OBJECTIVE To establish a clinical pharmaceutical pathway of anti-infective therapy for high-risk populations of antibiotic-associated encephalopathy （AAE）， and analyze its application effects. METHODS Clinical pharmacists developed the “AAE High-Risk Population Screening Form” and “Antibiotic AAE Risk Comparison Form” based on literature and expert opinions， and established the “Clinical Pharmaceutical Pathway of Anti-infective Treatment for AAE High-Risk Population” in our hospital. A prospective， non-randomized controlled study was conducted from May 2023 to April 2024， including 50 cases in the observation group and 50 cases in the control group among patients with pulmonary infections admitted to the Dept. of Internal Medicine in our hospital. The observation group was involved in the development of an anti-infective treatment following the clinical pharmaceutical pathway by clinical pharmacists， while the control group received routine anti-infective treatment by clinical physicians. The occurrence of AAE， the rational antibiotic drug use， and the effectiveness of initial anti-infective treatment in the two groups were observed， and the intervention measures and outcomes of AAE cases were summarized. RESULTS The anti-infective treatment clinical pharmaceutical pathway for AAE high-risk population was preliminarily established in our hospital. The analysis of the application effects showed that there was 1 case of AAE in the observation group and 8 cases in the control group， with a significantly lower incidence of AAE in the observation group than in the control group； the rational antibiotic drug use and the effectiveness of initial anti-infective treatment in the observation group were both significantly superior to those in the control group （P＜0.05）. Drug withdrawal and dressing change were the preferred effective intervention measures for AAE， and encephalopathy treatment drugs could be used as auxiliary measures for symptom relief. Timely and effective intervention was conducive to rapid symptom relief， with a total improvement rate of AAE of 88.89%. CONCLUSIONS The anti-infective treatment clinical pharmaceutical pathway for AAE high-risk population can effectively prevent the occurrence of AAE as well as contribute to promoting rational drug use and the effectiveness of initial anti-infection plans and strengthening treatment outcomes.

Objective To explore the characteristics of speech prosody chunking,affect,focus and interaction function in patients with non-fluent aphasia after stroke. Methods From December,2023 to March,2024,patients with non-fluent aphasia after stroke(experimental group,n=25)and healthy subjects(control group,n=25)were recruited from Shanghai Fifth Rehabilitation Hospital,and the two groups were compared in terms of chunking,affect,focus and interaction performance using a self-ad-ministered speech prosody function assessment tool and acoustic analyzing instrument. Results In chunking prosody,there were differences in auditory discrimination(Z=-4.856,P<0.001),auditory recog-nition of"two chunks"(Z=-3.024,P=0.002),and subjective scores,total pause duration,average pause dura-tion,average syllabic duration and structural sonic rate(|Z|>2.911,P<0.001)of imitating"two chunks"and au-tonomously outputing"two chunks"and"three chunks"between two groups.In affect prosody,there were differ-ences in listening to distinguish different emotions(Z=-3.322,P=0.001),listening to identify"like emotion"(Z=-3.481,P=0.001),and the subjective score(Z=-6.214,P<0.001),average intensity(Z=-3.581,P<0.001)and standard deviation of intensity(Z=-3.181,P=0.001)of imitating"like emotion"between two groups;there were differences in the subjective score(Z=-5.510,P<0.001),average intensity(Z=-3.429,P=0.001),standard deviation of intensity(Z=-4.777,P<0.001)and fundamental frequency variation range(t=1.852,P=0.029)of autonomously outputing"like emotion"between two groups.In focus prosody,there were differences in listening to distinguish different focuses(Z=-2.658,P=0.008),listening to identify the"end of sentence"focus(Z=-2.023,P=0.011),and the peak stress intensity of imitating the"first sentence"focus(t=8.294,P<0.001);the subjective score(|Z|>5.102,P<0.001)and peak stress intensity(t>8.298,P<0.001)of imitating the"mid-sentence"and"end-sentence",and the subjective score(Z=-4.371,P<0.001)and peak stress intensity(t=8.842,P<0.001)of autonomously outputing the focus of the"first sentence"between two groups;there were differences in the subjective score(|Z|>4.970,P<0.001),peak stress intensity(t>9.373,P<0.001)and stress duration(|t|>2.912,P<0.01)of autonomously outputing the focus of the"mid-sentence"and"end-sentence".In the interaction prosody,there were no significant difference in auditory resolution and au-ditory recognition between two groups(P>0.05),however,there were significant differences in the subjective score(|Z|>4.938,P<0.001)and the fundamental frequency slope k(|t|>4.609,P<0.001)of the interrogative tone both in imitative output and autonomous output. Conclusion Patients with non-fluent aphasia showed significant abnormalities in the recognition and expression of"2 chunks""like emotion""sentence-final focus"and"questioning tone."

