A Delphi Study to Construct an Index of Practice for Community Nurses Providing Transitional Home Care for Patients with Chronic Diseases.

Community nurses play a key role in providing continuous home care for patients with chronic diseases. However, a perfect system of responsibilities and requirements has not yet been formed, and nurses cannot provide high-quality nursing services for home-based patients. We attempted to construct an index of the scope of practice for community nurses providing home-based transitional care for patients with chronic diseases and to guide nurses in playing an active role in transitional care work. From March to May 2023, 14 representative community nurses from the Shanghai Community Health Service Center were selected for group interviews and 2 rounds of Delphi consultation. A total of 14 valid questionnaires were collected. The authority coefficients were 0.94 and 0.93, and the Kendall coefficients were 0.56 and 0.59 for the 2 rounds of expert consultation (P < .05). Finally, an index system, including 6 primary indices (transitional caring provider, patient self-management facilitator, community group intervention organizer, home caregiver supporter, family physician team collaborator and supervisor of home medical equipment use, and medical waste disposal) was constructed for community nurses involved in providing home-based transitional care for patients with chronic diseases. The weight values of the 6 indices were 0.19, 0.17, 0.21, 0.13, 0.14 and 0.16, respectively (CR = 0.035, and the consistency test was passed), and 16 secondary indicators and 42 tertiary indicators were identified. In this Delphi study, an index system that can be used to determine community nurses' roles in providing home-based transitional and continuous care for patients with chronic diseases was successfully established. The index system is considered reliable and easy to use and will provide a meaningful reference for community nurses and policy-makers.

Relationship between workplace violence, job satisfaction, and burnout among healthcare workers in mobile cabin hospitals in China: Effects of perceived stress and work environment.

Background: Although workplace violence is prevalent in the healthcare system, the relationship between workplace violence, job satisfaction, and burnout among healthcare workers (HCWs) in mobile cabin hospitals in China during the COVID-19 pandemic has not yet been investigated. This study analyzes the mediating effects of perceived stress and work environment in the relationship between workplace violence, job satisfaction, and burnout. Methods: A cross-sectional study was conducted in December 2022 on 1,199 frontline HCWs working in mobile cabin hospitals in Chongqing, China, during the COVID-19 pandemic. Multiple linear regression and mediation analysis were performed. Results: A positive correlation was observed between workplace violence and burnout (r = 0.420, P < 0.01) and perceived stress (r = 0.524, P < 0.01), and a negative correlation was observed with job satisfaction (r = -0.254, P < 0.01). The perceived stress was positively correlated with burnout (r = 0.528, P < 0.01) and negatively with job satisfaction (r = -0.397, P < 0.01). Job satisfaction was negatively correlated with burnout (r = -0.300, P < 0.01). Perceived stress plays a significant mediating role between workplace violence and job burnout and between workplace violence and job satisfaction. The work environment has a significant moderating effect between workplace violence and job burnout and between workplace violence and job satisfaction. Conclusion: To reduce burnout among HCWs, hospital administrators should focus on reducing the incidence of workplace violence and perceived stress from work and on improving the work environment and job satisfaction.

Foodborne Pathogen and Microbial Community Differences in Fresh Processing Tomatoes in Xinjiang, China.

The microbes on fresh processing tomatoes correlate closely with diseases, preservation, and quality control. Investigation of the microbial communities on processing tomatoes from different production regions may help define microbial specificity, inform disease prevention methods, and improve quality. In this study, surface microbes on processing tomatoes from 10 samples in two primary production areas of southern and northern Xinjiang were investigated by sequencing fungal internal transcribed spacer and bacterial 16S rRNA hypervariable sequences. A total of 133 different fungal and bacterial taxonomies were obtained from processing tomatoes in the two regions, of which 63 genera were predominant. Bacterial and fungal communities differed significantly between southern and northern Xinjiang, and fungal diversity was higher in southern Xinjiang. Alternaria and Cladosporium on processing tomatoes in southern Xinjiang were associated with plant pathogenic risk. The plant pathogenic fungi of processing tomatoes in northern Xinjiang were more abundant in Alternaria and Fusarium. The abundance of Alternaria on processing tomatoes was higher in four regions of northern Xinjiang, indicating that there is a greater risk of plant pathogenicity in these areas. Processing tomatoes in northern and southern Xinjiang contained bacterial genera identified as gut microbes, such as Pantoea, Erwinia, Enterobacter, Enterococcus, and Serratia, indicating the potential risk of contamination of processing tomatoes with foodborne pathogens. This study highlighted the microbial specificity of processing tomatoes in two tomato production regions, providing a basis for further investigation and screening for foodborne pathogenic microorganisms.

