OBJECTIVE: To observe the clinical efficacy of acupoint thread-embedding therapy of regulating governor vessel, dispersing lung, and suppressing reflux for gastroesophageal reflux cough (GERC). METHODS: A total of 120 GERC patients were randomly assigned to an observation group (60 cases, 1 case dropped out) and a control group (60 cases, 1 case was eliminated). The observation group received acupoint thread-embedding treatment at positive response points of governor vessel. If no such points were detected, the following acupoints were used: Dazhui (GV14), Fenghu (Extra), Shendao (GV11), Lingtai (GV10), and Zhiyang (GV9). Treatment was administered once every two weeks. The control group received oral rabeprazole enteric capsules at 20 mg twice daily. All the treatment was given for 6 weeks. Clinical outcomes were assessed using cough symptom score, reflux disease questionnaire (RDQ) score, and Leicester cough questionnaire (LCQ) score before and after treatment in the two groups. Clinical efficacy was also compared between the two groups. RESULTS: After treatment, both groups showed decreased cough symptom scores and the each item scores and total scores of RDQ (P<0.001), and increased LCQ scores (P<0.001) compare with those before treatment. The observation group exhibited lower cough symptom score and chest pain, reflux and total score of RDQ, and higher LCQ score compared to those in the control group (P<0.05). The total effective rate in the observation group was 94.9% (56/59), which was higher than 84.7% (50/59) in the control group (P<0.05). CONCLUSION Acupoint thread-embedding therapy of regulating governor vessel, dispersing lung, and suppressing reflux could effectively alleviate cough and reflux symptoms in patients with GERC and improve their quality of life.
Humans ; Acupuncture Points ; Gastroesophageal Reflux/physiopathology* ; Male ; Female ; Cough/physiopathology* ; Middle Aged ; Aged ; Acupuncture Therapy ; Adult ; Treatment Outcome ; Lung/physiopathology* ; Meridians

Objective To investigate the intervention effects of a progressive upper limb exercise rehabilitation program based on the multi-process action control theory on upper limb function,rehabilitation compliance,and quality of life in patients with permanent pacemaker implantation(PPI).Methods A total of 130 patients scheduled for PPI from March to August 2024 were selected using a convenience sampling method.Among them,65 patients admitted from June to August were assigned to the experimental group,and 65 patients admitted from March to May formed the control group.The experimental group received the progressive upper limb exercise program in addition to routine care,while the control group received routine care only.The intervention lasted for 3 months.The differences were compared between the 2 groups in terms of primary outcome measures,including the Shoulder Pain and Disability Index(SPADI)and grip strength.The secondary outcome measures were the Quality of Life Instrument for Chinese Patients with Pacemaker(QLICPP),hospital stay and incidence of complications.Results A total of 122 patients(62 in the experimental group and 60 in the control group)completed this study.Repeated-measures analysis of variance showed significant interaction effects between time and group for the total SPADI score and its pain and disability dimensions,as well as for the physical function,psychological function,and total score of QLICPP(P＜0.001).Simple effects analysis indicated that the experimental group had better grip strength than the control group at l month postoperatively,and lower SPADI scores and total score than the control group at 1 and 3 months postoperatively.At 1 month postoperatively,the total QLICPP score and each dimension of the experimental group were higher than those of the control group(P＜0.05).There were no significant differences between the 2 groups in the incidence of complications and length of hospital stay(P＞0.05).Conclusion The progressive upper limb exercise rehabilitation program developed in this study effectively addressed the issue of low rehabilitation compliance in PPI patients,improved their upper limb function and quality of life,and it was safe.It provides a feasible and effective new pathway for the rehabilitation of PPI patients.

