Multitarget stool DNA for colorectal cancer screening:A review and commentary on the United States Preventive Services Draft Guidelines

Multitarget stool DNA(mt-sDNA) testing was approved for average risk colorectal cancer(CRC) screening by the United States Food and Drug Administration and thereafter reimbursed for use by the Medicare program(2014).The United States Preventive Services Task Force(USPSTF) October 2015 draft recommendation for CRC screening included mt-s DNA as an "alternative" screening test that "may be useful in select clinical circumstances",despite its very high sensitivity for early stage CRC.The evidence supporting mt-s DNA for routine screening use is robust.The clinical efficacy of mt-s DNA as measured by sensitivity,specificity,life-years gained(LYG),and CRC deaths averted is similar to or exceeds that of the other more specifically recommended screening options included in the draft document,especially those requiring annual testing adherence.In a population with primarily irregular screening participation,tests with the highest point sensitivity and reasonable specificity are more likely to favorably impact CRC related morbidity and mortality than those depending on annual adherence.This paper reviews the evidence supporting mt-s DNA for routine screening and demonstrates,using USPSTF's modeling data,that mt-s DNA at three-year intervals provides significant clinical net benefits and fewer complications per LYG than annual fecal immunochemical testing,high sensitivity guaiac based fecal occult blood testing and 10-year colonoscopy screening.

Evaluation of the effectiveness of preventive nursing measures for pressure injuries in patients in the neurology intensive care unit

BACKGROUND Patients in neurology intensive care units(ICU)are prone to pressure injuries(PU)due to factors such as severe illness,long-term bed rest,and physiological dysfunction.PU not only causes pain and complications to patients,but also increases medical burden,prolongs hospitalization time,and affects the recovery process.AIM To evaluate and optimize the effectiveness of pressure injury prevention nursing measures in neurology ICU patients.METHODS A retrospective study was conducted,and 60 patients who were admitted to the ICU of the Department of Neurology were selected and divided into an observation group and a control group according to the order of admission,with 30 people in each group.The observation group implemented pressure injury prevention and nursing measures,while the control group adopted routine care.RESULTS Comparison between observation and control groups following pressure injury prevention nursing intervention revealed significantly lower incidence rates in the observation group compared to the control group at 48 h(8.3%vs 26.7%),7 d(16.7%vs 43.3%),and 14 d(20.0%vs 50.0%).This suggests a substantial reduction in pressure injury incidence in the observation group,with the gap widening over time.Additionally,patients in the observation group exhibited quicker recovery,with a shorter average time to get out of bed(48 h vs 72 h)and a shorter average length of stay(12 d vs 15 d)compared to the control group.Furthermore,post-intervention,patients in the observation group reported significantly improved quality of life scores,including higher scores in body satisfaction,feeling and function,and comfort(both psychological and physiological),indicating enhanced overall well-being and comfort following the implementation of pressure injury prevention nursing measures.CONCLUSION Implementing pressure injury preventive care measures for neurology ICU patients will have better results.

Epidemiology of isolated hand injuries in the United Arab Emirates

AIM To provide suggestions for hand injury prevention by study the demography and risk factors of casualties suffering from isolated hand injuries.METHODS All trauma patients with isolated hand injuries who were admitted to Al Ain Hospital for more than 24 h during a period of 3 years were studied. Patient demographics,location, mechanism/time of injury, and length of hospital stay were all analyzed.RESULTS Two hundred and ten patients were studied. Their mean age was 29.7 years. Males constituted 92%. Sixty-five point one percent of all cases were from the Indian subcontinent. The workplace was the most common location of injury(67.1%), followed by the home(17.1%)and road(6.2%). Machinery caused 36.2% of all injuries,followed by heavy object(20.5%) and fall(11%). Cases injured at home were young(P < 0.0001) with an associated higher incidence of females(P < 0.0001).CONCLUSION Male workers in Al Ain city are at greater risk of sustaining hand injuries, predominantly from machinery. Safety education, personal protection, and the enforcement of safety standards are essential to the prevention and avoidance of hand injury.