Transvaginal natural orifice transluminal endoscopic surgery-assisted versus transumbilical laparoendoscopic single-site ovarian cystectomy for ovarian mature cystic teratoma. A randomized controlled trial.

OBJECTIVES: Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and transumbilical laparoendoscopic single-site surgery (LESS) have shown the prospection as minimally invasive procedures. Here we aimed to compare ovarian cystectomy assisted by vNOTES and by LESS for ovarian mature cystic teratoma (OMCT). MATERIAL AND METHODS: A total of 81 premenopausal women with OMCT were randomized to undergo ovarian cystectomy assisted by either vNOTES (n = 41) or LESS (n = 40). The main outcome was the operative time. Secondary outcomes included the length of hospital stay, visual analog scale (VAS) pain scores, abdominal contamination by teratoma contents, and intraoperative and postoperative complications. RESULTS: There were no intergroup differences in age, body mass index, tumor size, or bilaterality of tumor. The operative time for the vNOTES group was significantly shorter than that for the LESS group (68.41 ± 20.92 min vs 85.05 ± 32.94 min, p = 0.008). The highest VAS pain score 24 hours postoperatively was 1.21 ± 0.48 in the vNOTES group and 2.43 ± 0.57 in the LESS group (p < 0.001). Twenty-four of the 40 patients in the LESS group experienced teratoma rupture intraoperatively, leading to abdominal contamination by the teratoma content, while 5 abdominal contamination was observed in the vNOTES group （p = 0.005. No significant differences between the two groups were observed in the other outcomes. CONCLUSIONS: vNOTES assisted ovarian cystectomy has short operative time, fast recovery, no scarring, less pain, and low rate of abdominal contamination. Consequently, vNOTES might be superior to LESS for treating OMCTs.

Molecular characterisation and antimicrobial resistance of Streptococcus agalactiae isolates from dairy farms in China.

Introduction: Streptococcus agalactiae (S. agalactiae) is a pathogen causing bovine mastitis that results in considerable economic losses in the livestock sector. To understand the distribution and drug resistance characteristics of S. agalactiae from dairy cow mastitis cases in China, multilocus sequence typing (MLST) was carried out and the serotypes and drug resistance characteristics of the bacteria in the region were analysed. Material and Methods: A total of 21 strains of bovine S. agalactiae were characterised based on MLST, molecular serotyping, antimicrobial susceptibility testing, and the presence of drug resistance genes. Results: The serotypes were mainly Ia and II, accounting for 47.6% and 42.9% of all serotypes, respectively. Five sequence types (STs) were identified through MLST. The ST103 and ST1878 strains were predominant, with rates of 52.4% and 28.6%, respectively. The latter is a novel, previously uncharacterised sequence type. More than 90% of S. agalactiae strains were susceptible to penicillin, oxacillin, cephalothin, ceftiofur, gentamicin, florfenicol and sulfamethoxazole. The bacteria showed high resistance to tetracycline (85.7%), clindamycin (52.1%) and erythromycin (47.6%). Resistant genes were detected by PCR, the result of which showed that 47.6%, 33.3% and 38.1% of isolates carried the tet(M), tet(O) and erm(B) genes, respectively. Conclusion: The results of this study indicate that S. agalactiae show a high level of antimicrobial resistance. It is necessary to monitor the pathogens of mastitis to prevent the transmission of these bacteria.

Preference for care models among older people living with HIV: cross-sectional study.

