Application of Intraoperative Neurophysiological Monitoring (IONM) for Preventing Dysphagia After Anterior Cervical Surgery: A Prospective Study.

OBJECTIVE: To evaluate the clinical value of intraoperative nerve monitoring (IONM) for dysphagia after anterior cervical surgery with and without IONM. METHODS: A prospective, randomized, controlled study was conducted on 46 patients who underwent anterior cervical spine surgery by an experienced orthopaedic surgeon. Twenty-three patients who underwent anterior cervical surgery did not undergo IONM (non-IONM group), while the other 23 patients who underwent anterior cervical surgery did ("IONM group"). The swallowing function of patients was evaluated using the EAT-10 and endoscopic evaluation of swallowing (FEES) after surgery. RESULTS: There was no difference in the incidence of swallowing difficulties between the intervention group and the control group on the third day or sixth week after surgery. At the 12th week after surgery, the incidence of swallowing difficulties in the intervention group and the control group was significantly different (43.5% vs. 13.0%, P = 0.024). CONCLUSIONS: IONM is a promising tool for identifying and protecting the spinal cord and nerves during anterior cervical surgery. Our research revealed that IONM significantly reduced the occurrence of swallowing disorders 12 weeks after surgery, but the effect was not significant at the third or sixth week after surgery.

A multicenter cross-sectional survey of the knowledge, attitude, and behaviour of nurses regarding dysphagia after anterior cervical spine surgery: a prospective multicentre study.

BACKGROUND: The incidence of dysphagia after anterior cervical spine surgery is high, which directly affects the quality of life of patients after surgery. The knowledge, attitude, and behavior of nurses can affect the identification and management of patients after anterior cervical spine surgery. Therefore, we need a survey to understand the current status of nurses' knowledge, attitude, and behavior towards dysphagia after anterior cervical spine surgery. OBJECTIVE: To investigate the knowledge, attitude, and behaviour of orthopaedic nurses towards patients with dysphagia after anterior cervical spine surgery and provide recommendations for management and intervention. METHOD: An online cross-sectional survey was conducted between March and June 2023, which among 894 orthopaedic nurses from 36 tertiary hospitals in Chongqing using a questionnaire. The questionnaire included general information and knowledge, attitudes, and behaviours related to the management of dysphagia after anterior cervical surgery. RESULTS: The orthopaedic nurses' mean score for dysphagia-related knowledge was 16.1 ± 3.640 (out of a total score of 30). The orthopaedic nurses' mean score for dysphagia-related attitude was 32.5 ± 4.623 (out of a total score of 40). The orthopaedic nurses' mean score for dysphagia-related behaviour was 43.6 ± 11.513 (out of a total score of 60). The results of statistical analysis showed that the dysphagia after anterior cervical spine surgery -related knowledge scores differed significantly among the nurses according to, education level, and training (P < 0.05). Correlation analysis showed that there was a positive correlation between the knowledge, attitude, and behaviour scores of neurological nurses and swallowing disorders after anterior cervical surgery (P < 0.05). CONCLUSION: Targeted knowledge and skills training should be carried out to improve the rules and regulations for dysphagia after anterior cervical spine surgery. Multidisciplinary team cooperation is needed, and dietary service processes and management standards should be improved to improve the management ability of orthopaedic nurses for dysphagia after anterior cervical spine surgery.

Symptoms and coping of patients with dysphagia after anterior cervical spine surgery: a qualitative study.

