Investigation of occupational burnout status and influencing factors among emergency department healthcare workers using the MBI-GS Scale. / 基于MBI-GSé‡è¡¨è°ƒæŸ¥æ€¥è¯Šç§‘åŒ»åŠ¡äººå‘˜èŒä¸šå€¦æ€ çŽ°çŠ¶åŠå½±å“å› ç´ .

OBJECTIVES: The incidence of occupational burnout among emergency department healthcare workers is high, and their occupational health deserves attention. Establishing a comprehensive occupational health system in medical institutions is crucial. This study aims to understand the current status of occupational burnout among emergency department healthcare workers, analyze its influencing factors, and provide references for preventing burnout in this population. METHODS: A cross-sectional survey was conducted using convenience sampling through the Questionnaire Star platform from December 2022 to January 2023 among emergency department healthcare workers. The Maslach Burnout Inventory-General Survey (MBI-GS) scale was used to assess the level of occupational burnout, and univariate analysis and binary Logistic regression analysis were employed to explore the influencing factors of burnout. RESULTS: A total of 1 173 valid questionnaires were collected, with 946 (80.65%) respondents experiencing occupational burnout. The proportions of mild-to-moderate and severe burnout were 73.57% and 7.08%, respectively. The scores for the three dimensions of burnout among emergency department healthcare workers were as follows: emotional exhaustion (EE) 2.33±0.31; depersonalization (DP) 1.88±0.28; low personal accomplishment (LPA) 3.20±0.39. The overall score was 2.46±0.22. Factors associated with occupational burnout included being an only child (OR=1.362, 95% CI -0.707 to -0.058), the average number of night shifts per month (OR=1.167, 95% CI 0.091 to 0.272), and personal experience of workplace violence (OR=1.094, 95% CI 0.027 to 0.195) (all P<0.05). CONCLUSIONS: The incidence of occupational burnout is high among emergency department healthcare workers. Effective measures should be taken by management to promptly intervene, reduce burnout, and ensure the smooth functioning of emergency medical services.

Using NEWS2 to triage newly admitted patients with COVID-19.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has spread globally and caused a major worldwide health crisis. Patients who are affected more seriously by COVID-19 usually deteriorate rapidly and need further intensive care. AIM: We aimed to assess the performance of the National Early Warning Score 2 (NEWS2) as a risk stratification tool to discriminate newly admitted patients with COVID-19 at risk of serious events. DESIGN: We conducted a retrospective single-centre case-control study on 200 unselected patients consecutively admitted in March 2020 in a public general hospital in Wuhan, China. METHODS: The following serious events were considered: mortality, unplanned intensive care unit (ICU) admission, and non-invasive ventilation treatment. Receiver operating characteristic (ROC) analysis and logistic regression analysis were used to quantify the association between outcomes and NEWS2. RESULTS: There were 12 patients (6.0%) who had serious events, where 7 patients (3.5%) experienced unplanned ICU admissions. The area under the ROC curve (AUROC) and cut-off of NEWS2 for the composite outcome were 0.83 and 3, respectively. For patients with NEWS2 ≥ 4, the odds of being at risk for serious events was 16.4 (AUROC = 0.74), while for patients with NEWS2 ≥ 7, the odds of being at risk for serious events was 18.2 (AUROC = 0.71). CONCLUSIONS: NEWS2 has an appropriate ability to triage newly admitted patients with COVID-19 into three levels of risk: low risk (NEWS2 = 0-3), medium risk (NEWS2 = 4-6), and high risk (NEWS2 ≥ 7). RELEVANCE TO CLINICAL PRACTICE: Using NEWS2 may help nurses in early identification of at-risk COVID-19 patients and clinical nursing decision-making. Using NEWS2 to triage new patients with COVID-19 may help nurses provide more appropriate level of care and medical resources allocation for patients safety.

Anticoagulation Effect and Safety Observation of Regional Citrate Anticoagulation for Double-Filtration Plasmapheresis in Critical Patients.

INTRODUCTION: Double-filtration plasmapheresis (DFPP) is a semi-selective blood purification method based on dual filtration system. Regional citrate anticoagulation (RCA) is an appealing anticoagulation alternative in DFPP. However, there are still few reports on the safety of RCA in DFPP treatment. OBJECTIVE: To investigate the anticoagulation effect and safety of RCA for DFPP in critical patients. METHODS: A total of 34 critical patients treated with DFPP were retrospectively studied. The incidence of coagulation during extracorporeal circulation after single treatment was compared before and after treatment. Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, blood routine indexes, blood gas analysis, peripheral ionic calcium (iCa), total peripheral calcium (TCa), TCa/iCa, and complications before and after single treatment were compared. The changes of transmembrane pressure, pressure drop were measured, and the indexes of coagulation before and after treatment were compared. RESULTS: The blood coagulation 0.05). Level of TCa was significantly decreased at 5 min after treatment (p < 0.05), but there was no statistically significant difference at 6 and 24 h (p > 0.05). No treatment-related serious complications were observed in any of the patients. CONCLUSIONS: For critical patients who underwent DFPP procedure, RCA is safety and had significant anticoagulation effects, which is worthy of clinical application.