Objective:To systematically evaluate the barriers for clinical nurses to implement enteral nutrition.Methods:Qualitative studies on barriers for clinical nurses to implement enteral nutrition were electronically retrieved from PubMed, Cochrane Library, CINAHL, PsycINFO, Embase, Web of Science, China National Knowledge Infrastructure, WanFang Data, and China Biology Medicine disc. The search period was from establishing of the database to January 15, 2024. The included literature was subjected to quality evaluation, and the aggregative synthesis method was used for Meta-synthesis.Results:A total of 11 articles were included, 30 results were extracted, and ten categories were summarized to form four integrated results, including individual factors (poor patient compliance, complex and diverse clinical conditions of patients, insufficient cognitive and executive abilities of nurses), evidence related factors (weak applicability of evidence, excessive evidence and recommendations related to enteral nutrition), organizational factors (lack of multidisciplinary team collaboration, lack of supervision from management departments, lack of enteral nutrition training), and resource-related factors (insufficient human resources, inadequate medical or infrastructure resources) .Conclusions:There are multiple barriers for clinical nurses to implement enteral nutrition. Clinical nurses should improve the nutritional knowledge of patients and their families, strengthen the training of clinical nurses on enteral nutrition, integrate clinical situations, continuously improve evidence, strengthen multidisciplinary collaboration, unify standards and regulations, strengthen organizational management, allocate resources reasonably to improve the decisions and practices of enteral nutrition management.

Objective To investigate the intervention effects of a progressive upper limb exercise rehabilitation program based on the multi-process action control theory on upper limb function,rehabilitation compliance,and quality of life in patients with permanent pacemaker implantation(PPI).Methods A total of 130 patients scheduled for PPI from March to August 2024 were selected using a convenience sampling method.Among them,65 patients admitted from June to August were assigned to the experimental group,and 65 patients admitted from March to May formed the control group.The experimental group received the progressive upper limb exercise program in addition to routine care,while the control group received routine care only.The intervention lasted for 3 months.The differences were compared between the 2 groups in terms of primary outcome measures,including the Shoulder Pain and Disability Index(SPADI)and grip strength.The secondary outcome measures were the Quality of Life Instrument for Chinese Patients with Pacemaker(QLICPP),hospital stay and incidence of complications.Results A total of 122 patients(62 in the experimental group and 60 in the control group)completed this study.Repeated-measures analysis of variance showed significant interaction effects between time and group for the total SPADI score and its pain and disability dimensions,as well as for the physical function,psychological function,and total score of QLICPP(P＜0.001).Simple effects analysis indicated that the experimental group had better grip strength than the control group at l month postoperatively,and lower SPADI scores and total score than the control group at 1 and 3 months postoperatively.At 1 month postoperatively,the total QLICPP score and each dimension of the experimental group were higher than those of the control group(P＜0.05).There were no significant differences between the 2 groups in the incidence of complications and length of hospital stay(P＞0.05).Conclusion The progressive upper limb exercise rehabilitation program developed in this study effectively addressed the issue of low rehabilitation compliance in PPI patients,improved their upper limb function and quality of life,and it was safe.It provides a feasible and effective new pathway for the rehabilitation of PPI patients.

OBJECTIVE To investigate the changes of air aerosols in the digestive endoscope cleaning and disinfec-tion room under real working conditions and observe the purification effects of aerosols under different ventilation and disinfection modes.METHODS Under the real working conditions(with both the air conditioner and recircu-lating air disinfection machine under the working mode),the air samples were collected every 1 hour from 8:00 to 16:00 from the digestive endoscope cleaning and disinfection room of Ren Ji Hospital,Shanghai Jiao Tong U-niversity School of Medicine from May 2023 to Oct.2023;the contents of particulate matters(PM)and microor-ganisms in the air were detected.At the busiest moment of the cleaning and disinfection room,the air was respec-tively sampled from the cleaning and disinfection room with the working condition modes of air condition systems,recirculating air disinfection machine or natural ventilation before the starting of systems and after the work for 0.5 hour,1 hour and 2 hours.The contents of PMs and microorganisms were detected.RESULTS The PM0.5 con-centrations during various time periods met the Grade 9 ISO clean room standard(≤35,200 particles/L)under the real working conditions,and the content of airborne viable particles also conformed to the Class Ⅲ environmental requirements(≤500 CFU/m3).All of the three ventilation and disinfection methods showed certain effects on purification of the con-tents of PM0.5 and microorganisms after the ventilation for 2 hours,the contents of PMs and microorganisms of the air disinfection machine group decreased most remarkably,followed by the air conditioner group,the natural ventilation group the least.There were no significant differences in the PM concentration and the content of microorganisms among the three groups at the time points;there were only significant differences in the PM concentration and the content of mi-croorganisms of the air disinfection machine group after the ventilation for 2 hours,0.5 hour and 1 hour(P＜0.05).CONCLUSIONS Both the air conditioning systems and recirculating air disinfection machine under the working con-dition mode have certain effect on purification of the contents of PM and microorganisms,and the specific effect need to be further studied.The implementation of multicenter dynamic surveillance with the help of intelli-gent techniques may provide reference for the optimization of ventilation and disinfection strategies.

