Using healthcare failure mode and effect analysis to reduce the emergency waiting risk / 中国实用护理杂志

Objective:To explore the application of effect of healthcare failure mode and effect analysis (HFMEA) in emergency waiting risk management.Methods:From May 2020 to April 2021, totally 87 902 emergency waiting patients from the First Affiliated Hospital of Anhui Medical University were assigned to control group by cluster sampling method. From May 2021 to April 2022, 80 594 emergency waiting patients were assigned to observed group. The patients in the control group received routine emergency waiting of itinerant management mode. In contrast, the patients in the observed group received emergency waiting risk management mode based on HFMEA. The process risk priority number (RPN) and waiting risk management index between two groups were compared.Results:The mean RPN of the observed group was (98.48 ± 8.27) points, significantly lower than that of the control group (251.27 ± 16.95) points. The nurses′ pre-identification rates of changes in the condition and adverse reaction in the observed group were 10.77%(8680/80 594) and 13.37%(10 775/80 594), which were higher than those in the control group, 5.77%(5072/87 902) and 8.12%(7134/87 902), the differences were statistically significant ( χ2 values were 1402.32 and 1221.66, all P<0.05). Conclusions:The application of HFMEA to optimize the emergency waiting management process can effectively reduce the risk of emergency waiting and improve the quality of emergency waiting management.

Advances in the study on brain-gut axis mechanism of common mental disorders and clinical intervention / 四川精神卫生

There are a large number of microbial communities in human intestine， which play an important role in many physiological processes of the body. It has been found that intestinal microorganisms can act on brain diseases through brain-gut axis mechanism. The purpose of this paper is to summarize the mechanism of intestinal microorganisms in schizophrenia， bipolar disorder and depression， and to provide new ideas for the prevention and treatment of psychiatric disorders.

Advances and utility of laboratory investigation in diagnosis of pediatric allergic diseases / 中华检验医学杂志

The rapid increase of childhood allergic disorders has become one of the major challenges in the pediatric health care system. Laboratory diagnosis is essential in order to determine appropriate strategies towards best clinical practice strategies, including accurate diagnosis, prophylaxis and optimized management. Once there are sufficient clinical grounds to support a diagnosis of allergy, confirmatory in vivo and in vitro tests should be performed. In vivo tests mainly include skin prick tests and allergen provocation tests. Provocation tests are the gold standard for diagnosing allergic diseases. In vitro tests mainly include allergen-specific IgE antibody, Th2 related cytokines, and mast cell activity markers. These tests can clarify the immune state status of the patient and lead to optimized treatment, such as avoiding allergens avoidance, allergens-specific immunotherapy, and anti-IgE therapy. Controlling disease progress and preventing relapses can benefit children who are suffering from the consequences of allergies.

Treatment-resistant depression and its diagnosis and treatment / 四川精神卫生

The aim of this study is to explore the diagnostic strategies and options for treatment-resistant depression （TRD）. Despite the well-established efficacy of antidepressants， 20%~30% of depressive patients in the clinic fail to respond or respond poorly to normative treatment with antidepressants. Patients with TRD are forced to bear a heavy burden of medical costs and disease. Therefore， this article discusses the TRD in terms of the definition， prevalence， disease burden， etiological mechanism， risk factors， assessment grading， highlighting different treatment strategies and options to inform clinical practice and scientific research on TRD.

Management of corona virus disease-19 (COVID-19): the Zhejiang experience / 浙江大学学报·医学版

