Application of psychological intervention in intensive care unit nursing for patients with severe acute pancreatitis

BACKGROUND Severe acute pancreatitis(SAP)is a familiar critical disease in the intensive care unit(ICU)patients.Nursing staff are important spiritual pillars during the treatment of patients,and in addition to routine nursing,more attention needs be paid to the patient’s psychological changes.AIM To investigate the effects of psychological intervention in ICU patients with SAP.METHODS One hundred ICU patients with SAP were hospitalized in the authors’hospital between 2020 and 2023 were selected,and divided into observation and control groups per the hospitalization order.The control and observation groups received routine nursing and psychological interventions,respectively.Two groups are being compared,using the Self-rating Anxiety Scale(SAS),Self-Determination Scale(SDS),Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱ,and 36-item Short Form Health Survey(SF-36)scores;nursing satisfaction of patients;ICU care duration;length of stay;hospitalization expenses;and the incidence of complications.RESULTS After nursing,the SDS,SAS,and APACHEⅡ scores in the experimental group were significantly lower than in the control group(P<0.05).The SF-36 scores in the observation group were significantly higher than those in the control group(P<0.05).The nursing satisfaction of patients in the experimental group was 94.5%,considerably higher than that of 75.6% in the control group(P<0.05).The ICU care duration,length of stay,and hospitalization expenses in the observation group were significantly lower than those in the control group,and the incidence of complications was lower(P<0.05).CONCLUSION For patients with SAP,the implementation of standardized psychological intervention measures can effectively alleviate adverse psychological conditions.

Effects of ultrasound monitoring of gastric residual volume on feeding complications,caloric intake and prognosis of patients with severe mechanical ventilation

BACKGROUND Monitoring of gastric residual is an important approach for assessing gastric emptying in patients with mechanical ventilation.By monitoring gastric contents,the enteral nutrition scheme can be adjusted in time to ensure feeding safety.AIM To investigate the effects of ultrasound monitoring on the incidence of feeding complications,daily caloric intake and prognosis of patients with severe mechanical ventilation.To analyze the clinical significance of ultrasound monitoring of gastric residual volume(GRV)up to 250 mL to provide a theoretical basis for clinical practice.METHODS Patients admitted to the department of emergency medicine of the Affiliated Hospital of Nantong University from January 2018 to June 2022 who received invasive mechanical ventilation and continuous enteral nutrition support within 24-48 h after admission were enrolled in this study.Medical records for patients within 7 d of hospitalization were retrospectively analyzed to compare the incidence of feeding complications,daily caloric intake and clinical prognosis between patients with gastric residual≥250 mL and<250 mL,as monitored by ultrasound on the third day.RESULTS A total of 513 patients were enrolled in this study.Incidences of abdominal distension,diarrhea,and vomiting in the<250 mL and≥250 mL groups were:18.4%vs 21.0%,23.9%vs 32.3%and 4.0%vs 6.5%,respectively;mortality rates were 20.8%vs 22.65%;mechanical ventilation durations were 18.30 d vs 17.56 d while lengths of stay in the intensive care units(ICU)were 19.87 d vs 19.19±5.19 d.Differences in the above factors between groups were not significant.Gastric residual≥250 mL was not an independent risk factor for death and prolonged ICU stay.However,target feeding time of patients in the≥250 mL group was longer than that of patients in the≥250 mL group,and caloric intake(22.0,23.6,24.8,25.3 kcal/kg/d)for patients in the≥250 mL group from the 4^(th) day to the 7^(th) day of hospitalization was lower than that of patients in the≥250 mL group(23.2,24.8,25.7,25.8 kcal/kg/d).On the 4^(th) day(Z=4.324,P=0.013),on the 5^(th) day(Z=3.376,P=0.033),while on the 6^(th) day(Z=3.098,P=0.04),the differences were statistically significant.CONCLUSION The use of ultrasound to monitor GRV and undertaking clinical interventions when the monitoring value is≥250 mL has no significant effects on incidences of feeding complications and clinical prognostic outcomes,however,it significantly prolongs the time to reach target feeding,reduces the daily intake of calories during ICU hospitalization,and increases the risk of insufficient nutrition of patients.The accuracy and necessity of monitoring gastric remnants and monitoring frequencies should be investigated further.

Comparison of prognostic factors in different age groups and prognostic significance of neutrophil-lymphocyte ratio in patients with gastric cancer

BACKGROUND Gastric cancer(GC)is one of the most common malignant tumors in the world.Although in recent years tremendous progress has been made in its early detection,the postoperative overall survival(OS)of GC patients remains extremely low.A number of studies have shown that age,to varying degrees,affects the prognosis of patients with GC.Therefore,this study retrospectively analyzed the clinical and pathologic data of patients with GC to explore the differences in the clinical characteristics and prognostic factors in different age groups.AIM To explore the difference in clinicopathological characteristics and prognostic factors in GC patients in different age groups.METHODS In this retrospective study,we analyzed 1037 GC patients admitted to Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from May 2010 to January 2013.The patients were divided into two groups based on age:Younger group(less than 70 years old)and older group(no less than 70 years old).In the younger group,we subdivided the patients in two subgroups by a cutoff value of 45 years.The clinical features and prognostic factors were analyzed in both groups.Subsequently,we retrieved studies that evaluated the predictive role of neutrophil-lymphocyte ratio(NLR)by searching two medical databases,PubMed and EMBASE,to conduct a meta-analysis.Random-effects model was used to pool the data.RESULTS In the retrospective study,the mean OS time of the younger group(64.7 mo)was significantly longer than that of the older group(48.1 mo)(P<0.001).Among patients under 70 years of age,hospitalization time,tumor–node–metastasis(TNM)stage,vascular invasion,and preoperative low pre-albumin were independently associated with OS(P<0.005).In patients aged 70 years and above,TNM stage,esophageal invasion,histological type,and preoperative NLR were independent factors for OS(P<0.05).The OS of these older patients was also significantly shorter(P<0.05).In the meta-analysis,19 retrieved studies included a total of 8312 patients,among whom 3558 had elevated NLR values.The results showed that high NLR value was a risk factor for the prognosis of GC(P<0.01).CONCLUSION The OS of elderly patients is significantly worse than that of younger patients.There are significant differences in clinicopathological characteristics and prognostic factors between younger and older patients.NLR is a convenient,inexpensive,and reproducible marker that can be used as an important predictor of the prognosis of GC.