Objective:To gain a deeper understanding of the comorbidity status of elderly patients with coronary heart disease and the effect of comorbidity on their hospitalization costs.Methods:Using the convenient sampling method, a total of 8 334 elderly hospitalized patients diagnosed with coronary heart disease in Beijing Hospital from January 2018 to December 2021 were selected as the research objects. General Inforamtion Questionnaire and Charson comorbidity index (CCI) were used to investigate the comorbidity of patients.Results:Among the 8 334 elderly patients with coronary heart disease included, 88.18% (7 349/8 334) had comorbidity, and there was a statistically significant difference in hospital costs among patients with different CCI scores ( P<0.01). Elderly patients with coronary heart disease with comorbidity had higher hospital costs. The results of the binomial logistic regression analysis showed that comorbidities increased the hospitalization costs of elderly coronary heart disease patients in both the unadjusted model and the gradually adjusted model for age, gender, occupation, education level, admission department, admission status, admission year, admission mode length of stay and disease classification ( P<0.05) . Conclusions:The comorbidity in elderly patients with coronary heart disease is serious, which is an important factor affecting hospitalization costs. In medical practice, it is necessary to strengthen the comprehensive management of elderly patients with coronary heart disease, pay attention to the influencing factors of hospitalization costs, optimize prevention and treatment strategies, control the occurrence and progression of comorbidities among patients, deepen the reform of medical insurance payment methods such as grouping payments based on disease diagnosis, so as to accurately reduce hospitalization costs and promote the sustainable and healthy development of the medical and health system.

Objectives:To investigate the feasibility of using bedside echocardiography on the evaluation of potential donors with different causes of brain death for adult heart transplantation. Methods:Bedside echocardiographic and clinical data of consecutive potential donors for adult heart transplantation evaluated by the team of our institution from February 2018 to December 2020 were retrospectively analyzed.Based on different causes of brain death,the potential donors were divided into stroke(ischemic or hemorrhagic,n=398)and non-stroke(head trauma,brain tumor,anoxia,n=272)groups.The clinical and echocardiographic features were compared between the two groups.A total of 350 donors were assigned to our hospital by the China Organ Transplant Response System and met the inclusion criteria for donor selection.There were 195 cases in the stroke group and 155 in the non-stroke group.Retrieval operations were performed and the retrieval rate of hearts for transplantation in stroke donors was compared to that in non-stroke donors. Results:(1)Among the 670 potential heart donors,compared with the non-stroke group,donors in the stroke group were significantly older,had higher body mass index,larger left ventricular end-diastolic diameter,thicker interventricular septum,higher rates of echocardiographic abnormalities,higher prevalence of hypertension(all P<0.001).Among the 670 potential heart donors,17.5%(117 cases)did not meet the echo selection criteria,the common causes were left ventricular hypertrophy(59 cases,50.4%),left ventricular ejection fraction<50%(27 cases,23.1%),wall motion abnormalities(21 cases,17.9%),and left ventricular dilation(14 cases,12.0%).(2)Among the 350 donors who had met the selection criteria and assigned to our hospital by the China Organ Transplant Response System and underwent retrieval operation,70.3%(246 cases)were successfully procured,110 cases(44.7%)in the stroke group and 136 cases(55.3%)in the non-stroke group.The retrieval rate of stroke donors(110/195,56.4%)was lower compared with that of non-stroke(136/155,87.7%,P<0.001),104 cases(29.7%)were not retrieved,and the leading cause of unsuccessful organ retrieval was the occlusion of at least one major coronary artery(91 cases,87.5%). Conclusions:Bedside echocardiography is of great value as a screening tool for cardiac donors.Cardiac structures of the potential donor with stroke as the cause of brain death were different from those with non-stroke causes.The retrieval rate of stroke donors was lower than that of non-stroke donors,even if the initial criteria for donor selection were fulfilled.

