Refining safety considerations for intradialytic blood flow restriction exercise. Commentary on “Concerns on the application of blood-flow restriction resistance exercise and thrombosis risk in hemodialysis patients”

I read with great interest the article“Concerns on the application of blood flow restriction resistance exercise and thrombosis risk in hemodialysis patients”by Correa et al.1 The study presents complementary data from a previous randomized controlled trial,2 exploring the application of intradialytic blood flow restriction exercise for hemodialysis patients.

Application Value of Early Comprehensive Rehabilitation Nursing in Patients with Occupational Asthma

Background Occupational asthma is a type of asthma caused by exposure to asthma-causing substances in an occupational setting. Its incidence is closely related to the degree of industrial development, but also related to the nature of asthma. In some specific industries, such as workers who are exposed to asthmatic isocyanates for a long time, the incidence of occupational asthma can reach 5%-10%, and the incidence of occupational asthma can even reach 50% or higher among workers engaged in the detergent industry who are in contact with proteolytic enzymes for a long time. Objective To analyze the clinical value of early comprehensive rehabilitation nursing for patients with occupational asthma, methods a total of 48 patients with occupational asthma who were admitted from January 2020 to December 2022 were divided into control group and study group by random number table method The disappearance time of chest tightness and shortness of breath, the disappearance time of wheezing and cough, and the FEV1, forced vital capacity (FVC) and peak expiratory flow (PEF) indexes before and after treatment were compared between the two groups after nursing, the disappearance time of clinical symptoms in the study group was shorter than that in the control group, and the levels of FEV1, FVC and PEF were higher than those in the control group, and the P < 0.05 was significantly improved.

Research on the Application of Evidence-Based Quality Control Circle to Improve the Implementation Rate of Airway Management Measures in Adult Critically Ill Patients

Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs Institute (JBI) evidence-based health care model, the best evidence of airway management in adult critically ill patients was obtained and applied to the clinic. Results: The total implementation rate of airway management measures in adult critically ill patients increased from 23.62% before the implementation of quality control circle to 88.82%, and the pulmonary infection rate in critically ill patients decreased from 42.31% to 21.74%, with statistical significance between the two groups (P 0.05). Conclusion: Evidence-based quality control circle activities can standardize the practice standards of airway management in critically ill patients, reduce the occurrence of patients’ airway related complications, and improve clinical outcomes.

Application Effect of Staged Health Education in the Nursing Care of Patients with Upper Gastrointestinal Bleeding

Objective:To investigate the application effect of staged health education in the care of patients with upper gastrointestinal bleeding.Methods:This study takes health education in the care of patients with upper gastrointestinal bleeding as the main direction.160 patients with upper gastrointestinal bleeding who received treatment in our hospital were selected as samples,and the grouping software was used to divide them into the reference group and the study group,with 80 patients each.The reference group and the study group used routine health education and staged health education respectively.Relevant research data were recorded during the nursing process,analyzed,and used as research indicators.Results:The compliance behavior of the study group was higher than that of the reference group after the staged nursing care,and at the same time,the nursing care satisfaction of the study group was higher than that of the reference group(P<0.05).Conclusion:The use of staged health education for the care of patients with upper gastrointestinal bleeding not only enhances the degree of patient awareness and compliance but also improves nursing satisfaction,which is worthy of promotion and application.

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.

Patient-centric periodontal research:A pioneering application of patient-reported outcome measures

Conventional dentistry or periodontal research often ignores the human component in favor of clinical outcomes and biological causes.Clinical research is driven by the statistical significance of outcome parameters rather than the satisfaction level of the patient.In this context,patient-centric periodontal research(PCPR)is an approach that considers the patient´s feedback concerning their functional status,experience,clinical outcomes,and accessibility to their treatments.It is argued that data self-reported by the patient might have low reliability owing to the confounding effect of their personal belief,cultural background,and social and economic factors.However,literature has shown that the incorporation of“patient-centric outcome”components considerably enhances the validity and applicability of research findings.Variations in the results of different studies might be due to the use of different and non-standardized assessment tools.To overcome this problem,this editorial enlists various reliable tools available in the literature.In conclusion,we advocate that the focus of researchers should shift from mere periodontal research to PCPR so that the results can be effectively applied in clinical settings and the therapeutic strategy can also change from mere periodontal therapy to patient-centric periodontal therapy.

