Dual-Decoupling With Frequency-Spatial Domains for Image Manipulation Localization.

Leveraging trace-rich features within embedded spaces has been established as effective in image manipulation localization (IML). Nevertheless, the feature of manipulated traces frequently comprises substantial redundant information only loosely related to IML tasks. This complexity has hindered existing methods in fully comprehending the essence of trace features. In light of this challenge, we introduce a novel decoupling representation learning network (DRN) tailored for IML. The DRN excels at decoupling intricate multidomain information and transforming it into representations directly pertinent to IML objectives. This is achieved through a meticulously designed frequency decoupling representation learning module (FDM) and spatial decoupling representation learning module (SDM). Specifically, the FDM operates by acquiring distinct low and high-frequency components to effectively decouple redundant information. The decoupled high-frequency components are then harnessed as intricate trace complements, enhancing the overall aggregation process. In addition, the redundant information is expertly separated into authentic and manipulated representations through the use of channel activation maps in SDM. Through extensive experimentation on three public benchmarks including CASIA, NIST, and Coverage, our method consistently demonstrates superior performance and enhanced robustness compared with existing state-of-the-art methods.

Clinical Factors Influencing the Radiation Dose of Circulating Immune Cells during Radiotherapy for Small Cell Lung Cancer.

Small cell lung cancer (SCLC) has garnered significant attention due to its high malignancy, propensity for distant metastasis, and poor prognosis. Radiotherapy remains the cornerstone of treatment for limited-stage small cell lung cancer (LS-SCLC). However, outcomes with radiotherapy alone or in combination with chemotherapy remain suboptimal. Radiotherapy can induce lymphopenia by directly irradiating hematopoietic organs or destroying mature circulating lymphocytes, leading to immunosuppression and consequently diminishing therapeutic efficacy. The estimated dose of radiation to immune cells (EDRIC) model integrates factors such as hemodynamics, lymphocyte radiosensitivity, and proliferation capacity. This study employs the EDRIC model with enhancements to calculate the circulating immune cell radiation dose. By utilizing the EDRIC methodology, the study explores the correlation between EDRIC and tumor target size, average lung dose, average heart dose, clinical features, and peripheral blood lymphocytopenia during radiotherapy for LS-SCLC, aiming to inform personalized patient treatment strategies. This study analyzed data from 64 LS-SCLC patients who met the inclusion criteria at the General Hospital of Ningxia Medical University from January 2023 to January 2024, all of whom received radical thoracic conventional fractionated radiotherapy. Lymphocyte counts were recorded at the following points: before radiotherapy, at the lowest observed value during radiotherapy, at the end of radiotherapy, and one-month post-radiotherapy. Dosimetric data, including average lung, heart, and body doses, were extracted from the treatment planning system, and the circulating EDRIC was calculated using this model. The relationship between EDRIC values and therapeutic outcomes was analyzed. In LS-SCLC, the EDRIC model effectively predicts lymphocyte count reduction, correlating with planning target volume (PTV; cm3), TNM stage, and the percentage of target lesion shrinkage. Post-radiotherapy, there was a significant decrease in peripheral blood lymphocyte counts, with greater EDRIC values indicating more pronounced lymphocyte reduction.

Effect of Comprehensive Nursing Based on Risk Factors in Liver Cancer Patients Accepted Intervention Therapy On Quality of Life and Prognosis.

Objective: To explore the effect of comprehensive nursing measures, based on the risk factors of dementia, in liver cancer patients, who accepted intervention therapy. Methods: 86 patients met the inclusion criteria, and exclusion criteria were divided into an experimental group (EG group) and a control group (CG group). The general baseline data of age, sex, and education level of groups were evaluated before intervention. CG group adopted routine nursing measures, while EG group gave comprehensive nursing measures on the basis of routine nursing measures. Cognitive function, severity, Barthel index (BI), and quality of life were evaluated on admission day, discharge day, and three months after discharge. Results: The scores of cognitive function, mental state, and self-care ability of daily life in the EG group were significantly higher than those in the CG group on the day of discharge and 3 months after discharge. Three months after discharge, the quality of life total score of EG group was significantly higher than that in CG group, and the scores in the family role, language, activity, self-care ability, social role, thinking and social function were also higher than those in CG group (P < .05). Three months after discharge, the readmission rate and retraining rate in the EG group were significantly lower than those in the CG group (P < .05), but there was no significant difference in mortality between the two groups(P > .05). Conclusion: Comprehensive nursing measures based on prognostic factors in patients undergoing interventional therapy for hepatocellular carcinoma can more effectively enhance patient recovery.

