Efficacy and safety of targeted therapy plus immunotherapy combined with hepatic artery infusion chemotherapy (FOLFOX) for unresectable hepatocarcinoma

BACKGROUND The advent of cutting-edge systemic therapies has driven advances in the treatment of hepatocellular carcinoma(HCC),and therapeutic strategies with multiple modes of delivery have been shown to be more efficacious than mono-therapy.However,the mechanisms underlying this innovative treatment modality have not been elucidated.AIM To evaluate the clinical efficacy of targeted therapy plus immunotherapy combined with hepatic arterial infusion chemotherapy(HAIC)of FOLFOX in patients with unresectable HCC.METHODS We enrolled 53 patients with unresectable HCC who received a combination of targeted therapy,immunotherapy,and HAIC of FOLFOX between December 2020 and June 2021 and assessed the efficacy and safety of the treatment regimen.RESULTS The objective response rate was 60.4%(32/53),complete response was 24.5%(13/53),partial response was 35.9%(19/53),and stable disease was 39.6%(21/53).The median duration of response and median progression-free survival were 9.1 and 13.9 months,respectively.The surgical conversion rate was 34.0%(18/53),and 1-year overall survival was 83.0%without critical complicating diseases or adverse events(AEs).CONCLUSION The regimen of HAIC of FOLFOX,targeted therapy,and immunotherapy was curative for patients with unresectable HCC,with no serious AEs and a high rate of surgical conversion.

Predicting the prognosis of hepatic arterial infusion chemotherapy in hepatocellular carcinoma

Hepatic artery infusion chemotherapy(HAIC)has good clinical efficacy in the treatment of advanced hepatocellular carcinoma(HCC);however,its efficacy varies.This review summarized the ability of various markers to predict the efficacy of HAIC and provided a reference for clinical applications.As of October 25,2023,51 articles have been retrieved based on keyword predictions and HAIC.Sixteen eligible articles were selected for inclusion in this study.Comprehensive literature analysis found that methods used to predict the efficacy of HAIC include serological testing,gene testing,and imaging testing.The above indicators and their combined forms showed excellent predictive effects in retrospective studies.This review summarized the strategies currently used to predict the efficacy of HAIC in middle and advanced HCC,analyzed each marker's ability to predict HAIC efficacy,and provided a reference for the clinical application of the prediction system.

Application of Patient Simulators Combined with Internet plus Scenario Simulation Teaching Models on Intravenous Infusion Nursing Education in China

Objective: To explore the effectiveness of applying patient simulators combined with Internet Plus scenario simulation teaching models on intravenous (IV) infusion nursing education, and to provide scientific evidence for the implementation of advanced teaching models in future nursing education. Methods: Enrolled 60 nurses who took the IV infusion therapy training program in our hospital from January 2022 to December 2023 for research. 30 nurses who were trained in traditional teaching models from January to December 2022 were selected as the control group, and 30 nurses who were trained with simulation-based teaching models with methods including simulated patients, internet, online meetings which can be replayed and scenario simulation, etc. from January to December 2023 were selected as the experimental group. Evaluated the learning outcomes based on the Competency Inventory for Nursing Students (CINS), Problem-Solving Inventory (PSI), comprehensive learning ability, scientific research ability, and proficiency in the theoretical knowledge and practical skills of IV infusion therapy. Nursing quality, the incidence of IV infusion therapy complications and nurse satisfaction with different teaching models were also measured. Results: The scientific research ability, PSI scores, CINS scores, and comprehensive learning ability of the experimental group were better than those of the control group (P 0.05), and their assessment results of practical skills, nursing quality of IV infusion therapy during training, and satisfaction with teaching models were all better than those of the control group with statistical significance (P < 0.05). The incidence of IV infusion therapy complications in the experimental group was lower than that in the control group, indicating statistical significance (P < 0.05). Conclusions: Teaching models based on patient simulators combined with Internet Plus scenario simulation enable nursing students to learn more directly and practice at any time and in any place, and can improve their proficiency in IV infusion theoretical knowledge and skills (e.g. PICC catheterization), core competencies, problem-solving ability, comprehensive learning ability, scientific research ability and the ability to deal with complicated cases. Also, it helps provide high-quality nursing education, improve the nursing quality of IV therapy, reduce the incidence of related complications, and ensure the safety of patients with IV therapy.