Objective:To evaluate the clinical effects of posterior reduction in the treatment of acute severe traumatic lumbar spondylolisthesis.Methods:A retrospective study was conducted to analyze the clinical data of 12 patients with acute severe traumatic lumbar spondylolisthesis who had been treated by posterior reduction at Department of Spinal Surgery, Zhengzhou Orthopaedic Hospital from June 2010 to December 2018. There were 7 males and 5 females with an age of (25.7±1.8) years. The spondylolisthesis was at L4 in 4 cases and at L5 in 8 cases, and grade Ⅲ in 7 cases, grade Ⅳ in 4 cases and grade Ⅴ in 1 case according to the Meyerding classification. By the American Spinal Injury Association (ASIA) grading, the preoperative neurological function was at level B in 6 cases, at level C in 4 cases, and at level D in 2 cases. All the 12 patients underwent posterior reduction and internal fixation with pedicle screws, as well as intervertebral bone graft fusion. Operation time and intraoperative blood loss were recorded. Clinical efficacy was evaluated by visual analogue scale (VAS) and Oswestry disability index (ODI) before and after surgery, and neurological function was evaluated by ASIA grading. X-ray, CT plain scan and reconstruction were used to observe internal fixation and bone grafting.Results:All patients were followed up for (18.5±2.1) months. The operation time was (165.7±42.3) min and the blood loss (497.7±75.3) mL. The VAS pain scores [(2.7±0.3) points and (1.8±0.2) points] and ODIs (18.2%±2.3% and 14.5%±2.6%) at 2 weeks after operation and at the last follow-up were significantly lower than the preoperational values [(8.5±0.6) points and 72.3%±12.3%] ( P<0.05), but there was no statistically significant difference between 2 weeks after operation and the last follow-up ( P>0.05). At the last follow-up, X-rays and CT scans showed good fixation and adequate bone grafting; the spondylolisthesis was grade 0 in 10 cases and grade I in 2 cases; the ASIA level of neurological function was C in 2 cases, D in 3 cases, and E in 7 cases. Healing of surgical incision was delayed in 2 patients but responded to symptomatic treatment. Follow-ups observed no such complications as loosening or pulling out of internal fixation. Conclusion:In the treatment of acute severe traumatic lumbar spondylolisthesis, posterior reduction can effectively restore the spondylolisthesis sequence and restore spinal stability, leading to satisfactory curative outcomes.

Objective:To investigate the clinical practice level and influencing factors of geriatric nursing specialist nurses.Methods:This study was a cross-sectional survey. Using the convenient sampling method, a total of 332 specialist nurses from 5 phases trained by Beijing Nursing Association from January to February 2021 were selected as the research objects. The general data questionnaire, Questionnaire on Clinical Practice Level of Geriatric Nursing Specialist Nurses, Questionnaire on Unit Support for Geriatric Nurses and Core Competence Self-Assessment Scale of Geriatric Nursing Specialist Nurses were used to investigate the nurses. Pearson correlation was used to analyze the relationship between unit support, self-assessment of core competence and practice level. Multiple linear regression was used to analyze the factors influencing the clinical practice level of geriatric nurses. A total of 332 questionnaires were distributed, 306 questionnaires were returned and 298 were valid questionnaires.Results:The total mean score of clinical practice of geriatric nursing specialist nurses was (3.42±0.83) . The results of multiple linear regression analysis showed that the work department, unit support and core competence were the influencing factors of the clinical practice level of geriatric nursing specialist nurses ( P<0.05) . Conclusions:Specialist nurses who work in the geriatric ward, have a high degree of unit support and have a high level of core competence have a higher clinical practice level.