Wearing individualized 3D printed oral stent to protect normal tissues in patients with nasopharyngeal carcinoma during radiotherapy.

PURPOSE: To demonstrate a new individualized 3D printed oral stent in radiotherapy of nasopharyngeal carcinoma (NPC) patients and carry out a comparative analysis combining with clinical case. MATERIAL AND METHODS: Thirty NPC patients treated in our institution from September 2021 to October 2022 were prospectively enrolled. An individualized 3D printed oral stent was designed for each patient, and one set of computed tomography (CT) slices were obtained with /without wearing the oral stent, respectively. After delineation of target volumes and organs at risk (OARs) on the two CT slices, we finished two treatment plans by using the same target objectives, critical constraints and plan setup for each patient. Finally, the dose distribution and other dosimetric parameters of target volumes and OARs between the two plans were compared. RESULTS: Tongue volume and tongue length outside of mouth was 10.4 ± 2.5 cm3 and 2.8 ± 0.6 cm, respectively, distance between dorsal surface of oral tongue and plate increased from 0.3 ± 0.3 cm to 2.2 ± 0.5 cm by wearing the oral stent. For the target volume, there was no significant difference. However, Dmax of tongue, tongue tip and periglottis decreased significantly from 6352.6 ± 259.9 cGy to 5994.9 ± 478.9 cGy, 3499.8 ± 250.6 cGy to 3357.7 ± 158.0 cGy and 6345.5 ± 171.0 cGy to 6133.4 ± 263.3 cGy, respectively (p = 0.000); Dmean of tongue, tongue tip and periglottis decreased significantly from 3714.7 ± 204.2 cGy to 3169.7 ± 200.9 cGy, 3060.8 ± 216.2 cGy to 2509.6 ± 196.7 cGy and 3853.3 ± 224.9 cGy to 3079.3 ± 222.0 cGy, respectively (p = 0.000). CONCLUSION: The individualized 3D printed oral stent can reduce the dose of oral tissues and organs, so as to reduce the oral adverse reactions and improve the compliance of patients and the quality of their life. The technique can be used in radiotherapy of NPC patients.

Circadian rhythm disturbance and delirium in ICU patients: a prospective cohort study.

BACKGROUND: Patients treated in the intensive care unit (ICU) may experience a reversal of day and night. The circadian rhythm in ICU patients can be disturbed. METHODS: To explore the relationship between ICU delirium and the circadian rhythms of melatonin, cortisol and sleep. A prospective cohort study was carried out in a surgical ICU of a tertiary teaching hospital. Patients who were conscious during the ICU stay after surgery and were scheduled to stay in the ICU for more than 24 h were enrolled. Serum melatonin and plasma cortisol levels were measured three times a day by drawing arterial blood on the first three days after ICU admission. Daily sleep quality was assessed by the Richard-Campbell Sleep Questionnaire (RCSQ). The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was performed twice a day to screen for ICU delirium. RESULTS: A total of 76 patients were included in this study, and 17 patients developed delirium during their ICU stay. Melatonin levels were different at 8:00 (p = 0.048) on day 1, at 3:00 (p = 0.002) and at 8:00 (p = 0.009) on day 2, and at all three time points on day 3 (p = 0.032, 0.014, 0.047) between delirium and non-delirium patients. The plasma cortisol level in the delirium patients was significantly lower than that in the non-delirium patients at 16:00 on day 1 (p = 0.025). The changes in melatonin and cortisol secretion levels exhibited obvious biological rhythmicity in non-delirium patients (p < 0.001 for melatonin, p = 0.026 for cortisol), while no rhythmicity was found in melatonin and cortisol secretion levels in the delirium group (p = 0.064 for melatonin, p = 0.454 for cortisol). There was no significant difference in RCSQ scores in the first three days between the two groups. CONCLUSIONS: The disturbance of the circadian rhythm of melatonin and cortisol secretion was associated with the development of delirium in ICU patients. Clinical staff should pay more attention to the importance of maintaining patients' normal circadian rhythms in the ICU. TRIAL REGISTRATION: The study was registered with the US National Institutes of Health ClinicalTrials.gov(NCT05342987) (25/04/2022).

