease diagnosed （≥11） and anti-tumor drugs are main influential factors for PIM in patients.