Objective:To explore the target management model for clinical pharmacists in primary hospitals facing current shortages of clinical pharmacists,in order to improve the work efficiency and service quality of clinical p...Objective:To explore the target management model for clinical pharmacists in primary hospitals facing current shortages of clinical pharmacists,in order to improve the work efficiency and service quality of clinical pharmacy,and promote the high-quality development of clinical pharmacy in primary hospitals.Methods:Developing a target management model,adopting a wide coverage work model of“1+1+N”(that is,1 clinical pharmacist,1 resident clinical department,and N contracted clinical departments).According to the SMART principle,various work assessment indicators were quantified.This involved setting clear work goals,diversifying work methods,personalizing work methods,standardizing workflows,and using numerical assessment indicators.Regular supervision,inspection,feedback,and improvement mechanisms were implemented.Results:The implementation of the target management model has made the work effectiveness of clinical pharmacists visualized.There were more than 200 annual consultations and multidisciplinary team(MDT)cases,with an opinion adoption rate of 90.2%and a patient improvement rate of 80.6%.More than 1500 rational drug use interventions were conducted,with a suggestion adoption rate of 83.5%.In terms of pharmaceutical indicators control.The intensity of antibacterial drug use in 2024(without CMI adjustment)was 30.07 DDDs,significantly lower than the 2023 value of 33.54 DDDs,and also significantly lower than the provincial average(32.87 DDDs)and the average for hospitals of the same level(32.49 DDDs).The daily usage of intravenous infusion per bed for hospitalized patients was 2.09,a decrease from 2.15 in 2023,significantly lower than the provincial average of 2.71 and the average of 2.56 in hospitals of the same level.The amount of the second batch of national key monitoring drugs accounts for the value was 6.48%,significantly lower than the provincial average of 8.27%and the same level hospital average of 8.82%.In terms of chronic disease pharmaceutical management,taking the pharmaceutical management of patients with chronic heart failure as an example,the usage rates of renin-aldosterone-angiotensin-system inhibitors(RAAS inhibitors)and beta-blockers for heart failure in the management group were 87.88%and 80.81%,respectively,significantly higher-1 than those in the control group(62.22%and 65.56%).Heart rate in the management group(69.54±10.68 times·min-1)was significantly lower than in the control group(80.04±17.68 times·min)(P<0.001).The low-density lipoprotein cholesterol(1.69±0.57 mmol·L-1)was significantly lower than the control group(1.95±0.77 mmol·L-1)(P<0.001),and the 1-year readmission rate was 47.47%,significantly lower than the control group 56.67%.The Minnesota Living with Heart Failure Questionnaire(MLHFQ)Score was(44.20±10.78),significantly lower than the control group(55.89±11.48)(P<0.001),indicating a significant improvement in the patient’s quality of life.Conclusions:The targeted management model for clinical pharmacists can effectively enhance communication and collaboration between clinical pharmacists and clinicians,improve the work efficiency and service quality of clinical pharmacists in primary hospitals,promote the work of clinical pharmacy towards standardization and scientificization,boost the high-quality development of pharmacy in primary hospitals,and also provide new ideas and methods for the management of clinical pharmacists in other primary hospitals.展开更多
Objective: to explore the nursing effect of visceral fat target management in overweight or obese diabetic patients. Methods: from October 2019 to October 2021, 80 overweight or obese diabetic patients in our hospital...Objective: to explore the nursing effect of visceral fat target management in overweight or obese diabetic patients. Methods: from October 2019 to October 2021, 80 overweight or obese diabetic patients in our hospital were randomly divided into two groups, with 40 patients in each group. The control group was treated with routine diabetes education and guided nursing. On the basis of the observation group, visceral fat index was established according to the standardized diabetes management system (MMC). Both groups were followed up for 6 months. Blood glucose control, body mass index, visceral fat area and quality of life were compared between the two groups. Results: after intervention, the fasting blood glucose (FPG), 2h postprandial blood glucose (2hPG), glycosylated hemoglobin (HbAlc), insulin resistance index (HOMA-IR) and body mass index (BMI) of the observation group were all lower than those of the control group, and the visceral fat area was all lower than that of the control group, and the quality of life score was higher than that of the control group (P < 0.05). Conclusion: objective management of visceral fat can effectively improve the glycemic control effect of overweight or obese diabetic patients, reduce their body mass index, reduce visceral fat area, and improve the quality of life of patients.展开更多
BACKGROUND: Targeted temperature management(TTM) is a common therapeutic intervention, yet its cost-effectiveness remains uncertain. This study aimed to evaluate the real-world cost-effectiveness of TTM compared with ...BACKGROUND: Targeted temperature management(TTM) is a common therapeutic intervention, yet its cost-effectiveness remains uncertain. This study aimed to evaluate the real-world cost-effectiveness of TTM compared with that of conventional care in adult out-of-hospital cardiac arrest(OHCA) survivors using clinical patient-level data.METHODS: We conducted a retrospective cohort study at an academic medical center in the USA to assess the cost-effectiveness of TTM in adult non-traumatic OHCA survivors between 1 January, 2019 and 30 June, 2023. The primary outcome was survival to hospital discharge. Incremental cost-effectiveness ratios(ICERs) were calculated and compared with various decision makers' willingness