Objective:To investigate the current status of vocational training for pediatric clinical research coordinators (CRC), and discuss the construction of base-based pediatric CRC training, and to promote the ability of pediatric CRCs.Methods:From July 25 to October 16, 2023, an anonymous self-designed questionnaire survey was conducted through the Wenjuanxing platform to investigate the current situation of pediatric CRC vocational training and base training needs. The data were collated using Excel. Categorical data were described as numbers and percentages.Results:A total of 328 usable questionnaires were returned. Only 7.62% (25 people) believed that existing CRC training was sufficient and could meet actual work needs; 4.88% (16 people) responded that there was no training; 46.34% (152 people) believed that the training was insufficient to support actual work needs; 87.50% (287 people) believed that continuous CRC training was needed; 46.95% (154 people) preferred experienced CRCs for teaching, who should have at least 3 years of CRC work experience; and 46.95% (154 people) preferred a duration of 3 months for CRC training. The preferred training methods were: practice under the direction of experienced CRCs (90.85%, 298 people), step-by-step teaching of practical skills (88.41%, 290 people), case analysis and discussion (87.20%, 286 people), process simulation (83.23%, 273 people), and lecture-based teaching (76.52%, 251 people). The preferred post-training assessment methods were: case analysis (76.52%, 251 people), operation simulation (74.09%, 243 people), process simulation (73.17%, 240 people), written examination (66.16%, 217 people), and interview (63.72%, 209 people).Conclusions:The current pediatric CRC training is not enough to meet actual work needs. It is urgent to develop and promote a CRC training system that can meet work needs, laying the foundation for the construction of pediatric clinical research ecology in China.

Objective To investigate the relationship between the levels of serum neuron-specific enolase(NSE)and tumor necrosis factor alpha(TNF-α)and the attack stage and prognosis of children with epilepsy secondary to viral encephalitis(VE).Methods A total of 96 children with VE admitted to the People's Hospital Affiliated to Inner Mongolia Medical University from January 2015 to January 2020 were selected as the research subjects,and they were divided into the control group(children with VE,n=30)and the observation group(children with epilepsy secondary to VE,n=66).In addition,30 healthy children who underwent physical examination in the hospital during the same period were selected as the health group.The levels of serum NSE and TNF-α in the health group,control group and observation group were compared.Children in the observation group were further divided into the 24h relapse group(n=48)and 24h non-relapse group(n=18)according to the attack of disease within 24h after admission.The levels of serum NSE and TNF-α were compared between the two groups.Pearson correlation was used to analyze the relationship between the levels of NSE,TNF-α and the attack stage of epilepsy secondary to VE.Children in the observation group were divided into the good prognosis group(n=45)and the poor prognosis group(n=21)according to the Glasgow Outcome Scale score at discharge.The serum levels of NSE,TNF-α and other possible prognostic factors were compared between the two groups.Multivariate logistic regression analysis was used to explore the prognostic factors of children with epilepsy secondary to VE,and the predictive value of serum NSE and TNF-αlevels on the prognosis of children with epilepsy secondary to VE was analyzed by drawing the receiver operating characteristic curve.Results The level of serum NSE in the control group was significantly higher than that in the health group(P＜0.05),and there was no significant difference in the level of serum TNF-α between the control group and the health group(P＞0.05).The serum levels of NSE and TNF-α in the observation group were significantly higher than those in the control group(P＜0.05).The serum levels of NSE and TNF-α in the observation group were significantly higher than those in the control group(P＜0.05).The levels of serum NSE and TNF-α in the 24 h relapse group were significantly higher than those in the 24 h non-relapse group(P＜0.05).The proportion of severe abnormal EEG,severe abnormal brain images and complicated respiratory failure,and serum levels of c-reactive protein,NSE and TNF-α in the good prognosis group were lower than those in the poor prognosis group(P＜0.05);there were no significant differences in sex,age,body mass,brain injury site,fever,hypokalemia,hyponatremia,previous convulsions,stress hyperglycemia,complicated organ dysfunction,viral infection,first episode of epilepsy,Glasgow Coma Scale score at admission,duration of convulsion,length of hospital stay,white blood cell count,aspartate transaminase,creatine kinase and cardiac troponin levels between the two groups(P＞0.05).The results of multivariate logistic regression analysis showed that complicated respiratory failure,serum NSE and TNF-α levels were correlated with the prognosis of children with epilepsy secondary to VE(P＜0.05).The area under the curve(AUC)of serum NSE and TNF-α levels in predicting the prognosis of children with epilepsy secondary to VE was 0.724(95％confidence interval:0.672-0.776)and 0.689(95％confidence interval:0.637-0.734),respectively,with a sensitivity of 82.22％and 75.56％and a specificity of 76.19％and 71.43％;the AUC of the combination of the two in predicting the prognosis of children with epilepsy secondary to VE was 0.826(95％confidence interval:0.774-0.873),with a sensitivity of 73.33％and a specificity of 80.95％.Conclusion The serum levels of NSE and TNF-α are abnormally high in children with epilepsy secondary to VE.Both of them are factors affecting the prognosis of children with epilepsy secondary to VE,showing a good predictive value for the prognosis of epilepsy secondary to VE.