The beliefs and attitudes of intensive care unit nurses and patient families regarding an open visitation policy in China.

AIMS: To investigate the beliefs and attitudes of intensive care unit (ICU) nurses and patients' family members towards an open visitation policy in the ICU in China and to explore the reasons that promote or hinder open visitation to improve visitation policy. BACKGROUND: Open visitation policies are widely recommended in many countries. However, there are gaps between evidence and practice. Most ICUs in China still use a restrictive policy for family visits, which raises controversy. There are limited visiting times, and family visitors are not allowed to enter the ICU. STUDY DESIGN: A multicentre survey was conducted in seven hospitals in China. The Beliefs and Attitudes towards Visitation in the Intensive Care Unit Questionnaire (BAVIQ) was administered to ICU nurses and patient families from 11 the ICUs of seven hospitals. A total of 275 questionnaires were completed and returned by ICU nurses and 139 by patients' family members. RESULTS: Among nurses, the belief scale score was 2.87 ± 0.33 (range 2-4), and the attitude scale score was 5.53 ± 1.12 (range 2.33-7). The belief scale was divided into three subscales: nurses, patients, and patients' families. The subscale score for patients' families was the highest, and the nurses' subscale score was the lowest. Most (84.0%) of the nurses were satisfied with the current ICU visitation policy. The belief and attitude scores were 3.13 ± 0.39 (range 1.96-4) and 6.18 ± 1.20 (range 1.67-7), respectively, for family members. The scores of the three subscales, that is, patients, patients' families and nurses, were 3.13 ± 0.40, 3.26 ± 0.43, and 3.04 ± 0.49, respectively. CONCLUSION: Nurses' beliefs and attitudes towards implementing an open visitation policy in China are at a less positive level than those of patient family members. RELEVANCE TO CLINICAL PRACTICE: The beliefs and attitudes of nurses towards open visitation policy in China need to be improved. The question of how to mobilize nurses' enthusiasm for an open visitation policy poses a challenge for ICU management.

Research on Voluntary Carbon Information Disclosure Mechanism of Enterprises from the Perspective of Stakeholders-A Case Study on the Automobile Manufacturing Industry.

As the primary source of carbon emissions, enterprises must work hard to save energy, reduce emissions, and disclose timely carbon information to the public. As a key means of communicating carbon management performance to stakeholders, carbon information disclosure is directly tied to the future sustainability of enterprises. Based on panel data of 118 listed firms in the automotive manufacturing industry from 2017 to 2021, this study rates the sample companies' quality of carbon information disclosure. The impact of the government, creditors, media, employees, and suppliers on such disclosure is also examined from the stakeholders' standpoint. The findings reveal that: (1) Although there has been a gradual increase in the degree of disclosure, overall levels are still low, and the willingness to voluntarily disclose is insufficient. (2) When other variables are neglected, the government, creditors, media, and employees all assist enterprises in disclosing carbon information, but the influence of suppliers will inhibit such disclosure. In the context of a complex economic system, the level of carbon disclosure is positively correlated with the government, the media, and employees, while negatively correlated with creditors. The influence of suppliers is not significant. These findings may aid in formulating related policies from different dimensions, directing enterprises to publish carbon information actively and strengthening carbon management.

Two-stage prediction model for postoperative delirium in patients in the intensive care unit after cardiac surgery.