BACKGROUND: The number of people living with HIV (PWH) aged 50 and above is increasing. The question of care among older PWH (aged ≥ 50 years) is an increasing concern. Understanding the care preference of older people can better provide care services for them. The purpose of this study was to investigate the care preference (home-based care, self-care, institutional care, community-based care, and mutual-aid care) among older PWH and identify the factors affecting their care preference. METHODS: A cross-sectional survey was conducted among older PWH (aged ≥ 50 years) about care preference from May to November 2021. We enrolled 319 participants using convenience sampling. We designed a questionnaire to assess the care preference of older PWH. The Chi-square test and Fisher's exact test were used to conduct univariate analysis of care preference. Multinomial logistic regression was used to identify factors influencing care preference. RESULTS: Most older PWH (72.7%) preferred home-based care, and few (15.7%) preferred self-care. Fewer older PWH preferred community-based care (5.3%), institutional care (5.0%) and mutual-aid care (1.3%). Multivariate analysis showed that older PWH with a house, spouse and more children were more inclined to choose home-based care (p < .05). Older PWH living alone, having higher monthly income and higher HIV stigma preferred to choose self-care (p < .05). CONCLUSION: Home-based care was the most preferred model of older PWH, and self-care ranked second. The number of those who preferred institutional care, community-based care and mutual-aid care were few. Nation and government should take measures to allocate care resources for older adults reasonably to better meet the care needs of older PWH. It is important to strengthen social security, reduce internalized HIV stigma, improve social support, and explore diversified care models for improving the quality of life of older PWH.

Effects of Umbilical Preparation Before Trans-umbilical Laparo-endoscopic Single-site Surgery on Umbilical Wounds Healing: a Randomized Controlled Trial.

OBJECTIVE: The umbilicus is the only anatomic entrance and incision site for trans-umbilical laparoendoscopic single-site surgery (TU-LESS). Data on incisional surgical site infections (ISSI) and incision healing in TU-LESS are lacking. Therefore, we aimed to observe umbilical incision healing and possible hernia after TU-LESS and explore the efficacy of preoperative umbilicus preparation on ISSI. SUBJECTS AND METHODS: Consecutive patients aged 18 to 65 years, who were scheduled to undergo TU-LESS at a teaching hospital between March 2020 and November 2021, were enrolled in this prospective study. All patients were randomized to the study group with preoperative umbilicus preparation 30 minutes before patients were sent to the operating room and to the control group without preparation. The umbilical dimple was disinfected twice using povidone-iodine in both groups before the skin incision. The primary outcome was ISSI within 30 days of surgery. Umbilical hernia at 3 months after surgery and perioperative data such as operation time, complications, and incision healing were recorded and compared. RESULTS: A total of 400 patients were recruited for this study. TU-LESS was performed in all patients without major complications. ISSI occurred in 5 patients in the study group (2.5%) and 3 patients in the control group (1.5%), with no significant differences between both groups ( P =0.479). No umbilical hernia occurred in any patient during the 3 months follow-up. Six patients in the study group (3.1%) and 1 in the control group (0.5%) experienced excessive scarring, a relatively high incidence in the study group, though the difference was not statistically significant ( P =0.067). CONCLUSIONS: TU-LESS-related umbilical hernias are rare with existing suturing methods. Umbilicus preparation before TU-LESS could not decrease ISSI; however, it increased the nursing workload, which should be avoided.

Antimicrobial Resistance and Virulence Genes of Streptococcus Agalactiae Isolated from Mastitis Milk Samples in China.

Introduction: Streptococcus agalactiae is an important zoonotic pathogen that affects milk production and quality and poses a threat to public health. Treatment of infections with this bacterium exploits antimicrobials, to which the resistance of S. agalactiae is a growing problem. Addressing the possibility of a correlation between this pathogen's genetic factors for antimicrobial resistance and virulence, this study attempted to identify the relevant genes. Material and Methods: Antimicrobial resistance of S. agalactiae isolated from 497 Chinese bovine mastitic milk samples was detected by the broth microdilution method. Eight drug resistance genes and eleven virulence genes were detected using PCR. Results: Streptococcus agalactiae was 100% susceptible to rifampicin and vancomycin, 93.33% susceptible to sulfisoxazole and sulfamethoxazole, but 100% resistant to ≥3 of the 16 antimicrobial agents, thereby being multidrug resistant, with resistance to oxacillin, tetracycline, erythromycin, clindamycin, and gentamicin being common. The ermB, ermA and lnuA genes were carried by 73.33%, 66.67% and 60.00% of the strains, respectively. The carriage rates of the glnA, clyE, hylB, bibA, iagA, and fbsA virulence genes were greater than 40%, lmb and bac were not observed in any strain, and glnA+hylB+bibA+iagA+fbsA+clyE combined virulence gene patterns were the most commonly detected. Conclusion: Antimicrobial resistance of S. agalactiae is still a great concern for cattle health in China, and multidrug resistance coupled with the high positive rates of this bacterium's strains for virulence genes indicates the importance of S. agalactiae surveillance and susceptibility tests.

