Objective To explore the application effect of the multidisciplinary team collaboration model in vascular access management for patients with maintenance hemodialysis.Methods A total of 102 patients with maintenance hemodialysis in the hospital from October 2023 to October 2024 were selected as the research subjects,and they were randomly divided into observation group and control group by the random number table method,with 51 cases in each group.The observation group re-ceived routine nursing combined with the multidisciplinary team collaboration model,while the control group received routine nursing.The multidisciplinary team collaboration model involved professionals from multiple disciplines,including nephrologists,vascular surgeons,interventional radiologists,B-ultrasound doctors,clinical pharmacists,nutritionists,psychological counselors,the head nurse of the blood purification center,and blood purification specialist nurses.The intervention duration was 6 months.The related indicators of dialysis adequacy[urea reduction ratio(URR),equilibrium urea clearance rate(eKt/V)],psychological burden[the Self-rating Anxiety Scale(SAS)and the Self-rating Depression Scale(SDS)],vascular access satisfaction degree[the Simple Version of Vascular Access Questionnaire(VAQ)],quality of life[the Kidney Disease-Targeted Areas Scale(KDTA)and the 36-item Short-form Health Survey(SF-36)],and complications were compared between the two groups before and after the intervention.Results After the intervention,the levels of URR and eKt/V and the score of each dimension of quality of life in the observation group were signifi-cantly higher than those in the control group,while the SAS and SDS scores were significantly lower than those in the control group(P＜0.05).After the intervention,the satisfaction rate of vascular access in the observation group was 96.08％(49/51),which was significantly higher than 80.39％(41/51)in the control group(x2=6.044,P=0.014).The total complication rate in the observa-tion group was 1.96％(1/51),which was significantly lower than 13.73％(7/51)in the control group(P＜0.05).Conclusion The adoption of the multidisciplinary team collaboration model for patients with maintenance hemodialysis is beneficial for improving the adequacy of hemodialysis,re-ducing psychological burden,enhancing vascular access satisfaction and quality of life,and preven-ting complications.

Objective:To investigate the clinicopathological characteristics, immunophenotype and differential diagnosis of atypical forms of microglandular hyperplasia of the cervix (AMGH).Methods:A total of 29 cases of AMGH diagnosed at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China from January 2010 to December 2024 were analyzed. Relevant clinical and pathological data of the patients were collected using the electronic medical record system and medical records copied from the outside hospitals. The patients were followed up.Results:Among the 29 cases, 28 were consultation cases, 22 (79%) of the 28 cases were considered as glandular neoplastic lesions by the original institutions. The nature of the lesion was uncertain in 1 case, the diagnosis was suspicious for AMGH in another 1 case, and only 4 cases were clearly diagnosed as AMGH. The median age of the 29 patients was 44 (43, 48) years. Eighteen (62%) of the 29 cases presented as cervical polyp. Twelve of the 16 tested cases were negative for human papillomavirus. The pathological presentation was complex and diverse, including solid, trabecular, cribriform, and papillary patterns, forming pseudo-invasive structures. The glandular epithelium and proliferating reserve cells had diverse morphologies, which presented with abundant eosinophilic cytoplasm or clear cytoplasm. Signet-ring or hobnail cells were also seen. The nuclear atypia was mild, with 0-7 mitotic figures per 10 HPF. Immature squamous metaplasia was noted. The stroma showed edema, myxoid change and hyaline degeneration, accompanied by infiltration of acute and chronic inflammatory cells. Immunohistochemistry demonstrated that p16 was negative in 8/16 of the cases or patchy positive in the other 8/16, Ki-67 positive rate was less than 10% in all 16 cases, p53 was wild phenotype (9/9), and carcinoembryonic antigen was negative in 4/5 cases and focally positive in 1/5 cases, while p63 was positive in 6/9 of the tested cases.Conclusions:AMGH is a benign non-neoplastic lesion of the cervical glands. Half of the cases occur in perimenopausal or postmenopausal women, often presenting as polypoid hyperplasia or localized cervical thickening/elevation with a friable, fragile texture. Microscopically, it may show a pseudoinvasive pattern, making it prone to misdiagnosis as a malignant lesion. Thus, differentiation from cervical adenocarcinoma, clear cell carcinoma and microglandular endometrioid carcinoma is required. Integration of clinical history, immunohistochemistry and molecular testing may aid in the differential diagnosis.