Objective:To establish a 180-day mortality predictive score based on frailty syndrome in elderly sepsis patients [elderly sepsis score (ESS)].Methods:A prospective study for sepsis patients aged 60 years and above who were admitted to a medical intensive care unit of the General Hospital of Southern Theatre Command from January 1st, 2018 to December 31st, 2018 was conducted. Univariate analysis was performed on 19 independent variables including gender, age, body mass index (BMI), tumor, charlson comorbidity index (CCI), activity of daily living (ADL), instrumental activity of daily living (IADL), mini-mental state examination (MMSE), geriatric depression scale (GDS), clinical frail scale (CFS), sequential organ failure assessment (SOFA), Glasgow coma scale (GCS), acute physiology and chronic health evaluation (APACHEⅡ, APACHEⅣ), modified NUTRIC score (MNS), multiple drug resistance (MDR), mechanical ventilation (MV), continuous renal replacement therapy (CRRT) and palliative care. Continuous independent variables were converted into classified variables. Multivariate binary regression analysis of risk factors was conducted to screen independent risk factors which affecting 180-day mortality in elderly sepsis patients. Then a 180-day mortality predictive score was established, and the discrimination of the mortality of patients using CFS, SOFA, GCS, APACHEⅡ, APACHEⅣ, MNS scores were compared.Results:A total of 257 patients were enrolled, with a 180-day mortality of 60.7%. Univariate analysis showed that age, tumor, CCI, ADL, IADL, MMSE, CFS, SOFA, GCS, APACHEⅡ, APACHEⅣ, MNS, MDR, MV, CRRT, palliative care were risk factors of 180-day mortality in elderly sepsis patients [age: odds ratio ( OR) = 1.027, 95% confidence interval (95% CI) was 1.005-1.050, P = 0.018; tumor: OR =2.001, 95% CI was 1.022-3.920, P = 0.043; CCI: OR = 1.193, 95% CI was 1.064-1.339, P = 0.003; ADL: OR = 0.851, 95% CI was 0.772-0.940, P = 0.001; IADL: OR = 0.894, 95% CI was 0.826-0.967, P = 0.005; MMSE: OR = 0.962, 95% CI was 0.937-0.988, P = 0.004; CFS: OR = 1.303, 95% CI was 1.089-1.558, P = 0.004; SOFA: OR = 1.112, 95% CI was 1.038-1.191, P = 0.003; GCS: OR = 0.918, 95% CI was 0.863-0.977, P = 0.007; APACHEⅡ: OR = 1.098, 95% CI was 1.053-1.145, P < 0.001; APACHEⅣ: OR = 1.032, 95% CI was 1.020-1.044, P < 0.001; MNS: OR = 1.315, 95% CI was 1.159-1.493, P < 0.001; MDR: OR = 2.029, 95% CI was 1.197-3.437, P = 0.009; MV: OR = 6.408, 95% CI was 3.480-11.798, P < 0.001, CRRT: OR = 2.744, 95% CI was 1.529-4.923, P = 0.001, palliative care: OR = 5.760, 95% CI was 2.177-15.245, P < 0.001]. By binary regression analysis, CFS stratification ( OR = 1.934, 95% CI was 1.267-2.953, P = 0.002), MV ( OR = 4.531, 95% CI was 2.376-8.644, P < 0.001), CRRT ( OR = 2.471, 95% CI was 1.285-4.752, P = 0.007), palliative care ( OR = 6.169, 95% CI was 2.173-17.515, P = 0.001) were independent risk factors of 180-day mortality in elderly patients with sepsis. The model of "ESS = 0.660×CFS stratification+1.511×MV+0.905×CRRT+1.820×palliative care" was established. Receiver operating characteristic curve (ROC curve) analysis showed that the area under the ROC curve (AUC) for predicting 180-day mortality by ESS was 0.785 (95% CI was 0.730-0.834, P < 0.001). When the best cut-off value was 2.2 points, its sensitivity was 78.9%, specificity was 70.3%, the positive predictive value was 80.4%, and the negative predictive value was 68.3%. Simplified ESS was defined as "0.5×CFS stratification+1.5×MV+1×CRRT+2×palliative care". ROC curve analysis showed that AUC for predicting 180-day mortality by simplified ESS was 0.784 (95% CI was 0.729-0.833, P < 0.001). When the best cut-off value was 2.0 points, sensitivity was 76.9%, specificity was 70.3%, the positive predictive value was 80.0%, and the negative predictive value was 66.4%. Compared with CFS, SOFA, GCS, APACHEⅡ, APACHEⅣ and MNS, ESS had a significant difference in discriminating 180-day mortality in elderly patients with sepsis (AUC was 0.785 vs. 0.607, 0.607, 0.600, 0.664, 0.702, 0.657, 95% CI: 0.730-0.734 vs. 0.537-0.678, 0.537-0.677, 0.529-0.671, 0.598-0.730, 0.638-0.766, 0.590-0.725, all P < 0.05). Conclusions:CFS, MV, CRRT, and palliative care are independent risk factors of 180-day mortality in elderly patients with sepsis. We established ESS based on these risk factors. The ESS model has good discrimination and can be used as a reference and assessment tool for prediction and treatment guidance in elderly patients with sepsis.

