Objective: To analyze the trends of the frequency of meat, egg, and milk consumption among rural primary and junior high school students in central and western China covered by the Nutrition Improvement Program for Rural Compulsory Education Students (NIPRCES) from 2015 to 2023, so as to provide basis for formulating more targeted nutrition intervention policies and health education strategies. Methods: Using data from six rounds of monitoring and evaluation (2015-2021 and 2023), the study included 323 870 students from grade 3 to 9 across 22 provinces (autonomous regions and municipalities) in central and western China. The consumption frequencies of meat, egg, and milk over the past week were collected via questionnaires. The Cochran-Armitage trend test was used to analyze temporal trends, and multivariable Logistic regression models were employed to analyze factors associated with the frequency of meat, egg and milk consumption and to test for interaction effects between the year and gender, region, and grade level. Results: From 2015 to 2023, the proportion of students consuming meat, egg, and milk ≥1 time/day increased from 23.20 %, 10.71%, and 0.74% to 35.53%, 22.09%, and 26.63%, respectively. Trend tests indicated a significant upward trend for the daily intake of all three food categories for meat, egg and milk over the years ( Z =67.18, 64.90, 93.14, all P <0.01). Multivariable Logistic regression analysis showed that the daily meat intake was lower in the central region than in the western region ( OR=0.77, 95%CI =0.76-0.78), whereas the daily intake of eggs ( OR=1.19, 95%CI =1.17-1.22) and milk ( OR= 1.27 , 95%CI =1.24-1.29) was higher in the central region (all P <0.05). Compared with grade 3-4 students, junior high school students had lower daily intake of meat, eggs, and milk≥1 time/day ( OR =0.95, 0.77, 0.77, all P <0.05), with a declining trend as grade increased. Girls also had lower daily intake of meat, eggs, and milk ≥1 time/day than boys ( OR =0.95，0.93，0.91, all P < 0.05). Significant interactions were observed between year and region, as well as between year and grade (all P <0.05). Conclusion From 2015 to 2023, the NIPRCES improved the intake level of among rural students, but the situation of relatively insufficient intake of egg and milk among females, junior high school students and those in the western region still exists.

Objective To evaluate the effectiveness of a preventive workflow in participatory observation based on healthcare failure mode and effect analysis(HFMEA)in reducing intraoperative acquired pressure injury(IAPI)in patients undergoing spinal surgery,and to provide evidences for prospective nursing management.Methods A preventive workflow of participatory observation-based HFMEA was established,which included defining HFMEA topic,forming a multidisciplinary team,creating a process map(through participatory observation),conducting failure mode and hazard analysis(using a Hazard scoring matrix and decision tree analysis,and identifying the causes of key failure through Pareto chart analysis),implementing improvement actions,and tracking effectiveness.Ultimately,11 high-risk failure modes were identified for further improvement:poor design of form/information system,heavy workload and fast pace,lack of departmental regulations,risk factors of IAPI,and unclear duty and responsibility in a multidisciplinary team.A series measures for improvement were developed and implemented based on the identified key causes.A pre-and post-control study was carried out.A total of 180 patients who received spinal surgery between November and April 2024 and received traditional preventive methods were assigned to a control group.While further 218 patients who received spinal surgery between May and December 2023 were assigned to the trial group with the participatory observation on the basis of HFMEA prevention workflow.IAPI incidence rate and severity were compared between the two groups,as well as the completion rate of preoperative IAPI risk assessment in the trial group.Results The trial group demonstrated significantly lower IAPI incidence and severity compared with those in the control group(P<0.05).In the trial group,178 patients(98.92%)completed the preoperative IAPI risk assessment,and 172 patients(95.47%)completed the intraoperative assessment.Conclusion The participatory observation based HFMEA prevention workflow can effectively reduce an incidence and severity of IAPI in patients undergoing spinal surgery,ensure patient safety and thereby enhance the quality of nursing management.

