Characteristics of bloodstream infection and initial antibiotic use in critically ill burn patients and their impact on patient prognosis.

To investigate the bacterial epidemiology of blood cultures taken during the treatment of critically ill burn patients, the use of antibiotics at admission and before the observation of positive blood cultures, and their effect on prognosis. A retrospective study method was used. From January 1, 2010, to December 31, 2019, burn patients who met the inclusion criteria and were treated at the Burn Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, were enrolled in the study. Data were collected from the patients' electronic medical records. General patient information, including length of hospital stay, length of intensive care unit (ICU) stay, in-hospital mortality, the bacteria epidemiological characteristics of blood cultures, and the use of antibiotics within 24 h after admission and before a positive blood culture was observed, was collected. Independent sample t tests and χ2 tests were used to compare the effects of a positive blood culture and the use of appropriate antibiotics within 24 h after admission and before the observation of a positive blood culture on prognosis. (1) The three most frequently detected bacteria in the blood cultures were Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii, and the amount of K. pneumoniae detected increased gradually. (2) Compared with the group of patients who were negative for bloodstream infection , the positive bloodstream infection group had a larger total body burn surface area (TBSA) (t = - 5.097, P = 0.000) and third-degree burn area (t = - 5.133, P = 0.000), a significantly longer length of hospital stay (t = 3.003, P = 0.003) and the length of ICU stay (t = 4.258, P = 0.000), and a significantly higher rate of in-hospital mortality (χ2 = 8.485, P = 0.004). When K. pneumoniae was detected, the length of hospital stay (t = 2.148, P = 0.035) and the length of ICU stay (t = 2.880, P = 0.005) were significantly prolonged. (3) The two antibiotics that were most frequently used in patients with acute burns within 24 h after admission were lincomycin (90 cases, 29.32%) and carbapenems (79 cases, 25.73%). Comparing the clinical characteristics of the lincomycin group and the carbapenem group, the TBSA (t = - 3.34, P = 0.001) and the third-degree burn area (t = - 6.08, P = 0.000) of the patients in the carbapenem group were larger, and the length of hospital stay (t = - 2.136, P = 0.035) and length of ICU stay (t = - 5.18, P = 0.000) were longer, but the difference in in-hospital mortality was not statistically significant (χ2 = 1.983, P = 0.159). (4) Comparing the group with appropriate initial antibiotic use within 24 h of admission to the inappropriate use group, the TBSA (t = - 0.605, P = 0.547), the third-degree burn area (t = 0.348, P = 0.729), the length of hospital stay (t = - 0.767, P = 0.445), the length of ICU stay (t = - 0.220, P = 0.827) and in-hospital mortality (χ2 = 1.271, P = 0.260) were not significantly different. (5) Comparing the group with appropriate antibiotic use before a positive blood culture was observed to the group with inappropriate antibiotic use, the TBSA (t = - 0.418, P = 0.677), the third-degree burn area (t = 0.266, P = 0.791), the length of hospital stay, the length of ICU stay (t = 0.995, P = 0.322) and in-hospital mortality (χ2 = 1.274, P = 0.259) were not significantly different. We found that patients with a positive blood culture had a larger burn area and a worse prognosis; that the greater the amount of K. pneumoniae in the bloodstream of burn patients was, the longer the hospital and ICU stays were; that whether appropriate antibiotics were administered to acute critical burn patients 24 h after admission had no effect on the prognosis; and that whether appropriate antibiotics were administered before a positive blood culture was observed had no effect on prognosis.