Objective:To establish a nomogram model for predicting the risk of sepsis in diabetic foot patients, and to provide reference for clinical prevention and treatment.Methods:The clinical data of 430 patients with diabetic foot who were hospitalized in Chu Hsien-I Memorial Hospital of Tianjin Medical University from January 2022 to March 2023 were reviewed and collected, including age, gender, past medical history, smoking and drinking history, family history, diabetes course, Texas grade of diabetic foot and laboratory indicators within 24 hours after admission. Patients were divided into sepsis group and non-sepsis group according to the presence or absence of sepsis during hospitalization. The differences in clinical data between the two groups were compared. Multivariate Logistic regression analysis was used to screen the influencing factors of sepsis in patients with diabetic foot during hospitalization, and a nomogram predictive model was established. The performance of the prediction model was evaluated by receiver operator characteristic curve (ROC curve), calibration curve and decision curve analysis (DCA). Internal validation was performed by using Bootstrap method.Results:A total of 430 patients were enrolled, among which 90 patients developed sepsis during hospitalization and 340 patients did not. There were statistically significant differences in diabetes course, Texas grade of diabetic foot, white blood cell count (WBC), neutrophil count (NEU), lymphocyte count (LYM), neutrophil to lymphocyte ratio (NLR), hemoglobin (Hb), albumin (Alb), glycosylated hemoglobin (HbA1c), C-reactive protein (CRP), and blood urea nitrogen (BUN) between the two groups. Multivariate Logistic regression analysis showed that diabetes course [odds ratio ( OR) = 2.774, 95% confidence interval (95% CI) was 1.053-7.308, P = 0.039], Texas grade of diabetic foot ( OR = 2.312, 95% CI was 1.014-5.273, P = 0.046), WBC ( OR = 1.160, 95% CI was 1.042-1.291, P = 0.007), HbA1c ( OR = 1.510, 95% CI was 1.278-1.784, P < 0.001), CRP ( OR = 1.007, 95% CI was 1.000-1.014, P = 0.036) were independent risk factors for sepsis in patients with diabetic foot during hospitalization, while Alb was a protective factor ( OR = 0.885, 95% CI was 0.805-0.972, P = 0.011). A nomogram predictive model was constructed based on the above 6 indicators. The ROC curve showed that the area under ROC curve (AUC) of the nomogram predictive model for identifying the sepsis patients was 0.919 (95% CI was 0.889-0.948). The AUC of the nomogram predictive model after internal verification was 0.918 (95% CI was 0.887-0.946). Hosmer-Lemeshow test showed χ2 = 2.978, P = 0.936, indicating that the calibration degree of the predictive model was good. Calibration curve showed that the predicted probability of sepsis was in good agreement with the actual probability. DCA curve showed that the nomogram predictive model had good clinical usefulness. Conclusion:The nomogram predictive model based on the risk factors of diabetes course, Texas grade of diabetic foot, WBC, HbA1c, CRP and Alb has good predictive value for the occurrence of sepsis in patients with diabetic foot during hospitalization, which is helpful for clinical screening of the possibility of diabetic foot patients progressing to sepsis, and timely personalized intervention for different patients.