Research progress of epithelial-mesenchymal transformation-related transcription factors in peritoneal metastases.

Metastasis is the leading cause of mortality in patients with malignant tumors, particularly characterized by peritoneal metastases originating from gastric, ovarian, and colorectal cancers. Regarded as the terminal phase of tumor progression, peritoneal metastasis presents limited therapeutic avenues and is associated with a dismal prognosis for patients. The epithelial-mesenchymal transition (EMT) is a crucial phenomenon in which epithelial cells undergo significant changes in both morphology and functionality, transitioning to a mesenchymal-like phenotype. This transition plays a pivotal role in facilitating tumor metastasis, with transcription factors being key mediators of EMT's effects. Consequently, we provide a retrospective summary of the efforts to identify specific targets among EMT-related transcription factors, aimed at modulating the onset and progression of peritoneal metastatic cancer. This summary offers vital theoretical underpinnings for developing treatment strategies against peritoneal metastasis.

Effects of mindfulness decompression therapy on mental health and job burnout among nurses working in the frontline of the novel coronavirus pandemic: A retrospective study.

OBJECTIVES: As the coronavirus disease 2019 (COVID-19) pandemic continues to spread worldwide, nucleic acid detection is a key step in controlling it. Psychological issues and job burnout of nurses working in nucleic acid sampling roles for long periods have become apparent. This study aimed to explore the effects of mindfulness decompression therapy on mental health and job burnout in front-line nurses working in nucleic acid sampling during the pandemic. METHODS: Nucleic acid sampling frontline nurses who were positive for burnout on both the Symptom Checklist-90 (SCL-90) and the Maslach Burnout Inventory-General Scale (MBI-GS) were selected as the participants. Frontline nurses in the nucleic acid testing area who received routine psychological nursing intervention from June 2020 to April 2021 were used as the control group. Nurses who received both routine psychological nursing and mindfulness decompression therapy from May 2021 to December 2021 formed the "mindfulness" subject group. We compared the two groups' primary outcome measures of SCL-90 and MBI-GS scores. RESULTS: Before the intervention, there were no significant differences between the two groups in general data, SCL-90 scores, and MBI-GS scores. After the mindfulness decompression therapy, according to SCL-90 and MBI-GS scales, psychological distress and job burnout of nurses in the mindfulness group were significantly better than those in the control group. CONCLUSION: Mindfulness decompression therapy can effectively improve mental health and relieve job burnout in frontline nurses in nucleic acid sampling areas, which is worthy of clinical application. Randomized controlled trials are still needed, however, to fully confirm the effects of mindfulness decompression therapy.

Association of Gender With Outcomes in Hospitalized Patients With 2019-nCoV Infection in Wuhan.

Aim: The aim of this study was to analyze the association of gender with psychological status and clinical outcomes among patients with 2019-nCoV infection to provide new directions for the prevention and control of the pandemic. Methods: One hundred and thirty-eight patients with confirmed 2019-nCoV infection at Wuhan Union Hospital, between February 8 and March 31, 2020, were included in the study analysis. General information and data on clinical characteristics were collected from patients' medical records. Participants' responses to self-report measures of psychological status were also collected. Results: Anxiety levels, depression levels, and recovery rates were significantly higher among women compared to men. Conversely, chronic disease history and smoking rates, dry cough incidence, C-reactive protein levels, and disease severity were significantly higher among men than women (p < 0.05). Conclusion: Female patients experienced more severe psychological issues, due to higher levels of anxiety and stress, than male patients; indicating that more attention should be paid to the psychological care of female patients. In contrast, the general condition of male patients was more severe, particularly among elderly male patients with a history of chronic disease and smoking, suggesting that, to prevent and control 2019-nCoV infection, male patients should be encouraged to quit smoking as soon as possible to reduce the risk of severe pneumonia.

Non-pharmacological interventions to reduce the incidence and duration of delirium in critically ill patients: A systematic review and network meta-analysis.