Application Analysis of Cardiac Rehabilitation Nursing in Patients with Acute Myocardial Infarction

Objective: Application analysis of cardiac rehabilitation in patients with acute myocardial infarction. Methods: A total of 102 patients with acute myocardial infarction admitted to our hospital from January 2020 to January 2022 were retrospectively selected as the observation objects. According to the nursing measures taken, they were divided into a control group and an observation group, with 51 cases in each group. A total of 51 patients in the control group received routine nursing, while 51 patients in the observation group were guided to actively participate in the cardiac rehabilitation nursing plan. The hospitalization conditions and effects of the two groups were compared. Results: The cardiac function index, bed time, hospitalization time, anxiety score and depression score of the observation group were significantly better than those of the control group, and the differences were statistically significant (P Conclusion: The application of cardiac rehabilitation nursing in patients with acute myocardial infarction has a good effect. The patients’ cardiac function recovers faster, they feel more comfortable, and they also reduce the time of hospitalization and bed rest, which is conducive to improving the psychological and anxiety state of patients and improving the quality of life.

Progress in Application of CBT Therapy in Patients with Post-stroke Mental Disorders

The application effects of CBT therapy in patients with post-stroke mental disorders were summarized to better understand the application effects of CBT therapy in patients with post-stroke mental disorders,so as to provide reference suggestions for better providing psychological treatment to patients with post-stroke mental disorders.

Application Effect of Medium-Length Peripheral Catheter in Critically Ill Patients Undergoing Hepatobiliary Surgery

Objective:To investigate the effect of using peripheral medium-length catheters in critically ill patients undergoing hepatobiliary surgery.Methods:A retrospective analysis of the nursing experience and effect of using medium-length catheters for infusion in 102 critically ill patients undergoing hepatobiliary surgery from March 2021 to April 2022 was conducted.Results:All 102 patients had successful catheter placement with no catheter-associated infections,blockage,decannulation,or breakage.However,four cases had blood oozing from the puncture site,but it resolved after changing the dressing.Conclusion:Medium-length catheters are superior to traditional infusion tools in terms of benefit;thus,they deserve to be widely promoted in clinical practice.

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.

Drilling-based measuring method for the c-φ parameter of rock and its field application

The technology of drilling tests makes it possible to obtain the strength parameter of rock accurately in situ. In this paper, a new rock cutting analysis model that considers the influence of the rock crushing zone(RCZ) is built. The formula for an ultimate cutting force is established based on the limit equilibrium principle. The relationship between digital drilling parameters(DDP) and the c-φ parameter(DDP-cφ formula, where c refers to the cohesion and φ refers to the internal friction angle) is derived, and the response of drilling parameters and cutting ratio to the strength parameters is analyzed. The drillingbased measuring method for the c-φ parameter of rock is constructed. The laboratory verification test is then completed, and the difference in results between the drilling test and the compression test is less than 6%. On this basis, in-situ rock drilling tests in a traffic tunnel and a coal mine roadway are carried out, and the strength parameters of the surrounding rock are effectively tested. The average difference ratio of the results is less than 11%, which verifies the effectiveness of the proposed method for obtaining the strength parameters based on digital drilling. This study provides methodological support for field testing of rock strength parameters.

