Development of Nursing Protocol for Preventing Interruptions during Clinical Examinations and Treatments in the Early Days of Hospitalization for Acute Exacerbation of Chronic Heart Failure in Patients with Impaired Cognitive Function

The purpose of this study is to prepare a nursing protocol for preventing interruptions during clinical examinations and treatments performed in the early days of hospitalization for acute exacerbation of chronic heart failure in patients with impaired cognitive function. For the first stage of the research, we prepared a draft of the nursing protocol based on a basic survey. For the second stage, semi-structured interviews were conducted with 5 nurses specialized in chronic heart failure and 11 nurses in dementia care to ensure content validity of the draft protocol. For the third stage, we examined the possibility of clinical application of the revised version of the protocol draft prepared in the second stage of the study. For assessment items, significant points of nursing care, and specific nursing care practice in this revised version, 73 subjects (84.9%) considered effective for patients, in terms of prevention of interruptions during clinical examinations and treatments in the early days of hospitalization. All items and contents were considered useful by more than 60% of the nurses. Considering that the nurses working in the clinical setting reported 84.9% of usefulness, we concluded that this nursing protocol remained valid at a certain level. We consider that this nursing protocol will be useful especially for newly graduated/employed nurses as a procedure manual which can reduce their anxiety or stress caused by lack of knowledge or experiences.

Research on 30 days Feeding Test of Rats with Irradiated Pet Food

[ Object] The research is aimed to provide scientific basis for irradiated pet food＇s standardized production, supervision and commercial- ized application. E Method] Take broiler breast meat with high-dose irradiation as testing material, then evaluate its safety after 30 days feeding test of rats [ Result] Compared with control group （Pet food＇s irradiation dose is 0 kGy）, the general situation, weight, food-intake, food utilization rate, hematological examinations, bio-chemical analysis of blood, viscera weight, ratio of viscera and body weight, histopathological examinations, physi- ological feature, life＇s basic characteristics （including height, tail length, body temperature, heart rate and blood pressure ） and other indexes of rats, which were fed respectively with 10, 15, 25 kGy irradiation dose pet food for 30 days, were not found abnormal. [ Conclusion] Pet food with 10, 15, 25kGy irradiation dose is safe.

Analysis on Related Factors of Hospitalization Days of Patients with Novel Coronavirus Pneumonia in Fangcang Shelter Hospitals

Objective:To study the factors influencing the length of stay in patients with COVID-19.Methods:The clinical data of 110 patients with COVID-19 who were infected with Omicron virus for more than 10 days from April to May 2022 were collected.Their gender,age,smoking status,clinical manifestations related to pneumonia,whether they were combined with other basic diseases and vaccination status were analyzed.The above influencing factors were analyzed by single factor regression analysis,followed by Cox regression model analysis.Results:The age of patients had an effect on the length of hospital stay.The median length of hospital stay of patients that are<50 years old,50-64 years old and≥65 years old were 14,14,and 17 days respectively(χ^(2)=9.346,P=0.009).The presence of coronavirus-related symptoms also affects the length of hospital stay(χ^(2)=4.840,P=0.028).The results of multivariate regression model showed that age(χ^(2)=8.669,P=0.006)and coronavirus-related symptoms(χ^(2)=5.424,P=0.020)were independent factors affecting the length of hospital stay.Conclusion:During the development of COVID-19,the age of patients and whether they have coronavirus-related symptoms are positively correlated with the length of stay.Gender,habit of smoking,presence of other basic diseases and vaccination are not related to the length of stay.

An Observational Study of the 30-50 Day Atmospheric Oscillations Part I: Structure and Propagation

Features of structure and propagation of the 30 to SO day atmospheric oscillations are investigated using the ECMWF analysis of 1980-1983. Evidence is provided to confirm the characteristics of the oscillation in the equatorial region. Those in the mid-high latitudes, however, are revealed to be very different from the tropics and pose a strong barotropic structure. Horizontal coherence shows teleconnection patterns which can be identified as EAP and PNA. The wind field of the specified time scale of the oscillation appears as long-lived vortices and vortex pairs. Mid-latitude perturbations propagate clearly westwards, especially during the winter season. In the high latitudes, they propagate westwards in the winter but eastwards in the summer. Meridional propagations are rather different from region to region.