OBJECTIVES: Postoperative delirium is a common severe complication in patients in the intensive care unit after cardiac surgery. We developed a two-stage prediction model and quantified the risk of developing postoperative delirium to assist in early prevention before and after surgery. METHODS: We conducted a prospective cohort study and consecutively recruited adult patients after cardiac surgery. The Confusion Assessment Method for patients in the intensive care unit was used to diagnose delirium 5 days postoperatively. The stage I model was constructed using patient demographics, health conditions and laboratory results obtained preoperatively, whereas the stage II model was built on both pre- and postoperative predictors. The model was validated internally using the bootstrap method and externally using data from an external cohort. RESULTS: The two-stage model was developed with 654 patients and was externally validated with 214 patients undergoing cardiac surgery. The stage I model contained 6 predictors, whereas the stage II model included 10 predictors. The stage I model had an area under the receiver operating characteristic curve of 0.76 (95% confidence interval: 0.68-0.81), and the stage II model's area under the receiver operating characteristic curve increased to 0.85 [95% confidence interval (CI): 0.81-0.89]. The external validation resulted in an area under the curve of 0.76 (95% CI: 0.67-0.86) for the stage I model and 0.78 (95% CI: 0.69-0.86) for the stage II model. CONCLUSIONS: The two-stage model assisted medical staff in identifying patients at high risk for postoperative delirium before and 24 h after cardiac surgery. This model showed good discriminative power and predictive accuracy and can be easily accessed in clinical settings. TRIAL REGISTRATION: The study was registered with the US National Institutes of Health ClinicalTrials.gov (NCT03704324; registered 11 October 2018).

Prediction models for postoperative delirium after cardiac surgery: Systematic review and critical appraisal.

BACKGROUND: Many studies have developed or validated prediction models to estimate the risk of delirium after cardiac surgery, but the quality of the model development and model applicability remain unknown. OBJECTIVES: To systematically review and critically evaluate currently available prediction models for delirium after cardiac surgery. DATA SOURCES: PubMed, EMBASE, and MEDLINE were systematically searched. This systematic review was registered in PROSPERO (Registration ID: CRD42021251226). STUDY SELECTION: Prospective or retrospective cohort studies were considered eligible if they developed or validated prediction models or scoring systems for delirium in the ICU. We included studies involving adults (age ≥18 years) undergoing cardiac surgery and excluded studies that did not validate a prediction model. DATA EXTRACTION: Data extraction was independently performed by two authors using a standardized data extraction form based on the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies checklist. Quality of the models was assessed with the Prediction Model Risk of Bias Assessment Tool (PROBAST). DATA SYNTHESIS: Of 5469 screened studies, 13 studies described 10 prediction models. The postoperative delirium incidence varied from 11.3 % to 51.6 %. The most frequently used predictors were age and cognitive impairment. The reported areas under the curve or C-statistics were between of 0.74 and 0.91 in the derivation set. The reported AUCs in the external validation set were between 0.54 and 0.90. All the studies had a high risk of bias, mainly owing to poor reporting of the outcome domain and analysis domain; 10 studies were of high concern regarding applicability. CONCLUSIONS: The current models for predicting postoperative delirium in the ICU after cardiac surgery had a high risk of bias according to the PROBAST. Future studies should focus on improving current prediction models or developing new models with rigorous methodology.

Effects of Enteral Nutrition on Patients With Oesophageal Carcinoma Treated With Concurrent Chemoradiotherapy: A Prospective, Multicentre, Randomised, Controlled Study.

Background: The oesophageal carcinoma patients show high incidence of malnutrition, which negatively affects their therapy outcome. Moreover, benefits of enteral nutrition remain to be studied in details in these patients. Therefore, we set to assess the effects of enteral nutrition on the nutritional status, treatment toxicities and survival in the oesophageal carcinoma patients treated with concurrent chemoradiotherapy (CCRT). Materials and Methods: Eligible patients were randomly assigned to either the experimental or control group. The patients in the experimental group were treated with a whole-course enteral nutrition management, while the control group were provided a unsystematic nutrition without setting intake goals for energy and protein. The primary endpoint was a change in body weight, while the secondary endpoints included nutrition-related haematological indicators, toxicities, completion rate of treatment and survival. Results: A total of 222 patients were randomised to either the experimental (n=148) or control (n=74) group. Patients in the experimental group showed significantly less decrease in body weight, serum albumin and haemoglobin levels, a lower incidence rates of grade ≥3 myelosuppression and infection, and a higher completion rate of CCRT than those in the control group. While analyses of the 2 and 3 year overall survival (OS) and progression-free survival (PFS) did not reveal differences between these groups, we observed a significantly higher OS at 1 year (83.6% vs. 70.0%). In the subgroup analysis, patients with patient-generated subjective global assessment (PG-SGA)=C were likely to have better OS and PFS with enteral nutrition. Conclusions: In EC patients treated with CCRT, enteral nutrition conferred positive effects on the nutritional status, treatment toxicities and prognosis, which mandate its inclusion in clinical practice. Clinical Trial Registration: This prospective trial has been registered with www.clinicaltrials.gov as NCT02399306.