The current epidemic situation of corona virus disease-19 (COVID-19) still remained severe. As the National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Zhejiang University School of Medicine is the primary medical care center for COVID-19 inZhejiang Province. Based on the present expert consensus carried out by National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on "Four-Anti and Two-Balance" for clinical practice. The "Four-Anti and Two-Balance"strategy included antivirus, anti-shock, anti-hyoxemia, anti-secondary infection, and maintaining of water, electrolyte and acid base balance and microecological balance. Meanwhile, integrated multidisciplinarypersonalized treatment was recommended to improve therapeutic effect. The importance of early viralogical detection, dynamic monitoring of inflammatory indexes and chest radiograph was emphasized in clinical decision-making. Sputum was observed with the highest positive rate of RT-PCR results. Viral nucleic acids could be detected in10% patients'blood samples at acute periodand 50% of patients had positive RT-PCR results in their feces. We also isolated alive viral strains from feces, indicating potential infectiousness of feces.Dynamic cytokine detection was necessary to timely identifyingcytokine storms and application of artificial liver blood purification system. The "Four-Anti and Two-Balance"strategyeffectively increased cure rate and reduced mortality. Early antiviral treatment could alleviate disease severity and prevent illness progression, and we found lopinavir/ritonavir combined with abidol showed antiviraleffects in COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system could rapidly remove inflammatory mediators and block cytokine storm.Moreover, it also favoredthe balance of fluid, electrolyte and acid-base and thus improved treatment efficacy in critical illness. For cases of severe illness, early and also short periods of moderate glucocorticoid was supported. Patients with oxygenation index below 200 mmHg should be transferred to intensive medical center. Conservative oxygen therapy was preferred and noninvasive ventilation was not recommended. Patients with mechanical ventilation should be strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis should be prescribed rationally and was not recommended except for patients with long course of disease, repeated fever and elevated procalcitonin (PCT), meanwhile secondary fungal infection should be concerned.Some patients with COVID-19 showed intestinal microbialdysbiosis with decreasedprobiotics such as and . Nutritional and gastrointestinal function should be assessed for all patients.Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infection due to bacterial translocation. Anxiety and fear were common in patients with COVID-19. Therefore, we established dynamic assessment and warning for psychological crisis. We also integrated Chinese medicine in treatment to promote disease rehabilitation through classification methods of traditional Chinese medicine. We optimized nursing process for severe patients to promote their rehabilitation. It remained unclear about viral clearance pattern after the SARS-CoV-2 infection. Therefore, two weeks' quarantine for discharged patients was required and a regular following up was also needed.The Zhejiang experience above and suggestions have been implemented in our center and achieved good results. However, since COVID-19 was a newly emerging disease, more work was warranted to improve strategies of prevention, diagnosis and treatment for COVID-19.

Management of COVID-19: the Zhejiang experience / 浙江大学学报·医学版

The current epidemic situation of coronavirus disease 2019 (COVID-19) still remained severe. As the National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Zhejiang University School of Medicine is the primary medical care center for COVID-19 in Zhejiang province. Based on the present expert consensus carried out by National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on "Four-Anti and Two-Balance" for clinical practice. The "Four-Anti and Two-Balance" strategy included antivirus, anti-shock, anti-hyoxemia, anti-secondary infection, and maintaining of water, electrolyte and acid base balance and microecological balance. Meanwhile, integrated multidisciplinary personalized treatment was recommended to improve therapeutic effect. The importance of early viralogical detection, dynamic monitoring of inflammatory indexes and chest radiograph was emphasized in clinical decision-making. Sputum was observed with the highest positive rate of RT-PCR results. Viral nucleic acids could be detected in 10%patients' blood samples at acute period and 50%of patients had positive RT-PCR results in their feces. We also isolated alive viral strains from feces, indicating potential infectiousness of feces.Dynamic cytokine detection was necessary to timely identifying cytokine storms and application of artificial liver blood purification system. The "Four-Anti and Two-Balance" strategy effectively increased cure rate and reduced mortality. Early antiviral treatment could alleviate disease severity and prevent illness progression, and we found lopinavir/ritonavir combined with abidol showed antiviral effects in COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system could rapidly remove inflammatory mediators and block cytokine storm.Moreover, it also favored the balance of fluid, electrolyte and acid-base and thus improved treatment efficacy in critical illness. For cases of severe illness, early and also short period of moderate glucocorticoid was supported. Patients with oxygenation index below 200 mmHg should be transferred to intensive medical center. Conservative oxygen therapy was preferred and noninvasive ventilation was not recommended. Patients with mechanical ventilation should be strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis was not recommended except for patients with long course of disease, repeated fever and elevated procalcitonin (PCT), meanwhile secondary fungal infection should be concerned.Some patients with COVID-19 showed intestinal microbial dysbiosis with decreased probiotics such as and , so nutritional and gastrointestinal function should be assessed for all patients.Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infection due to bacterial translocation. Anxiety and fear were common in patients with COVID-19. Therefore,we established dynamic assessment and warning for psychological crisis. We also integrated Chinese medicine in treatment to promote disease rehabilitation through classification methods of traditional Chinese medicine. We optimized nursing process for severe patients to promote their rehabilitation. It remained unclear about viral clearance pattern after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Therefore, two weeks' quarantine for discharged patients was required and a regular following up was also needed.The Zhejiang experience and suggestions have been implemented in our center and achieved good results. However, since COVID-19 was a newly emerging disease, more work was warranted to improve strategies of prevention, diagnosis and treatment for COVID-19.

