Objective:To analyze the changes in the variables of venous thromboembolism (VTE) management among inpatients after implementing clinical care classification (CCC) system, and to explore the impacts.Methods:This was a quasi experimental study. Based on the network monitoring data in Zhongshan Hospital, Fudan University, all the inpatients were included in this study from January 2022 to June 2023. According to the date of implementing CCC, we took July 2022 as the intervention cut-off point, and two phases of pre-CCC (January 2022 to June 2022) and post-CCC (July 2022 to June 2023) were defined. The interrupted time series (ITS) analysis was used to evaluate the impacts of implementing CCC system on VTE management among inpatients.Results:ITS analysis showed that in the period of post-CCC (August 2022 to June 2023), the slope of VTE evaluation rate was 0.000 415 5, with a significant upward trend ( t=2.49, P<0.05). In the month of CCC system launched (July 2022), the implementation rate of VTE preventive measures increased significantly, with a significant statistical difference ( t=3.10, P<0.05). In the post-CCC phase (August 2022 to June 2023), the slope of VTE preventive measures implementation rate was -0.012 876, with no significant statistical difference ( P>0.05). The implementation of CCC system had no significant impacts on the overall and high-risk incidence of VTE among inpatients. Conclusions:After the implementation of the CCC system, the VTE evaluation rate of inpatients increased significantly, which suggesting that the CCC system standardized the clinical VTE management among inpatients.

Objective To establish and validate a risk prediction model based on multiple blood routine parameters for preliminary differential diagnosis of influenza A and influenza like illness(ILI)in children.Methods Children with influenza A(n=2 686)and ILI(n=1 369)who were treated in Department of Pediatrics,The First Affiliated Hospital of Naval Medical University(Second Military Medical University)from Jul.1,2022 to Jun.30,2023 were enrolled,and their clinical and laboratory features were collected for retrospective analysis.According to age,patients were divided into 2 subgroups:1 year≤age≤6 years and 6 years＜age≤16 years.Patients in each subgroup were randomly divided into training set(70%)and internal validation set(30%).Children with influenza A(n=204)and ILI(n=404)who were treated in Department of Pediatrics of The Second Affiliated Hospital of Naval Medical University(Second Military Medical University)and Naval Hospital of PLA Eastern Theater Command from Jul.1,2022 to Jun.30,2023 were selected as the external validation set.Multivariate logistic regression analysis was performed on the training set to obtain the independent influencing factors of influenza A.The prediction model based on these factors were displayed as a nomogram.Receiver operating characteristic(ROC)curve,Hosmer-Lemeshow test,and decision curve analysis(DCA)were used to evaluate the performance of the model from 3 aspects:discrimination,calibration,and clinical practicality,respectively.The diagnostic performance of the model was verified in both internal validation set and external validation set.Results In the subgroup of 1 year≤age≤6 years,age,white blood cell count,lymphocyte count and C reactive protein were the independent influencing factors of influenza A(all P＜0.01);the area under the curve(AUC)value of the established nomogram prediction model for identifying influenza A was 0.746 in the training set,0.771 in the internal validation set,and 0.753 in the external validation set;the predicted probability of the model was highly consistent with the actual probability(P=0.216);and taking intervention measures within a threshold probability range of 16%-60%could yield net benefits.In the subgroup of 6 years＜age≤16 years,gender,white blood cell count and lymphocyte count were the independent influencing factors of influenza A(all P＜0.01);the AUC value of the established nomogram prediction model for identifying influenza A was 0.733,0.747 in the internal validation set,and 0.753 in the external validation set;the predicted probability of the model was highly consistent with the actual probability(P=0.06);and taking intervention measures within a threshold probability range of 12%-58%could yield net benefits.Conclusion This risk prediction model based on easily obtainable blood routine parameters shows good diagnostic performance for influenza A,with high accuracy and clinical practicality.

A 32-year-old woman,previously diagnosed with schizophrenia and undergoing long-term treatment with clozapine,experienced the onset of symptoms such as shallow coma,persistent high fever,and increased muscle tone one day after transitioning from clozapine to amisulpride.Combining with elevated creatine kinase levels and other examination findings,the patient was diagnosed with amisulpride-related neuroleptic malignant syndrome(NMS).Amisulpride treatment was promptly discontinued,and the patient was treated with bromocriptine,but it failed to relieve the symptoms.On the same day,intravenous administration of dantrolene sodium was conducted,then her body temperature decreased,convulsions and tremors improved,and other symptoms gradually relieved.After 5 days,her consciousness improved,and she was discharged after 10 days.Amisulpride-related NMS are relatively rare,and dantrolene sodium can be used as a potential option when conventional treatments prove ineffective.