OBJECTIVE To investigate the changes of air aerosols in the digestive endoscope cleaning and disinfec-tion room under real working conditions and observe the purification effects of aerosols under different ventilation and disinfection modes.METHODS Under the real working conditions(with both the air conditioner and recircu-lating air disinfection machine under the working mode),the air samples were collected every 1 hour from 8:00 to 16:00 from the digestive endoscope cleaning and disinfection room of Ren Ji Hospital,Shanghai Jiao Tong U-niversity School of Medicine from May 2023 to Oct.2023;the contents of particulate matters(PM)and microor-ganisms in the air were detected.At the busiest moment of the cleaning and disinfection room,the air was respec-tively sampled from the cleaning and disinfection room with the working condition modes of air condition systems,recirculating air disinfection machine or natural ventilation before the starting of systems and after the work for 0.5 hour,1 hour and 2 hours.The contents of PMs and microorganisms were detected.RESULTS The PM0.5 con-centrations during various time periods met the Grade 9 ISO clean room standard(≤35,200 particles/L)under the real working conditions,and the content of airborne viable particles also conformed to the Class Ⅲ environmental requirements(≤500 CFU/m3).All of the three ventilation and disinfection methods showed certain effects on purification of the con-tents of PM0.5 and microorganisms after the ventilation for 2 hours,the contents of PMs and microorganisms of the air disinfection machine group decreased most remarkably,followed by the air conditioner group,the natural ventilation group the least.There were no significant differences in the PM concentration and the content of microorganisms among the three groups at the time points;there were only significant differences in the PM concentration and the content of mi-croorganisms of the air disinfection machine group after the ventilation for 2 hours,0.5 hour and 1 hour(P＜0.05).CONCLUSIONS Both the air conditioning systems and recirculating air disinfection machine under the working con-dition mode have certain effect on purification of the contents of PM and microorganisms,and the specific effect need to be further studied.The implementation of multicenter dynamic surveillance with the help of intelli-gent techniques may provide reference for the optimization of ventilation and disinfection strategies.

Objective:To systematically evaluate the barriers for clinical nurses to implement enteral nutrition.Methods:Qualitative studies on barriers for clinical nurses to implement enteral nutrition were electronically retrieved from PubMed, Cochrane Library, CINAHL, PsycINFO, Embase, Web of Science, China National Knowledge Infrastructure, WanFang Data, and China Biology Medicine disc. The search period was from establishing of the database to January 15, 2024. The included literature was subjected to quality evaluation, and the aggregative synthesis method was used for Meta-synthesis.Results:A total of 11 articles were included, 30 results were extracted, and ten categories were summarized to form four integrated results, including individual factors (poor patient compliance, complex and diverse clinical conditions of patients, insufficient cognitive and executive abilities of nurses), evidence related factors (weak applicability of evidence, excessive evidence and recommendations related to enteral nutrition), organizational factors (lack of multidisciplinary team collaboration, lack of supervision from management departments, lack of enteral nutrition training), and resource-related factors (insufficient human resources, inadequate medical or infrastructure resources) .Conclusions:There are multiple barriers for clinical nurses to implement enteral nutrition. Clinical nurses should improve the nutritional knowledge of patients and their families, strengthen the training of clinical nurses on enteral nutrition, integrate clinical situations, continuously improve evidence, strengthen multidisciplinary collaboration, unify standards and regulations, strengthen organizational management, allocate resources reasonably to improve the decisions and practices of enteral nutrition management.