A qualitative study on the training experience of nurses participating in the desktop deduction competition of disaster care / 中国实用护理杂志

Objective:To understand the role of desktop deduction competition on improving nurses' ability of disaster nursing, explore new models of disaster nursing training.Methods:A purposive sampling method was used to recruit 12 nurses who participated in the desktop deduction competition and semi-structured interviews were conducted. Thematic analysis was used for data analysis.Results:After reading, analyzing, comparing and refining, five themes were extracted: raise the awareness of nurses' disaster nursing: recognize the importance of nurses participating in disaster rescue and mastering the disaster rescue related knowledge and skills; improve the nurses' preparedness of disaster nursing: reserve disaster knowledge, improve the skills of disaster rescue, and cultivate disaster management ability; improve the use of critical thinking and communication skills: in deciding the game to answer questions, each player of the team must independently consider the questions raised by the host and propose solutions. Then, the three players of the team communicated quickly to form the final answer of the team and express them in a reasonable language. Improved players ′ critical thinking and communication skills; enhance nurses ′ psychological quality: calm was the basis for successful competition as well as dealing with public emergencies and participating in disaster care and rescue. It was also a basis for relieving nurses' anxiety and reducing post-traumatic stress disorder; explore a new training model of disaster nursing. Conclusion:Emergent emergency medical rescue desktop deduction competition as a new disaster nursing training model, can effectively improve nurses' ability of disaster nursing.

Effect of constructive therapeutic communication on preoperative anxiety of rectal cancer patients undergoing da Vinci robot surgery / 中国实用护理杂志

Objective:To explore the effect of constructive therapeutic communication on preoperative anxiety of rectal cancer patients undergoing da Vinci robot surgery.Methods:Patients with rectal cancer who were hospitalized in gastrointestinal surgery ward from January 2016 to December 2018 in the hospital and were identified as anxious patients after the anxiety self-assessment were selected for study. The patients were numbered according to the order of entry, the odd number was control group, the even number was experimental group. Finally, control group was 48 cases, and the experimental group was 46 cases. The control group received routine nursing measures and the experimental group received constructive therapeutic communication intervention based on it. The changes of anxiety levels before and after intervention were evaluated by Self-rating Anxiety Scale(SAS) and compared between the two groups.Results:Before the intervention, the SAS score of the experimental group was 54.15±4.92, and the control group was 54.17±4.81. There was no statistically significant difference between the two groups ( t value was 0.014, P>0.05). After the intervention, the anxiety score in the experimental group was 45.39±5.82, and the control group was 51.81±4.96. The difference between the two groups was statistically significant ( t value was -5.761, P<0.05). Conclusions:The constructive therapeutic communication can effectively reduce anxiety of on preoperative anxiety of rectal cancer patients undergoing da Vinci robot surgery, and is superior to conventional nursing measures. Constructive therapeutic communication can effectively manage the adverse emotions of patients, promote the establishment and use of positive coping methods, and improve the compliance of treatment. It is worth clinical application.