Hemoperfusion and continuous veno-venous hemodiafiltration for eliminating chlorfenapyr in poisoning patients

Chlorfenapyr is a liposoluble insecticide belonging to the pyrrole family.Chlorfenapyr is activated when the N-ethoxymethyl side chain breaks,forming a toxic metabolite,which uncouples oxidative phosphorylation in the mitochondria,inhibits the production of adenosine triphosphate (ATP),and leads to the death of cells and targe organisms.[1] Symptoms of chlorfenapyr poisoning in patients are mild and atypical in the early stage,especially in patients receiving low dose exposure;however,such cases are rare and may be ignored by physicians,often leading to delayed treatment.[2,3].

Aggressive fluid management may be associated with disease progression in suspected sepsis patients admitted to the intensive care unit: a retrospective cohort study

Sepsis is a lethal condition characterized by multiple organ dysfunction due to disrupted host responses to severe infections.[1]Aff ected patients often have a Sequential Organ Failure Assessment(SOFA)score≥2.[2]Patients with a SOFA score<2 and at least one of the following were considered as“suspected sepsis”:(1)quick SOFA(qSOFA)score≥2;(2)SOFA score=1;or(3)National Early Warning Score(NEWS)4-6.[3]Compared with studies on fluid resuscitation in sepsis patients,there are few studies on fluid management in patients with suspected sepsis.Therefore,we conducted a retrospective cohort study to evaluate the relationship between fluid management and disease progression in suspected sepsis patients.

The association between C-reactive protein to albumin ratio and 6-month neurological outcome in patients with in-hospital cardiac arrest

The global incidence rates of in-hospital cardiac arrest(IHCA)range from1.2 to 9.0 per1,000 hospitalized patients,as per the National Cardiac Arrest Database.[1] While IHCAs tend to exhibit superior 30-day survival rates relative to out-of-hospital cardiac arrests (OHCA) due to situational advantages,such as immediate access to medical personnel and treatments.

Association of cardiometabolic multimorbidity with all-cause and cardiovascular disease mortality among Chinese hypertensive patients

BACKGROUND Hypertension usually clusters with multiple comorbidities.However,the association between cardiometabolic multimorbidity(CMM)and mortality in hypertensive patients is unclear.This study aimed to investigate the association between CMM and all-cause and cardiovascular disease(CVD)mortality in Chinese patients with hypertension.METHODS The data used in this study were from the China National Survey for Determinants of Detection and Treatment Status of Hypertensive Patients with Multiple Risk Factors(CONSIDER),which comprised 5006 participants aged 19–91 years.CMM was defined as the presence of one or more of the following morbidities:diabetes mellitus,dyslipidemia,chronic kidney disease,coronary heart disease,and stroke.Cox proportional hazard models were used to calculate the hazard ratios(HR)with 95%CI to determine the association between the number of CMMs and both all-cause and CVD mortality.RESULTS Among 5006 participants[mean age:58.6±10.4 years,50%women(2509 participants)],76.4%of participants had at least one comorbidity.The mortality rate was 4.57,4.76,8.48,and 16.04 deaths per 1000 person-years in hypertensive patients without any comorbidity and with one,two,and three or more morbidities,respectively.In the fully adjusted model,hypertensive participants with two cardiometabolic diseases(HR=1.52,95%CI:1.09–2.13)and those with three or more cardiometabolic diseases(HR=2.44,95%CI:1.71–3.48)had a significantly elevated risk of all-cause mortality.The findings were similar for CVD mortality but with a greater increase in risk magnitude.CONCLUSIONS In this study,three-fourths of hypertensive patients had CMM.Clustering with two or more comorbidities was associated with a significant increase in the risk of all-cause and cardiovascular mortality among hypertensive patients,suggesting more intensive treatment and control in this high-risk patient group.

