Risk Factors of Intraoperative Pressure Injury in Adult Patients Undergoing Neurologic Surgery.

GENERAL PURPOSE: To present research investigating the incidence of and risk factors associated with intraoperative pressure injury in patients undergoing neurologic surgery at Xiangya Hospital, Central South University in China. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Identify the incidence of intraoperative pressure injuries (PIs) in patients undergoing neurologic surgery at Xiangya Hospital, Central South University in China.2. Describe risk factors for intraoperative PI.3. Outline strategies to help mitigate intraoperative PI risk.

Intraoperative pressure injury (PI) development is an adverse event that impacts thousands of patients globally and is associated with extended hospital stays and increased risk of mortality. To investigate the incidence of intraoperative PI in patients undergoing neurologic surgery and identify associated risk factors. A total of 1,728 patients who underwent neurosurgery in Xiangya Hospital, Central South University between January 2021 and December 2022 were included in this retrospective study. The authors collected patients' demographic data and clinical characteristics and used univariate and multivariate regression to evaluate significant PI risk factors. Intraoperative PI was observed in 1.8% of all surgical cases (n = 31). Having a body mass index greater than 24 kg/m2 (odds ratio, 3.87; 95% CI, 1.62­9.23; P = .002), being in a lateral position (odds ratio, 2.53; 95% CI, 1.04­6.17; P = .042) or a prone position (odds ratio, 10.43; 95% CI, 3.37­32.23; P < .001), and having a longer operation time (cutoff point at 7.92 hours for increased risk of PI; odds ratio, 1.36; 95% CI, 1.21­1.53; P < .001) were significant risk factors for intraoperative PI. This study identified three independent risk factors for intraoperative PI development: body position, surgery duration, and high body mass index. These findings can help OR nurses identify patients who are vulnerable to intraoperative PI and provide appropriate preventive measures. For these patients, perioperative protection and frequent microrepositioning during surgery would be indispensable.

Cost-effectiveness comparison of routine transfusion with restrictive and liberal transfusion strategies for surgical patients in China.

BACKGROUND AND OBJECTIVES: A health industry standard recommending restrictive transfusion is to be in effect in China in April 2019. We aim to explore its potential economic and clinical impacts among surgical patients. MATERIALS AND METHODS: A decision tree model was applied to compare cost-effectiveness of current routine transfusion in China, a restrictive (transfusion at Hb < 8 g/dl or ischaemic symptoms) and a liberal (transfusion at Hb < 10 g/dl) strategy. Parameters were estimated from empirical data of 25 227 surgical inpatients aged ≥30 years in a multicenter study and supplemented by meta-analysis when necessary. Results are shown for cardio-cerebral-vascular (CCV) surgery and non-CCV (orthopaedics, general, thoracic) surgery separately. RESULTS: Per 10 000 patients in routine, restrictive, liberal transfusion scenarios, total spending (transfusion and length of stay related) was 7·67, 7·58 and 9·39 million CNY (1 CNY × 0.157 = 1 US dollar) for CCV surgery and 6·35, 6·70 and 8·09 million CNY for non-CCV surgery; infectious and severe complications numbered 354, 290, and 290 (CCV) and 315, 286, and 330 (non-CCV), respectively. Acceptability curves showed high probabilities for restrictive strategy to be cost-effective across a wide range of willingness-to-pay values. Such findings were mostly consistent in sensitivity and subgroup analyses except for patients with cardiac problems. CONCLUSION: We showed strong rationale, succeeding previous findings only in cardiac or joint procedures, to comply with the new standard as restrictive transfusion has high potential to save blood, secure safety, and is cost-effective for a wide spectrum of surgical patients. Experiences should be further summarized to pave the way towards individualized transfusion.

[Application of heterogeneous VIKOR method in surgical selection for a case of rectal cancer].

According to the literature and expert experience, a comprehensive index system of subjective and objective was established, including the patient's condition, the treatment information for the same kind of patients, technical level of the medical team, and the medical conditions. Secondly, in the light of the heterogeneous evaluation information, the comprehensive index weight was computed by combining subjective weight and objective entropy weight. Furthermore, the VIKOR method was applied to deal with heterogeneous evaluation information and obtain the priority of potential surgical treatments. Taking a rectal cancer patient in a general hospital in Hunan Province as an example, the optimal surgical treatment obtained by this method was consistent with the actual treatment. The reliability and effectiveness of the heterogeneous VIKOR method based on probabilistic linguistic term sets are verified by an experimental example of rectal cancer, and the method can be used to help doctors, patients and family members to select the surgical treatments for rectal cancer effectively.

Impact of a Task-Grabbing System for surgical technicians on operating room efficiency.