OBJECTIVE To explore the value of bronchoalveolar lavage fluid(BALF)metagenomic next generation sequencing(mNGS)technique in diagnosis of the pulmonary cryptococcosis patients with different clinical features so as to raise the clinicians' awareness of the diagnosis of pulmonary cryptococcosis with BALF-mNGS.METHODS Totally 73 patients with pulmonary cryptococcosis and 73 non-pulmonary cryptococcosis patients who were treated in Wenzhou People's Hospital from Jan.2021 to May 2024 were recruited as the research subjects.The clinical data including baseline data,complications,clinical manifestations,clinical laboratory test data,ima-ging findings and serological test data were collected from the patients.The sensitivity and specificity of BALF-mNGS in diagnosis of the pulmonary cryptococcosis were observed,and the difference in the sensitivity in diagno-sis of the patients with various clinical features was analyzed.RESULTS A total of 73 patients with pulmonary cryp-tococcosis were enrolled in the study,44 of whom were male,and 29 were female;62 were positive for BALF-mNGS,11 were negative;all of the 73 non-pulmonary cryptococcosis patients were tested negative for BALF-mNGS,the sensi-tivity of the BALF-mNGS test was 84.93％,with the specificity 100.00％,the positive predictive value 100.00％,the negative predictive value 86.95％.Totally 45 patients had the symptoms of cough and expectoration,42 of whom were positive for BALF-mNGS,the test sensitivity of the patients with the symptoms of cough and expectoration was 93.33％,higher than that of the patients without the symptoms of cough and expectoration(P＜0.05).Totally 31 pa-tients had the lesion site of right lung,30 of whom were positive for BALF-mNGS,and the test sensitivity of the patients with lesion site of right lung was 96.77％,higher than that of the patients with the lesion site of left lung or both lungs(P＜0.05).Totally 44 patients had multiple lesions,41 of whom were positive for BALF-mNGS,the test sensitivity of the patients with multiple lesions was 93.18％,higher than that of the patients with single lesion(P＜0.05).CONCLUSIONS The sensitivity of the BALF-mNGS is high in diagnosis of the patients with pulmonary cryptococ-cosis,especially for the patients with symptoms of cough and expectoration,lesion site of right lung and multiple lesions.It can be used for the early diagnosis of pulmonary cryptococcosis.

Objective To establish an expert consensus on home exercise for prevention and rehabilitation of breast cancer related lymphedema.Methods Evidence-based nursing method was used to systematically retrieve and evaluate relevant studies in databases and guideline networks,with a search period from the establishment of the databases to October 2023.Evidence was synthesized to form the expert consensus draft after literature screening,quality evaluation,evidence extraction and evidence integration.Then the final draft was formed through expert discussion meeting and 2 rounds of expert letter consultation.Results The consensus includes 5 dimensions with a total of 22 items,involving evaluation of home exercise,management of home exercise,principles of home exercise,program of home exercise and significance of home exercise.Conclusion This"consensus"was constructed in a scientific and rigorous way,and can provide guidance for promoting the home exercise for prevention and rehabilitation of breast cancer related lymphedema,and ensure the safe and effective implementation of home exercise rehabilitation.