Objective:To compare the clinical efficacy of axillary transthoracic approach and posterior approach in the treatment of upper thoracic tuberculosis with vertebral clearance, bone graft fusion, and internal fixation surgery.Methods:Fifty five patients with upper thoracic tuberculosis admitted to Changsha Central Hospital, University of South China from March 2017 to March 2022 were selected and divided into axillary transthoracic group and posterior group according to different surgical approaches. The incision length, surgical time, intraoperative blood loss, and postoperative hospitalization time were compared between the two groups of patients. Two groups of patients were recorded for preoperative and postoperative pain visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores at 1 week, 3 months, and 12 months, preoperative and postoperative serum inflammatory indicators, CD4 + /CD8 + ratio of T lymphocyte subsets, and complications. Results:The incision length, operation time, and intraoperative blood loss in the axillary transthoracic group were significantly less than those in the posterior group, and the differences were statistically significant (all P<0.05). However, there was no statistically significant difference in postoperative hospitalization time between the two groups of patients ( P>0.05). The VAS and ODI scores of the two groups of patients showed significant improvement compared to preoperative levels at 1 week, 3 months, and 12 months after surgery (all P<0.05); And at 1 week and 3 months after surgery, the VAS scores of patients in the axillary transthoracic group were significantly lower than those in the posterior group (all P<0.05), and the ODI scores at 3 and 12 months after surgery were significantly lower than those in the posterior group (all P<0.05). The erythrocyte sedimentation rate and CRP levels of both groups of patients increased significantly one week after surgery compared with preoperative levels (all P<0.05), but the erythrocyte sedimentation rate and CRP levels basically returned to normal levels at three months after surgery. The CD4 + /CD8 + ratio of T lymphocyte subsets in both groups was lower than preoperative levels at one week after surgery, but with the continuation of treatment, the CD4 + /CD8 + ratio increased significantly at three months after surgery. Conclusions:Both axillary and posterior approaches can be used for surgical treatment of upper thoracic tuberculosis, but axillary and thoracic approaches have the advantages of less trauma, less bleeding, and faster recovery.

Objective:To understand the degree of professional autonomy of nurses in Pediatric Nursing Alliance and the status of pediatric nursing practice environment, which providing guidance for the development of a series of specialized training in the alliance.Methods:Stratified random sampling method was used to conduct a questionnaire survey on nursing staff of different professional levels in Pediatric Nursing Alliance, which through the questionnaire star by using the questionnaire general information and training demand questionnaire, nurses practice professional autonomy scale, pediatric nursing staff structural empowerment questionnaire and nursing practice influencing factors questionnaire through the questionnaire star.Results:The total score for professional autonomy of nurses in the pediatric alliance was 192.66±18.63, the structural empowerment ( OR=1.137, 95% CI=1.084-1.194), lack of caring team ( OR=2.763, 95% CI=1.443-5.292) and performance evaluation ( OR=0.498, 95% CI= 0.274-0.908), specialized education and professional experience ( OR=0.548, 95% CI= 0.334-0.871) were affecting the clinical nursing practice. Conclusion:The degree of professional autonomy of nurses in the Pediatric Nursing Alliance is in the middle and high level. Key factors affecting nursing practice including insufficient structural empowerment, lack of opportunities to continue learning, lack of nursing teams, lack of effectiveness evaluation and the lack of specialized education and work experience, which guiding the pediatric nursing alliance to continuously deepen the connotation of pediatric nursing professional and innovative team collaboration new model, utilize the advantages of resources to actively cultivate specialized nursing research personnel, carry out multi-disciplinary and cross-disciplinary cooperation, improve the nursing quality evaluation index system, so as to enhance the professional nursing service capacity and value.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause acute respiratory distress syndrome, hypercoagulability, hypertension, and multiorgan dysfunction. Effective antivirals with safe clinical profile are urgently needed to improve the overall prognosis. In an analysis of a randomly collected cohort of 124 patients with COVID-19, we found that hypercoagulability as indicated by elevated concentrations of D-dimers was associated with disease severity. By virtual screening of a U.S. FDA approved drug library, we identified an anticoagulation agent dipyridamole (DIP) , which suppressed SARS-CoV-2 replication . In a proof-of-concept trial involving 31 patients with COVID-19, DIP supplementation was associated with significantly decreased concentrations of D-dimers ( < 0.05), increased lymphocyte and platelet recovery in the circulation, and markedly improved clinical outcomes in comparison to the control patients. In particular, all 8 of the DIP-treated severely ill patients showed remarkable improvement: 7 patients (87.5%) achieved clinical cure and were discharged from the hospitals while the remaining 1 patient (12.5%) was in clinical remission.