Effects of the COVID-19 pandemic on acute stress disorder and career planning among healthcare students.

This study aimed to investigate the effects of COVID-19 on the prevalence of acute stress disorder and subsequent effects on career planning among healthcare students. A cross-sectional survey was conducted among 1158 healthcare students across five medical universities in February 2020. Acute stress disorder was assessed using the Stanford Acute Stress Response Questionnaire. Further data regarding COVID-19 knowledge, individual behaviours, occupational choices, and career planning were collected. Based on the results of the Stanford Acute Stress Response Questionnaire, the students were divided into high-risk and low-risk groups for acute stress disorder. The correlation between acute stress disorder and the impact on career planning was analysed. The high-risk group comprised 143 (12.3%) participants, while 1015 (87.7%) participants were in the low-risk group. Two factors increased the risk of acute stress disorder in the students, including 'I think the pandemic is far away from me' (B: 1.27, 95%CI: 1.60-7.87) and 'Physical contact with confirmed or suspected cases' (B: 2.49, 95%CI: 3.42-42.44). Those who obtained pandemic information from official media sources indicated a lower risk of acute stress disorder (B: -0.24, 95%CI: 0.49-1.26). The high-risk group was more likely to quit the medical profession after graduation. The COVID-19 pandemic may cause acute stress disorder among healthcare students and affect their career planning. Universities and relevant departments should provide more information and moral support for these students.

The effect of clamping the indwelling urinary catheter before removal in cervical cancer patients after radical hysterectomy.

AIMS AND OBJECTIVES: To determine the effect of clamping the indwelling urinary catheter before its removal on bladder reconditioning in patients with cervical cancer after radical hysterectomy. BACKGROUND: It is suggested that indwelling urinary catheters should be clamped intermittently to fill the bladder and restore bladder function before removal. However, indwelling urinary catheter clamping showed no effect on bladder reconditioning according to some clinical studies. DESIGN: Randomised controlled study. METHODS: A total of 210 patients with cervical cancer after type C radical hysterectomy were randomised on 1:2 into two groups. In the clamping group, indwelling urinary catheters were clamped intermittently for 48 hours before removal based on a bladder-training sheet, while in the control group, the indwelling urinary catheters were removed without clamping. The primary outcome of the study was the rate of recatheterisation. The secondary outcomes included residual urine volume 24 hours after removal, incidence of urinary tract infection and duration of recatheterisation. RESULTS: Seventy patients were assigned to the clamping group and 128 to the control group with paralleled baseline characteristics. The days of the primary catheterisation (13·20 ± 0·79 vs. 13·38 ± 1·04) and the incidence of urinary tract infection (22·9% vs. 20·3%) had no significant differences between the two groups. Ten patients in the clamping group and 19 in the control group underwent recatheterisation, the incidence of which showed no significant difference (14·3% vs. 14·8%). The days of recatheterisation were not statistically different between the two groups (11·40 ± 6·75 vs. 9·42 ± 5·23). However, the residual urine volume 24 hours after removal was higher in the clamping group than that in the control group. CONCLUSIONS: Bladder recondition through indwelling urinary catheter clamping may not restore bladder function in patients after radical hysterectomy. RELEVANCE TO CLINICAL PRACTICE: As indwelling urinary catheter clamping may increase the residual urine volume after indwelling urinary catheter removal and lead to an increased nursing workload, it should not be recommended in patients with cervical cancer postoperatively.

Ultrasound-guided high-intensity focused ultrasound vs laparoscopic myomectomy for symptomatic uterine myomas.