A modified Delphi study on establishing a curriculum content structure for the leadership and management competency cultivation for future nurse managers in China.

Background: It is critical to train future nursing managers in advance for the prospective development of healthcare organizations, but a widely recognized curriculum content structure for leadership and management competency development for nurturing future nurse managers was lacking in China. Objective: To establish a curriculum content structure for the leadership and management competency cultivation for future nurse managers in Chinese healthcare setting. Methods: A modified Delphi study was conducted. 22 experts who have in-depth knowledge of nursing leadership and management from 4 main geographical regions in China were included. The initial curriculum content structure was constructed based on a previous qualitative study and two team meetings. Subsequently, a two-round Delphi survey was conducted with 22 panelists in the first round and 19 in the second round. Scores of importance and textual comments were collected and used to judge the achievement of consensus. Results: After the two-round Delphi process, consensus was reached, as each item was rated ≥4 by 84.21-100% of the experts and each one had a coefficient of variance (CV) ≤ 0.174. The finalized curriculum content contains 9 modules and 27 items. Conclusions: This study formed a curriculum content structure for leadership and management competency training for nurses preparing for managerial roles, which contribute to the establishment of a nursing management talent pipeline to meet the needs of healthcare institutions for contemporary nurse managers.

Effect of a nursing intervention strategy oriented by Orem's self-care theory on the recovery of gastrointestinal function in patients after colon cancer surgery.

OBJECTIVE: To investigate the effect of nursing intervention strategies based on the Orem self-care theory on the recovery of gastrointestinal function in patients after colon cancer surgery. METHODS: In this prospective study, a total of 115 patients with colon cancer who had radical resection of the colon cancer tissue were selected as the research subjects and randomized into two groups: an Orem group (59 cases), which was given nursing based on the Orem self-care model and a control group (56 cases), which was given regular nursing. The postoperative recovery of the two groups was compared. RESULTS: After the intervention, the time to first getting out of bed, gastric tube removal, first postoperative flatus, first fluid food intake and general food intake were significantly earlier than those of the control group. Time of intestinal peristalsis and the average length of hospital stay of the Orem group were much shorter than those of the control group (all P<0.001). The cost of nutrient supply of the Orem group was significantly lower than that of the control group (P<0.001), and the postoperative pain and incidence of complications of patients in the Orem group were significantly lower than those in the control group (P<0.05). After 3 months of follow-up, the scores of positive attitude, intimacy and total score of hope in the hope level of the patients in the Orem group were significantly higher than those in the control group (all P<0.01). There was no significant difference in the positive action scores (P>0.05). Besides, the scores of the Orem group in all dimensions of the quality of life were significantly higher than those of the control group (all P<0.01). CONCLUSION: Nursing intervention based on the Orem self-care theory can promote the recovery of patients with colon cancer after surgery, speed up the recovery of their gastrointestinal function, and ultimately improve their level of hope and quality of life. Therefore, it is worthy of promotion in clinical practice.

The predictive prognostic values of serum interleukin-2, interleukin-6, interleukin-8, tumor necrosis factor-α, and procalcitonin in surgical intensive care unit patients.