Objective To search,evaluate and synthesise the best available evidence on prevention strategies for unplanned extubation of nasogastric tube in adult inpatients and to offer a reference in management of safety and efficiency.Methods Literature on prevention strategies for unplanned extubation of nasogastric tube in adult inpatients was retrieved across BMJ Best Practice,UpToDate,JBI Center for Evidence Based Healthcare International Collaboration Library,Medlive,US National Guidelines Database,International Guidelines Collaboration Group,Scottish InterAcademy Guidelines Network,Ontario Registered Nurses Association of Canada,UK National Institute for Clinical Optimization,New Zealand Guidelines Research Group,PubMed,EMbase,Cochrane Library,Web of Science,EBSCO,CINAHL,CNKI,CBM Database,Wanfang Data and VIP Database,from the inception of databases to August 2024.Retrieved literature included guidelines,clinical decisions,recommended practices,evidence summaries,expert consensus and systematic reviews.Two researchers evaluated the literature methodologically and then summarised evidence from the included data.Results Fifteen publications(2 guidelines,1 clinical decision,3 recommended practices,7 evidences and 2 systematic reviews)were included.A total of 30 pieces of evidence were extracted and they were grouped into 7 themes:risk assessment,selection of nasogastric tube,depth of intubation,tube fixation,tube position,tube management and patient education.Conclusion Clinicians should integrate the best evidences into clinical practice and assess risk factors for unplanned extubation of nasogastric tube in adult inpatients.Personalised early intervention plans should be made to reduce or avoid the unplanned extubation.

Objective:To investigate lung function differences in patients with varying severities of chronic obstructive pulmonary disease and construct a risk decision tree prediction model.Methods:A prospective cross-sectional study was conducted among 102 patients with chronic obstructive pulmonary disease (COPD) who received treatment at Tongde Hospital of Zhejiang Province between September 2022 and September 2023. The severity of each patient's condition was evaluated according to the "Guidelines for the Diagnosis and Management of Chronic Obstructive Pulmonary Disease (Revised Version 2021)." All patients were grouped based on the evaluation results. Upon admission, all patients underwent assessments of pulmonary function, ventilation function, blood gas analysis, and laboratory indicators. The baseline data of the patients were statistically analyzed and compared. Risk factors associated with the progression of COPD were analyzed using ordinal regression, and a decision tree model was constructed using the Classification and Regression Trees algorithm. The receiver operating characteristic curve was used to evaluate the predictive value of the decision model for the progression of COPD in patients.Results:The results of the ordinal regression analysis indicated that being female and having a high diffusing capacity of the lungs for carbon monoxide (DLCO) level were protective factors for the development of COPD ( OR < 1, both P < 0.05), while a high concentration of alveolar nitric oxide (CaNO) was a risk factor ( OR > 1, P < 0.05). According to the decision tree, CaNO, DLCO, and female sex were identified as independent risk factors, with CaNO having the most considerable effect. The receiver operating characteristic curve was generated based on the decision tree model. The results showed that the area under the curve of the decision tree model in the moderate group was 0.782, with an optimal cut-off value of 0.314, a specificity of 0.721, a sensitivity of 0.780, and a Youden index of 0.501. The area under the curve of the severe group was 0.845. Conclusions:Sex, DLCO levels, and CaNO levels are factors affecting the development of COPD in patients. The decision tree model based on these factors can effectively predict the risk of COPD progression.

Objective:To develop a Knowledge-Attitude-Practice (KAP) Scale for Dietary Management During Hemodialysis and to test its reliability and validity.Methods:Based on the KAP theoretical framework, an initial version of the scale was developed through a literature review and expert consultations. A convenience sampling method was used to recruit hemodialysis patients from four hospitals in Suzhou in March 2024. Questionnaire item analysis and reliability and validity tests were conducted.Results:A total of 460 questionnaires were distributed and 438 valid responses were collected, with an effective response rate of 95.22%. The final scale included three dimensions (knowledge, attitude, and practice) with 34 items. Content validity at the scale level was 0.910, and the item level ranged from 0.800 to 1.000. Exploratory factor analysis extracted three common factors, with a cumulative variance contribution rate of 74.520%. Confirmatory factor analysis showed a good model fit. The total Cronbach's α coefficient of the scale was 0.971, and the Cronbach's αcoefficients for the three dimensions were 0.963, 0.933, and 0.934, respectively. The test-retest reliability coefficient was 0.839.Conclusions:The Knowledge-Attitude-Practice Scale for Dietary Management During Hemodialysis demonstrates good reliability and validity, making it a valuable tool for assessing the KAP level of dietary management in hemodialysis patients.