Association of prealbumin with short-term and long-term outcomes in patients with acute ST-segment elevation myocardial infarction

BACKGROUND Prealbumin is considered to be a useful indicator of nutritional status. Furthermore, it has been found to be associated with severities and prognosis of a range of diseases. However, limited data on the association of baseline prealbumin level with outcomes of patients with acute ST-segment elevation myocardial infarction(STEMI) are available.METHODS We analyzed 2313 patients admitted for acute STEMI between October 2013 and December 2020. In-hospital outcomes and mortality during the 49 months(interquartile range: 26–73 months) follow-up period were compared between patients with the low prealbumin level(< 170 mg/L) and those with the high prealbumin level(≥ 170 mg/L).RESULTS A total of 114 patients(4.9%) died during hospitalization. After propensity score matching, patients with the low prealbumin level than those with the high prealbumin level experienced higher incidences of heart failure with Killip class Ⅲ(9.9%vs. 4.4%, P = 0.034), cardiovascular death(8.4% vs. 3.4%, P = 0.035) and the composite of major adverse cardiovascular events(19.2%vs. 10.3%, P = 0.012). Multivariate logistic regression analysis identified that the low prealbumin level(< 170 mg/L) was an independent predictor of in-hospital major adverse cardiovascular events(odds ratio = 1.918, 95% CI: 1.250–2.942, P = 0.003). The cutoff value of prealbumin level for predicting in-hospital death was 170 mg/L(area under the curve = 0.703, 95% CI: 0.651–0.754, P< 0.001;sensitivity = 0.544, specificity = 0.794). However, after multivariate adjustment of possible confounders, baseline prealbumin level(170 mg/L) was no longer independently associated with 49-month cardiovascular death. After propensity score matching, Kaplan-Meier survival curves revealed consistent results.CONCLUSIONS Decreased prealbumin level closely related to unfavorable short-term outcomes. However, after multivariate adjustment and controlling for baseline differences, baseline prealbumin level was not independently associated with an increased risk of long-term cardiovascular mortality in STEMI patients.

Multimorbidity and mortality among older patients with coronary heart disease in Shenzhen,China

BACKGROUND The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease(CHD)is insufficient.We aimed to assess the association and population-attributable fractions(PAFs)between multimorbidity and mortality among hospitalized older patients who were diagnosed with CHD in Shenzhen,China.METHODS We conducted a retrospective cohort study of older Chinese patients(aged≥65 years)who were diagnosed with CHD.Cox proportional hazards models were used to estimate the associations between multimorbidity and all-cause and cardiovascular disease(CVD)mortality.We also calculated the PAFs.RESULTS The study comprised 76,455 older hospitalized patients who were diagnosed with CHD between January 1,2016,and August 31,2022.Among them,70,217(91.9%)had multimorbidity,defined as the presence of at least one of the predefined 14 chronic conditions.Those with cancer,hemorrhagic stroke and chronic liver disease had the worst overall death risk,with adjusted HRs(95%CIs)of 4.05(3.77,4.38),2.22(1.94,2.53),and 1.85(1.63,2.11),respectively.For CVD mortality,the highest risk was observed for hemorrhagic stroke,ischemic stroke,and chronic kidney disease;the corresponding adjusted HRs(95%CIs)were 3.24(2.77,3.79),1.91(1.79,2.04),and 1.81(1.64,1.99),respectively.All-cause mortality was mostly attributable to cancer,heart failure and ischemic stroke,with PAFs of 11.8,10.2,and 9.1,respectively.As for CVD mortality,the leading PAFs were heart failure,ischemic stroke and diabetes;the corresponding PAFs were 18.0,15.7,and 6.1,respectively.CONCLUSIONS Multimorbidity was common and had a significant impact on mortality among older patients with CHD in Shenzhen,China.Cancer,heart failure,ischemic stroke and diabetes are the primary contributors to PAFs.Therefore,prioritizing improved treatment and management of these comorbidities is essential for the survival prognosis of CHD patients from a holistic public health perspective.