Propofol sedation in routine endoscopy:A case series comparing target controlled infusion vs manually controlled bolus concept

BACKGROUND Many studies have addressed safety and effectiveness of non-anaesthesiologist propofol sedation(NAPS)for gastrointestinal(GI)endoscopy Target controlled infusion(TCI)is claimed to provide an optimal sedation regimen by avoiding under-or oversedation.AIM To assess safety and performance of propofol TCI sedation in comparison with nurse-administered bolus-sedation.METHODS Fouty-five patients undergoing endoscopy under TCI propofol sedation were prospectively included from November 2016 to May 2017 and compared to 87 patients retrospectively included that underwent endoscopy with NAPS.Patients were matched for age and endoscopic procedure.We recorded time of sedation and endoscopy,dosage of medication and adverse events.RESULTS There was a significant reduction in dose per time of propofol administered in the TCI group,compared to the NAPS group(8.2±2.7 mg/min vs 9.3±3.4 mg/min;P=0.046).The time needed to provide adequate sedation levels was slightly but significantly lower in the control group(5.3±2.7 min vs 7.7±3.3 min;P<0.001),nonetheless the total endoscopy time was similar in both groups.No differences between TCI and bolus-sedation was observed for mean total-dosage of propofol rate as well as adverse events.CONCLUSION This study indicates that sedation using TCI for GI endoscopy reduces the dose of propofol necessary per minute of endoscopy.This may translate into less adverse events.However,further and randomized trials need to confirm this trend.

Hepatic arterial infusion chemotherapy with anti-angiogenesis agents and immune checkpoint inhibitors for unresectable hepatocellular carcinoma and meta-analysis

BACKGROUND Hepatic arterial infusion chemotherapy(HAIC)has been proven to be an ideal choice for treating unresectable hepatocellular carcinoma(uHCC).HAIC-based treatment showed great potential for treating uHCC.However,large-scale studies on HAIC-based treatments and meta-analyses of first-line treatments for uHCC are lacking.AIM To investigate better first-line treatment options for uHCC and to assess the safety and efficacy of HAIC combined with angiogenesis inhibitors,programmed cell death of protein 1(PD-1)and its ligand(PD-L1)blockers(triple therapy)under real-world conditions.METHODS Several electronic databases were searched to identify eligible randomized controlled trials for this meta-analysis.Study-level pooled analyses of hazard ratios(HRs)and odds ratios(ORs)were performed.This was a retrospective single-center study involving 442 patients with uHCC who received triple therapy or angiogenesis inhibitors plus PD-1/PD-L1 blockades(AIPB)at Sun Yat-sen University Cancer Center from January 2018 to April 2023.Propensity score matching(PSM)was performed to balance the bias between the groups.The Kaplan-Meier method and cox regression were used to analyse the survival data,and the log-rank test was used to compare the suvival time between the groups.RESULTS A total of 13 randomized controlled trials were included.HAIC alone and in combination with sorafenib were found to be effective treatments(P values for ORs:HAIC,0.95;for HRs:HAIC+sorafenib,0.04).After PSM,176 HCC patients were included in the analysis.The triple therapy group(n=88)had a longer median overall survival than the AIPB group(n=88)(31.6 months vs 14.6 months,P<0.001)and a greater incidence of adverse events(94.3%vs 75.4%,P<0.001).CONCLUSION This meta-analysis suggests that HAIC-based treatments are likely to be the best choice for uHCC.Our findings confirm that triple therapy is more effective for uHCC patients than AIPB.

Accelerated infliximab infusions for inflammatory bowel disease improve effectiveness