The Impacts of Childhood Trauma on Psychosocial Features in a Chinese Sample of Young Adults

OBJECTIVE: The aims of the present study were to explore the occurrence of childhood trauma and importantly to determine the impacts of childhood trauma on psychosocial features in a Chinese sample of young adults. METHODS: A survey was carried out in a group of 555 university students by using Childhood Trauma Questionnaire (CTQ), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), Dysfunctional Attitudes Questionnaire (DAS), Eysenck Personality Questionnaire (EPQ), and Social Support Rating Scale (SSRS). The moderate-severe cut-off scores for CTQ were used to calculate the prevalence of childhood trauma, and then psychosocial features were compared between individuals with and without childhood trauma. RESULTS: A proportion of 18.6% of university students had self-reported childhood trauma exposures. Subjects with childhood trauma reported higher scores of SDS, SAS, DAS, and psychoticism and neuroticism dimensions of EPQ (t=4.311–5.551, p < 0.001); while lower scores of SSRS and extraversion dimension of EPQ (t=-4.061– -3.039, p < 0.01). Regression analyses further revealed that scores of SAS and DAS were positively (Adjusted B=0.211–0.230, p < 0.05), while scores of SSRS were negatively (Adjusted B=-0.273– -0.240, p < 0.05) associated with specific CTQ scores. CONCLUSION: Childhood trauma is still a common social and psychological problem. Individuals with childhood trauma show much more depression, anxiety, distorted cognition, personality deficits, and lower levels of social support, which may represent the social and psychological vulnerability for developing psychiatric disorders after childhood trauma experiences.

An investigation of the emergency preparedness of emergency rescue nurses and the study on the influencing factors in Anhui Province / 中国实用护理杂志

Objective To analyze the current situation and influencing factors of disaster preparedness of emergency rescue nurses in Anhui Province. Methods Using the convenience sampling method, 261 emergency rescue nurses from 48 tertiary and secondary hospitals drawn from the Disaster Nursing and Practice Classes organized by the Anhui Provincial Nursing Association in November 2017 were selected as research subjects. The questionnaire was conducted by using the Chinese version of Nurses Disaster Preparedness Scale. Results The score of disaster preparedness degree of nurses was 180.00(164.50, 201.00), which level was middle to upper,among the three dimensions, the highest score of disaster knowledge item was 4.50(4.00, 5.50), the second was disaster management 4.20(3.50, 5.00), the lowest disaster technology score was 4.00(3.00, 5.00); the disaster management (H = 7.968-40.324, P<0.01 or 0.05), the qualification level of rescue nurses (H = 13.341-61.550, P <0.01), grade of hospital (Z =-3.927-1.202, P <0.01 or 0.05), disaster education score (H = 19.517-65.061, P < 0.01), and participation in disaster rescue (Z =-8.219--6.280, P <0.01) were the influencing factors of disaster preparedness for emergency rescue nurses. Conclusions The disaster preparedness level of emergency rescue nurses in Anhui Province is at the upper middle level, disaster nursing should be included in the regular emergency rescue nurses′continuing education programs to carry out special lectures and regular emergency drills to establish a team of emergency nursing personnel training emergency rescue nurses for training at the same time, disaster relief incidents collect and analyze so that the combat experience at the disaster rescue site can be shared and promoted.

Application of table-top exercise in evaluating rescue ability of nursing staff in different stages of coping with public health emergency / 中国实用护理杂志

Objective To analyze the situation of table tennis competitions in emergency public health events, find the possible weak links in the emergency rescue and care work, put forward the hospital in response to emergency public health emergency preparedness plan, health emergency drills and emergency rescue personnel training and so on targeted reference views. Methods A total of four public health emergencies such as traffic accident, mass food poisoning, fire and bird flu were selected as the theme of the competition to simulate the emergency rescue process after the emergency,the examination of each team is divided into pre-hospital disposal and hospital disposal links. Results The score of Crash in Batches was 225.13 ± 8.38, followed by Fire accident 222.78 ± 16.57, Avian Influenza 210.32 ± 11.19, Group Food poisoning 204.80 ± 6.77, the difference was statistically significant (F=8.706,P=0.000). The scores of pre-hospital treatment in all four subjects were109.04±4.80, 108.62±10.12, 98.24±6.95, 101.14± 8.85,lower than those in hospital, which were 116.09±4.79, 114.16±7.61, 106.56±5.31, 109.18±4.24, the difference was statistically significant (t=-6.130--2.338,P＜0.01 or 0.05). Conclusions On the different topics exposed in the desktop exercise competition and the differences between the pre-hospital treatment and the hospital disposal, the nursing managers should strengthen the training and practice of public health emergencies with different themes, and pay attention to the pre-hospital emergency public health emergencies training and rehearsal,the emergency response plans for public health emergencies were revised and improved through the health emergency drills.