Objective:To explore the needs of parents of hospitalized neonates with the challenges of implementing family-centered care during the Covid-19 pandemic.Methods:Using a method of phenomenological interviewing and Colaizzi′s method of data analysis, the information of 18 parents of admitted infants of Children′s Hospital of Fudan University from January 1 to 20, 2022 were collected and analyzed.Results:In the post-epidemic era, 5 themes of needs for parents of hospitalized neonates during family-centered care were identified: closeness to babies; emotional support; training about feeding; accommodation services; financial support.Conclusions:In the post-epidemic era, experiencing worry, anxiety, uncertainty, helplessness, loss and other negative psychological experience, the parents of hospitalized neonates have many unsatisfied needs. Hospital administrators need to focus on the needs of parents for family-centered nursing care, and actively explore effective coping strategies.

Objective:To investigate the normal range of exhaled nitric oxide (FeNO) in 6-18-year-old children in China, so as to provide a data base for the establishment of FeNO standards for Chinese children.Methods:A multi-center study was conducted on 5 949 children aged 6-18 (3 101 males and 2 848 females) in 16 pro-vinces of 7 administrative districts in China.According to the technical standard recommended by American Thoracic Society/European Respiratory Association, FeNO was measured, and the relationship of FeNO with the sex, age, height, weight, body mass index and region was discussed.Results:The geometric mean FeNO value of Chinese children aged 6-18 was 14.1 ppb, and its 95% confidence interval (skewness distribution) was 1.0-38.2 ppb.The geometric mean FeNO values of children aged 6-11 and 12-18 were 13.1 ppb and 15.7 ppb, respectively, and their 95% confidence intervals (skewness distribution) were 1.0-38.1 ppb and 2.0-38.2 ppb.For children at and under 11 years old, FeNO decreased with age, with a mean decline of 1 ppb per year.The multiple linear regression results suggested that there was a significant correlation between FeNO and age for children aged 6-11, and FeNO of children aged 12-18 was significantly correlated with the gender, height, and region(all P<0.01). Conclusions:FeNO values of Chinese children and adolescents in this study are higher than those obtained by the previous study conducted from 2010 to 2012.For children aged 12-18, 16 ppb is recommended as the clinical cut-off point.For children at or under 11 years old, the influence of age on FeNO should be considered, and the cut-off point of FeNO decreases by 1 ppb as the age is reduced by one year.

Objective: To test the reliability and validity of the Chinese version of the Handoff Clinical Examination Exercise (Handoff CEX). Methods: The Chinese version of the Handoff CEX was composed of two parts, one to assess the nurse providing the handoff and another to assess the nurse receiving the handoff. A total of 80 handoffs was evaluated to test the reliability and validity of the Chinese version of the Handoff CEX. Results: A total of 320 evaluations of handoff was obtained. The Cronbach α coefficient was 0.85 for the handoff provider, and that was 0.80 for the handoff recipient. Weighted kappa scores for provider evaluations ranged from 0.31-0.52, and that for recipient evaluations ranged from 0.35-0.55. The correlation coefficients between each factor ranged from 0.23 to 0.62, and that between each factor and the total scale ranged from 0.33 to 0.64 (P<0.05). Experienced nurses (>5 years) received significantly higher mean scores than inexperienced nurses(≤5 years) in all domains except organizational efficiency and professionalism(P<0.05). Conclusion The Chinese version of the Handoff CEX is a reliable and valid tool to assess the nursing handoff, which is useful for educators, supervisors and clinical nurses to provide training, ongoing assessment and feedback to improve the quality of handoff.