AIM:To study the safety and effectiveness associated with accelerated infliximab infusion protocols in patients with inflammatory bowel disease(IBD).METHODS:Original protocols and infusion rates were developed for the administration of infliximab over 90-min and 60-min.Then the IBD patients on stable maintenance infliximab therapy were offered accelerated infusions.To be eligible for the study,patients needed a minimum of four prior infusions.An initial infusion of 90-min was given to each patient;those tolerating the accelerated infusion were transitioned to a 60-min infusion protocol at their next and all subsequent visits.Any patient having significant infusion reactions would be reverted to the standard 120-min protocol.A change in a patient's dose mandated a single 120-min infusion before accelerated infusions could be administered again.RESULTS:The University of Virginia Medical Center's Institutional Review Board approved this study.Fifty IBD patients treated with infliximab 5mg/kg,7.5mg/kg and 10mg/kg were offered accelerated infusions.Forty-six patients consented to participate in the study.Nineteen(41.3%) were female,five(10.9%) were African American and nine(19.6%) had ulcerative colitis.The mean age was 42.6 years old.Patients under age 18 were excluded.Ten patients used immunosuppressive drugs concurrently out of which six were taking azathioprine,three were taking 6-mercaptopurine and one was taking methotrexate.One of the 46 study patients used corticosteroid therapy for his IBD.Seventeen of the patients used prophylactic medications prior to receiving infusions;six patients received corticosteroids as pre-medication.Four patients had a history of distant transfusion reactions to infliximab.These reactions included shortness of breath,chest tightness,flushing,pruritus and urticaria.These patients all took prophylactic medications before receiving infusions.46 patients(27 males and 19 females) received a total of fifty 90-min infusions and ninety-three 60-min infusions.No infusion reactions were reported.There were no adverse events,including drug-related infections.None of the patients developed cancer of any type during the study timeframe.Total cost savings for administration of the both 90-min and 60-min accelerated infusions compared to standard 120-min infusions was estimated to be $53 632($116 965 vs $63 333,P=0.001).One hundred and eighteen hours were saved in the administration of the accelerated infusions(17 160 min vs 10 080 min,P=0.001).In the study population,overweight females [body mass index(BMI)>25.00kg/m2] were found to have statistically higher BMIs than overweight males(mean BMI 35.07±2.66kg/m2 vs 30.08±0.99kg/m2,P=0.05),finding which is of significance since obesity was described as being one of the risk factors for Crohn's disease.CONCLUSION:We are the first US group to report substantial cost savings,increased safety and patient satisfaction associated with accelerated infliximab infusion.

Real-Time Analytical Solutions as Series Formulas and Heaviside off/on Switch Functions for Multiple Intermittent Intravenous Infusions in One- and Two-Compartment Models

Pharmacokinetic compartment models are the only models that can extract pharmacokinetic parameters from data collected in clinical studies but their estimates lack accuracy, explanations and physiological significance. The objective of this work was to develop particular solutions to drug concentration and AUC in the form of mathematical series and Heaviside functions for repetitive intermittent infusions in the one- and two-compartment models, as a function of dose number and total time using differential calculus. It was demonstrated that the central and peripheral compartment volumes determined from regression analysis of the aminoglycoside antibiotic Sisomicin concentration in plasma represent the actual physiological body fluid volumes accessible by the drug. The drug peak time and peak concentration in the peripheral compartment were also calculated as a function of dose number. It is also shown that the time of intercompartmental momentary distribution equilibrium can be used to determine the drug’s apparent volume of distribution within any dosing interval in multi-compartment models. These estimates were used to carry out simulations of plasma drug concentration with time in the one-compartment model. In conclusion, the two-compartment open mammillary pharmacokinetic model was fully explained for the aminoglycoside antibiotic sisomicin through the new concept of the apparent volume of distribution.

Aluminum Contents in Dry Leaves and Infusions of Commercial Black and Green Tea Leaves: Effects of Sucrose and Ascorbic Acid Added to Infusions

Tea consumption has increased due to its beneficial effects. Results from a lab study on the effect of sucrose (5 g per cup, 150 mL) and/or ascorbic acid (2 mL per cup, 150 mL) on dissolved aluminum compounds during the infusion of two commercial types of dry tea leaves (black, green) with boiling water (5, 15 min infusion time) are presented. Factors influencing the presence of dissolved aluminum in the infusions of both tea leaves were infusion time and sugar contents, as well as the interaction between ascorbic acid and sucrose (p < 0.05). Aluminum contents found after 15 min of infusion were 0.7 mg L–1 for black tea infusions added with sugar, and 0.69 mg L–1 for green tea added with both sugar and ascorbic acid. Both concentrations are higher than the level accepted in Mexico for drinking water (there is no act concerning tea infusions), that is 0.2 mg L–1.