Random control trial study on effect of narrative medicine mode on rehabilitation of patients underwent radical nephrectomy / 中国实用护理杂志

Objective To investigate the effect of narrative medicine mode in perioperative medical and nursing care for patients underwent radical nephrectomy. Methods A total of 124 patients received radical nephrectomy from February 2014 to October 2016 were selected and divided into experimental group and control group by block randomization grouping method with 62 cases each. Narrative medical treatment and care was applied in experimental group while control group received conventional treatment and care. The psychological status and social support of the patients were evaluated by Zung Self-rating Anxiety Scale(SAS), Self-rating Depression Scale (SDS) and social support rating scale(SSRS), as well as rehabilitation indexes including complications, first feeding time, hospitalization time, costs, etc. Results Anxiety and depression status were existed in both experimental and control groups before operations, and there were no significant difference in all pre-operative scales between two groups (P>0.05). The score of SAS, SDS, SSRS was (44.71 ± 4.67), (40.84 ± 4.05), (43.21 ± 3.60) points after operation and (54.98 ± 5.93), (46.52 ± 5.07), (31.87 ± 3.22) points before operation in experimental group. The score of SAS, SDS, SSRS was (53.24±5.97), (44.63±4.37), (32.61± 2.72) points after operation and (54.92 ± 5.83), (46.53 ± 4.89), (32.16 ± 2.48) points before operation in control group. Significant differences were found between before and after operation in experimental group (t=18.73, 8.85, 18.18, all P0.05). After operation, the complications, first feeding time, hospitalization time and costs was 22.58%(14/62), (2.50±0.92) d, (11.16±3.72) d, (24.6±4.0) thousand yuan in experimental group, which was 48.39%(30/62), (3.98 ± 1.44) d, (15.48 ± 5.44) d, (40.2 ± 3.1) thousand yuan in control group. Significant differences were found between experimental group and control group (χ2=9.02, t=2.07, 8.06, 3.93, P<0.05 or 0.01). Conclusions Narrative medicine mode can provide medical care filled with respect, empathy, and humanistic concern, andimprove patients′psychological status, thus promoting rehabilitation.

The level and influencing factors of nurses preparedness for disasters in nurses with low seniority in tertiary hospitals of Anhui province / 中国实用护理杂志

Objective To investigate the level of nurses′preparedness and influencing factors of nurses with low seniority in Anhui province. Methods Totally 295 nurses with low seniority were recruited by convenience sampling method. They were investigated by a self-designed demographic data questionnaire and the Disaster Preparedness Evaluation Tool. Results The score of the disaster nursing ability of the nursing managers was 163.85 ± 32.41, the mean score was 3.64 ± 0.72. Regression analysis showed that the gender, the experience of disaster rescue,disaster training were the influencing factors of disaster preparedness. Conclusions The capacity of disaster preparedness for nurses is not ideal. There is still room for improvement among nurses in Anhui province to enhance disaster preparedness, and improved disaster nursing training system is needed to achieve this.

Protective effect of active ingredients of Kang Fu Ling on PC12 cells oxidative injury induced by microwave irradiation / 军事医学