BACKGROUND: The pathophysiological roles of serum cytokine levels in critically ill surgical patients has yet to be determined. This study aimed to determine the predictive prognostic values of serum interleukin IL-2, IL-6, IL-8, tumor necrosis factor-α (TNF-α), and procalcitonin (PCT) in surgical intensive care unit (ICU) patients. METHODS: Cytokine concentrations were measured with an IMMULITE 1000 Immunoassay System (Siemens Healthcare Diagnostics GmbH, Berlin, Germany). The study population was divided into quartiles according to the patients' cytokine levels: Q1, Q2, Q3, and Q4. The optimal cutoff values of IL-2, IL-6, IL-8, TNF-α, and PCT level for predicting mortality were established by drawing receiver operating characteristic curves. RESULTS: The levels of IL-2 in Q3 [odds ratio (OR) =4.434, 95% confidence intervals (95% CI): 1.527-12.874] and Q4 (OR =7.715, 95% CI: 2.744-21.693) were significantly higher than those in the Q1. The same results were noted in IL-6 and IL-8, and only Q4 (OR =2.383, 95% CI: 1.419-4.001) showed significance in the level of TNF-α. For IL-2, a cutoff value of 930.5 U/mL yielded a sensitivity of 69.39% and a specificity of 80.16% for the prediction of clinical outcome [area under the curve (AUC): 0.822; 95% CI: 0.789-0.855]. For IL-6, a cutoff value of 50.95 pg/mL showed discrimination ability, yielding a sensitivity of 71.43% and a specificity of 61.75% for (AUC: 0.704; 95% CI: 0.660-0.748). For IL-8, a cutoff value of 44.1 pg/mL yielded a sensitivity of 57.82% and a specificity of 79.58% for predicting clinical outcome (AUC: 0.753; 95% CI: 0.713-0.793). For TNF-α, a cutoff value of 11.95 pg/mL yielded a sensitivity and specificity of 68.66% and 72.90%, respectively, in predicting clinical outcome (AUC: 0.758; 95% CI: 0.717-0.800). The positive likelihood ratios for IL-2, IL-6, IL-8, and TNF-α were 3.50, 1.87, 2.83 and 2.53, and the negative likelihood ratios were 0.38, 0.46, 0.53, and 0.43, respectively. CONCLUSIONS: In critically ill patients, high levels of IL-2, IL-6, IL-8, and TNF-α in the first 24 h postoperatively were associated with clinical outcome. However, the effect of PCT level on prognosis still requires further study.

In situ constructed zeolite membranes on rough supports with the assistance of reticulated hydrotalcite interlayer.

Zeolite membranes with unique physical and chemical properties are emerging as attractive candidates for membrane separation. However, defects in the zeolite layer seriously affect their molecular sieving performance. In this study, a novel strategy for preparing compact zeolite membranes on rough supports with the assistance of a reticulated hydrotalcite layer was developed. The reticulated hydrotalcite layer was grown on the inner surface of a 170 mm length ceramic tube by an in situ hydrothermal method, and a NaA zeolite membrane was prepared on this reticulated layer by the microwave-heating method. The hydrotalcite interlayer could not only improve the smoothness and regularity of the surface of the support but also fix the Si/Al active ingredients using its reticulate structure, finally effectively improving the quality and stability of the zeolite layer. The optimal molar ratio of the synthesis solution for the synthesis of the zeolite membrane was 3Na2O : 2SiO2 : Al2O3 : 200H2O. The permeance flux of H2 through the zeolite membrane synthesized under the optimal conditions was high as 0.47 × 10-6 mol m-2 s-1 Pa-1, and its permselectivity for H2 over N2 was 4.7, which was higher than the corresponding Knudsen diffusion coefficient. This study provides a new idea for the preparation of defect-free membranes on rough supports.

Family satisfaction in the intensive care unit: The influence of disease severity, care relationship, patient anxiety and patient pain.