Knowledge of“Guidelines for the prevention of intravascular catheter-related infections(2011)”:A survey of intensive care unit nursing staffs in China

Aims and objectives:To evaluate intensive care unit(ICU)nurses'knowledge of the updated guidelines for the prevention of intravascular catheter-related infections;to identify the factors that affect the nurses'knowledge and to explore the barriers to adherence to evidence-based guidelines in clinical practice in China.Methods:Cross-sectional surveys were carried out in Chinese ICUs from January 2013 to March 2014.The nurses'demographic information,knowledge of the guidelines,and barriers to adherence were assessed by a validated questionnaire and then analyzed statistically.Results:The questionnaires were completed by 455 ICU nurses from 4 provinces of China.The mean score was 8.17 of 20,and higher scores were significantly associated with province,years of experience,and years of ICU experience.Forty-nine(10.7%)nurses had not heard of the guidelines,whereas 231(50.7%)nurses heard of the guidelines but did not receive training for them.Trained nurses'scores were higher than untrained nurses'scores.The three main barriers to compliance with the guidelines were an unfamiliarity with them,an excessive workload due to a shortage of nurses,and a lack of training.Conclusions:ICU nurses'knowledge of the updated guidelines is quite low,which could be a potential risk factor for patient safety.Multidisciplinary interventions and continuous.

Optimal Maintenance Modeling for Systems with Multiple Non-Identical Units Using Extended DSSP Method

In the optimal maintenance modeling, all possible maintenance activities and their corresponding probabilities play a key role in modeling. For a system with multiple non-identical units, its maintenance requirements are very complicated, and it is time-consuming, even omission may occur when enumerating them with various combinations of units and even with different maintenance actions for them. Deterioration state space partition (DSSP) method is an efficient approach to analyze all possible maintenance requirements at each maintenance decision point and deduce their corresponding probabilities for maintenance modeling of multi-unit systems. In this paper, an extended DSSP method is developed for systems with multiple non-identical units considering opportunistic, preventive and corrective maintenance activities for each unit. In this method, different maintenance types are distinguished in each maintenance requirement. A new representation of the possible maintenance requirements and their corresponding probabilities is derived according to the partition results based on the joint probability density function of the maintained system deterioration state. Furthermore, focusing on a two-unit system with a non-periodical inspected condition-based opportunistic preventive-maintenance strategy;a long-term average cost model is established using the proposed method to determine its optimal maintenance parameters jointly, in which “hard failure” and non-negligible maintenance time are considered. Numerical experiments indicate that the extended DSSP method is valid for opportunistic maintenance modeling of multi-unit systems.

Is every microorganism detected in the intensive care unit a nosocomial infection?Isn’t prevention more important than detection?

The present letter to the editor is related to the study entitled“Multidrug-resistant organisms in intensive care units and logistic analysis of risk factors.”Not every microorganism grown in samples taken from critically ill patients can be considered as an infectious agent.Accurate and adequate information about nosocomial infections is essential in introducing effective prevention programs in hospitals.Therefore,the development and implementation of care bundles for frequently used medical devices and invasive treatment devices(e.g.,intravenous catheters and invasive ventilation),adequate staffing not only for physicians,nurses,and other medical staff but also for housekeeping staff,and infection surveillance and motivational feedback are key points of infection prevention in the intensive care unit.

Trends of central line-associated bloodstream infections in the intensive care unit in the Kingdom of Bahrain:Four years’experience

BACKGROUND The central venous line is an essential component in monitoring and managing critically ill patients.However,it poses patients with increased risks of severe infections with a higher probability of morbidity and mortality.AIM To define the trends of the rates of central line-associated bloodstream infections(CLABSI)over four years,its predicted risk factors,aetiology,and the antimicrobial susceptibility of the isolated pathogens.METHODS The study was a prospective case-control study,performed according to the guidelines of the Center for Disease Control surveillance methodology for CLABSI in patients admitted to the adult intensive care unit(ICU)and auditing the implementation of its prevention bundle.RESULTS Thirty-four CLABSI identified over the study period,giving an average CLABSI rate of 3.2/1000 central line days.The infection's time trend displayed significant reductions over time concomitantly with the CLABSI prevention bundle's reinforcement from 4.7/1000 central line days at the beginning of 2016 to 1.4/1000 central line days by 2018.The most frequently identified pathogens causing CLABSI in our ICU were gram-negative organisms(59%).The most common offending organisms were Acinetobacter,Enterococcus,and Staphylococcus epidermidis,each of them accounted for 5 cases(15%).Multidrug-resistant organisms contributed to 56%of CLABSI.Its rate was higher when using femoral access and longer hospitalisation duration,especially in the ICU.Insertion of the central line in the non-ICU setting was another identified risk factor.CONCLUSION Implementing the prevention bundles reduced CLABSI significantly in our ICU.Implementing the CLABSI prevention bundle is crucial to maintain a substantial reduction in the CLABSI rate in the ICU setting.