Objective Evaluation of Chinese-thyroid imaging reporting and data system(C-TIRADS)combined with contrast-enhanced ultrasound(CEUS)for the assessment of category 4 nodules in the setting of Hashimoto's thyroiditis.Methods Retrospective analysis of 120 C-TIRADS category 4 thyroid nodules from 79 patients with confirmed Hashimoto's thyroiditis who attended the Yiyang Central Hospital from June to December 2022.Thyroid nodules exhibiting one or more benign or malignant features that were suspicious on CEUS were treated as downgraded or upgraded one level.Using the final surgical pathology results as the gold standard,working characteristic(ROC)curves of subjects based on C-TIRADS grading before and after CEUS adjustment were plotted to compare diagnostic efficacy.Results The sensitivity,specificity,and accuracy of the CEUS-adjusted C-TIRADS were 93.0％,87.8％and 90.8％,respectively(P<0.05).The area under the ROC curve was 0.811 and 0.904,respectively(P<0.05).Conclusion C-TIRADS combined with CEUS has better diagnostic efficacy in evaluating category 4 nodules in Hashimoto's thyroiditis.

ObjectiveTo investigate a suspected outbreak of carbapenem-resistant Acinetobacter baumannii （CRAB） nosocomial infection in an intensive care unit （ICU） and provide scientific evidence for prevention and control of multi-drug resistant nosocomial infection. MethodsClinical and epidemiological data of 4 patients with CRAB infection were retrospectively investigated in the ICU of Renji Hospital in November 2021. Environmental hygiene monitoring and multilocus sequence typing （MLST） were conducted and intervention measures were taken. ResultsA total of 4 cases with CRAB infection were identified， among which 1 case was determined to be community-acquired and3 cases were hospital-acquired. The isolated strains shared the same drug resistance， and were all classified into ST368 type. In the surface and hand samples （n=40）， 2 CRAB strains were detected in the air filter beside the bed of the first case， with a detection rate of 5%. After adopting comprehensive prevention and control strategies， including environmental cleaning and disinfection， hand hygiene， staff management and training， and supervision， no similar case with CRAB infection was found. ConclusionThis suspected outbreak of CRAB nosocomial infection may be induced by inadequate environmental cleaning and disinfection， and inadequate implementation of hand hygiene. Timely identification， investigation， and targeted measures remain crucial to effective control of possible nosocomial infection.

ObjectiveTo understand the use of antibiotics in inpatients and the incidence and trend of hospital infections， to explore the implementation effect of comprehensive management measures， and to provide reference for hospitals to use antibiotics reasonably. MethodsBased on the hospital infection monitoring and management system， a retrospective analysis and comparison were conducted on the use of antibiotics， submission of microbial test samples， and incidence of hospital infections among inpatients in a tertiary hospital from 2012 to 2021. ResultsFrom 2012 to 2021， the use of antibiotics showed a downward trend， from 50.82% in 2012 to 41.29% in 2021. At the same time， the use rate of restricted and special antibiotics had also decreased， and the use rate of restricted and special antibiotics in patients without hospital infection was significantly lower than that in patients with hospital infection， and the microbial testing rate was also on the rise. The annual incidence rate of hospital infection was 0.69%‒1.92%， and the annual case-time prevalence rate was 0.79%‒2.17%. The annual average rate of the above two in 10 years was 1.18% and 1.34%， respectively. The results of the exponential smoothing model also showed that the utilization rate of antibiotics was decreasing and the incidence of nosocomial infection was stable. ConclusionLarge general hospitals took comprehensive management measures to strengthen the management of rational use of antibiotics， which led to a decline in the use rate of antibacterial drugs for inpatients and an increase in the rate of microbial examination. At the same time， the overall incidence of hospital infection was relatively stable， suggesting that the comprehensive management measures of antibacterial drugs in hospitals had achieved certain results. The current measures need to be optimized in the future to continuously improve the management level of rational use of antibacterial drugs.