A Further Inquiry on the Mechanism of 30-60 Day Oscillation in the Tropical Atmosphere

In a simple semi-geostropic model on the equatorial β-plane, the theoretical analysis on the 30-60 day oscillation in the tropical atmosphere is further discussed based on the wave-CISK mechanism. The convection heating can excite the CISK-Kelvm wave and CISK-Rossby wave in the tropical atmosphere and they are all the low-frequency modes which drive the activities of 30-60 day oscillation in the tropics. The most favorable conditions to excite the CISK-Kelvin wave and CISK-Rossby wave are indicated: There is convection heating but not very strong in the atmosphere and there is weaker disturbance in the lower troposphere.The influences of vertical shearing of basic flow in the troposphere on the 30-60 day oscillation in the tropics are also discussed.

An Observational Study of the 30-50 Day Atmospheric Oscillations Part II: Temporal Evolution and Hemispheric Interaction across the Equator

In this part, the temporal evolution and interaction across the equator of 30-50 day oscillation in the atmosphere are investigated further. The annual variation of 30-50 day oscillation is quite obvious in the mid-high latitudes. In the tropical atmosphere, the obvious interannual variation is an important property for temporal evolution of 30-50 day oscillation. The low-frequency wavetrain across the equator over the central Pacific and central Atlantic area, the movement of the long-lived low-frequency system across the equator and the meridional wind component across the equator will obviously show the interaction of 30-50 day oscillation in the atmosphere across the equator.

RELATIONSHIP BETWEEN THE 30 TO 60 DAY OSCILLATION OF ATMOSPHERIC HEAT SOURCE AND THE DROUGHT AND FLOOD EVENTS IN JUNE IN THE SOUTH OF CHINA

Based on the NCEP/NCAR reanalysis data and the observed precipitation data in the south of China from 1958 to 2000,the impact of 30 to 60 day oscillation of atmospheric heat sources on the drought and flood events in June in the south of China is discussed.During the flood(drought) events,there exists an anomalous low-frequency anticyclone(cyclone) at the low level of the troposphere over the South China Sea and the northwestern Pacific,accompanied with anomalous low-frequency heat sinks(heat sources),while there exists an anomalous low-frequency cyclone(anticyclone) with anomalous heat sources(sinks) over the area from the south of China to the south of Japan.On average,the phase evolution of the low-frequency in drought events is 7 to 11 days ahead of that in flood events in May to June in the south of China.In flood events,low-frequency heat sources and cyclones are propagated northward from the southern South China Sea,northwestward from the warm pool of the western Pacific and westward from the northwestern Pacific around 140°E,which have very important impact on the abundant rainfall in June in the south of China.However,in drought events,the northward propagations of the low-frequency heat sources and cyclones from the South China Sea and its vicinity are rather late compared with those in flood events,and there is no obvious westward propagation of the heat sources from the northwestern Pacific.The timing of the low-frequency heat source propagation has remarkable impact on the June rainfall in the south of China.

STUDY ON DYNAMICS OF TROPICAL CISK-ROSSBY WAVES AND MECHANISM OF 30-50 DAY OSCILLATIONS

To add to the growing mature research on the tropical 30-50 day oscillations from a new prospective, the current work bases on dynamic analysis of baroclinic quasi-geostrophic models to discuss dynamic mechanisms for the generation and propagation of CISK-Rossby waves, and to understand restraints and effects of different wave structures and thermodynamic forcing on the 30-50 day oscillations in the tropical atmosphere. Some important properties of the oscillation propagation have been explained and, in detail, with respect to its meridional propagation and vertical "baroclinic" structure. The work has come up with some new opinions and viewpoints. New opinions about the propagation and energy dispersion are to be proved by more observations and study.

The Characteristics of 30-60 Day Oscillation and Its Relations to the Interannual Oscillations

The characteristics of 30-60 day oscillation (hereafter called LFO ) of the outgoing longwave radiation data (OLR) and its relations to the interannual oscillations of the sea surface temperature (SST) are investigated by using the daily OLR data for the period from January, 1979 to December, 1987 and the corresponding monthly SST data. It is found that the LFO the band the interannual oscillations of the SST monthly anomaly (SSTA) interact each other and they all relate to the occurrence and development of El Nino events closely. Before El Nino event happens, it contributes to the SST's wanning up and to the SST's quasi-biennial oscillation (called QBO for brevity) and three and half years oscillation (called SO for short) being in warm water phase in the equatorial central and eastern Pacific (ECP and EEP) that the LFO in the equatorial western Pacific (EWP) enhances and propagates eastward; When El Nino event takes place, the LFO, SSTA and SSTA's QBO and SO in the EEP interact and strengthen each other; But the warmer SST and the SSTA's QBO and SO in the warm water phase in the EEP contribute to the LFO's weakening in the equatorial Pacific. Moreover, these contribute to the SST in the EEP becoming cold and the SSTA's QBO and SO in the EWP being in cold water phase and then impel the El Nino event to end.