Causes Leading to Formation of Shot Cokes and Measures for Its Prevention in Super Viscous Oil Delayed Coking Unit

射击焦炭经常在对待 thes 更起来的推迟的 coking 单位被形成粘滞在 PetroChina 的 Liaohe 石油化学的公司的油。可观的工作被执行了避免射击焦炭的形成。获得的测试结果证明了性质 ofs 更起来粘滞油在射击焦炭的形成起了一个关键作用。在调整并且优化以后，这个过程在产量 of118t/h 索引推迟的 coking 单位的操作政体超级粘滞油作为 498-502 °C 的 follows:a 反应温度被指定，是 0.17-0.25 MPa 的行动压力， 0.5-0.6 的recycle 比率和 355-365 °C .In 的分别塔底部温度同时，推迟的 coking 过程采用了措施提高化工物品的分别前讲道理地移开轻部分并且维持稳定的煤气的速度以便避免射击焦炭的形成。

ICU护士血管导管相关感染预防与控制知识的现状调查

目的调查重症医学科(intensive care unit,ICU)护士血管导管相关感染(vessel catheter associated infection,VCAI)预防与控制知识的现状,为提高ICU护理质量提供改进依据。方法采用便利抽样方法,选取2022年11—12月厦门大学附属第一医院ICU 60名在职护士作为调查对象。采用一般资料调查表、VCAI预防与控制知识现状调查表和学习情况调查表对其进行调查,并调查2020—2022年ICU的VCAI发生率。结果60名护士VCAI预防与控制知识总得分为10~27分,平均(20.57±3.50)分,平均得分率为76.18%,处于中等水平,各维度知识掌握水平不等。2020年发生1例VCAI,发生率为3.19‰;2021年发生2例VCAI,发生率分别为2.52‰、2.91‰;2022年未发生VCAI。结论ICU护士对VCAI知识掌握程度处于中等水平,应进一步加强对护士相关知识的培训和考核,规范操作流程,提高ICU护理质量。

特大型硫磺储运系统粉尘防控技术应用总结

普光天然气净化厂设计硫磺产能2.4 Mt/a,是亚洲最大的硫磺生产基地。针对该厂特大型硫磺储运系统存在的皮带输送单元落地硫磺粉尘扩散、地下廊道硫磺粉尘超标、装车单元粉尘闪爆等安全隐患,围绕固体硫磺仓储、输送、装车环节开展粉尘风险防控难题攻关,研究皮带机集成清扫、地下廊道粉尘消减及粉尘闪爆综合治理技术,形成了特大型固体硫磺储运系统全流程粉尘防控关键技术,实现了安全清洁生产,提高了装置本质安全水平。

Infection management strategy based on prevention and control of nosocomial infections in intensive care units

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection,which is clinical problem often faced by intensive care units (ICU) doctors.Without positive treatment,the incidence and mortality of sepsis are high.^[1]As hospital infection control plays an essential role in treating the nosocomial infections in the ICU,and according to the clinical presentation of critically ill patients,the biological characteristics of pathogenic microorganisms and the ICU environment,this article put forward a strategy for the nosocomial infections in the ICU.