AIM: To explore the subjective symptoms, psychological characteristics and coping strategies of patients with dysphagia after anterior cervical spine surgery, so as to provide the basis for formulating strategies to help patients with dysphagia solve clinical practice problems and to improve their quality of life after surgery. METHODS: Using the phenomenological research method and the purpose sampling method, semi-structured interviews were conducted with 22 participants with dysphagia at 3-time points after anterior cervical spine surgery (7 days, 6 weeks, and 6 months). RESULTS: A total of 22 (10 females and 12 males) patients, with years old ranging between 33 and 78 years were interviewed. When analysing the data, the following 3 categories were extracted from the participant interviews: "Subjective symptoms, Coping style and impact on social life". The 3 categories consist of 10 sub-categories. CONCLUSIONS: The results showed that swallowing-related symptoms may occur after anterior cervical spine surgery. Many patients had developed compensatory strategies to manage or reduce the burden of these symptoms, but lacked professional guidance from health care professionals. Moreover, dysphagia after neck surgery has its unique characteristics, involving the interaction of physical, emotional and social factors, which requires early screening.Healthcare professionals should provide better psychological support in the early or late postoperative period to ensure the improvement of health outcomes and patients' quality of life.

General anesthesia versus deep sedation for dental treatment in children: comparison of parental acceptance, oral health-related quality of life, and treatment efficacy / 南方医科大学学报

OBJECTIVE@#To compare the parental acceptance of dental treatment under general anesthesia and deep sedation in children and assess the changes in postoperative oral health-related quality of life and treatment efficacy.@*METHODS@#The parents of 131 children undergoing dental treatment in the Department of Stomatology of Sichuan Provincial People's Hospital from January, 2022 to June, 2022 were surveyed using a questionnaire of children's advanced oral behavior management, and 83 children receiving general anesthesia or deep sedation for dental treatment between January, 2018 and December, 2021 were also investigated for changes in quality of life after the treatment using a questionnaire. The treatment efficacy was assessed at the 1-year follow-up visit in 149 children who received dental treatment under general anesthesia or deep sedation during the same period.@*RESULTS@#The survey of perantal acceptance showed that 62.6% of the parents preferred deep sedation, 29.01% preferred general anesthesia, and 8.4% preferred compulsory treatment. Dental treatments under general anesthesia and deep sedation both significantly improved oral health-related quality of life of the children. While dental surgeries under general anesthesia resulted in the most significant improvement of pain symptoms, deep sedation was associated with both obvious relief of the children's pain symptoms and reduction of the parents' pressure level. No significant difference was found in the efficacy of treatments under general anesthesia and deep sedation at the 1-year follow-up.@*CONCLUSION@#Dental treatment in children under deep sedation has the highest parental acceptance, followed by treatment under general anesthesia, and the acceptance of compulsory treatment is the lowest. The treatments under general anesthesia and deep sedation significantly improve the quality of life of the children and their parents and both have good treatment efficacy.

A qualitative study on employment experiences of coordinators of In-Hospital Organ Procurement Organization / 中国实用护理杂志

Objective:To explore the employment experiences of coordinators of In-Hospital Organ Procurement Organization (OPO).Methods:Based on purpose sampling, 12 full-time In-Hospital OPO coordinators in Chongqing City were recruited from July to December 2020. A semi-structured and in-depth interview was performed and the data was analyzed by Colaizzi.Results:4 first-level themes were extracted, including professional identity process, negative emotional experience, improvement of professional practice competence and job expectancy. 12 second-level themes were identified including career expectations and identity confusion, professional values, shortage of respect and ratification, huge workloads, great psychological pressure, influence of the bereaved families, enhancement of the ability to communicate, improvement of problem-solving ability, improvement of team-work ability, optimization of scenario simulation, a perfection of the assessment system, a clear career path.Conclusions:In-Hospital OPO coordinators are lack of professional awareness in an initial stage. While feeling a sense of professional value, they also experience some negative emotions. Furthermore, their competences are improved in practice and they, meanwhile, express a strong desire for career development. It is suggested that the administrators could explore establishment of academic education, enhancement of psychological and social support, creation of pretty working environments and improvement of training, assessment and promotion systems to facilitate the career development of coordinators.

The impact of vaccination on patients with COVID-19 during the wave of Omicron in Shanghai.