Objective To observe the effect of the three active ingredients of a Chinese traditional medicine compound named Kang Fu Ling( KFL) against PC12 cells oxidative damage induced by microwave radiation.Methods PC12 cells were differentiated into neuros induced by nerve growth factor ( NGF ) .PC12 cells were incubated for 48 hours after astragalosides,total paeony glycoside and tanshinones were added at different concentrations (1, 3, or 9 μg/ml) .The cells in the control group were cultivated with the only medium of the same volume.Then, cells were irradiated with 30 mW/cm2 microwave for 6 minutes.The morphology of PC12 cells was observed under an inverted microscope soon before and after irradiation and the cell viability was measured by methylthiazolyl tetrazolium ( MTT) colorimetry.Reactive oxygen species ( ROS ) was determined using active oxygen probe 2′, 7′-dichlorodihyarofluolescen diacetde ( DCFH-DA ) while malonyldialdehyde(MDA) was measured in the homogenate of PC12 cells through thiobarbituric acid ( TBA) reactive substance assay.Results The cell morphology of each group showed no obvious difference.6 h after irradiation, the viability of irradiation control group measured by MTT declined apparently(P<0.01)compared with the normal control group.The 3 μg/ml astragalosides treatment group increased the viability of PC12 cells after microwave exposure ( P <0.01).The contents of ROS and MDA were increased after irradiation(P<0.01).However, in the three active ingredients of Kang Fu Ling treatment groups, both ROS and MDA were much lower than in irradiation control group.Conclusion Astragalosides, total paeony glycoside and tanshinones, which are the three active ingredients of Kang Fu Ling, all have protective effect against PC12 cell injury caused by microwave radiation,possibly by scavenging free radicals and reducing oxidative stress injury.

The level and influence factors of disaster nursing ability and cognitive status of nursing managers / 中国实用护理杂志

Objective To investigate the level of disaster nursing ability and cognitive status of nursing manager,explore the characteristics and influencing factors,in order to provide a basis for intervention in improving the capacity of disaster nursing care.Methods 113 nursing managers were recruited by convenience sampling from a first-class ternary hospitals in Anhui province.They were investigated by a self-designed demographic data questionnair and disaster nursing and cognitive scale.Results The score of the disaster nursing ability of the nursing managers was 114.12±18.21,the mean score was 2.65±0.42,both below the medium level.Regression analysis showed that the nursing age of nurse manager,whether accepted disaster nursing training after work were the influencing factors of the disaster nursing ability of the nursing managers and explained 33.5％ of the variance.Conclusions The capacity of disaster nursing care of nurse managers is not high.The nursing age of nurse manager,whether accepted disaster nursing training after work were the influencing factors of the disaster nursing ability of the nursing managers.

Investigation in the influencing factors of activities of daily living of patients after abdominal surgery / 中国实用护理杂志

Objective To study the affecting factors of the activities of daily living in patients after abdominal surgery.Methods Using survey methodology,95 abdominal surgery patients were investigated br general condition questionnaire and Barthel index scales.The data were analyzed using descriptive analysis,t test,variance analysis and multiple regression analysis.Results The total number of valid return was 91.and the valid usable return rate was 95.8% .The affecting factors of recovery to ADL2 of abdominal surgery patients after operation were gender,age,education level,economic condition,type of illness,postoperation complications,operation times,nutrition risk scores and activities of daily living of preoperation,and the differences were significant.The affecting factors of recovery to ADL1 of abdominal surgery patients after operation were age,education level economic condition,marital status,type of illness,postoperation complications,nutrition risk scores and activities of daily living of preoperation,the differences wen significant.Conclusions The affecting factors of ADL of abdominal surgery patients after operation were gender,age,education level economic level,type of illness,postoperation complications,marital status,operation times,nutrition risk scores and activities of daily living of preoperation.

Clinical value of two types of draingae tubes for hepatectomy / 中国实用护理杂志

Objective To investigate the clinical value of closed-type mono-lumen drainage tube(M) and open double-lumen drainage tube(D)for hepstectomy.Methods The data from 99 patients who un-derwent hepatectomy in our depamnent from July 2005 to May 2008 were analyzed retrospectively.All patients were divided into two groups according to the draining methods:group M (n=59)used closed-type mono-lu-men drainage tube and group D(n=40) used double-lumen drainage tube.The incidence of pipe blockage,ef-fusion under diaphragm,the duration of drainign and the duration of hospitalization between the two groups was compsred.Results M group was better than D group in the patency of drainage tube,effusion under di-aphragm,the duration of draining and the duration of hospitalization,P＜0.05.Condusions It is advocated to apply closed-type mono-lumen drainage tube after refined hepsteetomy.