Objective To understand the readiness of gynecological wards in conducting the evidence-based practice for the prevention and management of urinary retention after cervical cancer radical resection,and to analyze the influencing factors.Methods The 190 nursing staffs in the gynecological oncology wards of this hospital in June 2020 were selected as the study subjects.The assessment of readiness for evidence-based nursing practice (CREBNA) and general information questionnaire were used to conduct the questionnaire survey,single factor and multiple factor stepwise regression to analyze the influencing factors.Results The score of CREBNA was (135.94±17.83) points,the evidence subscale was (52.41±7.88) points,the organi-zational environment subscale was (40.58±5.01) points and the promoting factors subscale was (42.67±6.24) points.The results of univariate analysis showed that the total score of CREBNA was related to the ed-ucational background,professional title,position,scientific research experience,understand degree on evidence-based and necessity of conducting evidence-based (P<0.05).The multiple stepwise regression analysis showed that the understanding degree on the evidenced-base and necessity of conducting evidence-based were the influencing factors of CREBNA scale (P<0.05).Conclusion The readiness of the evidence-based nursing practice in this study is good and has good feasibility.

ObjectiveTo investigate the effect of speech imagery therapy combined with traditional dysarthria training on dysarthria in children with cerebral palsy. MethodsFrom August to December, 2022, 21 children with cerebral palsy combined with dysarthria in Wuhu Fifth People's Hospital were randomly divided into three groups A, B and C. Group A was given traditional dysarthria training for 30 minutes everytime, group B was given implantable speech imagery combined with traditional dysarthria training for 40 minutes everytime, and group C was given additional speech imagery combined with traditional dysarthria training for 40 minutes everytime, five days a week, for three weeks. Articulation and Phonology Assessment Scale, Mouth Sensory-Motor Assessment Scale, and mandibular distance, tongue distance and vowel space area (VSA) were evaluated before and after treatment. ResultsThere was no significant difference in all the indexes among three groups before treatment (F < 1.247, P > 0.05). After treatment, the scores of phonological function and sensory-motor assessment scale increased (|t| > 2.575, P < 0.05), and the mandibular distance and VSA increased in groups A and B (|t| > 2.632, P < 0.05). The d-value of phonological function before and after treatment was more in groups B and C than in group A (P < 0.05), and no difference was found in the d-value of other indexes before and after treatment among three groups (P > 0.05). ConclusionBoth speech imagery therapies are effective in improving diction clarity, oral range of motion, and motion control ability in children with cerebral palsy, and are more effective in improving articulatory clarity than traditional speech-language training.

ObjectiveTo discuss the diagnosis, assessment and rehabilitation for children with cerebral palsy complicated with speech disorder based on the tools of World Health Organization Family of International Classifications (WHO-FICs). MethodsThe diagnosis of speech disorder after cerebral palsy was classified using International Classification of Diseases, 11th Revision (ICD-11). The disorders of speech function were classified using International Classification of Functioning, Disability and Health (ICF). A structured speech function rehabilitation solution was developed based on the International Classification of Health Interventions (ICHIβ-3). ResultsAccording to ICD-11, cerebral palsy was classified as 08 Neurological Disorder, which was further classified as 8D20.0 Spastic Unilateral Cerebral Palsy and 8D20.1 Spastic Bilateral Cerebral Palsy (8D20.10 Spastic Quadriplegic Cerebral Palsy and 8D20.11 Spastic Bilateral Cerebral Palsy), with the speech disorders involving 6A00 Disorders of Intellectual Development, 6A01 Developmental Speech or Language Disorders, MA80 Speech Disturbances, MA81 Speech Dysfluency and MA82 Voice Disturbances. For ICF, the speech disorders mainly involved s1 structures of the nervous system, s3 structures invoved in voice and speech, b3 voice and speech functions, d1 learning and applying knowledge, and environment and individual factors; and could be further classified as b310 voice functions, b320 articulation functions, and b330 fluency and rhythm of speech functions. Based on ICHIβ-3, a rehabilitation solution was developed, involving the areas of body structure and function, activity and participation, and environmental factors. ConclusionBased on ICD-11, ICF and ICHIβ-3, a methodological system of assessment and interventions for speech disorders after cerebral palsy has been systematically constructed, including diagnosis of disease, assessment, intervention and coding of speech disorder.