STUDY OBJECTIVE: To assess the quality of life (QoL) of women at 1 and 12 months after ultrasound-guided high-intensity focused ultrasound (USgHIFU) treatment as compared with laparoscopic myomectomy for treatment of symptomatic uterine myomas. DESIGN: Nonrandomized prospective clinical trial (Canadian Task Force classification II-2). SETTING: Urban university-based hospital in China. INTERVENTIONS: One hundred thirty premenopausal women underwent USgHIFU (n = 89) or laparoscopic myomectomy (n = 41) for treatment of symptomatic uterine myomas. MEASUREMENTS AND MAIN RESULTS: Eighty-three patients in the HIFU group and 39 in the surgical group were followed up at 1 and 12 months. QoL was assessed using the Medical Outcomes Study 36-Item Short-Form General Health Survey, which showed no significant differences between groups in any of the 8 subscales at the 12-month follow-up visit. Symptom score, willingness to recommend the treatment to a friend, hospital stay, and recovery period were compared between the 2 groups. In the HIFU group, hospital stay was shorter (mean [SD] 2.9 [1.5] days vs 6.2 [2.7] days; p <.001) and patients resumed normal activities sooner (4.5 [1.5] days vs 10.9 [3.8] days; p <.001). Significant clinical complications and adverse events after each treatment were documented and compared, and HIFU yielded significantly better results. CONCLUSIONS: Compared with laparoscopic myomectomy, HIFU treatment of symptomatic uterine myomas leads to comparable QoL and symptom improvement, fewer significant clinical complications and adverse events, shorter hospital stay, and faster recovery. Randomized studies with long-term follow-up are needed to reach definitive conclusions insofar as HIFU treatment of uterine myomas.

[Ultrasound criterion for the diagnosis of polycystic ovary syndrome: ovarian stroma/total area ratio].

OBJECTIVE: To evaluate the diagnostic value of ultrasound parameters of ovarian stroma area (S), total ovarian area (A) and S/A ratio for polycystic ovarian syndrome (PCOS). METHODS: The A, S and S/A ratio were determined by use of transvaginal pelvic ultrasound, and serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (T) were assayed in 58 PCOS patients and 60 controls. Of 58 PCOS patients, 32 underwent hyperinsulinemic euglycemic clamp technique (HGCT). RESULTS: Patients with PCOS showed significantly higher ovarian S and S/A ratio when compared to the control groups (P = 0.045, P = 0.001, respectively). S/A ratio and S were significantly related to HGCT results and T. CONCLUSION: The S/A ratio and S are of value in diagnosis of PCOS.

Performance evaluation of quality improvement team in an anesthesiology department.

BACKGROUND: In health care community, quality improvement pathway has always been treated as critical index to control cost, improve efficiency and promote service quality, particularly in the last decade. From theoretical standpoint, clinical practice as well as research data, quality improvement team has been demonstrated to play an important role in the adaptation to the changing health environment and enhancement of the competition through the improvement process. The purpose of this study was to explore members' job satisfaction, morale, organizational commitment and inventory management through quality improvement team intervention in a department of anesthesiology. METHODS: This study was of a quasi-experimental and longitudinal design. The subjects involved 45 nurse anesthetists (the experiment group, intervention of quality improvement team) and 50 operation room nurses (control group) in a general hospital. The quality improvement team had been initiated and implemented pursuant to the quality improvement process for 8 months. GEEs (Generalized Estimating Equations) model was used to examine the differences in job satisfaction, morale, organizational commitment, and the inventory management was also examined between two groups. RESULTS: After control of all variables, except education background, such as age, marital status, education, position and nursing experience, a natural growth effect was observed on quality improvement team. The results revealed that the experimental group showed significant positive effects on both job satisfaction and organizational commitment after the intervention. The morale scale did not differ significantly between two groups. In the inventory management, the experimental group successfully decreased the monthly consumable materials stock with a descending rate of 24.8%, while in the control group, the inventory was increased 16.9% in the basal stock instead. CONCLUSIONS: As other previous reports did, the present study also demonstrated that intervention of the quality improvement team improves the nurse anesthetists' job satisfaction, such as promotion of autonomy, organizational policy and positive member interaction. Moreover, it improves work efficiency, service quality as well as control of the stock inventory.