Objective:To investigate the clinical characteristics of pediatric methicillin-resistant Staphylococcus aureus (MRSA) infection and the antibiotic sensitivity of the isolates. Methods:The clinical data of children with MRSA infection and antibiotic sensitivity of the isolates from 11 children′s hospitals in Infectious Diseases Surveillance of Paediatrics (ISPED) group of China between January 1, 2018 and December 31, 2018 were collected retrospectively. The children′s general condition, high-risk factors, antimicrobial therapy and prognosis, differences in clinical disease and laboratory test results between different age groups, and differences of antibiotic sensitivity between community-acquired (CA)-MRSA and hospital-acquired (HA)-MRSA were analyzed. The t test and Wilcoxon rank sum test were used for statistical analysis of the quantitative data and Chi-square test were used for comparison of rates. Results:Among the 452 patients, 264 were males and 188 were females, aged from 2 days to 17 years. There were 233 cases (51.5%) in the ≤1 year old group, 79 cases (17.5%) in the>1-3 years old group, 29 cases (6.4%) in the >3-5 years old group, 65 cases (14.4%) in the >5-10 years old group, and 46 cases (10.2%) in the>10 years old group. The main distributions of onset seasons were 55 cases (12.2%) in December, 47 cases (10.4%) in February, 46 cases (10.2%) in November, 45 cases (10.0%) in January, 40 cases (8.8%) in March. There were 335 cases (74.1%) CA-MRSA and 117 (25.9%) cases HA-MRSA. Among all cases, 174 cases (38.5%) had basic diseases or long-term use of hormone and immunosuppressive drugs. During the period of hospitalization, 209 cases (46.2%) received medical interventions. There were 182 patients (40.3%) had used antibiotics (β-lactams, glycopeptides, macrolides, carbapenems, oxazolones, sulfonamides etc) 3 months before admission. The most common clinical disease was pneumonia (203 cases), followed by skin soft-tissue infection (133 cases), sepsis (92 cases), deep tissue abscess (42 cases), osteomyelitis (40 cases), and septic arthritis (26 cases), suppurative meningitis (10 cases). The proportion of pneumonia in the ≤1 year old group was higher than the >1-3 years old group,>3-5 years old group,>5-10 years old group,>10 years old group (57.5% (134/233) vs. 30.4% (24/79), 31.0% (9/29), 38.5% (25/65), 23.9% (11/46), χ 2=17.374, 7.293, 7.410, 17.373, all P<0.01) The proportion of skin and soft tissue infections caused by CA-MRSA infection was higher than HA-MRSA (33.4% (112/335) vs. 17.9% (21/117), χ 2=10.010, P=0.002), and the proportion of pneumonia caused by HA-MRSA infection was higher than CA-MRSA (53.0% (62/117) vs. 42.1% (141/335), χ 2=4.166, P=0.041). The first white blood cell count of the ≤1 year old group was higher than that children > 1 year old ((15±8)×10 9/L vs. (13±7)×10 9/L, t=2.697, P=0.007), while the C-reactive protein of the ≤1 year old group was lower than the 1-3 years old group,>5-10 years old group,>10 years old group (8.00 (0.04-194.00) vs.17.00 (0.50-316.00), 15.20 (0.23-312.00), 21.79(0.13-219.00) mg/L, Z=3.207, 2.044, 2.513, all P<0.05), there were no significant differences in procalcitonin (PCT) between different age groups (all P>0.05). After the treatment, 131 cases were cured, 278 cases were improved, 21 cases were not cured, 12 cases died, and 10 cases were abandoned. The 452 MRSA isolates were all sensitive to vancomycin (100.0%), linezolid (100.0%), 100.0% resistant to penicillin, highly resistant to erythromycin (85.0%, 375/441), clindamycin (67.7%, 294/434), less resistant to sulfonamides (5.9%, 23/391), levofloxacin (4.5%, 19/423), gentamicin (3.2%, 14/438), rifampicin (1.8%, 8/440), minocycline (1.1%, 1/91). The antimicrobial resistance rates were not significantly different between the CA-MRSA and HA-MRSA groups (all P>0.05). Conclusions:The infection of MRSA is mainly found in infants under 3 years old. The prevalent seasons are winter and spring, and MRSA is mainly acquired in the community. The main clinical diseases are pneumonia, skin soft-tissue infection and sepsis. No MRSA isolate is resistant to vancomycin, linezolid. MRSA isolates are generally sensitive to sulfonamides, levofloxacin, gentamicin, rifampicin, minocycline, and were highly resistant to erythromycin and clindamycin. To achieve better prognosis. clinicians should initiate anti-infective treatment for children with MRSA infection according to the clinical characteristics of patients and drug sensitivity of the isolates timely and effectively.

Objective To study the superiority of severe multiple trauma treatment model based on damage control strategy. Methods In the intergrated injury first-aid mode, the intensive care unit-guided damage control strategy was used to treat severe multiple trauma. Results A total of 789 severe multiple damage patients were treated with damage control strategies in our hospital from December 2018 to December 2018. Sixty-nine patients died and the survival rate was 91.25％. Conclusions The intensive care unit-guided trauma control strategy has a satisfactory clinical effect in the treatment of patients with severe multiple trauma.