2023年美国预防临床服务指南工作组《成年人抑郁症和自杀风险筛查推荐声明》解读

成年人抑郁症和自杀已成为我国乃至全球重要的公共卫生问题,给患者及社会带来了沉重的疾病负担。2023年美国预防临床服务指南工作组在JAMA上发表了《成年人抑郁症和自杀风险筛查推荐声明》(以下简称USPSTF推荐),并发布了最新证据报告和系统评价结果,认为应对成年人进行抑郁症筛查,包括孕妇、产妇及老年人,但目前自杀筛查的风险与获益证据不充分,无法确定筛查的利弊。本文结合USPSTF推荐和国内外研究现状,从成年人抑郁症和自杀的流行病学、危险因素、早期筛查工具及利弊、治疗和干预、推荐对全科指导价值等方面进行了概述。

2023年美国预防临床服务指南工作组《儿童和青少年血脂异常筛查推荐声明》解读

家族性高胆固醇血症和多因素所致血脂异常是导致儿童期血脂异常的重要原因,而儿童期血脂异常可能导致早发动脉粥样硬化性心血管疾病甚至威胁生命。已有众多指南和声明提出不同的儿童和青少年时期血脂筛查策略。2023年美国预防临床服务指南工作组(USPSTF)针对儿童家族性高胆固醇血症及多因素血脂异常筛查的利弊进行了系统综述,并发布《儿童和青少年血脂异常筛查推荐声明》,目前尚无充足的证据评估针对20岁以下儿童青少年血脂异常筛查的益处或危害,呼吁对此开展进一步深入研究,并建议临床医生根据自己的判断决定是否进行筛查。

《成年人阻塞性睡眠呼吸暂停低通气综合征筛查:美国预防临床服务指南工作组推荐声明》解读

成年人阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是一种常见的睡眠呼吸障碍,与高血压、糖尿病、心血管疾病和其他健康问题紧密相关。尽管OSAHS对全球人民的健康有着广泛影响,OSAHS的筛查和诊断在临床实践中的普及率仍不高。在此背景下,美国预防临床服务指南工作组(USPSTF)最近发布了一项最新的成年人OSAHS筛查推荐,以帮助更多人识别和治疗潜在的睡眠呼吸障碍。本文将解读最新推荐,结合我国实际情况,为我国成年人OSAHS筛查提供参考。

三级医院ICU护士对ICU获得性衰弱评估及预防策略实践现状的调查研究

目的调查三级医院ICU护士对ICU获得性衰弱(intensive care unit acquired weakness,ICU-AW)评估及预防策略实践现状,并分析影响因素。方法采用便利抽样法,于2022年11月—12月选取北京市、辽宁省、河北省28所三级医院的397名护士为调查对象,采用自行设计的问卷进行调查。结果ICU-AW评估主要由医生完成(55.42%),肌力评估是首选方法(65.49%)。84.13%护士反映临床未有ICU-AW相关的标准化策略或流程,主要预防措施是镇痛镇静(65.24%)、早期活动(62.47%),活动形式主要是呼吸功能指导(33.00%)、床上被动训练(33.25%)。护士ICU-AW评估与预防策略认知得分为(20.74±8.03)分,态度得分(26.68±4.19)分,实践得分(29.79±5.40)分。年龄、工作年限、学历、医院地区分布是护士对ICU-AW评估与预防措施实践的影响因素(P<0.05)。结论目前护士对ICU-AW认知水平不足,ICU-AW评估方式受限,缺乏标准化干预流程,人力资源不足。建议加强ICU-AW教育培训,完善资源配置,构建标准化的评估和实践流程,促进ICU-AW评估与预防实践的临床开展。

护士采取深静脉血栓形成预防性措施意向量表的汉化及信效度检验

目的对护士采取深静脉血栓形成预防性措施意向量表进行汉化,并对中文版量表进行信效度检验。方法在取得原作者的授权后,严格遵循Brislin翻译回译模型对量表进行翻译、回译,邀请16名专家对量表的内容进行效度评价,得到中文版量表。同时采用该量表对674名ICU护士采取深静脉血栓形成预防性措施的意向进行评估,检验量表的信度及效度。结果中文版量表共15个条目及4个开放式问题,经探索性因子分析共提取4个公因子,累计方差贡献率为82.66%;验证性因子分析结果显示模型拟合良好;效标关联效度显示相关系数为0.426,效标关联效度较为理想。量表总的Cronbach'sα系数为0.872,折半信度为0.840,重测信度为0.843(P<0.01);量表平均内容效度为0.870,量表各条目内容效度指数为0.900~1.000。结论中文版护士采取深静脉血栓形成预防性措施意向量表具有良好的信效度,适合对我国ICU护士采取深静脉血栓形成预防性措施的意向进行评价。