Weight Gain during Neoadjuvant Chemotherapy is Associated with Worse Outcome among the Patients with Operable Breast Cancer / 한국유방암학회지

PURPOSE: This study was aimed at identifying the influence of initial weight and weight change during neoadjuvant chemotherapy (NAC) on pathologic complete response (pCR) and long-term survival in Chinese patients with operable breast cancer. METHODS: We conducted a retrospective study using data from 409 female patients who received NAC for stage II or III breast cancer and had complete record of body mass index (BMI) before and after NAC. BMI of 2 kg/m² following NAC was considered to be significant, else was considered stable. The study end points included pCR rates, disease-free survival (DFS), and overall survival (OS). RESULTS: The median follow-up time was 43.2 (8.9–93.6) months. The average BMI was 23.40 ± 3.04 kg/m² before NAC and 23.66 ± 3.02 kg/m² after NAC (t = −3.604, p < 0.001). The pCR rate was 25.3% in the NW/UW group and 24.1% in the OW/OB group (p = 0.811), and was similar between the BMI-gain (23.3%) and the BMI-stable/loss (25.1%) groups (p = 0.787). Initial BMI was an independent prognostic factor for DFS (hazard ratio, 1.69; 95% confidence interval [CI], 1.13–2.53; p = 0.011) but not for OS, while BMI-gain was an independent prognostic factor for both DFS (hazard ratio, 2.09; 95% CI, 1.28–3.42; p = 0.003) and OS (hazard ratio, 1.97; 95% CI, 1.04–3.74; p = 0.039). CONCLUSION: BMI increased after NAC in Chinese breast cancer patients. Initial BMI and BMI change during NAC were not associated with pCR but were reversely associated with survival.

Development of an assessment tool for nursing professional values / 中国实用护理杂志

Objective The purpose of the study was to develop an instrument to measure nursing professional values held by Chinese nurses.Methods 381 nurses were enrolled for the survey on their professional values by the draft of nursing professional values assessment tool(NPVAT).With the item analysis,such as dispersion degree,correlation efficient,discriminability,alpha coefficients index and exploratory factor analysis,the items were selected.Results As a result of the item analysis,the final version of NPVAT was composed of 20 items selected from a total of 32 items.Exploratory factor analysis resulted in a four-factor solution explaining 51.99％ of the common variance.Conculsions The NPVAT developed in this research can be used for measuring the nursing professional values among nurses.

Comprehensive nutritional assessment scale for hospitalized patients established with analytical hierarchy process / 上海交通大学学报（医学版）

Objective To establish a comprehensive nutritional assessment scale for hospitalized patients with objective and subjective nutritional assessment indicators. Methods The hierarchical structure model was established to evaluate the nutritional status of hospitalized patients by analytic hierarchy process,and the weight coefficients of various assessment indicators were worked out by Satty product method,then the comprehensive nutritional assessment scale for hospitalized patients was established. ResuIts The newly established comprehensive nutritional assessment scale included 11 subjective and objective indicators,and the weight coefficients of indicators varied.The leading three important indicators for nutritional assessment were serum prealbumin(2.3),serum albumin(2.3)and degree of weight loss(1.6).Conclusion With both snbjective and objective indicators,the new comprehensive nutritional assessment scale established with analytic hierarchy process transforms the qualitative indicator into the quantitative one.It is a new attempt to apply the mathematical theory into the area of clinical medicine.

The value of using the subjective global assessment as a nutritional assessment and prognosis prediction tool in inpatient / 肠外与肠内营养

The Subjective Global Assessment(SGA) is widely applied in the clinic.The usage and the clinical purpose of SGA is quite different among the various studies.In some studies,SGA proved to be a good screening tool for nutritional risk or a prognostic indicator for poorer outcomes.In several clinical setting,SGA was employed as a "gold standard" method against which new nutritional assessment methods were validated.At present,the different indicators of nutritional assessment reflect the different characteristics of the body's nutritional status changes.The different indicators and methods should be incorporated according to the patient in order to objectively and correctly assess the patient's nutritional status.

Glutamine in the prevention and treatment of bone marrow transplantation-related mucositis and veno-occlusive disease / 肠外与肠内营养

Glutamine is the most abundant free amino acid in the body,which is regarded as a conditionally essential amino acid under the conditions of stress and hypermetabolism.It has been proved that glutamine can enhance the proliferation of immune cells and the repair of impaired mucosa and can also improve the nitrogen balance and skeletal muscle protein synthesis.Therefore,it is now more and more widely used in the bone marrow transplantation.The roles of glutamine in the prevention and treatment of bone marrow transplantation-related mucositis and veno-occlusive disease are reviewed in this article.