Effect of Non-Routine Perioperative Laboratory Values on 30 Day Mortality after Non-Cardiac Surgery

Background: It is known that certain laboratory value abnormalities may increase mortality in patient populations with specific risk factors and specific procedures. The purpose of this paper was to investigate the effect of drawing a non-routine lab (regardless of its result) on 30 day mortality and to investigate the effect of an abnormal non-routine laboratory value on 30 day mortality. Methods: The electronic medical records of adult patients undergoing non-cardiac surgery from 2011-2014 at LAC + USC Medical Center were reviewed retrospectively as approved by our institutional review board. Demographic data, surgical risk assessment, and routine and non-routine laboratory values (TSH, Troponin, Creatine Kinase, Hb A1c) were recorded;patients were grouped according to the single non-routine lab they had drawn. Multivariate logistic regression analysis was used to determine significant risk factors associated with increased 30 day mortality. Results: 11,306 patients met our inclusion criteria. Drawing a non-routine lab was associated with a statistically significant increase in mortality in the Troponin group (OR = 3.05, P < 0.001) but not in the TSH, Creatine Kinase, or Hb A1c groups. An abnormal non-routine lab value was associated with a statistically significantly increase in mortality in the TSH group (OR = 11.07, P = 0.008) but not in the other three groups. Conclusions: Drawing a non-routine lab was associated with a statistically significant increase in mortality in the Troponin group but not in the TSH, Creatine Kinase, or Hb A1c groups. An abnormal TSH value was associated with a statistically significant increase in mortality but not an abnormal Troponin, Creatine Kinase, or Hb A1c. Routine and non-routine laboratory testing may guide perioperative patient care and result in improved post-surgical outcome.

某三甲医院住院超过30天患者分布特征及影响因素分析

目的 分析某三甲医院2019—2022年患者住院超30天的分布特点及影响因素,为控制超长住院日提供参考依据。方法 通过收集某三甲综合医院2019—2022全部出院病案首页数据,对其中1 826例住院超过30天的患者特点进行描述性分析,然后对单因素分析中有显著性意义的因素纳入Logistic回归模型,探究住院超30天患者分布特征和影响因素。结果 1 826例住院超30天的患者的男女比例为1.6∶1,住院超过30天的患者中45~59岁患者最多,前三位的出院科室为血液内科、胃肠外科、肿瘤科,疾病集中在肿瘤、影响健康状态和与保健机构接触的因素、损伤、中毒和外因的某些其他后果。Logistic回归分析显示性别,年龄,手术,付款方式,抢救,病例分型,入院途径是患者住院超30天的影响因素。结论 医疗机构应构建多学科综合诊疗模式、积极推进临床路径、单病种管理,落实推进分级诊疗制度,建立相关的预警制度,推广加速康复外科理念,实现对住院日的管控,合理配置医疗资源。

某肿瘤医院1180例外科患者住院时间超30天原因分析及对策

目的分析某肿瘤医院1180例外科患者住院时间超30d的原因并提出对策。方法对2015年某三级甲等肿瘤医院1180例住院超30d外科患者的临床资料进行回顾性分析。结果从科室上看,住院时间超30d占比排名前三位的科室依次是:妇瘤外科(35.25%)、胃肠外科(13.14%)、乳腺外科(11.19%)。从原因构成上看,疾病自身原因(49.92%)是导致住院时间超30d的主要原因,其中占比排名前三位的原因依次是:治疗周期较长(19.58%)、术后化疗或放疗(11.78%)、病情复杂涉及多学科诊疗(9.83%);其次是院方原因(47.63%),其中占比排名前三位的原因依次是:出现并发症(11.95%)、内科转科(10.26%)、术后感染或切口感染(7.71%)。结论由于肿瘤治疗的多学科模式,肿瘤患者较易出现住院时间超30d。通过加强疑难患者治疗管理、提高疑难病例诊疗能力、加快治疗前诊断和治疗方案确定、提高转科效率、加强围手术期管理、实行快速康复外科、加强医患沟通等措施是减少肿瘤外科患者住院时间超30天的重要途径。