to pay. Cost-effectiveness acceptability curves were utilized to evaluate the economic attractiveness of TTM. Uncertainty about the incremental cost and effect was explored with a 95% confidence ellipse.RESULTS: Among 925 non-traumatic OHCA survivors, only 30(3%) received TTM. After adjusting for potential confounders, the TTM group did not demonstrate a significantly lower cost(delta cost-$5,141, 95% confidence interval [95% CI]: $-35,347 to $25,065, P=0.79) and higher survival to hospital discharge(delta effect 6%, 95% CI:-11% to 23%, P=0.41). Additionally, a 95% confidence ellipse indicated uncertainty reflected by evidence that the true value of the ICER could be in any of the quadrants of the cost-effectiveness plane.CONCLUSION: Although TTM did not demonstrate a clear survival benefit in this study, its potential cost-effectiveness warrants further investigation with larger sample sizes. These findings highlight the need for additional research to optimize TTM use in OHCA care and inform resource allocation decisions.展开更多
Targeted temperature management(TTM) shows the most promising neuroprotective therapy against hypoxic/ischemic encephalopathy(HIE).In addition, TTM is also useful for treatment of elevated intracranial pressure(ICP).H...Targeted temperature management(TTM) shows the most promising neuroprotective therapy against hypoxic/ischemic encephalopathy(HIE).In addition, TTM is also useful for treatment of elevated intracranial pressure(ICP).HIE and elevated ICP are common catastrophic conditions in patients admitted in Neurologic intensive care unit(ICU).The most common cause of HIE is cardiac arrest.Randomized control trials demonstrate clinical benefits of TTM in patients with post-cardiac arrest.Although clinical benefit of ICP control by TTM in some specific critical condition, for an example in traumatic brain injury, is still controversial, efficacy of ICP control by TTM is confirmed by both in vivo and in vitro studies.Several methods of TTM have been reported in the literature.TTM can apply to various clinical conditions associated with hypoxic/ischemic brain injury and elevated ICP in Neurologic ICU.展开更多
BACKGROUND:Targeted temperature management(TTM),as a therapeutic temperature control strategy for cardiac arrest(CA),is recommended by guidelines.However,the relationship between postrewarming fever(PRF)and the progno...BACKGROUND:Targeted temperature management(TTM),as a therapeutic temperature control strategy for cardiac arrest(CA),is recommended by guidelines.However,the relationship between postrewarming fever(PRF)and the prognosis of CA patients is unclear.Therefore,we aim to summarize the studies regarding the infl uence of PRF on patients with CA.METHODS:EMBASE,PubMed,and Cochrane Central databases were searched from inception to March 13,2022.Randomized clinical trials(RCTs)and cohort studies on PRF in CA patients were included.According to the heterogeneity,the meta-analysis was performed using a random eff ects model or fi xed eff ects model to calculate the pooled odds ratios(ORs)and corresponding 95%confi dence intervals(CIs).The outcome data were unfavorable neurological outcome and mortality.RESULTS:The meta-analysis included 11 observational studies involving 3,246 patients.The results of the meta-analysis show that PRF(body temperature>38.0℃)has no eff ect on the neurological outcome of CA patients(OR 0.71,95%CI 0.43–1.17,I282%)and has a signifi cant relationship with lower mortality(OR 0.63;95%CI 0.49–0.80,I239%).However,PRF with a stricter defi nition(body temperature>38.5℃)was associated with worse neurological outcome(OR 1.44,95%CI 1.08–1.92,I245%)and higher mortality(OR 1.71,95%CI 1.25–2.35,I247%).CONCLUSION:This study suggests that PRF>38.0℃ may not affect the neurological outcome and have a lower mortality in CA patients who completed TTM.However,PRF>38.5℃ is a potential prognostic factor for worse outcomes in CA patients.展开更多
Core body temperature(CBT)is increasingly attracting attention as crucial data during target temperature management(TTM).Accurate and continuous measurement of human CBT can effectively identify and monitor central hi...Core body temperature(CBT)is increasingly attracting attention as crucial data during target temperature management(TTM).Accurate and continuous measurement of human CBT can effectively identify and monitor central high fever,and provide a basis for the effective implementation during TTM,which is therefore of great significance for human health care and disease monitoring.The reliable core measurement sites are nasopharynx,esophagus,bladder,rectum,pulmonary artery,etc.,but the measurement methods in these sites are all invasive.At present,the medical field is more inclined to noninvasive data collection methods through monitoring an appropriate site(such as forehead,mouth,or axilla)depending on clinical circumstances,so as to ensure the comfort and security of patients to the greatest extent.This review will provide reference choosing more safe and accurate temperature measurement methods for patients during TTM by reviewing the sites and accuracy of invasive and noninvasive CBT measurements.展开更多
Cardiac or respiratory arrest lasting only a few minutes can inflict grave harm on numerous bodily organs, not least of all, the brain. Neurocognitive deficits, which are often severe and profoundly life altering, rem...Cardiac or respiratory arrest lasting only a few minutes can inflict grave harm on numerous bodily organs, not least of all, the brain. Neurocognitive deficits, which are often severe and profoundly life altering, remain a major source of morbidity among survivors.展开更多