山区切坡活动引发地质灾害风险评估及其防控措施

以秦岭北麓西安市临潼区仁宗街道为研究区,在野外调查、遥感解译的基础上,确定、分析了40处地质灾害隐患点的发育特征及其主要影响因素;基于DEM数据,构建了研究区663个斜坡单元地质灾害风险评估体系,通过地质灾害易发性、危险性和易损性分析,得到了考虑斜坡稳定性和承灾体危害性的仁宗街道斜坡单元地质灾害综合风险评估结果;通过野外实地验证,证实了评估结果的准确性和可靠性。据此划分了地质灾害防治区,从防灾减灾和工程建设两维度提出了仁宗街道的地质灾害风险防控措施建议,为研究区国土空间规划提供参考依据。

成人ICU患者医用粘胶相关性皮肤损伤预防与管理最佳实践的障碍因素分析

目的了解成人ICU患者医用粘胶剂相关性皮肤损伤预防与管理的临床现状,明确证据转化过程中的障碍因素并探讨其应对策略。方法系统化检索相关文献,对纳入文献进行质量评价后提取证据,通过共识会议构建审查指标和确定目标值,开展基线审查,根据审查现状进行障碍因素分析。结果筛选出转化的证据共29条,制订27条审查指标,仅3条指标的执行率达到目标值。变革层面的主要障碍为缺乏相关护理制度及流程、需调整原有工作程序、冲击护士固有的思维方式;变革接受者层面的主要障碍为护士对工作量增加的抗拒、知识和技能缺乏、家属对医疗负担的担忧;组织环境层面的主要障碍为缺乏激励、支持和反馈机制,现场环境有待改善。结论成人ICU患者医用粘胶相关性皮肤损伤预防与管理最佳实践的障碍因素多样,应根据这些因素制订以变革、变革接受者、组织环境为中心的改进策略,将变革融入工作流程和管理体系,建立有效的激励机制与反馈机制,促使组织环境改善,推动最佳证据向临床实践转化。

新生儿重症监护病房医院感染预防指标的构建

目的:构建适用于新生儿重症监护病房的医院感染预防指标体系,降低医院感染发生率,保障患儿的生命安全和健康。方法:通过文献资料分析和实地调研,初步确定了新生儿重症监护病房医院感染预防指标,再通过德尔菲法对指标进行修订和评价后最终建立了一套包括环境管理、医护人员操作规范、患儿个体化预防措施等多个方面的医院感染预防指标体系。结果:构建出包含结构指标、过程指标和结果指标的适用于新生儿重症监护病房医院感染预防的指标体系。其中,共包括3个一级指标、14个二级指标和43个三级指标。2轮函询专家的积极系数均为100%,专家权威系数分别0.836和0.842,肯德尔和谐系数为0.263和0.217。内容包括环境管理、消毒隔离、手卫生、医疗废物处理、仪器设备管理、人员培训等多个方面,覆盖了新生儿重症监护病房医院感染防控的各个环节。结论:本研究构建的新生儿重症监护病房医院感染预防指标体系具有可操作性和指导性,有助于提高新生儿重症监护病房的治疗质量和安全性。同时,本研究的方法和经验也为其他医院感染预防指标的构建提供了参考。

英国中小学校园欺凌行为预防与管理研究

校园欺凌是世界各国高度关注的社会问题。英国为应对校园欺凌,建立了较完备的预防和干预体系。其中包括:创建完整、系统的校园欺凌政策和法律体系,从预防、应对和监督这三个层面防治校园欺凌;构建由政府、学校、社会组织等多元主体参与的校园欺凌治理机制,学校在校园欺凌的治理中处于责任主体地位;形成一系列以学校为核心的反欺凌项目共同体,促进各利益相关方的合作,推动校园欺凌防治行动的顺利实施。英国的校园欺凌治理方案和反欺凌项目实践,可为中小学校园欺凌防治工作提供有价值的经验启示。