Donor-derived CD 19 CAR-T Cells versus Chemotherapy Plus Donor Lymphocyte Infusion for Treatment of Recurrent CD 19-positive B-ALL after Allogeneic Hematopoietic Stem Cell Transplantation

Objective:This study aimed to compare the efficacy of anti-CD19 chimeric antigen receptor T cells(CAR-T cells)versus chemotherapy plus donor lymphocyte infusion(chemo-DLI)for treating relapsed CD 19-positive B-cell acute lymphoblastic leukemia(B-ALL)after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:Clinical data of 43 patients with B-ALL who relapsed after allo-HSCT were retrospectively analyzed.Twenty-two patients were treated with CAR-T cells(CAR-T group),and 21 with chemotherapy plus DLI(chemo-DLI group).The complete remission(CR)and minimal residual disease(MRD)-negative CR rates,leukemia-free survival(LFS)rate,overall survival(OS)rate,and incidence of acute graft-versus-host disease(aGVHD),cytokine release syndrome(CRS)and immune effector cell-associated neurotoxicity syndrome(ICANS)were compared between the two groups.Results:The CR and MRD-negative CR rates in the CAR-T group(77.3%and 61.5%)were significantly higher than those in the chemo-DLI group(38.1%and 23.8%)(P=0.008 and P=0.003).The 1-and 2-year LFS rates in the CAR-T group were superior to those in the chemo-DLI group:54.5%and 50.0%vs.9.5%and 4.8%(P=0.0001 and P=0.00004).The 1-and 2-year OS rates in the CAR-T versus chemo-DLI group were 59.1%and 54.5%vs.19%and 9.5%(P=0.011 and P=0.003).Six patients(28.6%)with grade 2-4 aGVHD were identified in the chemo-DLI group.Two patients(9.1%)in the CAR-T group developed grade 1-2 aGVHD.Nineteen patients(86.4%)developed CRS in the CAR-T group,comprising grade 1-2 CRS in 13 patients(59.1%)and grade 3 CRS in 6 patients(27.3%).Two patients(9.1%)developed grade 1-2 ICANS.Conclusion:Donor-derived anti-CD19 CAR-T-cell therapy may be better,safer,and more effective than chemo-DLI for B-ALL patients who relapse after allo-HSCT.

An iterative Approach to Deriving Drug Infusions

A simple iterative process can be used to generate intravenous drug infusion profiles. It overcomes limitations in deriving compartmental pharmacokinetic models and has application to evaluation of new drugs and to clinical practice.

Efficacy of continuous gastric artery infusion chemotherapy in relieving digestive obstruction in advanced gastric cancer

BACKGROUND Obstruction or fullness after feeding is common in gastric cancer(GC)patients,affecting their nutritional status and quality of life.Patients with digestive obstruction are generally in a more advanced stage.Existing methods,including palliative gastrectomy,gastrojejunostomy,endoluminal stent,jejunal nutrition tube and intravenous chemotherapy,have limitations in treating these symptoms.AIM To analyze the efficacy of continuous gastric artery infusion chemotherapy(cGAIC)in relieving digestive obstruction in patients with advanced GC.METHODS This study was a retrospective study.Twenty-nine patients with digestive obstruction of advanced GC who underwent at least one cycle of treatment were reviewed at The Second Affiliated Hospital of Zhejiang University School of Medicine.The oxaliplatin-based intra-arterial infusion regimen was applied in all patients.Mild systemic chemotherapy was used in combination with local treatment.The clinical response was evaluated by contrast-enhanced computed tomography using Response Evaluation Criteria In Solid Tumors(RECIST)criteria.Digestive tract symptoms and toxic effects were analyzed regularly.A comparison of the Karnofsky Performance Status(KPS)score and Stooler’s Dysphagia Score before and after therapy was made.Univariate survival analysis and multivariate survival analysis were also performed to explore the key factors affecting patient survival.RESULTS All patients finished cGAIC successfully without microcatheter displacement,as confirmed by arteriography.The median follow-up time was 24 mo(95%CI:20.24-27.76 mo).The overall response rate was 89.7%after cGAIC according to the RECIST criteria.The postoperative Stooler’s Dysphagia Score was significantly improved.Twentytwo(75.9%)of the 29 patients experienced relief of digestive obstruction after the first two cycles,and 13(44.8%)initially unresectable patients were then considered radically resectable.The median overall survival time(mOS)was 16 mo(95%CI:9.32-22.68 mo).Patients who received radical surgery had a significantly longer mOS than other patients(P value<0.001).Multivariate Cox regression analysis indicated that radical resection after cGAIC,intravenous chemotherapy after cGAIC,and immunotherapy after cGAIC were independent predictors of mOS.None of the patients stopped treatment because of adverse events.CONCLUSION cGAIC was effective and safe in relieving digestive obstruction in advanced GC,and it could improve surgical conversion possibility and survival time.