Objective: to explore the knowledge and application status of undergraduate nursing students on target temperature management of coma patients after cardiopulmonary resuscitation. Methods: 100 nursing students from a ...Objective: to explore the knowledge and application status of undergraduate nursing students on target temperature management of coma patients after cardiopulmonary resuscitation. Methods: 100 nursing students from a university in Hengyang city were selected by simple random sampling method. They were investigated by general situation questionnaire, undergraduate nursing students knowledge and application ability test on target temperature management of coma patients after cardiopulmonary resuscitation and satisfaction survey on practical skills class of cardiopulmonary resuscitation. Results: among the 96 nursing students surveyed, only 40.63% said they knew the concept of TTM, only 13.54% of them knew the specific range of the target body temperature in the 2020 edition of the guidelines for cardiopulmonary resuscitation, and only 14.58% of the nursing students practice departments carried out TTM. The most commonly used methods of body temperature detection were body surface measurement, intravascular measurement, rectal temperature probe, bladder probe, rectal mercury meter and esophageal temperature catheter standard measurement methods were less used. Nursing students in the practice department would prefer intravenous drip of ice salt water, ice cap, ice bag and ice blanket to induce and maintain mild hypothermia, while the more advanced and standard intravascular cooling method is applied less frequently in undergraduate nursing students. Conclusion: undergraduate nursing students lack the relevant knowledge of target temperature management for patients after cardiopulmonary resuscitation, and need to further strengthen the teaching of target temperature management for coma patients after cardiopulmonary resuscitation.展开更多
Objective: to explore the clinical efficacy of individualized targeted nutrition management in patients undergoing chemotherapy in oncology department. Methods: 80 cases of chemotherapy patients admitted to the oncolo...Objective: to explore the clinical efficacy of individualized targeted nutrition management in patients undergoing chemotherapy in oncology department. Methods: 80 cases of chemotherapy patients admitted to the oncology department of our hospital from March 2020 to March 2021 were randomly divided into two groups according to the different nursing methods, 40 patients in each group were named as the control group and the experimental group, 40 patients in the control group were all given routine nursing intervention, 40 patients in the experimental group were all given individualized targeted nutrition management intervention according to the requirements, after the 2-month nursing course, the nursing satisfaction, quality of life and nutrition index level of the two groups of patients were recorded in detail by full-time nursing staff. Results: after the nursing course was over, the data of the two groups of patients were comprehensively compared by the full-time nursing staff. the data such as nursing satisfaction, quality of life score and various nutritional index levels of the patients in the experimental group were significantly better than those in the control group (p < 0.05), and the comparison was statistically significant in clinic. Conclusion: in the clinic of oncology department, in order to help the majority of tumor patients to obtain good chemotherapy effect, individualized targeted nutrition management should be implemented. By improving the nutritional status of patients, significant clinical curative effect can be achieved, thus promoting the improvement of clinical nursing quality. It is the preferred nursing plan for the majority of tumor patients.展开更多
Interactions among ecosystem services(ESs)are spatially heterogeneous,shaped by both stable(unidirectional)and unstable(context-dependent)influences of socio-economic development and climate change.These complexities ...Interactions among ecosystem services(ESs)are spatially heterogeneous,shaped by both stable(unidirectional)and unstable(context-dependent)influences of socio-economic development and climate change.These complexities pose significant challenges for spatially adaptive ecosystem management.Ecosystem service bundles(ESBs),as recurring combinations of ESs,offer a valuable framework to capture such interactions.Here,we proposed an integrated analytical framework that combines K-means clustering,the geographical detector(GD)model,and geographically and temporally weighted regression(GTWR)models to evaluate how socio-economic and climatic drivers influence ESBs across space and time.Using Hanshui River Basin(HRB)in central China as a case study,we quantified ES dynamics from 2000 to 2020,identified ESBs and stable and unstable effects of multiple drivers.The results showed that carbon sequestration(CS),water yield(WY),and aesthetic landscape(AL)increased by 32.80%,9.00%,and 7.34%,respectively,while soil retention(SR)and food supply(FS)declined by 8.38%and 5.36%.Five distinct ESBs were identified,namely ecologically fragile bundle(EFB),agricultural production bundle(APB),water supply bundle(WSB),forest ecological bundle(FEB),and ecological conservation bundle(ECB).Among these,FEB expanded to more than 35.75%of the HRB,and APB exhibited the sharpest decline(-28.64%).Land use intensity(LUI)was the primary driver of the spatial heterogeneity of ESBs,while synergistic and nonlinear interactions among multiple factors increasingly amplified their effects over time.Notably,annual precipitation(AP)emerged as the only stable basin-scale driver,consistently enhancing ES performance,while gross domestic product(GDP)and normalized difference vegetation index(NDVI)had stable yet spatially differentiated effects across bundles.Our findings highlight the significance of distinguishing stable/unstable driver effects on ES dynamics to inform regionally adaptive ecosystem governance.The proposed framework provides valuable insights into ES interactions,identify spatial priorities,and support policy interventions that balance ecological conservation with socio-economic development.展开更多