BACKGROUND: There is little empirical evidence that can be used to identify factors associated with family satisfaction in the context of the intensive care unit, especially from the perspectives of the patient and patient-family member interactions. OBJECTIVES: To explore the influence of disease severity, care relationship, anxiety, and pain of patients on family satisfaction in the intensive care unit. STUDY DESIGN: A cross-sectional descriptive and exploratory study was conducted in the Surgical unit in the Zhongshan Hospital Fudan University, Shanghai, China. METHODS: A total of 227 patients and their family member dyads were included and surveyed. The dependent variable family satisfaction was measured by the Chinese version of the critical care family satisfaction survey. The independent variables included patient characteristics, care relationship, disease severity, patient anxiety, and patient pain. Disease severity was assessed by The Acute Physiology and Chronic Health Evaluation II. Patient anxiety was measured using the Self-Rating Anxiety Scale. Patient pain was measured with Numeric rating scale. RESULTS: Patients with higher self-rating anxiety scores (OR 0.92, 95% CI 0.87-0.97) were less likely to have higher family satisfaction for their family member dyad. However, those with mild perceived pain (OR 5.21, 95% CI 1.97-13.80) were more likely to have higher family satisfaction for their family member dyad. Disease severity and care relationship showed no significant associations with family satisfaction. CONCLUSIONS: Future interventions may include open communication with family members giving explanations regarding the physical and psychological condition of the patient, care delivered and interventions received.

External use of Mirabilite combined with Lactulose improves postoperative gastrointestinal mobility among older patients undergoing abdominal surgery.

AIMS: To evaluate the feasibility and efficacy of Mirabilite combined with Lactulose in older patients after abdominal surgery. DESIGN: It is a retrospective observational cohort study with a pre and post intervention group. METHODS: Medical records were retrospectively reviewed of postoperative Intensive Care patients with postoperative gastrointestinal tract dysfunction (aged >60 years) in the Surgical Intensive Care Unit from January 2017-December 2018. RESULTS: One hundred and sixty-seven post-surgical Intensive Care patients with postoperative gastrointestinal tract dysfunction were analysed; 74 patients received Mirabilite + Lactulose treatment and 93 patients received Lactulose treatment. The recovery rate of bowel sounds was better in the Mirabilite + Lactulose group (62.16%) compared with the Lactulose group (37.63%) after 3-day treatment (p = 0.002) and the relative risk (RR) was 1.65 (95% CI, 1.20, 2.27). Moreover 70.27% patients in the Mirabilite + Lactulose group finally had flatus or defecation compared with 46.24% patients in Lactulose group (p = 0.003) and the RR was 1.52 (1.17, 1.98). The abdominal girth and Inter Abdominal Pressure in Mirabilite + Lactulose group showed significantly greater decrease over a 3-day period compared with Lactulose group (4.86 vs. 3.46 cm, p = 0.027; 4.80 vs. 3.11 mmHg, p = 0.002 respectively). The pain score had greater decrease from the baseline in Mirabilite + Lactulose group than in Lactulose group (2.40 vs. 1.11; p < 0.01). Patients in the Mirabilite + Lactulose group had shorter hospital stay than the Lactulose group 12.5 (SD 3.51) versus 13.9 (SD 5.14), p = 0.05. CONCLUSIONS: This study demonstrated that external use of Mirabilite combined with Lactulose can be considered as an easy intervention to improve postoperative gastrointestinal mobility in older intensive care patients who suffer from postoperative gastrointestinal tract dysfunction after surgery. IMPACT: Our results provide a great option to alleviate the sufferings of postoperative patients. The externally use Mirabilite is a painless and safe interventions that is easy to implement by ICU nurses.

Stress, Burnout, and Coping Strategies of Frontline Nurses During the COVID-19 Epidemic in Wuhan and Shanghai, China.