Background: The global health has been affected by the COVID-19 pandemic persistently, of which Omicron is currently the predominant variant. However, the impact of vaccination on Omicron remained uncertain. Objective: This study sought to explore the effect of vaccination on patients infected with Omicron. Methods: A retrospective observational cohort was conducted in the largest Fangcang shelter hospital in Shanghai from April 1 to May 30, 2022. The demographics, length of hospital stay, clinical symptoms, the comorbidities and vaccination status were recorded. Clinical outcomes of the vaccinated and non-vaccinated groups were compared and analyzed. Results: Of the 3,119 patients who fulfilled the eligibility criteria and were enrolled in the study, 2,226 (71.4%) patients had received nCoV-19 vaccine while 893 (28.6%) patients had not received it before admission. Patients in the vaccinated group had significantly shorter length of hospital stay than those in the unvaccinated group (15.48 ± 2.708 vs. 15.85 ± 3.102, p < 0.001). More asymptomatic patients were observed in the vaccinated group than the non-vaccinated (70.4 vs. 64.5%, p < 0.001). Further subgroup analysis demonstrated that the older the age, the more significant the difference was (p < 0.005). Conclusions: Vaccination was associated with a significant reduction in the severity of Omicron infection compared with no vaccination. Vaccination appears to make Omicron-infected people with milder symptoms than unvaccinated people. This suggests the potential effectiveness of current vaccines against Omicron.

Effect of positive end-expiratory pressure on the incidence of acute respiratory distress syndrome in non-acute lung injury/acute respiratory distress syndrome patients in ICU: a Meta-analysis / 中华危重病急救医学

Objective:To systematically review the therapeutic effect of continuous high positive end-expiratory pressure (PEEP) ventilation in patients with non-acute lung injury/acute respiratory distress syndrome (non-ALI/ARDS) under general anesthesia mechanical ventilation in the intensive care unit (ICU).Methods:PubMed, JBI Evidence-based Nursing Center Library, Cochrane Library, Embase, Medline, Wanfang Date, CNKI and VIP Database were searched for randomized controlled trials (RCT) and clinical controlled trials (CCT) using different levels of PEEP for the treatment of patients (uncombined ALI/ARDS) in ICU. The search period was from January 1st, 1990 to November 30th, 2018. Compared with the control group, the experimental group was treated with relatively high levels of PEEP ventilation. Outcome indicators were hospital mortality or 28-day mortality, partial oxygen pressure, and incidence of ARDS, atelectasis, and lung infections, etc. The RevMan 5.3 software was used for Meta-analysis.Results:Twelve articles were included, all of which were RCT studies; with 2 Chinese articles and 10 English articles. Meta-analysis showd that there was no statistically significant difference in the effect of different levels of PEEP on the mortality of patients [hospital mortality: odds ratio ( OR) = 1.06, 95% confidence interval (95% CI) was 0.57 to 1.96, P = 0.85; 28-day mortality: OR = 0.34, 95% CI was 0.09 to 1.32, P = 0.12]. Compared with low PEEP, persistently high PEEP could increase the patient's partial oxygen pressure [weighted mean difference ( WMD) = 48.27, 95% CI was 22.56 to 73.97, P = 0.000 2], prevent the occurrence of ARDS ( OR = 0.32, 95% CI was 0.13 to 0.82, P = 0.02), and decrease the incidence of lung infection ( OR = 0.52, 95% CI was 0.30 to 0.89, P = 0.02), but there was no significant difference in the incidence of atelectasis between the two groups ( OR = 0.69, 95% CI was 0.23 to 2.06, P = 0.51). Conclusion:In the treatment of patients in ICU with non-ALI/ARDS under general anesthesia mechanical ventilation, using relatively high levels of PEEP (10-16 cmH 2O, 1 cmH 2O = 0.098 kPa) instead of low levels of PEEP (≤8 cmH 2O) can significantly increase the partial oxygen pressure and significantly reduce the incidences of ARDS and lung infection.