OBJECTIVE To explore the value of bronchoalveolar lavage fluid(BALF)metagenomic next generation sequencing(mNGS)technique in diagnosis of the pulmonary cryptococcosis patients with different clinical features so as to raise the clinicians' awareness of the diagnosis of pulmonary cryptococcosis with BALF-mNGS.METHODS Totally 73 patients with pulmonary cryptococcosis and 73 non-pulmonary cryptococcosis patients who were treated in Wenzhou People's Hospital from Jan.2021 to May 2024 were recruited as the research subjects.The clinical data including baseline data,complications,clinical manifestations,clinical laboratory test data,ima-ging findings and serological test data were collected from the patients.The sensitivity and specificity of BALF-mNGS in diagnosis of the pulmonary cryptococcosis were observed,and the difference in the sensitivity in diagno-sis of the patients with various clinical features was analyzed.RESULTS A total of 73 patients with pulmonary cryp-tococcosis were enrolled in the study,44 of whom were male,and 29 were female;62 were positive for BALF-mNGS,11 were negative;all of the 73 non-pulmonary cryptococcosis patients were tested negative for BALF-mNGS,the sensi-tivity of the BALF-mNGS test was 84.93％,with the specificity 100.00％,the positive predictive value 100.00％,the negative predictive value 86.95％.Totally 45 patients had the symptoms of cough and expectoration,42 of whom were positive for BALF-mNGS,the test sensitivity of the patients with the symptoms of cough and expectoration was 93.33％,higher than that of the patients without the symptoms of cough and expectoration(P＜0.05).Totally 31 pa-tients had the lesion site of right lung,30 of whom were positive for BALF-mNGS,and the test sensitivity of the patients with lesion site of right lung was 96.77％,higher than that of the patients with the lesion site of left lung or both lungs(P＜0.05).Totally 44 patients had multiple lesions,41 of whom were positive for BALF-mNGS,the test sensitivity of the patients with multiple lesions was 93.18％,higher than that of the patients with single lesion(P＜0.05).CONCLUSIONS The sensitivity of the BALF-mNGS is high in diagnosis of the patients with pulmonary cryptococ-cosis,especially for the patients with symptoms of cough and expectoration,lesion site of right lung and multiple lesions.It can be used for the early diagnosis of pulmonary cryptococcosis.

Objective To investigate the drug-drug interaction between donepezil hydrochloride and moxifloxacin hydrochloride during combined administration through in vitro liver microsomal metabolism and changes in pharmacokinetic characteristics in rats.Methods A rat liver microsomal incubation system was constructed and optimized.Liquid chromatography-tandem mass spectrometry(LC-MS/MS)analysis of donepezil hydrochloride and high-performance liquid chromatography(HPLC)analysis of moxifloxacin hydro-chloride were performed.The pharmacokinetic and metabolic characteristics of the two drugs,alone and in combination,were compared in vitro using rat liver microsomes and in vivo using rats.Results In the liver microsomal system,the half-life(T1/2)of donepezil hydro-chloride in the combined administration 1 group was prolonged by 29.892％(P＜0.01)and the intrinsic clearance(CLint)was reduced by 23.194％(P＜0.01)compared with the donepezil hydrochloride group.Conversely,the metabolic parameters of moxifloxacin hydrochlo-ride in the combined administration 2 group did not differ significantly from that of the moxifloxacin hydrochloride group(P＞0.05).In the in vivo study,the AUC0～t and AUC0～∞ of donepezil hydrochloride in the combined administration 1 group increased by 44.259％and 44.496％,respectively,maximum plasma concentration(Cmax)increased by 117.723％,T1/2 was prolonged by 98.063％,and CLint was reduced by 35.293％,compared with that in the donepezil hydrochloride group.Moreover,the differences were all statistically significant(P＜0.05).The in vivo study findings were consistent with the results of the in vitro study.Conclusion A drug-drug interaction occurs when moxifloxacin hydrochloride is used in combination with donepezil hydrochloride.Moxifloxacin hydrochloride promotes the absorption of donepezil hydrochloride,inhibits its metabolism,slows its CLint,and increases donepezil exposure in the body.