Objective:To explore the current status and hot trends of geriatric nursing in China in the past five years, in order to provide a reference for related research.Methods:This research adopted the bibliometric research method. The Wanfang database, China National Knowledge Infrastructure (CNKI) , and China Biomedical Literature Database were searched on October 30, 2020, and bibliometric analysis was carried out based on the literature related to geriatric nursing published from 2016 to 2020.Results:A total of 4 930 papers included were published in 359 journals. The cumulative number of papers published in the top 15 journals exceeded 50%, and one third of them were non-nursing journals. The number of papers published in the region where the first author of the paper was located was from 1 to 555, and the top 3 regions were Beijing, Jiangsu, and Guangdong respectively. Research hotspots were mainly concentrated in five areas, namely, common clinical problem nursing in elderly patients, geriatric nursing services in institutions and communities, quality of life and psychological nursing, chronic disease management, and safety risk management.Conclusions:In the past five years, geriatric nursing research has been large in volume and published in journals. The research attention of different cities is quite different, and the research field is continuously expanding, which is in line with the background of my country's population aging and the guiding direction of national policies.

Objective:To explore the current situation and related factors of asphyxia prevention and management for the elderly in elderly care institutions, so as to provide a reference for improving the safety management of elderly care institutions.Methods:This research was a cross-sectional survey. From December 2020 to January 2021, convenience sampling was used to select 43 elderly care institutions from the China Aged Care Alliance. The self-designed questionnaire was used to collect the content related to asphyxia prevention and management for the elderly in institutions, and analyze its current situation and related factors. A total of 43 questionnaires were distributed in this survey, and 43 were recovered, with a recovery rate of 100%.Results:Among the 43 elderly care institutions, and 3 (6.98%) were state-run, and 22 (51.16%) were private, and 18 (41.86%) were public and private. The average occupancy rate was (67.63±20.59) %, and the average proportion of moderate to severe disability among the elderly residents was (80.10±20.25) %. The proportions of elderly care institutions that formulated systems and regulations for monitoring and early warning of asphyxia events, reporting of asphyxia events, analysis and improvement of asphyxia incidents in the elderly were 53.49%, 51.16%, and 51.16%, respectively. The proportions of elderly care institutions that carried out asphyxia risk screening, swallowing function assessment, and swallowing function training for the elderly residents were 65.12%, 51.16%, and 46.51%, respectively.Conclusions:Most elderly care institutions have problems in the prevention and management of asphyxia for the elderly, which needs to be improved. It is recommended that building a complete asphyxia prevention and management system, carrying out risk screening, assessment and training of swallowing function for high-risk groups, strengthening the professional training of agency leaders and caregivers, and seeking continuous external professional support so as to improve the safety management system of elderly care institutions, and ensure the quality of life and personal safety of the elderly.