Drop Factor and Infusion Dose Calculation Discrepancies among Nurses in Southern Nigeria: A Cross-Sectional Study

Nurses must deliver infusions as prescribed since too slow or fast a dose could be deleterious to patients. Nurses experience challenges with infusion dose calculations, making them vulnerable to errors. The research team examined drop factor and infusion dose calculation discrepancies among nurses in southern Nigeria. Five university teaching hospitals were involved in this cross-sectional study conducted in 2019. To establish the drop factor of commonly available macro drip sets, the team randomly sourced 25 macro drip sets from the hospitals’ pharmacies. A sample of 291 nurses was selected using a proportionate random sampling technique. The team collected data using the Adult Infusion Dose Calculation Quiz and analyzed it at a 5% significance level. Twenty (80%) of the sampled macro drip sets displayed a drop factor value of 20 drops per milliliter (gtt/ml) on their packaging. When measured experimentally, 25 (100%) of the macro drip sets delivered exactly 20 gtt/ml. Only 36 (12.4%) respondents calculated macro drip infusion doses using the correct drop factor of 20 gtt/ml. Non-attendance of infusion administration training updates significantly increased the risk of error by 38% (p ≤ 0.001). In conclusion, the drop factor of macro drip sets used in southern Nigeria is 20 gtt/ml;nurses were prone to infusing patients at a lower dose than prescribed. Special training in infusion therapy might remedy this concern.

Virtual Reality as an Adjunct to Ketamine Infusion Therapy Increases Patient Satisfaction in the Management of Chronic Pain and Depression: A Retrospective Pilot Study

The management of patients with concomitant chronic pain (CP) and Major Depressive Disorder (MDD) remains challenging for clinicians. Current chronic pharmacologic management is often unsuccessful, or has intolerable side effects to the patients. While not restricted to patients with chronic pain, these patients are often diagnosed with depression, presenting with symptoms such as poor mood, anhedonia, and altered cognitive processes. It is estimated that a substantial proportion of treated patients do not derive a substantive benefit from traditional pharmacological treatments for depression. The present study involved a retrospective review of cases, exploring the patient-reported satisfaction with and tolerability of a novel use of virtual reality (VR), coined KVR, as an adjunct to intravenous ketamine infusion therapies. Specifically, the ketamine-virtual reality protocol was employed as a potential adjunctive intervention for patients suffering from chronic pain and depression. Visual Analog Scores (VAS) associated with pain were significantly lower on the third than on the first assessment day. Montgomery-?sberg Depression Rating Scale (MADRS) scores improved following infusion and across days (i.e., sessions). Lastly, 2/3 of patients preferred the use of VR with their ketamine infusion. The results are considered in terms of implementing prospective studies to examine whether the combination therapies have a synergistic benefit and the nature and magnitude of clinically meaningful treatment effects, if any.

Efficacy and safety of propofol target-controlled infusion combined with butorphanol for sedated colonoscopy