Objective To explore the effect of life reconstruction training on anxiety and depression among individuals with chronic spinal cord injury(SCI)and their caregivers,and to analyze the influencing factors.Methods A total of 216 SCI patients and 79 caregivers who participated in life reconstruction training were recruited from the Hope House for SCI individuals in Shanghai Yangzhi Rehabilitation Hospital from May,2017 to Octo-ber,2019.They were assessed with Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)be-fore and after intervention.Results After intervention,the scores of SAS and SDS decreased(P<0.05)in both SCI patients and their caregivers.SAS scores were more likely to reduce in SCI patients who suffered anxiety at admission(OR=2.315,95%CI 1.328 to 4.033,P=0.003)and their caregivers(OR=3.632,95%CI 1.270 to 10.390,P=0.016),as well as non-agricultural-registered SCI patients(OR=1.908,95%CI 1.074 to 3.391,P=0.028).Being unmarried,having an injury duration≥21 years,injury due to disease,and having depression at admission significantly promoted the reduction in SDS scores among SCI patients(P<0.05).Caregivers with a junior-high-school education or less were more likely to experience reductions in scores of SAS and SDS compared with those with higher education(P<0.05).Caregivers with five to 15 years of caregiving experience achieved more anxiety reduction(OR=7.155,95%CI 1.806 to 28.342,P=0.005).Conclusion Life reconstruction training is effective on anxiety and depression among individuals with chronic SCI and their caregivers.It is recommended to prioritize anxiety interventions for patients with rural household registra-tion in China,along with depression management for the married/divorced/widowed individuals,with<21 years since injury,and trauma-induced lesions.For caregivers,it is needed to focus to anxiety and depression in better-educated individuals,as well as anxiety in those with either<5 or≥15 years of caregiving experience.

Objective To evaluate the effectiveness of a preventive workflow in participatory observation based on healthcare failure mode and effect analysis(HFMEA)in reducing intraoperative acquired pressure injury(IAPI)in patients undergoing spinal surgery,and to provide evidences for prospective nursing management.Methods A preventive workflow of participatory observation-based HFMEA was established,which included defining HFMEA topic,forming a multidisciplinary team,creating a process map(through participatory observation),conducting failure mode and hazard analysis(using a Hazard scoring matrix and decision tree analysis,and identifying the causes of key failure through Pareto chart analysis),implementing improvement actions,and tracking effectiveness.Ultimately,11 high-risk failure modes were identified for further improvement:poor design of form/information system,heavy workload and fast pace,lack of departmental regulations,risk factors of IAPI,and unclear duty and responsibility in a multidisciplinary team.A series measures for improvement were developed and implemented based on the identified key causes.A pre-and post-control study was carried out.A total of 180 patients who received spinal surgery between November and April 2024 and received traditional preventive methods were assigned to a control group.While further 218 patients who received spinal surgery between May and December 2023 were assigned to the trial group with the participatory observation on the basis of HFMEA prevention workflow.IAPI incidence rate and severity were compared between the two groups,as well as the completion rate of preoperative IAPI risk assessment in the trial group.Results The trial group demonstrated significantly lower IAPI incidence and severity compared with those in the control group(P<0.05).In the trial group,178 patients(98.92%)completed the preoperative IAPI risk assessment,and 172 patients(95.47%)completed the intraoperative assessment.Conclusion The participatory observation based HFMEA prevention workflow can effectively reduce an incidence and severity of IAPI in patients undergoing spinal surgery,ensure patient safety and thereby enhance the quality of nursing management.

The clinical pharmacist was involved in the whole process of drug treatment and monitoring of a patient with ulcerative colitis(UC)and facial aseptic abscesses.After admission,clinical pharmacists and physicians jointly formulated an empirical anti-infection plan for meropenem and linezolid glucose injection.After the 5th day of medication,the patient continued to have high fever.After discussion with the physician and clinical pharmacist,it was considered that the patient's facial boil was caused by aseptic abscess syndrome,and UC with extraintestinal manifestations could not be ruled out.Hydrocortisone succinate sodium was added intravenously.After the 9th day of treatment,the patient's facial abscesses improved.Subsequently,the physician followed the clinical pharmacist's advice and used infliximab as the subsequent treatment plan.After the 11th day of treatment,the patient's symptoms improved significantly.During the 2-month follow-up,the facial abscesses completely disappeared,the stool was normal,and there were no special discomforts.The participation of clinical pharmacists in clinical practice improves patients' understanding of the disease and treatment compliance,providing patients with individualized medication support to ensure the safety and effectiveness of medication.