Updates of developments in interventional therapy for elderly patients with cardiovascular diseases

Cardiovascular diseases(CVD)are the leading cause of death in the world and one of the most common diseases in the elderly,with high prevalence and poor prognosis,which seriously affect the health of the elder patients.One report showed that global deaths from CVD increased from 12.4 million in 1990 to 19.8 million in 2022,reflecting the global population growth and aging,as well as the impact of metabolic,environmental,and behavioral risks.[1]With the progress of aging population,the burden of CVD in the elderly in China has increased year by year,and factors including multiple complications,organ function decline,and high complication rate have made the interventional treatment of CVD in the elderly one of the difficulties and focuses in the field of cardiology in China.

Comparative utility of vestibular function tests in patients with peripheral and central vestibular dysfunction

Background: Bithermal caloric irrigation, video head impulse test(vHIT), and rotational testing are commonly used to assess peripheral vestibular function, but the relative clinical utility of each test in differentiating patients with peripheral vestibulopathy is debated.Objectives: To determine whether(1) the combination of two or more vestibular tests enhances diagnostic utility over a single test;(2) abnormal test results on vestibular tests correlate with one another.Methods: Retrospective analysis of data collected from multidisciplinary vestibular clinics at two academic medical centers from 2016 to 2022.Results: 150 patients(54.10 ± 15.09 years, 88 females) were included. No individual test was significantly better at predicting the presence of peripheral vestibular damage(p > 0.05). vHIT test results improved significantly when combined with either the caloric test(p = 0.007) or rotary chair test(p = 0.039). Caloric and rotational testing had high sensitivity(74.65% and 76.06%, respectively) and specificity(83.54% and 78.48%, respectively). vHIT demonstrated excellent specificity(89.87%) but poor sensitivity(47.89%). Caloric, vHIT, and rotary chair tests results did not correlate with one another(p > 0.05).Conclusions: Vestibular function tests have comparable diagnostic utility, yet each offers unique advantages. Caloric and rotational testing may be best suited for screening peripheral damage and vHIT may function ideally as a confirmatory test.

Development and validation of a model integrating clinical and coronary lesion-based functional assessment for longterm risk prediction in PCI patients

OBJECTIVES To establish a scoring system combining the ACEF score and the quantitative blood flow ratio(QFR) to improve the long-term risk prediction of patients undergoing percutaneous coronary intervention(PCI).METHODS In this population-based cohort study, a total of 46 features, including patient clinical and coronary lesion characteristics, were assessed for analysis through machine learning models. The ACEF-QFR scoring system was developed using 1263consecutive cases of CAD patients after PCI in PANDA Ⅲ trial database. The newly developed score was then validated on the other remaining 542 patients in the cohort.RESULTS In both the Random Forest Model and the Deep Surv Model, age, renal function(creatinine), cardiac function(LVEF)and post-PCI coronary physiological index(QFR) were identified and confirmed to be significant predictive factors for 2-year adverse cardiac events. The ACEF-QFR score was constructed based on the developmental dataset and computed as age(years)/EF(%) + 1(if creatinine ≥ 2.0 mg/d L) + 1(if post-PCI QFR ≤ 0.92). The performance of the ACEF-QFR scoring system was preliminarily evaluated in the developmental dataset, and then further explored in the validation dataset. The ACEF-QFR score showed superior discrimination(C-statistic = 0.651;95% CI: 0.611-0.691, P < 0.05 versus post-PCI physiological index and other commonly used risk scores) and excellent calibration(Hosmer–Lemeshow χ^(2)= 7.070;P = 0.529) for predicting 2-year patient-oriented composite endpoint(POCE). The good prognostic value of the ACEF-QFR score was further validated by multivariable Cox regression and Kaplan–Meier analysis(adjusted HR = 1.89;95% CI: 1.18–3.04;log-rank P < 0.01) after stratified the patients into high-risk group and low-risk group.CONCLUSIONS An improved scoring system combining clinical and coronary lesion-based functional variables(ACEF-QFR)was developed, and its ability for prognostic prediction in patients with PCI was further validated to be significantly better than the post-PCI physiological index and other commonly used risk scores.