BACKGROUND Propofol is a short-acting,rapid-recovering anesthetic widely used in sedated colonoscopy for the early detection,diagnosis and treatment of colon diseases.However,the use of propofol alone may require high doses to achieve the induction of anesthesia in sedated colonoscopy,which has been associated with anesthesia-related adverse events(AEs),including hypoxemia,sinus bradycardia,and hypotension.Therefore,propofol co-administrated with other anesthetics has been proposed to reduce the required dose of propofol,enhance the efficacy,and improve the satisfaction of patients receiving colonoscopy under sedation.AIM To evaluate the efficacy and safety of propofol target-controlled infusion(TCI)in combination with butorphanol for sedation during colonoscopy.METHODS In this controlled clinical trial,a total of 106 patients,who were scheduled for sedated colonoscopy,were prospectively recruited and assigned into three groups to receive different doses of butorphanol before propofol TCI:Low-dose butorphanol group(5μg/kg,group B1),high-dose butorphanol group(10μg/kg,group B2),and control group(normal saline,group C).Anesthesia was achieved by propofol TCI.The primary outcome was the median effective concentration(EC50)of propofol TCI,which was measured using the up-and-down sequential method.The secondary outcomes included AEs in perianesthesia and recovery characteristics.RESULTS The EC50 of propofol for TCI was 3.03μg/mL[95%confidence interval(CI):2.83-3.23μg/mL]in group B2,3.41μg/mL(95%CI:3.20-3.62μg/mL)in group B1,and 4.05μg/mL(95%CI:3.78-4.34μg/mL)in group C.The amount of propofol necessary for anesthesia was 132 mg[interquartile range(IQR),125-144.75 mg]in group B2 and 142 mg(IQR,135-154 mg)in group B1.Furthermore,the awakening concentration was 1.1μg/mL(IQR,0.9-1.2μg/mL)in group B2 and 1.2μg/mL(IQR,1.025-1.5μg/mL)in group B1.Notably,the propofol TCI plus butorphanol groups(groups B1 and B2)had a lower incidence of anesthesia AEs,when compared to group C.Furthermore,no significant differences were observed in the rates of AEs in perianesthesia,including hypoxemia,sinus bradycardia,hypotension,nausea and vomiting,and vertigo,among group C,group B1 and group B2.CONCLUSION The combined use with butorphanol reduces the EC50 of propofol TCI for anesthesia.The decrease in propofol might contribute to the reduced anesthesia-related AEs in patients undergoing sedated colonoscopy.

Double pigtail catheter reduction for seriously displaced intravenous infusion port catheter:A case report

BACKGROUND Implanted intravenous infusion port(TIAP)is mainly used for patients who need central venous infusion and poor peripheral vascular conditions.With the advantages of easy to carry,long maintenance cycle,few complications and excellent quality of life,it has been widely used in the fields of malignant tumor chemotherapy,parenteral nutrition support and repeated blood collection.Implanted intravenous infusion port(IVAP)dislocation can have significant complications if not recognised and reinstated immediately.CASE SUMMARY A 24-year-old man was treated with adjuvant chemotherapy for osteosarcoma.Severe displacement of IVAP catheter was found by chest X-ray examination.The IVAP cannot be used normally.Therefore,we conducted an emergency procedure to reset the catheter through double pigtail catheters,the operation was successful and the infusion port was restored.CONCLUSION When IVAP catheter displacement cannot be reset by conventional techniques,two pigtail catheters can be successfully used instead.

新质人才培养:数智时代教育的新使命

大力培养新质人才是深入实施人才强国战略、加快建设世界重要人才中心和创新高地的行动要义。新质人才所具有的创变思维使其具有了创新恒常性,复合思维使其具有了生态营造性,技术思维使其具有了技术具身性,这就使得他们符合新质生产力的需要,助力中国式现代化不断开拓发展新赛道。新质人才具有成长心态与高意识学习特质、人机共生思维与AI渗透技能、开拓精神与“破界”能力、创想能力与实践智慧、人文精神与科技合伦行动力、人类共同体思维与跨文化行动力等特质。新质人才的培育需要建构一体化的培养范式,包括:细化融通培养机制,以素养导向的AI教育培育新质后备人才的基础教育;依托智能学科平台,以“AI+X”微专业塑造新质中坚人才的高等教育;建立数字孪生平台,以产教融合认证发展新质技能人才的职业教育。未来的新质人才应当是具有创新潜质的AI原民,新质人才培养思路应推广到新生代(AI原民)人才的培养,致力培植好人才成长的沃土,让新质人才不断涌现。

Observation on the Application Effect of Targeted Infusion Safety Nursing in Inpatients with Cancer

Objective:To study the clinical effect of targeted infusion safety nursing during infusion of inpatients with cancer.Methods:From January 1,2020,to January 1,2023,a total of 6,614 infusion patients were treated in The First Affiliated Hospital of Wenzhou Medical University,and 300 inpatients with cancer were selected as the research objects and randomly divided into the observation group and the control group,with 150 patients in each group.The control group received routine infusion nursing,and the observation group received targeted infusion safety nursing.The targeted infusion safety nursing was judged by comparing the nursing quality assessment,incidence of adverse events,patient compliance,and patients’mastery of infusion knowledge between the two groups.clinical effect.Results:After the targeted infusion safety nursing was given to the patients in the observation group,the patients in this group recognized the nursing quality,and the statistical score was higher than that in the control group;the incidence of adverse events in the observation group was lower than that in the control group.The compliance of the observation group was higher than that of the control group.The mastery of health knowledge in the observation group was also higher than that in the control group and the difference was statistically significant(P<0.02).Conclusion:After implementing targeted infusion safety nursing for inpatients with cancer,it can effectively prevent the occurrence of adverse events,improve patient compliance,and increase the mastery of relevant knowledge of patients.