Bowel preparation protocol for hospitalized patients ages 50 years or older:A randomized controlled trial

BACKGROUND The incidence and mortality rate of colorectal cancer progressively increase with age and become particularly prominent after the age of 50 years.Therefore,the population that is≥50 years in age requires long-term and regular colonoscopies.Uncomfortable bowel preparation is the main reason preventing patients from undergoing regular colonoscopies.The standard bowel preparation regimen of 4-L polyethylene glycol(PEG)is effective but poorly tolerated.AIM To investigate an effective and comfortable bowel preparation regimen for hospitalized patients≥50 years in age.METHODS Patients were randomly assigned to group 1(2-L PEG+30-mL lactulose+a lowresidue diet)or group 2(4-L PEG).Adequate bowel preparation was defined as a Boston bowel preparation scale(BBPS)score of≥6,with a score of≥2 for each segment.Non-inferiority was prespecified with a margin of 10%.Additionally,the degree of comfort was assessed based on the comfort questionnaire.RESULTS The proportion of patients with a BBPS score of≥6 in group 1 was not significantly different from that in group 2,as demonstrated by intention-to-treat(91.2%vs 91.0%,P=0.953)and per-protocol(91.8%vs 91.0%,P=0.802)analyses.Furthermore,in patients≥75 years in age,the proportion of BBPS scores of≥6 in group 1 was not significantly different from that in group 2(90.9%vs 97.0%,P=0.716).Group 1 had higher comfort scores(8.85±1.162 vs 7.59±1.735,P<0.001),longer sleep duration(6.86±1.204 h vs 5.80±1.730 h,P<0.001),and fewer awakenings(1.42±1.183 vs 2.04±1.835,P=0.026)than group 2.CONCLUSION For hospitalized patients≥50 years in age,the bowel preparation regimen comprising 2-L PEG+30-mL lactulose+a low-residue diet produced a cleanse that was as effective as the 4-L PEG regimen and even provided better comfort.

某三级乙等医院住院超过30天患者分析及管理

目的:通过对某三级乙等医院2017年住院超过30天患者进行统计,分析原因,并提出相应措施,以达到减少住院天数的目的。方法:根据医院HIS系统抓取数据,并从科室上报的"住院超30天患者专项分析表"中录入住院时间延长原因,进行综合统计、归纳。结果:某三级乙等综合医院2017年住院超过30天患者主要集中在≥60岁老年患者,男性多于女性、内科系统高于外科系统,"危重、疑难、高龄、术后伤口感染、各种检查、术前等待"是住院时间超过30天的主要原因。结论:医院可从多部门、多方面进行监督管理,有效运用PDCA质量管理办法缩短平均住院日。

30例咯血患儿临床分析

目的探讨儿童咯血的原因。方法采用回顾性调查方法,对30例咯血原因待查患儿进行了病因分析。结果30例咯血患儿中气管、支气管炎引起的咯血占16例(53%),特发性肺含铁血黄素沉着症5例(17%),支气管内膜、肺结核3例(10%),支气管扩张症3例(10%),肿瘤、消化道畸形所致的咯血在儿童也可见到。结论气管、支气管炎是儿童咯血最常见的病因,特发性肺含铁血黄素沉着症是儿童咯血的常见原因。

迭代型方法在住院超30天患者管理决策中的应用研究

参考医院住院超30天患者管理的相关规范及文献,遵循迭代型方法的设计思路,结合信息技术,将其应用于医院住院超30天患者的管理决策。通过比较应用前后住院超30天患者人数占出院总人数的比例,可以看出:迭代型方法在医院住院超30天患者管理决策中的应用有效降低了住院超30天患者人数占出院总人数的比例,符合医疗管理的需求,有利于实现医疗质量的持续性改进。