The purpose of this study was to evaluate the effect of the Task-Grabbing System on operating room efficiency. Based on the competition-driven concept of the 'Uber' app, an Task-Grabbing System was designed for task allocation and quality assessment. We implemented the Task-Grabbing System in our hospital operating room and compared the differences in consecutive operation preparation time, turnover time, and task completion time performed by surgical technicians for tasks such as patient pick-up, operating room cleaning, medical equipment recovery, three-piece set delivery, as well as blood gas analysis and intraoperative specimen submission before (October 2019) and after (December 2019) the implementation of the Task-Grabbing System. After the implementation of the Task-Grabbing System, the consecutive operation preparation time was reduced from the average of 43.56-38.55 min (P < 0.05), and the turnover time was decreased from the average of 14.25-12.61 min (P < 0.05). And the respective time consuming of surgical technicians for patients picking up, operating room cleaning, medical facilities recovering, the three-piece set delivering, blood gas analysis sending and intraoperative specimen submitting was significantly shortened (P < 0.05). The Task-Grabbing System could improve the operating room efficiency and effectively mobilize the enthusiasm and initiative of the surgical technicians.

The preventive and relieving effects of ginger on postoperative nausea and vomiting: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Postoperative nausea and vomiting are common uncomfortable symptoms experienced by patients. Besides drugs, non-pharmaceutical therapies such as herbal medicine therapy are available. Ginger has played a therapeutic role in patients undergoing chemotherapy and pregnant women, but results from postoperative patients are inconsistent. OBJECTIVES: The aim of this study was to examine and evaluate the preventive effect of ginger on postoperative nausea and vomiting. DESIGN: A systematic review and meta-analysis of randomized controlled trials METHODS: Two independent researchers searched Chinese and English databases from their inception dates to November 2020. The Chinese databases used were CNKI and SinoMed, and the English databases used were PubMed, Embase, and the Cochrane Library. We only included randomized controlled trials. The primary outcomes were nausea score, presented as standard mean difference, and the number of vomiting episodes, presented as risk ratio. The secondary outcomes were side effects and antiemetic drug use, presented as risk ratios. We used the random-effects model. RESULTS: Fourteen randomized trials with a total of 1,506 patients were pooled. At the different time points, the control group had higher postoperative nausea scores than the experimental group, and the differences were significant between the ginger and placebo groups at 2, 6, and 12 h after operation, with standard mean differences and 95% confidence intervals of -1.10 and -1.95 to -0.25, -1.54 and -3.05 to -0.03, and -2.04 and -3.67 to -0.41, respectively. Except in the recovery room, no statistically significant correlation was found between ginger intake and postoperative vomiting, postoperative nausea and vomiting, or antiemetic drug use. CONCLUSION: The results of this meta-analysis demonstrate that ginger can reduce postoperative nausea but showed no significant difference in the incidence rates of postoperative vomiting, postoperative nausea and vomiting, and antiemetic drug use. More high-quality and rigorous trials are needed to elucidate the relationship between ginger intake and the reduction in the incidence of postoperative nausea and vomiting. PROTOCOL REGISTRATION: CRD42020220916.

Perceived stress, coping style and burnout of Chinese nursing students in late-stage clinical practice: A cross-sectional study.

AIM: The aim of this study was to examine the levels of stress, coping style and burnout among Chinese nursing students in late-stage clinical practice and to identify their relationships. BACKGROUND: High stress, passive coping and burnout among nursing students in late-stage clinical practice may contribute to severe psychological consequences. DESIGN: A descriptive and cross-sectional study was conducted in November and December 2020. METHODS: Participants completed the Perceived Stress Scale, Simplified Coping Style Questionnaire and Maslach Burnout Inventory-Human Service Survey to examine their stress levels, coping style and burnout. Intention to leave the profession was also assessed. RESULTS: Approximately 36.1 % of nursing students experienced emotional exhaustion and 85.3 % of nursing students perceived themselves to have moderate to high stress levels. A positive coping style can protect nursing students from depersonalization and reduced personal accomplishment. High stress and passive coping style predicted emotional exhaustion. Passive coping style and high stress were significant factors leading to intention to quit nursing education before graduation. CONCLUSIONS: Lowering the level of stress and using positive coping behaviors may help students during late internship to mitigate burnout and avoid leaving nursing education. Therefore, nurse educators and clinical nursing mentors need to consider developing strategies and interventions to reduce the decline in nursing students entering nursing education and prevent burnout.

The influence of mobile phone addiction and work procrastination on burnout among newly graduated Chinese nurses.