刍议冰片入汤剂

冰片一般入丸散用,通过整理古今冰片入汤剂的文献,发现冰片在历代就有直接入汤剂使用的情况,现代文献中也记载部分中医用冰片入汤剂,其中以冲服居多。冰片气清香,有挥发性,在水中微溶,考虑中药汤剂处方灵活,冰片入汤剂能迅速起效,因此也未尝不可,建议直接冲服,并注意冰片用量。

老年髋关节置换术中实施丙泊酚闭环靶控输注麻醉的效果及对患者术后谵妄风险的影响

目的研究老年髋关节置换术中实施丙泊酚闭环靶控输注麻醉的效果及对术后谵妄风险的影响。方法回顾性选取2020年1月至2023年1月入安庆市第一人民医院接受治疗的90例髋关节骨折老年患者,择期行髋关节置换术。参考麻醉方式不同分为A组、B组和C组,每组各30例。A组给予丙泊酚闭环靶控持续输注麻醉,B组给予丙泊酚开环靶控持续输注麻醉,C组给予丙泊酚人工持续输注麻醉。比较3组患者的术中相关指标(麻醉时间、手术时间以及拔管时间)、麻醉相关指标(术中丙泊酚总计用量、术中维持泵调节次数)、血流动力学变化[麻醉诱导开始(T_(0))、插管(T_(1))、手术开始(T_(2))、手术结束(T_(3))、拔管(T_(4))的平均动脉压、心率以及脑电双频指数(BIS)值]情况、术后恢复情况及术后谵妄发生情况。结果(1)术中指标:3组患者麻醉时间、手术时间以及拔管时间比较,差异均无统计学意义(P>0.05)。(2)麻醉相关指标:A组患者术中丙泊酚总计用量、术中维持泵调节次数均明显低于B、C组,差异均有统计学意义(P<0.05);B组患者单位麻醉时间内丙泊酚用量、单位手术时间内丙泊酚用量均明显高于A、C组,差异均有统计学意义(P<0.05)。(3)血流动力学:A组T_(2)、T_(3)时平均动脉压均高于B组、C组,A组T_(4)时的平均动脉压更加接近于T_(0);3组患者不同时刻心率差异无统计学意义(P>0.05);A组T_(2)、T_(3)时BIS值均低于B组、C组,差异均有统计学意义(P<0.05)。(4)术后恢复情况:A组患者PACU停滞时间、自主呼吸恢复时间、指令反应恢复时间均明显低于B、C组,差异均有统计学意义(P<0.05)。(5)术后谵妄:A组患者术后谵妄发生率为16.67%,显著低于B、C组(40.00%、46.67%),差异均有统计学意义(P<0.05)。结论老年髋关节置换术中采用丙泊酚靶控输注麻醉可减少丙泊酚用量,术中生命体征更加平稳,可降低人工操作次数,术后麻醉苏醒更快,且术后谵妄发生率也更低,是老年患者首选的麻醉方案。

成人患者安全输注血管活性药物的最佳证据总结

目的总结成人患者安全输注血管活性药物的最佳证据总结,为临床护理工作提供证据支持。方法检索UpToDate、BMJ Best Practice、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、Cochrane Library、美国国立指南库、美国疾病预防与控制中心、英国国家临床医学研究所指南库、国际指南协作网、CINAHL、Embase、加拿大安大略注册护士协会、英国重症监护协会、美国静脉输液护理学会、PubMed、Web of Science、中国知网、万方数据库、维普网、中华护理学会、中国生物医学文献数据库和医脉通中有关成人患者血管活性药物输注的指南、专家共识、团体标准、系统评价、证据总结和原始研究等证据。检索时限为2013年1月1日-2023年3月10日。由2名具有循证护理研究背景的研究者独立进行文献质量评价及证据筛查,证据汇总后由团队归类综合。结果共纳入12篇文献,从培训与教育、评估、血管通路选择、输注方案、并发症管理5个维度总结了29条证据。结论该研究总结了成人患者血管活性药物输注的最佳证据,可为医务人员提供科学的输注方案,保证患者安全,提高护理质量。