Through analyzing the problems of Chinese government public relations, using the idea of the Balanced Scorecard, we analyze the reasons of these problems and discuss the countermeasures from four aspects that conclude...Through analyzing the problems of Chinese government public relations, using the idea of the Balanced Scorecard, we analyze the reasons of these problems and discuss the countermeasures from four aspects that conclude financial, internal operations, customers, learning and growth to achieve the all-round and balanced development of public relations and establish a high level of government public relations organization, regarding the overall strategic goal of government public relations that aim to strengthen the communication with various public, establish an innovative, pragmatic, honest and efficient government image in the public and the international community as the center.展开更多
Heat stroke is the most severe type of heat illness,it is often accompanied by severe multiorgan damage and has a high fatality rate.In January 2020,based on new research evidence and the experiences of Chinese expert...Heat stroke is the most severe type of heat illness,it is often accompanied by severe multiorgan damage and has a high fatality rate.In January 2020,based on new research evidence and the experiences of Chinese experts in heat stroke,the Expert Group of Heat Stroke Prevention and Treatment of the Chinese People’s Liberation Army(PLA)and the Professional Committee of Critical Care Medicine of the Chinese PLA jointly issued a new Expert Consensus on the Diagnosis and Treatment of Heat Stroke in China.This article aims to interpret and supplement the major updates to the new consensus.展开更多
Background:Post–cardiac arrest syndrome involves systemic inflammation,which causes subsequent neurological impairments.We investigated the influence of targeted temperature management(TTM)therapy in patients with ou...Background:Post–cardiac arrest syndrome involves systemic inflammation,which causes subsequent neurological impairments.We investigated the influence of targeted temperature management(TTM)therapy in patients with out-of-hospital cardiac arrest(OHCA)after return of spontaneous circulation(ROSC)by observing the changes in circulating CD14^(+)monocytes and the expression of human leukocyte antigen D–related(HLA-DR)and programmed cell death ligand 1(PD-L1)in CD14^(+)monocytes.Methods:Adult patients admitted to the emergency department of Beijing Chao-Yang Hospital after OHCA between January 2017 and March 2018 were included in this study.Thirty control subjects,10 patients with OHCA,and 37 patients with OHCA who received 72 hours of TTM therapy were enrolled.Peripheral blood samples of patients in the OHCA and TTM groups were collected on Days 1 and 3(D1 and D3)after ROSC and evaluated for HLA-DR and PD-L1 expression on CD14^(+)monocytes using flow cytometry.Results:Compared with control subjects,the percentage of circulating CD14^(+)monocytes,HLA-DR+/CD14^(+)monocyte ratios,and mean fluorescence intensity were significantly decreased in patients with OHCA.After ROSC,HLA-DR expression in CD14^(+)monocytes in the TTM group was lower than that in patients with OHCA.However,there were no significant differences in the percentage of PD-L1+/CD14^(+)monocytes or the mean fluorescence intensity between patients with OHCA and healthy volunteers.Conclusion:After ROSC,circulating CD14^(+)monocytes and HLA-DR+/CD14^(+)monocyte ratios decreased significantly in patients with OHCA.Human leukocyte antigen D–related expression in CD14^(+)monocytes was lower in patients treated with TTM.展开更多
Targeted temperature management(TTM)is a promising and multifaceted modern treatment modality that has been widely used in neurological intensive care patients in recent years.A comprehensive study on the treatment of...Targeted temperature management(TTM)is a promising and multifaceted modern treatment modality that has been widely used in neurological intensive care patients in recent years.A comprehensive study on the treatment of neurocritical patients at home and abroad found that TTM is an intervention that can effectively improve the survival rate and neurological prognosis of patients;its implementation process consists of four stages:induction of hypothermia,maintenance of hypothermia,rewarming,and control of normal body temperature,and scientific nursing measures in each stage can reduce the occurrence of adverse reactions in patients and improve nursing satisfaction.This article provides an overview of TTM,including common methods,brain protection mechanisms,clinical applications in neurocritical patients,and nursing advances to provide a reference for clinical decision-making and the development of appropriate nursing interventions.展开更多
Small-scale fisheries,particularly those targeting small pelagic fish,are a vital sector in Liberia,providing essential food for the local population and generating income for livelihoods.Sardinella maderensis,predomi...Small-scale fisheries,particularly those targeting small pelagic fish,are a vital sector in Liberia,providing essential food for the local population and generating income for livelihoods.Sardinella maderensis,predominantly caught by motorized canoes using gill nets and seine nets,is the primary species in these fisheries.To establish management target reference points for the S.maderensis fishery,this study applied the Schaefer production model to aggregated and disaggregated catch and effort data collected by Liberia's National Fisheries and Aquaculture Authority(NaFAA)from 2018 to 2022.The findings indicate that,in both the aggregated and disaggregated models,the current(2022)fishing effort exceeds the MEY level,leading to diminishing economic returns and approaching economic overfishing thresholds.The economic reference points,MEY and EMEY,were estimated to be 3%and 19%lower in the aggregated model,and 30%and 44%lower in the disaggregated model,compared to the current(2022)catch and relative fishing effort.This situation arises when the cost of fishing exceeds the price of fish,driven by inefficient and ineffective fishing boats,which leads to high unit costs of effort compared to unit revenue.To fully realize the potential of the S.maderensis fishery,this study recommends a combination of input and output control management strategies,the adoption of more efficient fishing technologies,and the provision of alternative livelihoods for coastal communities.展开更多