Objective To search,evaluate and synthesise the best available evidence on prevention strategies for unplanned extubation of nasogastric tube in adult inpatients and to offer a reference in management of safety and efficiency.Methods Literature on prevention strategies for unplanned extubation of nasogastric tube in adult inpatients was retrieved across BMJ Best Practice,UpToDate,JBI Center for Evidence Based Healthcare International Collaboration Library,Medlive,US National Guidelines Database,International Guidelines Collaboration Group,Scottish InterAcademy Guidelines Network,Ontario Registered Nurses Association of Canada,UK National Institute for Clinical Optimization,New Zealand Guidelines Research Group,PubMed,EMbase,Cochrane Library,Web of Science,EBSCO,CINAHL,CNKI,CBM Database,Wanfang Data and VIP Database,from the inception of databases to August 2024.Retrieved literature included guidelines,clinical decisions,recommended practices,evidence summaries,expert consensus and systematic reviews.Two researchers evaluated the literature methodologically and then summarised evidence from the included data.Results Fifteen publications(2 guidelines,1 clinical decision,3 recommended practices,7 evidences and 2 systematic reviews)were included.A total of 30 pieces of evidence were extracted and they were grouped into 7 themes:risk assessment,selection of nasogastric tube,depth of intubation,tube fixation,tube position,tube management and patient education.Conclusion Clinicians should integrate the best evidences into clinical practice and assess risk factors for unplanned extubation of nasogastric tube in adult inpatients.Personalised early intervention plans should be made to reduce or avoid the unplanned extubation.

Objective:To investigate lung function differences in patients with varying severities of chronic obstructive pulmonary disease and construct a risk decision tree prediction model.Methods:A prospective cross-sectional study was conducted among 102 patients with chronic obstructive pulmonary disease (COPD) who received treatment at Tongde Hospital of Zhejiang Province between September 2022 and September 2023. The severity of each patient's condition was evaluated according to the "Guidelines for the Diagnosis and Management of Chronic Obstructive Pulmonary Disease (Revised Version 2021)." All patients were grouped based on the evaluation results. Upon admission, all patients underwent assessments of pulmonary function, ventilation function, blood gas analysis, and laboratory indicators. The baseline data of the patients were statistically analyzed and compared. Risk factors associated with the progression of COPD were analyzed using ordinal regression, and a decision tree model was constructed using the Classification and Regression Trees algorithm. The receiver operating characteristic curve was used to evaluate the predictive value of the decision model for the progression of COPD in patients.Results:The results of the ordinal regression analysis indicated that being female and having a high diffusing capacity of the lungs for carbon monoxide (DLCO) level were protective factors for the development of COPD ( OR < 1, both P < 0.05), while a high concentration of alveolar nitric oxide (CaNO) was a risk factor ( OR > 1, P < 0.05). According to the decision tree, CaNO, DLCO, and female sex were identified as independent risk factors, with CaNO having the most considerable effect. The receiver operating characteristic curve was generated based on the decision tree model. The results showed that the area under the curve of the decision tree model in the moderate group was 0.782, with an optimal cut-off value of 0.314, a specificity of 0.721, a sensitivity of 0.780, and a Youden index of 0.501. The area under the curve of the severe group was 0.845. Conclusions:Sex, DLCO levels, and CaNO levels are factors affecting the development of COPD in patients. The decision tree model based on these factors can effectively predict the risk of COPD progression.

Objective:To develop a Knowledge-Attitude-Practice (KAP) Scale for Dietary Management During Hemodialysis and to test its reliability and validity.Methods:Based on the KAP theoretical framework, an initial version of the scale was developed through a literature review and expert consultations. A convenience sampling method was used to recruit hemodialysis patients from four hospitals in Suzhou in March 2024. Questionnaire item analysis and reliability and validity tests were conducted.Results:A total of 460 questionnaires were distributed and 438 valid responses were collected, with an effective response rate of 95.22%. The final scale included three dimensions (knowledge, attitude, and practice) with 34 items. Content validity at the scale level was 0.910, and the item level ranged from 0.800 to 1.000. Exploratory factor analysis extracted three common factors, with a cumulative variance contribution rate of 74.520%. Confirmatory factor analysis showed a good model fit. The total Cronbach's α coefficient of the scale was 0.971, and the Cronbach's αcoefficients for the three dimensions were 0.963, 0.933, and 0.934, respectively. The test-retest reliability coefficient was 0.839.Conclusions:The Knowledge-Attitude-Practice Scale for Dietary Management During Hemodialysis demonstrates good reliability and validity, making it a valuable tool for assessing the KAP level of dietary management in hemodialysis patients.