OBJECTIVE: To compare non-pharmacological interventions in their ability to prevent delirium in critically ill patients, and find the optimal regimen for treatment. METHODS: Literature searches were conducted using PubMed, Embase, CINAHL, and Cochrane Library databases until the end of June 2019. We estimated the risk ratios (RRs) for the incidence of delirium and in-hospital mortality and found the mean difference (MD) for delirium duration and the length of ICU stay. The probabilities of interventions were ranked based on clinical outcomes. The study was registered on PROSPERO (CRD42020160757). RESULTS: Twenty-six eligible studies were included in the network meta-analysis. Studies were grouped into seven intervention types: physical environment intervention (PEI), sedation reducing (SR), family participation (FP), exercise program (EP), cerebral hemodynamics improving (CHI), multi-component studies (MLT) and usual care (UC). In term of reducing the incidence of delirium, the two most effective interventions were FP (risk ratio (RR) 0.19, 95% confidence interval (CI) 0.08 to 0.44; surface under the cumulative ranking curve (SUCRA) = 94%) and MLT (RR 0.43, 95% CI 0.30 to 0.57; SUCRA = 68%) compared with observation. Although all interventions demonstrated nonsignificant efficacy in regards to delirium duration and the length of the patient's stay in the ICU, MLT (SUCRA = 78.6% and 71.2%, respectively) was found to be the most effective intervention strategy. In addition, EP (SUCRA = 97.2%) facilitated a significant reduction in hospital mortality, followed in efficacy by MLT (SUCRA = 73.2%), CHI (SUCRA = 35.8%), PEI (SUCRA = 34.8%), and SR (SUCRA = 31.8%). CONCLUSIONS: Multi-component strategies are overall the optimal intervention techniques for preventing delirium and reducing ICU length of stay in critically ill patients by way of utilizing several interventions simultaneously. Additionally, family participation as a method of patient-centered care resulted in better outcomes for reducing the incidence of delirium.

Amitriptyline Reduces Sepsis-Induced Brain Damage Through TrkA Signaling Pathway.

Sepsis can induce acute and chronic changes in the central nervous system termed sepsis-associated encephalopathy (SAE). Not only cognitive deficits but also anxiety, depression, and post-traumatic stress disorder are common in severe sepsis survivors. In this study, we demonstrated that amitriptyline, a classic tricyclic antidepressant, reduced sepsis-induced brain damage through the tropomyosin receptor kinase A (TrkA) signaling pathway. Amitriptyline ameliorated neuronal loss assessed by Nissl staining in a mouse cecal ligation and puncture (CLP)-induced sepsis model. Furthermore, amitriptyline reduced early gliosis assessed by immunofluorescence and late cognitive deficits assessed by the Morris water maze (MWM) test. Moreover, amitriptyline treatment attenuated oxidative stress indicated by less superoxide dismutase (SOD) and catalase (CAT) activity consumption and malondialdehyde (MDA) accumulation. Interestingly, those protective effects of amitriptyline could be abolished by GW441756, a TrkA signaling pathway inhibitor. Immunoblot directly showed that TrkA signaling pathway-associated proteins, such as Akt and GSK3ß, were involved in the neuroprotective effects of amitriptyline. Thus, amitriptyline appears to be an encouraging candidate to treat cognitive deficits and depression after severe sepsis.

Genetic variants in interleukin-6 modified risk of obstructive sleep apnea syndrome.

Obesity and inflammation are known to correlate with the pathogenesis of obstructive sleep apnea syndrome (OSAS). Interleukin (IL)-6, an important regulator of obesity and inflammation, was reported to phenotypically increase in patients with OSAS. This study aimed to investigate whether genetic variants in IL-6 confer susceptibility to OSAS. The study population consisted of 151 patients with OSAS and 75 healthy controls from Southeast China. Five haplotype-tagging single nucleotide polymorphisms (tSNPs) were selected across 21 kb of the IL-6 locus using Haploview software V4.1. The tSNPs were amplified by polymerase chain reaction (PCR) and genotyped by restriction enzyme digestion followed by gel electrophoresis. Linkage disequilibrium (LD) and haplotype reconstruction were carried out by means of a SHEsis program. No distribution difference of any of the five tSNPs between OSAS patients and controls was observed. However, in non-obese individuals (n=117), the minor allele G (rs1800796) decreased risk of OSAS compared with the major allele C [odds ratio (OR), 0.48; 95% confidence interval (CI), 0.26-0.86; p=0.014], and the haplotype TG (rs1880242, rs1800796) conferred a significantly decreased risk of OSAS than single allele G (rs1800796) (OR, 0.39; 95% CI, 0.20-0.74; p=0.003). Moreover, the severity of sleep-disordered breathing (measured by apnea hypopnea index) increased linearly in carriers of the C variant of IL-6 -572G/C polymorphism (14.3+/-5.1, 22.0+/-3.6 and 34.8+/-3.5 for GG, CG and CC, respectively; p=0.012). To the best of our knowledge, this is the first study to suggest that genetic variants in IL-6 could modify OSAS susceptibility. SNP genotyping of IL-6 is a potential strategy for detecting the risk of breathing disordered diseases in non-obese individuals.

CpG island methylator phenotype involving tumor suppressor genes located on chromosome 3p in non-small cell lung cancer.