Background: Nurses at the frontline of caring for COVID-19 patients might experience mental health challenges and supportive coping strategies are needed to reduce their stress and burnout. The aim of this study was to identify stressors and burnout among frontline nurses caring for COVID-19 patients in Wuhan and Shanghai and to explore perceived effective morale support strategies. Method: A cross-sectional survey was conducted in March 2020 among 110 nurses from Zhongshan Hospital, Shanghai, who were deployed at COVID-19 units in Wuhan and Shanghai. A COVID-19 questionnaire was adapted from the previous developed "psychological impacts of SARS" questionnaire and included stressors (31 items), coping strategies (17 items), and effective support measures (16 items). Burnout was measured with the Maslach Burnout Inventory. Results: Totally, 107 (97%) nurses responded. Participants mean age was 30.28 years and 90.7% were females. Homesickness was most frequently reported as a stressor (96.3%). Seven of the 17 items related to coping strategies were undertaken by all participants. Burnout was observed in the emotional exhaustion and depersonalization subscales, with 78.5 and 92.5% of participants presenting mild levels of burnout, respectively. However, 52 (48.6%) participants experienced a severe lack of personal accomplishment. Participants with longer working hours in COVID-19 quarantine units presented higher emotional exhaustion (OR = 2.72, 95% CI 0.02-5.42; p = 0.049) and depersonalization (OR = 1.14, 95% CI 0.10-2.19; p = 0.033). Participants with younger age experienced higher emotional exhaustion (OR = 2.96, 95% CI 0.11-5.82; p = 0.042) and less personal accomplishment (OR = 3.80, 95% CI 0.47-7.13; p = 0.033). Conclusions: Nurses in this study experienced considerable stress and the most frequently reported stressors were related to families. Nurses who were younger and those working longer shift-time tended to present higher burnout levels. Psychological support strategies need to be organized and implemented to improve mental health among nurses during the COVID-19 pandemic.

Prevalence, Predictors, and Early Outcomes of Post-operative Delirium in Patients With Type A Aortic Dissection During Intensive Care Unit Stay.

Objectives: The aim of this study was to investigate the prevalence and explore the predictors and early outcomes of post-operative delirium (POD) in patients with type A aortic dissection (AAD) during intensive care unit (ICU) stays. Methods: We retrospectively reviewed the records of 301 patients with AAD who underwent surgical treatment in our institution from January 2017 to December 2018. Results: Delirium developed in 73 patients (24.25%) during the ICU stay. Patients with lower estimated glomerular filtration rates [odds ratio (OR) 0.84, 95% CI 0.74-0.94, p = 0.003], post-operative midazolam use (OR 2.37, 95% CI 1.33-4.23, p = 0.004), and post-operative morphine use (OR 1.87, 95% CI 1.07-3.29, p = 0.029) were more susceptible to developing POD. Patients who developed POD had a longer ICU stay (11.52 vs. 7.22 days, p < 0.001) and hospital stay (23.99 vs. 18.91, p = 0.007) with higher hospitalization costs (48.82 vs. 37.66 thousand dollars, p < 0.001) than those without POD. The in-hospital mortality rate was higher in the delirium group, but the difference was not significant (6.85 vs. 4.82%, p = 0.502). Conclusions: The incidence of POD in patients with AAD was high and was associated with renal dysfunction and the use of midazolam and morphine. POD was associated with poor early outcomes, suggesting the importance of early screening, such as for renal dysfunction, and prevention by using sedation scales to minimize the use of midazolam and morphine in these patients.

Synthetic Evaluation of China's Regional Low-Carbon Economy Challenges by Driver-Pressure-State-Impact-Response Model.

The "driver-pressure-state-impact-response" (DPSIR) model has recently become a popular approach to deal with environmental problems. The combination of DPSIR with analytic hierarchy process (AHP) is a useful method to study low-carbon evaluation because the AHP model has a special advantage in multi-indexes evaluation. This paper constructs the low-carbon economy evaluation system and comprehensively evaluates the numerical value of low-carbon economic development of China's 30 regions from 2000 to 2015 by using the AHP method. It shows that the numerical value of low-carbon economy of China's 30 regions varies in terms of growth rate. The numerical value of east regional low-carbon economy shows a pattern that is gradually higher than that of the west region. The numerical value of low carbon economic development in the south region is higher than that of the north region by degrees. In addition, based on the model of coordination degree in 2015, the result indicated that the four subsystems have primary coordination in the east area and bare coordination in the central and west areas. It is indicated that the four sub-indexes should be developed at the same pace and promoting the development of a low-carbon economy in the mid-west areas is the key in China. Finally, we proposed that environmental regulations and policies should be formulated to improve coordination in various aspects and various departments. Calculating the degree of low-carbon economic coupling coordination may be helpful for policy makers to formulate effective policies and take actions in the future.