Objective: To observe the changes in cerebral regional oxygen saturation (CrSO₂) during neonatal blood exchange transfusion(BET) and its effect on the level of bilirubin in neonates with severe hyperbilirubinemia. Methods: From January 2017 to March 2018, 52 newborns with severe hyperbilirubinemia were hospitalized in the Department of Neonatology, Children′s Hospital of Fudan University.Every newborn was treated with BET.Near infrared spectroscopy was used to monitor CrSO₂ in the process of BET.The monitoring lasted from 2 hours before the beginning of BET to 2 hours after the completion of BET.The CrSO₂ were recorded every 2 minutes and total surem bilirubin (TSB) and transcutaneous bilirubin(TCB) was measured.During this period, it is accompanied by the monitoring of neonatal body temperature, heart rate, respiration and bolld oxygen saturation(SpO₂). The differences in CrSO₂ changes at different time points during BET were compared.At the same time, the correlations between CrSO₂ and blood oxygen saturation, TSB and TCB levels were analyzed.The results of repeated measurement analysis of variance compared between the two groups were corrected by Bonfferoni. Results: Among the 52 children, there were 33 males (63.46%) and 19 females (36.54%). The gestational age, average birth weight and average head circumference of newborns were (38.6±2.1) weeks, (3 338±444) g and (33.6±3.2) cm, respectively.The Apgar score of newborn was (8.1±1.6) scores at 1 minute after birth.The level of TSB detected for the first time after admission was (457.9±97.8) μmol/L.The CrSO₂ after BET (74.6%-76.0%) was significantly higher than that before BET (69.4%-69.0%), and the difference was statistically significant (P<0.05). Correlation analysis showed that during BET, CrSO₂ showed a gradual upward trend, SpO₂ also showed a synchronous increase, while the level of bilirubin showed a downward trend, and the downward trend of TSB level was more obvious than that of TCB. Conclusions CrSO₂ can reflect the improvement of cerebral oxygenation during neonatal blood exchange transfusion and avoid cerebral hypoxia in the course of treatment.

BACKGROUND: The aim of this study was to analyze the incidence of lower limb deep venous thrombosis (DVT) and the corresponding coagulation status in severe patients after thoracic surgery. METHODS: Severe patients after thoracic surgery who received mechanical prophylaxis of lower limb DVT between July 2016 and June 2018 were analysed retrospectively. Their general information, disease species, surgical treatment, and coagulation index were reviewed. RESULTS: Fifty patients were finally included. There were 34 male and 16 female, aging from 22 to 80 years. The incidence of DVT was 22.0%, all of them were isolated calf DVT. The incidence was 29.4% in male patients, while 6.3% in female; 23.5% in malignant diseases and 18.6% in benign. All coagulation index presented no statistical difference between patients with and without DVT, except activated partial thromboplastin time (APTT). CONCLUSIONS Even on the basis of adequate mechanical prophylaxis, lower limb DVT is common in severe patients after thoracic surgery. Meanwhile, male patients and malignant diseases are more suscepted.
Adult ; Aged ; Aged, 80 and over ; Blood Coagulation ; Female ; Humans ; Incidence ; Lower Extremity ; blood supply ; Lung Neoplasms ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Thoracic Surgical Procedures ; adverse effects ; Venous Thrombosis ; etiology ; physiopathology ; Young Adult

Objective To explore the incidence of delirium among Neurosurgery Intensive Care Unit(ICU)patients and analyze the characteristics of delirium.Methods This study carried out perspective cohort study design.From May 2016 to July 2017,we selected 150 Neurosurgery ICU patients of a Class Ⅲ Grade A hospital by convenience sampling as respondents.Delirium was evaluated with the Confusion Assessment Method for the ICU(CAM-ICU)daily.Logistic regression was used in data analysis to analyze the related risk factors of delirium.Results The incidence of delirium of was 42％in those patients.Types of delirium were main in the type of increasing activity accounting for 36.5％.There were 57.1％of patients with delirium two to five days after being admitted to ICU.Logistic regression analysis showed that the independent predictors of delirium of Neurosurgery ICU patients were Acute Physiology,Age,Chronic Health Evaluation Ⅱ(APACHE Ⅱ)(OR=0.901,95％CI 0.813-0.998),physical restraint(OR=11.382,95％CI 3.616-35.826),hypoproteinemia(OR=6.102,95％CI 1.729-21.530).Conclusions The incidence of delirium is high in Neurosurgery ICU patients.There are many risk factors inducing delirium of patients.We should closely pay attention to patients' mental state so as to early take effective measures to prevent delirium.