Objective:To understand the psychological, behavioral and cognitive experience of patients receiving hemodialysis for a long time, so as to provide reference for the implementation of targeted nursing intervention.Methods:Using grounded theory research methods, 12 patients receiving long-term hemodialysis were given in-depth interviews and recordings, and the recordings were transcribed.Results:Psychological experience of patients who received hemodialysis for the first time included denial, despair, depression and acceptance. Behavioral experience included mainly self-psychological adjustment, positive and optimistic face, firm belief, cognitive disadvantage and active avoidance. Cognitive experience included family and social support and medical help.Conclusions:Medical staff need to strengthen the guidance of the negative psychology of newly diagnosed patients and increase their positive psychological experience. It is necessary to encourage patients to adopt suitable health and psychological adjustment methods and face the disease optimistically.

Objective? To further explore the promoting factors and obstructing factors of triage among emergency nurses by qualitative interview. Methods? We interviewed with emergency nurses at four ClassⅢ Grade A hospitals in Shanghai by purposive sampling until interview content was saturated. A total of 26 emergency nurses took part in this interview including 14 nurses of triage and 12 nurses with non-triage. The data were analyzed with the Colaizzi 7-step analysis method. Results? A total of 5 themes on obstructing factors were analyzed involving the nature of work, functional factors, environmental factors, psychological factors and interpersonal relation. There were 3 promoting factors involving the sense of belonging on profession, professional value and professional needs. Conclusions? Nursing managers should perfect triage training system, cultivate the team of triage, improve nursing management model and professional responsibility of triage nurses.

Objective To evaluate the efficiency of matrix assisted laser analytical ionization time of flight mass spectrometry(MALDI-TOF-MS)for identification of Candida species which caused vulvovaginal candidiasis(VVC).Methods Candida strains from VVC were first identified by PCR amplification of the ITS regions and transposable intron of DNA and sequencing analysis.MALDI-TOF-MS wasfurther performed to identify the strainsconfirmedby molecular methods, and at the same time the MALDI-TOF-MS identification database of C.albicans complex was set up.Results In total, 324 Candida strains were identifiedby molecular methods from VVC samples,which encompassed20 different yeast species, including C.albicans,C.africana,C.dubliniesis, C.glabrata, C.bracarensis, C.nivariensis, C.guilliermondii, C.lusitaniae,C.krusei,C.kefyr,C.parapsilosis,C.metapsilosis,C.tropicalis,Kodamaea ohmeri,C. fabianii, Rhodotorula mucilaginosa, Saccharomyces cerevisiae, and Trichosporon asahii.314of all 324 Candida strains were correctly identified by MALDI-TOF-MS.3 C.albicans,1 C.africana,1 C.glabrata, 2 C.metapsilosis,1 C.guilliermondii and 1 Saccharomyces cerevisiae were incorrectly identified, while 1 Torulaspora pretoriensiscannot identified.The accuracy ofidentification was 96.91 %(314/324).97.95%(191/195)of Candida strains, including 153(98.08%)C.albicans, 37(97.37%)C.africanaand 1 (100%)C.dubliniesis, can be correctly identifiedby the newbuiltC.albicans complex database. Conclusion MALDI-TOF-MS is proved to be a rapid and reliable method for identification of Candida strains from VVC,which also has advantages of identification of Candida complex.(Chin J Lab Med,2018, 41:296-299)

Objective To develop clinical practice guidelines for breastfeeding in neonates in hospital conforming to the situation in China by adaptation of existing guidelines.Methods According to ADAPTE methodology and current status of breastfeeding in neonates in hospital,we searched existing guidelines and systematic reviews of breastfeeding,used AGREE Ⅱ to evaluate the guidelines,content analysis method was used to select and integrate the content of the evidence,and feasibility investigation and expert external review were performed for the established guidelines.Results A total of 10 guidelines,3 evidence summaries and 4 systematic reviews were included,and the "Evidence-Based Guideline:Breastfeeding of Neonates in the Hospital" were established,involving 8 aspects:breastfeeding promotion,screening,expression,storage,transport,reception,procedures and quality management,and a total of 83 evidences were recommended,which were practical and recommended by all experts.Conclusion High quality evidence resources provided by the established clinical practice guideline can provide reliable evidence support for clinical practice.