CpG island methylator phenotype (CIMP) involving methylation abnormalities of tumor suppressor gene (TSG) on short arm of chromosome 3 (chromosome 3p) has not been so far epigenetically elucidated in non-small cell lung cancer (NSCLC). Using methylation-specific PCR (MSP) method, we examined methylation profiles for eight TSGs harbored in chromosome 3p in 60 NSCLC tissues and 60 paired normal tissues as well as 11 normal blood samples. CIMP positive is referred to having four or more than four synchronously methylated genes per sample. Consequently, 59 of 60 (98.3%) NSCLC presented promoter methylation of at least one gene while only one malignant tumor showed no methylation of any of eight genes. The frequency of promoter methylation for eight genes explored ranged from 12% for hMLH1 to 67% for RASSF1A given that of VHL (none) was not considered. Interestingly, CIMP+ was found in 56.7% (34/60) of NSCLC, and in 6.7% (4/60) of paired normal tissues and 0% (0/11) of normal blood samples, respectively; CIMP- was present in 43.3% (26/60) of NSCLC, 93.3% (56/60) of paired normal tissues, and 100% (11/11) of normal blood samples, respectively. The data suggest that CIMP status was significantly associated with NSCLC, paired normal tissues and normal blood samples (P<0.001). In addition, there appeared to be a significant association between CIMP status and survival prognosis of NSCLC (P=0.0166). In the present study, for the first time, we shed light on the presence of chromosome 3p-specific CIMP, which might play an important role in tumorigenesis of NSCLC.

Prevention by Ce3+ of DNA destruction caused by Hg2+ in fish intestine.

The interactions between Hg2+, Ce3+, and the mixture of Ce3+ and Hg2+, and DNA from fish intestine in vitro were investigated by using absorption spectrum and fluorescence emission spectrum. The ultraviolet absorption spectra indicated that the addition of Hg2+, Ce3+, and the mixture of Ce3+ and Hg2+ to DNA generated an obviously hypochromic effect. Meanwhile, the peak of DNA at 205.2 nm blue-shifted and at 258.2 nm red-shifted. The size of the hypochromic effect and the peak shift of DNA by metal ion treatments was Hg2+>Hg2++Ce3+>Ce3+. The fluorescence emission spectra showed that with the addition of Hg2+, Ce3+, and the mixture of Ce3+ and Hg2+ the emission peak at about 416.2 nm of DNA did not obviously change, but the intensity reduced gradually and the sequence was Hg2+>Hg2++ Ce3+>Ce3+. Hg2+, Ce3+, and the mixture of Ce3+ and Hg2+ had 1.12, 0.19, and 0.41 binding sites to DNA, respectively; the fluorescence quenching of DNA caused by the metal ions all attributed to static quenching. The binding constants (KA) of binding sites were 8.98 x 104 L/mol and 1.02 x 104 L/mol, 5.12 x 104 L/mol and 1.10 x 103 L/mol, 6.66 x 104 L/mol and 2.36 x 103 L/mol, respectively. The results showed that Ce3+ could relieve the destruction of Hg2+ on the DNA structure.

CpG island methylator phenotype involving chromosome 3p confers an increased risk of non-small cell lung cancer.

PURPOSE: This study aims to explore the association of CpG island methylator phenotype (CIMP) involving tumor suppressor genes on short arm of chromosome 3 (3p) with increased risk of non-small cell lung cancer (NSCLC). METHODS AND MATERIALS: In this study, four NSCLC cell lines were cultured, and peripheral blood mononuclear cell (PBMC) specimens from 80 patients with NSCLC and 80 matched controls were collected for 3p-involved CIMP (3pCIMP) analysis. 3pCIMP was referred to as having at least three synchronously methylated genes of 3p per sample. Methylation-specific polymerase chain reaction was performed to examine the methylation status of each gene. DNA demethylation of NSCLC cell lines was achieved through the treatment with 5-aza-deoxycytidine. Logistic regression was used to assess odds ratios and 95% confidence intervals, which were adjusted for gender, age, and smoking status. RESULTS: Demethylation experiment showed that 3pCIMP status could play an important role in NSCLC cell proliferation. A total of 97.5% of PBMC specimens from NSCLC patients presented promoter methylation of any one of six genes (hOGG1, RAR-B, SEMA3B, RASSF1A, BLU, or FHIT) on 3p. Interestingly, 3pCIMP+ was found in 43.8% of NSCLC PBMC specimens and only in 6.3% of normal PBMC samples. The data suggest that 3pCIMP status is significantly associated with NSCLC and normal PBMC samples (p 0.001). More importantly, the results show that 3pCIMP positive carriers have a 12.8-fold increased risk of NSCLC (adjusted odds ratio, 12.8; 95% confidence interval, 4.38 -37.4, p 0.001) in Chinese population. CONCLUSIONS: This is the first evidence of an association between PBMC 3pCIMP and risk for NSCLC.