Effects of multimodal fast-track surgery on liver transplantation outcomes

BACKGROUND: Fast-track surgery and enhanced recovery after surgery have been applied to many surgical procedures; however, data on fast-track surgery and enhanced recovery after surgery following liver transplantation is limited. This study aimed to conduct a prospective study to determine the effects of fast-track surgery on prognosis after liver transplantation. METHODS: This was a prospective, single-blinded, randomized study. One hundred twenty-eight patients undergoing liver transplantation were selected for the fast-track (FT group, n=54) or conventional process (NFT group, n=74). The primary endpoints were intensive care unit (ICU) stay and hospital stay. The secondary endpoints were as follows: operative time, anhepatic phase time, intraoperative blood loss, intraoperative blood transfusion volume, postoperative complications, readmission rate, and postoperative mortality. RESULTS: There was no significant difference in preoperative demographics between the two groups. The median ICU stay was 2 days (range 1-7 days) in the FT group and 5 days (range 3-12 days) in the NFT group (P<0.01). Furthermore, the hospital stay was also significantly reduced in the FT group (P<0.01). The operative time, anhepatic phase time, intraoperative blood loss, and intraoperative blood transfusion volume were decreased in the FT group compared with the NFT group (P<0.05). Based on Spearman correlation analysis, the ICU stay and hospital stay may be positively correlated with operative time, anhepatic phase time and intraoperative blood loss. There were no differences in the incidence of postoperative complications, readmissions, and postoperative mortality between the two groups. CONCLUSION: Fast-track procedures effectively reduce the ICU stay and hospital stay without adversely affecting prognosis. This study demonstrated that fast-track protocols are safe and feasible in liver transplantation.

加强肿瘤患者住院超30天管理 缩短平均住院日的体会

目的探讨通过改进医疗服务、加强质量管理等缩短平均住院日。方法分析2014年肿瘤患者住院超过30 d的原因,提出相应改进措施。结果2014年造成肿瘤患者住院超30 d的主要原因是放疗治疗疗程、手术后并发症、放疗与化疗后不良反应、放疗与化疗合并施行和医疗纠纷病人滞留医院等因素造成。结论通过改进服务理念、规范诊疗行为、加强围手术期管理、做好有效医患沟通和妥善解决医疗纠纷等举措,减少了住院时间超30 d患者的数量,缩短了平均住院日。

A STUDY ON RESPONSE OF PRECIPITATION IN CHINA TO MONSOON INTRASEASONAL OSCILLATION

Temporal and spatial evolution characteristics of the 30-60 day oscillation (intraseasonal oscillation, ISO) of summer rainfall in China and the effects of East Asian monsoon on the rainfall ISO are analyzed in this paper. Results show that the annual and decadal variations of the oscillation exist between 1960 and 2008, and the intensity is weakest in the late 1970s and early 1980s. In the typical strong years of the rainfall ISO obtained from empirical orthogonal functions (EOF mode 1), an anticyclone is in northwestern Pacific and a cyclone is in the east of China. In the typical weak years, the wind ISO is much weaker. The low-frequency zonal wind and water vapor transport from the low latitudes to mid-latitudes in the typical strong years, and the oscillation strength of diabatic heating is much stronger than that in the weak years of the rainfall ISO. The anomaly characteristics of the rainfall ISO show anti-phases between the Yangtze River basin and south of China. As for the typical strong years of the rainfall ISO in the Yangtze River basin (EOF mode 2), the main oscillation center of water vapor is in the east of China (20-30°N, 110-130°E). In the peak (break) phase of the rainfall oscillation, a low-frequency cyclone (anticyclone) is in the Yangtze River basin and an anticyclone (cyclone) is near Taiwan Island. In addition, the peak rainfall corresponds to the heat source in the Yangtze River basin and the heat sink in the Qinghai-Tibet Plateau. As for the typical strong years of the rainfall ISO in the south of China, the main oscillation center of water vapor is south of 20°N. In the peak (break) phase of the rainfall ISO, a low-frequency cyclone (anticyclone) is in the south of China and an anticyclone (cyclone) is in the Philippines. The peak rainfall corresponds to the heat source in the south of China and the South China Sea, and the heat sink in the west of Indochina.

CISK-rossby wave and the 30-60 Day Oscillation in the Tropics

The 30-60 day oscillation is an important aspect of the atmospheric variance in the tropical area. A number of works have been done on this phenomenon, this article is a further one. A quasi-geostrophic linear model that consists of a two-layer free atmosphere and a well-mixed boundary layer is used to investigate the instability of intraseasonal oscillation, its propagation and vertical structures. Results show that the dynamical coupling and interaction between the barotropic and baroclinic components via boundary layer convergence / divergence are responsible for the appearance of a new kind of low-frequency wave. Such wave is very different from the traditional tropical Rossby wave. It can propagate westward and eastward. Some behaviours of it appear to resemble the observed 30-60 day oscillation mode in many aspects, such,as vertical structures, zonal and meridional propagations. Now many researchers emphasize the direct relationship between CISK-Kelvin mode and the tropical atmospheric 30-60 oscillation. It is considered that CISK-Rossby mode should not be neglected.