Objective:To investigate the clinicopathological characteristics, immunophenotype and differential diagnosis of atypical forms of microglandular hyperplasia of the cervix (AMGH).Methods:A total of 29 cases of AMGH diagnosed at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China from January 2010 to December 2024 were analyzed. Relevant clinical and pathological data of the patients were collected using the electronic medical record system and medical records copied from the outside hospitals. The patients were followed up.Results:Among the 29 cases, 28 were consultation cases, 22 (79%) of the 28 cases were considered as glandular neoplastic lesions by the original institutions. The nature of the lesion was uncertain in 1 case, the diagnosis was suspicious for AMGH in another 1 case, and only 4 cases were clearly diagnosed as AMGH. The median age of the 29 patients was 44 (43, 48) years. Eighteen (62%) of the 29 cases presented as cervical polyp. Twelve of the 16 tested cases were negative for human papillomavirus. The pathological presentation was complex and diverse, including solid, trabecular, cribriform, and papillary patterns, forming pseudo-invasive structures. The glandular epithelium and proliferating reserve cells had diverse morphologies, which presented with abundant eosinophilic cytoplasm or clear cytoplasm. Signet-ring or hobnail cells were also seen. The nuclear atypia was mild, with 0-7 mitotic figures per 10 HPF. Immature squamous metaplasia was noted. The stroma showed edema, myxoid change and hyaline degeneration, accompanied by infiltration of acute and chronic inflammatory cells. Immunohistochemistry demonstrated that p16 was negative in 8/16 of the cases or patchy positive in the other 8/16, Ki-67 positive rate was less than 10% in all 16 cases, p53 was wild phenotype (9/9), and carcinoembryonic antigen was negative in 4/5 cases and focally positive in 1/5 cases, while p63 was positive in 6/9 of the tested cases.Conclusions:AMGH is a benign non-neoplastic lesion of the cervical glands. Half of the cases occur in perimenopausal or postmenopausal women, often presenting as polypoid hyperplasia or localized cervical thickening/elevation with a friable, fragile texture. Microscopically, it may show a pseudoinvasive pattern, making it prone to misdiagnosis as a malignant lesion. Thus, differentiation from cervical adenocarcinoma, clear cell carcinoma and microglandular endometrioid carcinoma is required. Integration of clinical history, immunohistochemistry and molecular testing may aid in the differential diagnosis.

Objective:To investigate the factors influencing the success of external cephalic version.Methods:Pregnant women who underwent an external cephalic version due to breech or transverse presentation by the same operator in the Third Affiliated Hospital of Zhengzhou University from July 2015 to July 2021 were selected as the study objects. Univariate analysis and logistic regression analysis were used to explore the clinical factors influencing the success of the external cephalic version. The receiver operating characteristic (ROC) curve was used to analyze the best cut-off value of gestational week and amniotic fluid index at the time of operation and to evaluate the predictive value of the influencing factors on the success of the external cephalic version.Results:(1) A total of 118 cases finally entered this study. Among the 118 cases,77 cases (65.3%) succeeded in the external cephalic version, among which the success rate was 49.1% (27/55) for primipara and 79.4% (50/63) for multipara. The vaginal delivery rate was 56.8% (67/118). (2) Complications occurred in 19 (16.1%) of the 118 cases. The main complications were abnormal fetal heart rate (13 cases, 11.0%), umbilical cord presentation, and fetal position reversion (two cases and 1.7% in each), and the serious complications were intrauterine fetal death and placental abruption (one case and 0.8% in each).The complication rate of patients with successful external cephalic version was 7.8% (6/77), which was lower than that of those who failed the external cephalic version [31.7%(13/41)] ( χ 2=11.33, P=0.001). (3) Multivariate analysis showed that gestational week at surgery before 38, amniotic fluid index >11.10 cm, and multipara were the factors affecting the success of the external cephalic version [ OR(95% CI)=0.561(0.351-0.897), 1.173(1.018-1.351) and 4.201(1.547-11.404), all P<0.05]. (4) The area under the ROC curve of the combination of the gestational week at surgery, amniotic fluid index, and parity was 0.744 (95% CI: 0.640-0.848, P<0.001), and the Youden index was 0.518, with a sensitivity of 70.0% and a specificity of 81.8%. Conclusion:Gestational weeks, amniotic fluid index, and multipara are related to the success of the external cephalic version, and the combination of the three has certain predictive power for the success of the surgery.