Objective    To explore the predictive value of a simple prediction model for patients with acute myocardial infarction. Methods    Clinical data of 280 patients with acute ST-segment elevation myocardial infarction (STEMI) in the Department of Emergence Medicine, West China Hospital of Sichuan University from January 2019 to January 2020 were retrospectively analyzed. The patients were divided into a death group (n=34) and a survival group (n=246). Results    Age, heart rate, body mass index (BMI), global registry of acute coronary events (GRACE), thrombolysis in myocardial infarction trial (TIMI) score, blood urea nitrogen, serum cystatin C and D-dimer in the survival group were less or lower than those in the death group (P<0.05). Left ventricle ejection fraction and the level of albumin, triglyceride, total cholesterol and low density lipoprotein cholesterol were higher and the incidence of Killip class≥Ⅲ was lower in the survival group compared to the death group (P<0.05). Multivariate logistic regression analysis showed that age, BMI, heart rate, diastolic blood pressure, and systolic blood pressure were independent risk factors for all-cause death in STEMI patients. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve of simple prediction model for predicting death was 0.802, and similar to that of GRACE (0.816). The H-L test showed that the simple model had high accuracy in predicting death (χ2=3.77, P=0.877). Pearson correlation analysis showed that the simple prediction model was significantly correlated with the GRACE (r=0.651, P<0.001) and coronary artery stenosis score (r=0.210, P=0.001). Conclusion    The simple prediction model may be used to predict the hospitalization and long-term outcomes of STEMI patients, which is helpful to stratify high risk patients and to guide treatment.

Objective:To investigate the role of blood ammonia in the evaluation of the prognosis of septic patients in the emergency department and to compare its value with mortality in emergency department sepsis (MEDS) score.Methods:A retrospective clinical study was conducted to septic patients who were diagnosed in the Emergency Department of West China Hospital of Sichuan University from June 2017 to May 2018, and met the diagnostic criteria established by the diagnostic criteria of the American College of Chest Physicians/Society of Critical Care Medicine in 2001. The subjects who had other diseases that affected blood ammonia level and were lost to follow-up were excluded. MEDS scores were collected, and the survival status of patients was followed up by telephone. The independent samples t test was used to compare the differences between the two groups, receiver operating characteristic (ROC) curve was used to assess the accuracy of the prediction of sepsis mortality, and the logistic regression model was used to explore the value of the combined use of blood ammonia and MEDS score.Results:Eighty subjects were finally included in the study and divided into the 1-week survival group ( n=52), 1-week death group ( n=28); 4-week survival group ( n=37), 4-week death group ( n=43); 12-week survival group ( n=33), 12-week death group ( n=47); 1-year survival group ( n=32), and 1-year death group ( n=48). There was no statistical difference in the demographic characteristics of subjects between the groups. The average blood ammonia level of all the subjects who died was higher than that of the patients who survived in the same period [(116.57 ± 85.33) μmol/L vs (77.63 ± 35.82) μmol/L, (108.53 ± 73.00) μmol/L vs (71.19 ± 32.53) μmol/L, (106.74 ± 71.59) μmol/L vs (69.21 ± 28.84) μmol/L, (105.77 ± 71.14) μmol/L vs (69.50 ± 29.25) μmol/L, P<0.05]. Based on death after one week, four weeks, twelve weeks and one year, the area under ROC curve (AUC) of blood ammonia was 0.668 (95% CI: 0.542-0.793, P=0.014), 0.706 (95% CI: 0.593-0.819, P=0.002), 0.705 (95% CI: 0.592-0.818, P=0.002), and 0.697 (95% CI: 0.582-0.811, P=0.003), respectively. Compared with the use of blood ammonia, lactic acid or MEDS score alone, the combined use of blood ammonia and MEDS score increased the accuracy of prognosis evaluation in sepstic patients ( P<0.05). Conclusions:Blood ammonia has a high value in predicting the short-term and 1-year prognosis of septic patients in the emergency department. The combined use of blood ammonia and MEDS score can further improve its predictive value.