Urban rail transit(URT)plays a pivotal role in mitigating urban congestion and emissions,positioning it as a sustainable transportation alternative.Nevertheless,URT’s function in transporting substantial numbers of p...Urban rail transit(URT)plays a pivotal role in mitigating urban congestion and emissions,positioning it as a sustainable transportation alternative.Nevertheless,URT’s function in transporting substantial numbers of passengers within confined public spaces renders it vulnerable to the proliferation of infectious diseases during public health crises.This study proposes a decision support model that integrates operational control strategies pertaining to passenger flow and train capacity utilization,with an emphasis on energy efficiency within URT networks during such crises.The model anticipates a URT system where passengers adhere to prescribed routes,adhering to enhanced path flow regulations.Simultaneously,train capacity utilization is intentionally limited to support social distancing measures.The model’s efficacy was assessed using data from the COVID-19 outbreak in Xi’an,China,at the end of 2021.Findings indicate that focused management of passenger flows and specific risk areas is superior in promoting energy efficiency and enhancing passenger convenience,compared to broader management approaches.展开更多
文摘Objective:To explore the target management model for clinical pharmacists in primary hospitals facing current shortages of clinical pharmacists,in order to improve the work efficiency and service quality of clinical pharmacy,and promote the high-quality development of clinical pharmacy in primary hospitals.Methods:Developing a target management model,adopting a wide coverage work model of“1+1+N”(that is,1 clinical pharmacist,1 resident clinical department,and N contracted clinical departments).According to the SMART principle,various work assessment indicators were quantified.This involved setting clear work goals,diversifying work methods,personalizing work methods,standardizing workflows,and using numerical assessment indicators.Regular supervision,inspection,feedback,and improvement mechanisms were implemented.Results:The implementation of the target management model has made the work effectiveness of clinical pharmacists visualized.There were more than 200 annual consultations and multidisciplinary team(MDT)cases,with an opinion adoption rate of 90.2%and a patient improvement rate of 80.6%.More than 1500 rational drug use interventions were conducted,with a suggestion adoption rate of 83.5%.In terms of pharmaceutical indicators control.The intensity of antibacterial drug use in 2024(without CMI adjustment)was 30.07 DDDs,significantly lower than the 2023 value of 33.54 DDDs,and also significantly lower than the provincial average(32.87 DDDs)and the average for hospitals of the same level(32.49 DDDs).The daily usage of intravenous infusion per bed for hospitalized patients was 2.09,a decrease from 2.15 in 2023,significantly lower than the provincial average of 2.71 and the average of 2.56 in hospitals of the same level.The amount of the second batch of national key monitoring drugs accounts for the value was 6.48%,significantly lower than the provincial average of 8.27%and the same level hospital average of 8.82%.In terms of chronic disease pharmaceutical management,taking the pharmaceutical management of patients with chronic heart failure as an example,the usage rates of renin-aldosterone-angiotensin-system inhibitors(RAAS inhibitors)and beta-blockers for heart failure in the management group were 87.88%and 80.81%,respectively,significantly higher-1 than those in the control group(62.22%and 65.56%).Heart rate in the management group(69.54±10.68 times·min-1)was significantly lower than in the control group(80.04±17.68 times·min)(P<0.001).The low-density lipoprotein cholesterol(1.69±0.57 mmol·L-1)was significantly lower than the control group(1.95±0.77 mmol·L-1)(P<0.001),and the 1-year readmission rate was 47.47%,significantly lower than the control group 56.67%.The Minnesota Living with Heart Failure Questionnaire(MLHFQ)Score was(44.20±10.78),significantly lower than the control group(55.89±11.48)(P<0.001),indicating a significant improvement in the patient’s quality of life.Conclusions:The targeted management model for clinical pharmacists can effectively enhance communication and collaboration between clinical pharmacists and clinicians,improve the work efficiency and service quality of clinical pharmacists in primary hospitals,promote the work of clinical pharmacy towards standardization and scientificization,boost the high-quality development of pharmacy in primary hospitals,and also provide new ideas and methods for the management of clinical pharmacists in other primary hospitals.
文摘Objective: to explore the nursing effect of visceral fat target management in overweight or obese diabetic patients. Methods: from October 2019 to October 2021, 80 overweight or obese diabetic patients in our hospital were randomly divided into two groups, with 40 patients in each group. The control group was treated with routine diabetes education and guided nursing. On the basis of the observation group, visceral fat index was established according to the standardized diabetes management system (MMC). Both groups were followed up for 6 months. Blood glucose control, body mass index, visceral fat area and quality of life were compared between the two groups. Results: after intervention, the fasting blood glucose (FPG), 2h postprandial blood glucose (2hPG), glycosylated hemoglobin (HbAlc), insulin resistance index (HOMA-IR) and body mass index (BMI) of the observation group were all lower than those of the control group, and the visceral fat area was all lower than that of the control group, and the quality of life score was higher than that of the control group (P < 0.05). Conclusion: objective management of visceral fat can effectively improve the glycemic control effect of overweight or obese diabetic patients, reduce their body mass index, reduce visceral fat area, and improve the quality of life of patients.