Survey of current status and influencing factors analysis of attitude and willingness of ICU nurses towards organ donation in Chongqing / 器官移植

Objective To investigate the attitude and willingness of nurses from intensive care unit (ICU) in Chongqing towards organ donation and analyze the influencing factors. Methods In this study, 4 Grade 3A hospitals with organ transplantation qualifications in Chongqing were selected by cluster sampling, and 321 nurses in ICU from these 4 hospitals were chosen by convenient sampling method to complete the questionnaire survey. The scores of ICU nurses' attitude and willingness towards organ donation were calculated. Spearman's correlation analysis was adopted to analyze the correlation between the attitude and willingness to donate organs. Multiple linear regression analysis was performed to identify the influencing factors of attitude and willingness towards organ donation. Results The average score of ICU nurses' attitude toward organ donation was (3.5±0.9) and the median score of willingness to donate organs was 2 (2-3). The attitude of ICU nurses towards organ donation was positively correlated with their willingness (P < 0.001). The experience of voluntary blood donation, the attitude of family members towards organ donation and the experience of organ donation persuasion were the influencing factors of ICU nurses' willingness to donate organs (all P < 0.05), among which the experience of voluntary blood donation and the attitude of family members towards organ donation were also the influencing factors of ICU nurses' attitude towards organ donation (both P < 0.05). Conclusions ICU nurses hold neutral attitude towards organ donation and show low willingness to donate organs. The experience of voluntary blood donation, the attitude of family members towards organ donation and the experience of organ donation persuasion are the main influencing factors.

Influencing factors for postoperative urinary retention in patients with spinal surgery / 中国实用护理杂志

Objective@#To investigate the influencing factors for postoperative urinary retention in patients with spinal surgery.@*Methods@#The clinical data of patients with spinal surgery were collected and divided into two groups according to the occurrence of urinary retention (urinary retention group and non occurring urinary retention group). The factors that may affect postoperative urinary retention were compared and multiple factor Logistic regression was used.@*Results@#Among the 292 patients, 56 cases had postoperative urinary retention and the morbidity was 19.18%. Single factor analysis indicated that Univariate analysis showed that there was a statistically significant difference in anesthetic mode, time of indwelling catheter, time of lying in bed, clamping catheter and timing of removal of urinary catheter (χ2=5.035-22.747, P<0.05 or <0.01). Multivariate Logistic regression analysis showed that the risk factors for urinary retention were time of catheter more than 3 days and bed time is no less than 5 days, and the protective factors were clamping the catheter indwelling training, having a sense of urine and bladder filling.@*Conclusions@#During the period of indwelling catheter can be closed catheter training, grasp the time of indwelling catheter 1-2 d best catheter time. Urinary catheter should be removed when urine is filled and bladder is filled. At the same time, under the premise of ensuring safety, the patient's bed time should be shortened as far as 5 days, and the rate of urinary retention can be reduced.

Influencing factors for postoperative urinary retention in patients with spinal surgery / 中国实用护理杂志

Objective To investigate the influencing factors for postoperative urinary retention in patients with spinal surgery. Methods The clinical data of patients with spinal surgery were collected and divided into two groups according to the occurrence of urinary retention (urinary retention group and non occurring urinary retention group). The factors that may affect postoperative urinary retention were compared and multiple factor Logistic regression was used. Results Among the 292 patients, 56 cases had postoperative urinary retention and the morbidity was 19.18% . Single factor analysis indicated that Univariate analysis showed that there was a statistically significant difference in anesthetic mode, time of indwelling catheter, time of lying in bed, clamping catheter and timing of removal of urinary catheter (χ2=5.035-22.747, P<0.05 or<0.01). Multivariate Logistic regression analysis showed that the risk factors for urinary retention were time of catheter more than 3 days and bed time is no less than 5 days, and the protective factors were clamping the catheter indwelling training, having a sense of urine and bladder filling. Conclusions During the period of indwelling catheter can be closed catheter training, grasp the time of indwelling catheter 1-2 d best catheter time. Urinary catheter should be removed when urine is filled and bladder is filled. At the same time, under the premise of ensuring safety, the patient's bed time should be shortened as far as 5 days, and the rate of urinary retention can be reduced.