Objective    To investigate the effectiveness of establishment of chest pain center and optimized process in the diagnostic and treatment progress and short-term prognostic value of acute non-ST segment elevation myocardial infarction (NSTEMI) patients. Methods    This was a retrospective study. We included NSTEMI patients admitted in the Emergency Department in our hospital, 41 patients admitted before the establishment of the chest pain center (April 2015) were included as group A (30 males and 11 females at age of 64.7±11.8 years), 42 patients after the establishment of the chest pain center (April 2016) as group B (31 males and 11 females at age of 64.6±11.8 years), and 38 patients after the establishment of the chest pain center (April 2017) as group C (30 males and 8 females at age of 62.6±10.0 years). The clinical outcomes of the three groups were compared. Results     The time from admission to electrocardiogram was 20.0 (17.0, 25.5) min in the group A, 4.0 (2.8, 5.0) min in the group B, and 3.0 (2.0, 4.0) min in the group C (P<0.001). The first doctor's non-electrocardiogram advice time was 13.0 (10.0, 18.0) min, 9.5 (6.8, 15.3) min, and 9.0 (7.0, 12.0) min (P=0.001) in the three groups, respectively. The diagnostic confirmed time was 139.4±48.5 min, 71.1±51.5 min, 63.9±41.9 min   (P<0.001). The proportion of patients receiving emergency dual anti-platelet load dose treatment was 53.1%, 70.0%, 100.0% (P=0.001), respectively. The time of receiving emergency dual anti-platelet load dose treatment was 208.0 (72.0, 529.0) min, 259.0 (91.0, 340.0) min, and 125.0 (86.0, 170.0) min (P=0.044) in the three groups, respectively. Emergency percutaneous coronary artery intervention (PCI) start time was 60.9 (42.1, 95.8) hours, 61.3 (43.3, 92.2) hours, 30.5 (2.8, 44.1) hours (P<0.001) in the three groups, respectively. Among them, the moderate risk patients’ PCI starting time was 63.0 (48.1, 94.2) hours, 62.3 (42.1, 116.2) hours, and 40.1 (17.2, 60.4) hours (P>0.05), respectively. The high risk patients’ PCI starting time was 47.9 (23.7, 102.4) hours, 55.2 (44.0, 89.6) hours, 23.2 (1.7, 41.8) hours in the three groups, respectively (P<0.001). The hospitalization time of the patients was 7.0 (5.4, 9.4) days, 5.9 (4.9, 8.7) days, 4.7 (3.1, 6.2) days in the three groups (P<0.001), respectively. The hospitalization time of the moderate risk patients was 6.9 (4.9, 8.8) days, 6.4 (4.9, 8.0) days, 4.8 (3.2, 6.5) days in the three groups (P>0.05), respectively. The hospitalization time of the high risk patients was 7.1 (5.5, 9.9) days, 5.9 (4.6, 9.8) days, and 4.4 (3.0, 6.1) days, respectively (P<0.001). The fatality rate of inpatients was 4.9%, 0.0%, and 0.0%, respectively (P>0.05). The correlation coefficient of hospitalization time, diagnosis confirmed time and PCI starting time was 0.219 and 0.456 (P<0.05), respectively. Conclusion    The establishment and optimized process of chest pain center can accelerate the time of early diagnosis of NSTEMI, which is helpful to obtain stratified and graded standardized treatment for patients according to their conditions, to accelerate the specific treatment process of high risk NSTEMI patients, and shorten the hospitalization time.

To investigate the impact of goal directed analgesia on the outcome of patients with mechanical ventilation in intensive care unit. A total of 126 patients who needed mechanical ventilation were recruited. With a method of before and after paired comparison, they were divided into two group:( 1 ) analgesia with empirical administration or control group; ( 2 ) goal directed analgesia based on critical-care pain observation tool (CPOT). Compared with the control group, after goal directed analgesia was applied, the consumption of midazolam significantly dropped from ( 368. 47 ± 27. 41 ) mg to ( 151. 27 ± 29. 31 ) mg (P<0. 05), whereas the consumption of dexmedetomidine significantly increased from ( 623. 62 ± 20. 91) μg to (812. 34 ± 22. 57) μg(P<0. 05). The median score of Richmond agitation-sedation scale increased from -3 to -1. The incidence of delirium significantly reduced from 23. 81% to 17. 46%( P<0. 05). The mean ventilator duration was significantly shortened from (168. 49 ± 11. 41) h to (142. 38 ± 13. 24) h(P<0. 05). ICU length of stay was significantly shortened from (23. 64 ± 9. 26) d to (19. 63 ± 8. 46) d ( P < 0. 05 ) . Due to the mild sedation, patients receiving goal directed analgesia report less delirium, less ventilation time and shorter ICU length of stay, suggesting that the general outcome is improved.