基金supported by Faculty of MedicineChiang Mai University+2 种基金supported by the National Center for Advancing Translational SciencesNational Institutes of Healththrough grant number UL1 TR001860. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH。
文摘BACKGROUND: Targeted temperature management(TTM) is a common therapeutic intervention, yet its cost-effectiveness remains uncertain. This study aimed to evaluate the real-world cost-effectiveness of TTM compared with that of conventional care in adult out-of-hospital cardiac arrest(OHCA) survivors using clinical patient-level data.METHODS: We conducted a retrospective cohort study at an academic medical center in the USA to assess the cost-effectiveness of TTM in adult non-traumatic OHCA survivors between 1 January, 2019 and 30 June, 2023. The primary outcome was survival to hospital discharge. Incremental cost-effectiveness ratios(ICERs) were calculated and compared with various decision makers' willingness to pay. Cost-effectiveness acceptability curves were utilized to evaluate the economic attractiveness of TTM. Uncertainty about the incremental cost and effect was explored with a 95% confidence ellipse.RESULTS: Among 925 non-traumatic OHCA survivors, only 30(3%) received TTM. After adjusting for potential confounders, the TTM group did not demonstrate a significantly lower cost(delta cost-$5,141, 95% confidence interval [95% CI]: $-35,347 to $25,065, P=0.79) and higher survival to hospital discharge(delta effect 6%, 95% CI:-11% to 23%, P=0.41). Additionally, a 95% confidence ellipse indicated uncertainty reflected by evidence that the true value of the ICER could be in any of the quadrants of the cost-effectiveness plane.CONCLUSION: Although TTM did not demonstrate a clear survival benefit in this study, its potential cost-effectiveness warrants further investigation with larger sample sizes. These findings highlight the need for additional research to optimize TTM use in OHCA care and inform resource allocation decisions.
基金the National Research University Project of Thailand from Office of Higher Education Commission and Center of Excellence in Integrated Sciences for Holistic Stroke Research from Thammasat University
文摘Targeted temperature management(TTM) shows the most promising neuroprotective therapy against hypoxic/ischemic encephalopathy(HIE).In addition, TTM is also useful for treatment of elevated intracranial pressure(ICP).HIE and elevated ICP are common catastrophic conditions in patients admitted in Neurologic intensive care unit(ICU).The most common cause of HIE is cardiac arrest.Randomized control trials demonstrate clinical benefits of TTM in patients with post-cardiac arrest.Although clinical benefit of ICP control by TTM in some specific critical condition, for an example in traumatic brain injury, is still controversial, efficacy of ICP control by TTM is confirmed by both in vivo and in vitro studies.Several methods of TTM have been reported in the literature.TTM can apply to various clinical conditions associated with hypoxic/ischemic brain injury and elevated ICP in Neurologic ICU.
基金supported by the National Natural Science Foundation of China(82072137,81571866).
文摘BACKGROUND:Targeted temperature management(TTM),as a therapeutic temperature control strategy for cardiac arrest(CA),is recommended by guidelines.However,the relationship between postrewarming fever(PRF)and the prognosis of CA patients is unclear.Therefore,we aim to summarize the studies regarding the infl uence of PRF on patients with CA.METHODS:EMBASE,PubMed,and Cochrane Central databases were searched from inception to March 13,2022.Randomized clinical trials(RCTs)and cohort studies on PRF in CA patients were included.According to the heterogeneity,the meta-analysis was performed using a random eff ects model or fi xed eff ects model to calculate the pooled odds ratios(ORs)and corresponding 95%confi dence intervals(CIs).The outcome data were unfavorable neurological outcome and mortality.RESULTS:The meta-analysis included 11 observational studies involving 3,246 patients.The results of the meta-analysis show that PRF(body temperature>38.0℃)has no eff ect on the neurological outcome of CA patients(OR 0.71,95%CI 0.43–1.17,I282%)and has a signifi cant relationship with lower mortality(OR 0.63;95%CI 0.49–0.80,I239%).However,PRF with a stricter defi nition(body temperature>38.5℃)was associated with worse neurological outcome(OR 1.44,95%CI 1.08–1.92,I245%)and higher mortality(OR 1.71,95%CI 1.25–2.35,I247%).CONCLUSION:This study suggests that PRF>38.0℃ may not affect the neurological outcome and have a lower mortality in CA patients who completed TTM.However,PRF>38.5℃ is a potential prognostic factor for worse outcomes in CA patients.
基金supported by the Young Teacher Project of Beijing University of Chinese Medicine(No.:2018-JYB-JS155).
文摘Core body temperature(CBT)is increasingly attracting attention as crucial data during target temperature management(TTM).Accurate and continuous measurement of human CBT can effectively identify and monitor central high fever,and provide a basis for the effective implementation during TTM,which is therefore of great significance for human health care and disease monitoring.The reliable core measurement sites are nasopharynx,esophagus,bladder,rectum,pulmonary artery,etc.,but the measurement methods in these sites are all invasive.At present,the medical field is more inclined to noninvasive data collection methods through monitoring an appropriate site(such as forehead,mouth,or axilla)depending on clinical circumstances,so as to ensure the comfort and security of patients to the greatest extent.This review will provide reference choosing more safe and accurate temperature measurement methods for patients during TTM by reviewing the sites and accuracy of invasive and noninvasive CBT measurements.
文摘Cardiac or respiratory arrest lasting only a few minutes can inflict grave harm on numerous bodily organs, not least of all, the brain. Neurocognitive deficits, which are often severe and profoundly life altering, remain a major source of morbidity among survivors.