Objective:To explore the demand for suffocation prevention training for nursing staff in elderly care institutions and analyze its influencing factors to provide reference for improving training strategies.Methods:In this cross-sectional study, from December 2020 to January 2021, the caregivers from 43 elderly nursing institutions under China Geriatric Care Alliance were selected by convenient sampling. Self-made questionnaires were used to collect personal information of caregivers as well as related experience and training needs of suffocation prevention for the elderly. Totally 526 questionnaires were recovered, of which 412 were valid, with an effective rate of 78.33%.Results:Among the 412 caregivers, 53 (12.86%) were registered nurses and 359 (87.14%) were senior caregivers. They had a high demand for suffocation prevention, identification, and emergency treatment training. The top three most demanded are the common causes of suffocation, the risk factors of suffocation for special elderly people, and the identification of abnormal physical signs to detect suffocation in time. There were statistically significant differences in the scores of content requirements for suffocation prevention training between institutions which had and had not experienced suffocation and caregivers who knew or did not know the medication status or suffocation history of the care recipients ( P<0.05) . Conclusions:Caregivers in elderly care institutions have a high demand for suffocation prevention training. It is recommended that elderly care institutions apply pre-prevention to the management of suffocation prevention for the elderly, and guide caregivers to fully understand the medication status, suffocation history, and swallowing function of the care recipients, and provide registered nurses and elderly caregivers with systematic training related to suffocation prevention.

Objective:To evaluate the effects of continuous nasal feeding on aspiration pneumonia in critically ill patients.Methods:The Cochrane systematic reviews were used to retrieve relevant articles by computer. In this study, PubMed, Web of Science, ScienceDirect, Chinese Biomedical Literature Database, Wanfang Database and CNKI were selected. Chinese articles published from January 2000 to November 2018, and English articles published up to November 2018 were retrieved. After the quality of the articles was evaluated, RevMan 5.3 was used to conduct a meta-analysis over the articles that met the inclusion criteria.Results:A total of 10 randomized controlled trials were included. The combined results of meta-analysis showed that continuous nasal feeding could effectively reduce the incidence of aspiration pneumonia (10 studies, 100%) , gastric retention (4 studies, 40%) , vomiting (3 studies, 30%) , and aspiration (3 studies, 30%) .Conclusions:Continuous nasal feeding can reduce the occurrence of aspiration pneumonia and related symptoms. The specific feeding programs included in the articles are not completely consistent, and there are certain heterogeneities in the studies. More high-quality, large-sample, and rigorously designed clinical trials are still needed to test the preventive effects of continuous nasal feeding on aspiration pneumonia.

Objective:To explore the COVID-19 knowledge and attitude, and its influences on protective behavior among clinical nurses so as to provide a reference for developing effective intervention strategy.Methods:Cross-sectional investigation was used to hospital-wide nurses selected by convenience sampling in February 2020 through sending a link of Wenjuanxing to work WeChat group of Nursing Department of Beijing Hospital and to circle of friends. Clinical nurses met the inclusion and exclusion criteria were invited to fill in the questionnaire. The self-designed COVID-19 related knowledge, attitude and behavior questionnaire was used to the investigation.Results:Among 750 clinical nurses, the self-assessment of COVID-19 related knowledge was≥7, with 70.04% for the average percentage. There were 91.6% of nurses with the confidence to fight with epidemic situation. After COVID-19 broke out, 94.1% of nurses strictly carried out the hand hygiene. Behavior changes in "wearing gloves when potentially contacting bloods, body fluids, secretions and excreta", "wearing goggles and protective clothing when bloods, body fluids, secretions and excreta potentially splashing" accounted for 89.2%, 81.5% and 71.6% respectively. Pearson correlation analysis showed that COVID-19 related knowledge of 750 nurses had no correlations with three dimensions "worrying about infecting COVID-19", "effectiveness of standard precaution" and "influencing factors of taking standard precaution" of attitude with no statistical differences ( P>0.05) . The results showed that the clinical knowledge of the first-line nurses of COVID-19 had no impact on the implementation of hand hygiene, but also had impacts on their attitudes ("views on dealing with the epidemic of COVID-19" dimension) and protective behavior habits ( P<0.05) ; their attitudes had no effect on the implementation of hand hygiene, and had impacts on other protective behavior habits ( P<0.05) . Conclusions:COVID-19 related knowledge of clinical nurses need to be improved and protective behavior should be changed further.