The application of nursing procedure in the patient′s care of Ebola virus disease / 重庆医学

Objective To explore the application and clinical effects of nursing procedure of in the patients of Ebola virus dis-ease (EVD).Methods We went on nursing assessments to the 5 EVD patients by applying nursing procedure and made the nursing diagnosis based on the results of nursing assessments.Then we analyzed the possible reasons of common nursing problems and made anticipated goals and carried out the nursing strategies.We evaluated the efficiency of nursing eventually.Results We carried out nursing procedures in 5 EVD patients.No complication was occurred in all patients.Three patients fully recovered and dis-charged from our hospital.We got a good treatment results and achieved good social benefits.Conclusion System nursing to EVD patients,which accords to nursing procedure,helps us reducing the nursing complications,and decreasing the mortality of patients.

Design and practice of multimodal phased protective training for medical staff in the Chinese Ebola Treatment Unit / 重庆医学

Objective To investigate the methods and effects of multimodal and phased protective training for medical staff against Ebola.Methods The 4 stages of the protective training include the theoretical teaching,track type simulative process train-ing,simulative ward training,on-site training.We combined the 4 protective training stages and made 4 protective skills assessments in sequence.Results The average scores and qualified rates of the medical staff in the second,third,fourth assessment increased significantly comparing with that in the first assessment.The qualified rate reached 100% in the fourth assessment and we realized zero infection during the mission.Conclusion Multimodal phased protective training reinforced the protective skills of medical staff.Zero infection of medical staff needed seamless supervision in work time eventually.

Construction of core competence evaluation index system for orthopaedic specialized nurse / 重庆医学

Objective To establish core competence evaluation index system of orthopaedic specialized nurse .Methods Alto‐gether 35 experts from Class Ⅲ Grade Ⅰ hospital in Chongqing ,Beijing ,Jiangshu were consulted by a three‐round delphi survey ,and finally established the core competence evaluation index system of orthopaedic and the weight of each index .Results The core com‐petence evaluation indexes of orthopaedic specialized nurse included 4 first class indexes ,14 second class indexes and 72 third class indexes .The expert authority coefficient was 0 .833 ,the familiar coefficient was 0 .794 ,the determination coefficient was 0 .872 ,The coordination coefficient of primary and secondary and third indicators were 0 .390 ,0 .324 ,0 .308 ,respectively ,and there were statis‐tically significant differences (P< 0 .05) .Conclusion The expert opinions for the core competence evaluation indexes are consist‐ent ,the results are objective and scientific .It can provide quantitative standards for training ,examining and evaluation of orthopaedic specialized nurse .

Tissue culture system of Cynanchum otophylum in genetic transformation / 中草药

Objective To establish the tissue culture system of Cynanchum otophylum in genetic transformation. Methods Asepsis seedling was set up by using different explant parts, disinfectors, and disinfecting time. The callus was induced, breeded, and differentiated by using different media, different hormone categories and combinations, and different hormone concentrations of 2,4-D and KT. Results It was the best method that asepsis seeding was built up by using seed as the explant and using 10% NaClO to treat the seed for 20—30 min or using 0.2% HgCl2 to treat the stem for 3 min. The seed, root, stem, and leaf of C. otophylum can form callus easily. The 2,4-D was important in forming callus. C. otophylum was more sensitivity to KT. The effect was better when KT was used to induce callus or adventitious buds. MS+2,4-D 1.0 mg/L+KT 1.0 mg/L was the better medium to induce callus to form. The callus cant be induced to form adventitous buds without reference to using seed or root, stem, and leaf as the explant, without reference to using hormone 6-BA or KT, ZT, 2ip. Gentamicin 100 ?g/mL is the optimum pressure in genetic transformation of C. otophylum. Conclusion The seed or stem is the ideal material bombarded by particle gun that is induced to form callus for 14 d in the media MS+2, 4-D 1.0 mg/L+KT 1.0 mg/L and without forming adventitious buds.