文摘Objective: to explore the knowledge and application status of undergraduate nursing students on target temperature management of coma patients after cardiopulmonary resuscitation. Methods: 100 nursing students from a university in Hengyang city were selected by simple random sampling method. They were investigated by general situation questionnaire, undergraduate nursing students knowledge and application ability test on target temperature management of coma patients after cardiopulmonary resuscitation and satisfaction survey on practical skills class of cardiopulmonary resuscitation. Results: among the 96 nursing students surveyed, only 40.63% said they knew the concept of TTM, only 13.54% of them knew the specific range of the target body temperature in the 2020 edition of the guidelines for cardiopulmonary resuscitation, and only 14.58% of the nursing students practice departments carried out TTM. The most commonly used methods of body temperature detection were body surface measurement, intravascular measurement, rectal temperature probe, bladder probe, rectal mercury meter and esophageal temperature catheter standard measurement methods were less used. Nursing students in the practice department would prefer intravenous drip of ice salt water, ice cap, ice bag and ice blanket to induce and maintain mild hypothermia, while the more advanced and standard intravascular cooling method is applied less frequently in undergraduate nursing students. Conclusion: undergraduate nursing students lack the relevant knowledge of target temperature management for patients after cardiopulmonary resuscitation, and need to further strengthen the teaching of target temperature management for coma patients after cardiopulmonary resuscitation.
文摘Objective: to explore the clinical efficacy of individualized targeted nutrition management in patients undergoing chemotherapy in oncology department. Methods: 80 cases of chemotherapy patients admitted to the oncology department of our hospital from March 2020 to March 2021 were randomly divided into two groups according to the different nursing methods, 40 patients in each group were named as the control group and the experimental group, 40 patients in the control group were all given routine nursing intervention, 40 patients in the experimental group were all given individualized targeted nutrition management intervention according to the requirements, after the 2-month nursing course, the nursing satisfaction, quality of life and nutrition index level of the two groups of patients were recorded in detail by full-time nursing staff. Results: after the nursing course was over, the data of the two groups of patients were comprehensively compared by the full-time nursing staff. the data such as nursing satisfaction, quality of life score and various nutritional index levels of the patients in the experimental group were significantly better than those in the control group (p < 0.05), and the comparison was statistically significant in clinic. Conclusion: in the clinic of oncology department, in order to help the majority of tumor patients to obtain good chemotherapy effect, individualized targeted nutrition management should be implemented. By improving the nutritional status of patients, significant clinical curative effect can be achieved, thus promoting the improvement of clinical nursing quality. It is the preferred nursing plan for the majority of tumor patients.
基金Under the auspices of National Natural Science Foundation of China(No.42171414)。
文摘Interactions among ecosystem services(ESs)are spatially heterogeneous,shaped by both stable(unidirectional)and unstable(context-dependent)influences of socio-economic development and climate change.These complexities pose significant challenges for spatially adaptive ecosystem management.Ecosystem service bundles(ESBs),as recurring combinations of ESs,offer a valuable framework to capture such interactions.Here,we proposed an integrated analytical framework that combines K-means clustering,the geographical detector(GD)model,and geographically and temporally weighted regression(GTWR)models to evaluate how socio-economic and climatic drivers influence ESBs across space and time.Using Hanshui River Basin(HRB)in central China as a case study,we quantified ES dynamics from 2000 to 2020,identified ESBs and stable and unstable effects of multiple drivers.The results showed that carbon sequestration(CS),water yield(WY),and aesthetic landscape(AL)increased by 32.80%,9.00%,and 7.34%,respectively,while soil retention(SR)and food supply(FS)declined by 8.38%and 5.36%.Five distinct ESBs were identified,namely ecologically fragile bundle(EFB),agricultural production bundle(APB),water supply bundle(WSB),forest ecological bundle(FEB),and ecological conservation bundle(ECB).Among these,FEB expanded to more than 35.75%of the HRB,and APB exhibited the sharpest decline(-28.64%).Land use intensity(LUI)was the primary driver of the spatial heterogeneity of ESBs,while synergistic and nonlinear interactions among multiple factors increasingly amplified their effects over time.Notably,annual precipitation(AP)emerged as the only stable basin-scale driver,consistently enhancing ES performance,while gross domestic product(GDP)and normalized difference vegetation index(NDVI)had stable yet spatially differentiated effects across bundles.Our findings highlight the significance of distinguishing stable/unstable driver effects on ES dynamics to inform regionally adaptive ecosystem governance.The proposed framework provides valuable insights into ES interactions,identify spatial priorities,and support policy interventions that balance ecological conservation with socio-economic development.
文摘Through analyzing the problems of Chinese government public relations, using the idea of the Balanced Scorecard, we analyze the reasons of these problems and discuss the countermeasures from four aspects that conclude financial, internal operations, customers, learning and growth to achieve the all-round and balanced development of public relations and establish a high level of government public relations organization, regarding the overall strategic goal of government public relations that aim to strengthen the communication with various public, establish an innovative, pragmatic, honest and efficient government image in the public and the international community as the center.