PURPOSE: The study was conducted to explore the relationship between mobile phone addiction, work procrastination, and burnout among newly graduated nurses. DESIGN AND METHODS: A cross-sectional survey involving 220 newly graduated nurses in China was conducted from June to July 2020. FINDINGS: Approximately 60.9% of newly graduated nurses experienced occupational burnout; 72.7% of newly graduated nurses were characterized by moderate or greater procrastination and mobile phone addiction was at a moderate level. Mobile phone addiction and work procrastination were significant factors leading to emotional exhaustion and cynicism. Work procrastination was also an independent predictor of reduced professional efficacy. PRACTICE IMPLICATIONS: Reducing the level of mobile phone addiction and work procrastination among newly graduated nurses might be effective for burnout prevention.

Mobile phone addiction and its association with burnout in Chinese novice nurses: A cross-sectional survey.

AIM: To explore the levels of mobile phone addiction and burnout and their relationships among novice nurses. DESIGN: A cross-sectional investigation design. METHODS: Questionnaires were distributed to 400 novice nurses in five public hospitals in China. A total of 366 participants completed the survey. Data collected in 2020 were analysed by using descriptive statistics, an independent t test and Pearson's correlation analysis. RESULTS: The results showed that the frequency of nursing adverse events was associated with higher level of mobile phone addiction in novice nurses, and 52.46% of the participants (N = 366) presented a high level of occupational burnout. Moreover, the results indicated that there was a positive correlation between the novice nurses' mobile phone addiction level and burnout (r = .33, p < .01). CONCLUSION: The level of mobile phone addiction may affect nursing adverse events and nurses' burnout. Education on novice nurses' mobile phone use seems necessary to ensure patient safety and burnout prevention. IMPACT: Findings of this study expanded important knowledge about mobile phone addiction and its potential influence on nursing safety and nurse burnout and may place significant implications to staff nurse management and in-service education.

Evaluating Surgical Risk Using FMEA and MULTIMOORA Methods under a Single-Valued Trapezoidal Neutrosophic Environment.

BACKGROUND: Human errors during operations may seriously threaten patient recovery and safety and affect the doctor-patient relationship. Therefore, risk evaluation of the surgical process is critical. Risk evaluation by failure mode and effect analysis (FMEA) is a prospective technology that can identify and evaluate potential failure modes in the surgical process to ensure surgical quality and patient safety. In this study, a hybrid surgical risk-evaluation model was proposed using FMEA and multiobjective optimization on the basis of ratio analysis plus full multiplicative form (MULTIMOORA) method under a single-valued trapezoidal neutrosophic environment. This work aimed to determine the most critical risk points during the surgical process and analyze corresponding solutions. METHODS: A team for FMEA was established from domain experts from different departments in a hospital in Hunan Province. Single-valued trapezoidal neutrosophic numbers (SVTNNs) were used to evaluate potential risk factors in the surgical process. Cmprehensive weights combining subjective and objective weights were determined by the best-worst method and entropy method to differentiate the importance of risk factors. The SVTNN-MULTIMOORA method was utilized to calculate the risk-priority order of failure modes in a surgical process. RESULTS: The hybrid FMEA model under the SVTNN-MULTIMOORA method was used to calculate the ranking of severity of 21 failure modes in the surgical process. An unclear diagnosis is the most critical failure in the surgical process of a hospital in Hunan Province. CONCLUSION: The proposed model can identify and evaluate the most critical potential failure modes of the surgical process effectively. In addition, such a model can help hospitals to reduce surgical risk and improve the safety of surgery.

Identification of disrupted pathways associated with colon cancer based on combining protein-protein interactions and pathway data.

OBJECTIVE: The objective of this paper was to identify the disrupted pathways associated with colon cancer at a network level based on protein-protein interaction (PPI) network and pathway analysis. MATERIALS AND METHODS: First of all, the Affymetrix microarray data of colon cancer, human PPIs relationships, and human pathways existed in the database were recruited and preprocessed. Second, differentially expressed genes (DEGs) between colon cancer and normal controls were identified. In the following, an objective PPI network was constructed using these DEGs. Ultimately, we calculated the disrupted pathways based on the intersection between pathway network and the objective network. Meanwhile, the topological centrality (degree) analysis was performed to explore the hub genes in the objective network. RESULTS: In our study, an objective network consisted of 2288 PPI pairs by 574 DEGs were constructed. In addition, ten disrupted pathways whose number of intersection was not <22 between objective network and each pathway, as well as P < 0.05, was selected. Furthermore, a total of 22 hub genes in the objective network were selected based on degree >30. Last, seven out of the above ten pathways were validated to involve in the intersections of pathway network and objective network. Moreover, cell cycle was the most significant disrupted pathway. CONCLUSIONS: We successfully identified several biologically disrupted pathways, and these pathways might be potential biomarkers in detection and treatment for colon cancer.