基金supported by the Military Medical Innovation Project Fund(18CXZ01918CXZ024)+2 种基金a Chinese military fund dedicated tosupported by the Military Medical Innovation Project Fund(18CXZ01918CXZ024)a Chinese military fund dedicated to the prevention and control of heat-related illness with no commercial interest。
文摘Heat stroke is the most severe type of heat illness,it is often accompanied by severe multiorgan damage and has a high fatality rate.In January 2020,based on new research evidence and the experiences of Chinese experts in heat stroke,the Expert Group of Heat Stroke Prevention and Treatment of the Chinese People’s Liberation Army(PLA)and the Professional Committee of Critical Care Medicine of the Chinese PLA jointly issued a new Expert Consensus on the Diagnosis and Treatment of Heat Stroke in China.This article aims to interpret and supplement the major updates to the new consensus.
基金the National Natural Science Foundation of China(Grant No.81372025).
文摘Background:Post–cardiac arrest syndrome involves systemic inflammation,which causes subsequent neurological impairments.We investigated the influence of targeted temperature management(TTM)therapy in patients with out-of-hospital cardiac arrest(OHCA)after return of spontaneous circulation(ROSC)by observing the changes in circulating CD14^(+)monocytes and the expression of human leukocyte antigen D–related(HLA-DR)and programmed cell death ligand 1(PD-L1)in CD14^(+)monocytes.Methods:Adult patients admitted to the emergency department of Beijing Chao-Yang Hospital after OHCA between January 2017 and March 2018 were included in this study.Thirty control subjects,10 patients with OHCA,and 37 patients with OHCA who received 72 hours of TTM therapy were enrolled.Peripheral blood samples of patients in the OHCA and TTM groups were collected on Days 1 and 3(D1 and D3)after ROSC and evaluated for HLA-DR and PD-L1 expression on CD14^(+)monocytes using flow cytometry.Results:Compared with control subjects,the percentage of circulating CD14^(+)monocytes,HLA-DR+/CD14^(+)monocyte ratios,and mean fluorescence intensity were significantly decreased in patients with OHCA.After ROSC,HLA-DR expression in CD14^(+)monocytes in the TTM group was lower than that in patients with OHCA.However,there were no significant differences in the percentage of PD-L1+/CD14^(+)monocytes or the mean fluorescence intensity between patients with OHCA and healthy volunteers.Conclusion:After ROSC,circulating CD14^(+)monocytes and HLA-DR+/CD14^(+)monocyte ratios decreased significantly in patients with OHCA.Human leukocyte antigen D–related expression in CD14^(+)monocytes was lower in patients treated with TTM.
基金This work was supported by the Nonprofit Applied Research Project of Huzhou Science and Technology Bureau[No.2021GYB14].
文摘Targeted temperature management(TTM)is a promising and multifaceted modern treatment modality that has been widely used in neurological intensive care patients in recent years.A comprehensive study on the treatment of neurocritical patients at home and abroad found that TTM is an intervention that can effectively improve the survival rate and neurological prognosis of patients;its implementation process consists of four stages:induction of hypothermia,maintenance of hypothermia,rewarming,and control of normal body temperature,and scientific nursing measures in each stage can reduce the occurrence of adverse reactions in patients and improve nursing satisfaction.This article provides an overview of TTM,including common methods,brain protection mechanisms,clinical applications in neurocritical patients,and nursing advances to provide a reference for clinical decision-making and the development of appropriate nursing interventions.
文摘Small-scale fisheries,particularly those targeting small pelagic fish,are a vital sector in Liberia,providing essential food for the local population and generating income for livelihoods.Sardinella maderensis,predominantly caught by motorized canoes using gill nets and seine nets,is the primary species in these fisheries.To establish management target reference points for the S.maderensis fishery,this study applied the Schaefer production model to aggregated and disaggregated catch and effort data collected by Liberia's National Fisheries and Aquaculture Authority(NaFAA)from 2018 to 2022.The findings indicate that,in both the aggregated and disaggregated models,the current(2022)fishing effort exceeds the MEY level,leading to diminishing economic returns and approaching economic overfishing thresholds.The economic reference points,MEY and EMEY,were estimated to be 3%and 19%lower in the aggregated model,and 30%and 44%lower in the disaggregated model,compared to the current(2022)catch and relative fishing effort.This situation arises when the cost of fishing exceeds the price of fish,driven by inefficient and ineffective fishing boats,which leads to high unit costs of effort compared to unit revenue.To fully realize the potential of the S.maderensis fishery,this study recommends a combination of input and output control management strategies,the adoption of more efficient fishing technologies,and the provision of alternative livelihoods for coastal communities.
基金supported by the National Natural Science Foundation of China(Grant Nos.72288101,72101018,72271127,71801134)the Dutch Research Council(NWO)The first author is grateful to the financial support by the China Scholarship Council(CSC).
文摘Urban rail transit(URT)plays a pivotal role in mitigating urban congestion and emissions,positioning it as a sustainable transportation alternative.Nevertheless,URT’s function in transporting substantial numbers of passengers within confined public spaces renders it vulnerable to the proliferation of infectious diseases during public health crises.This study proposes a decision support model that integrates operational control strategies pertaining to passenger flow and train capacity utilization,with an emphasis on energy efficiency within URT networks during such crises.The model anticipates a URT system where passengers adhere to prescribed routes,adhering to enhanced path flow regulations.Simultaneously,train capacity utilization is intentionally limited to support social distancing measures.The model’s efficacy was assessed using data from the COVID-19 outbreak in Xi’an,China,at the end of 2021.Findings indicate that focused management of passenger flows and specific risk areas is superior in promoting energy efficiency and enhancing passenger convenience,compared to broader management approaches.
