Background and Objective The development of modern palliative care in China began in the 1980s and is currently in an accelerating phase.However,inconsistencies in terminology and concepts have hindered policy-making,...Background and Objective The development of modern palliative care in China began in the 1980s and is currently in an accelerating phase.However,inconsistencies in terminology and concepts have hindered policy-making,clinical practice,and academic research.The Terminology of Clinical Medicine(2023 edition)has determined huan-he-yi-liao(缓和医疗)and an-ning-liao-hu(安宁疗护)as the formal terms of"palliative care"and"hospice care",respectively.To align with these terms,this study aims to establish expert consensus definitions tailored to the Chinese context.Methods We systematically retrieved and collected domestic and international literature and policy documents related to the definition of palliative care,then deconstructed and analyzed the relevant conceptual elements of these definitions.Core expert panel built the initial recommended definition upon the conceptual elements and consensus definition of palliative care by the International Association for Hospice and Palliative Care(IAHPC)through two rounds of online discussions.After nomination and selection,61 professionals in the field of palliative care in China were invited to participate in the consensus expert group.Two rounds of Delphi consultation were conducted among the consensus experts,who were asked to score their agreement using Likert scale to the items in the initial recommended definition and the definition statements of palliative care and hospice care.Agreement rate of over 80%was considered as reaching consensus for each items.The core expert panel revised the items and the statements of recommended definitions based on the results from Delphi surveys.The final recommended definitions were formulated after feedback from patient and public involvement(PPI)group members.Results The response rates for the first and second round of Delphi surveys were 83.6%and 100.0%,respectively.The agreement rates of the items and statements of the recommended definitions exceeded 90%.Accordingly,the definitions based on Chinese expert consensus are recommended.Palliative care is an active holistic approach aimed at patients of all ages suffering from life-threatening illness and their families and caregivers.It seeks to improve their quality of life by preventing,assessing,and relieving physical,psychological,social,and spiritual suffering.Hospice care is an integral part of palliative care,focusing on holistic care for patients at the end of life and their families and caregivers.Its goal is to help patients to maintain dignity and achieve a good death by alleviating physical,psychological,social,and spiritual distress without intentionally hastening or postponing death,meanwhile improve the quality of life for families and caregivers.Conclusions This study has established the Chinese expert consensus definitions of palliative care and hospice care in China,as well as the relationship between the two.The definitions highlight the holistic nature of palliative care,providing a foundation for discipline development,clinical practice,and public communication.展开更多
BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU ad...BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.展开更多
BACKGROUND Managing critical care emergencies in children with autism spectrum disorder(ASD)presents unique challenges due to their distinct sensory sensitivities,communication difficulties,and behavioral issues.Effec...BACKGROUND Managing critical care emergencies in children with autism spectrum disorder(ASD)presents unique challenges due to their distinct sensory sensitivities,communication difficulties,and behavioral issues.Effective strategies and protocols are essential for optimal care in these high-stress situations.AIM To systematically evaluate and synthesize current evidence on best practices for managing critical care emergencies in children with ASD.The review focuses on key areas,including sensory-friendly environments,communication strategies,behavioral management,and the role of multidisciplinary approaches.METHODS A comprehensive search was conducted across major medical databases,including PubMed,Embase,and Cochrane Library,for studies published between 2000 and 2023.Studies were selected based on their relevance to critical care management in children with ASD,encompassing randomized controlled trials,observational studies,qualitative research,and case studies.Data were extracted and analyzed to identify common themes,successful strategies,and areas for improvement.RESULTS The review identified 50 studies that met the inclusion criteria.Findings highlighted the importance of creating sensory-friendly environments,utilizing effective communication strategies,and implementing individualized behavioral management plans.These findings,derived from a comprehensive review of current evidence,provide valuable insights into the best practices for managing critical care emergencies in children with ASD.Sensory modifications,such as reduced lighting and noise,visual aids,and augmentative and alternative communication tools,enhanced patient comfort and cooperation.The involvement of multidisciplinary teams was crucial in delivering holistic care.Case studies provided practical insights and underscored the need for continuous refi-nement of protocols.CONCLUSION The review emphasizes the need for a tailored approach to managing critical care emergencies for children with ASD.Sensory-friendly adjustments,effective communication,and behavioral strategies supported by a mul-tidisciplinary team are integral to improving outcomes.Despite progress,ongoing refinement of care practices and protocols is necessary.This ongoing process addresses remaining challenges and engages healthcare professionals in continuous improvement of care for children with ASD in critical settings.展开更多
The integration of the digital economy with the traditional sales industry has prompted the robust growth of e-commerce.Live-streaming e-commerce,as a novel business model,has gained immense popularity.However,is⁃sues...The integration of the digital economy with the traditional sales industry has prompted the robust growth of e-commerce.Live-streaming e-commerce,as a novel business model,has gained immense popularity.However,is⁃sues of regulatory loopholes and inefficacy continue to surface.In live-streaming e-commerce,the head anchor,as host of the live-streaming rooms,wields significant influence in determining the goods to be showcased and marketed.Such influence expands risks such as infringement of intellectual property rights.Yet the uncertainty in law concerning the identity of head anchors results in a lack of accountability.Current norms are inadequate in constraining the group of head anchors.Drawing on the principles of risk control,the alignment between benefit and risk,and the theory of so⁃cial cost control,this paper argues that it is both justifiable and feasible to impose a duty to exercise reasonable care on head anchors.To effectively enshrine this duty in law,it is of great importance to redefine the mechanism of identifying the duty of care of head anchors in live-streaming e-commerce.In particular,the contents of the duty of care under⁃taken by head anchors and the consequences of breaching such a duty of care should be clarified.展开更多
BACKGROUND Empathetic psychological care improves mood and enhances the quality of life in critically ill patients.AIM To study the impact of combining 222-nm ultraviolet(UV)disinfection with empathetic psychological ...BACKGROUND Empathetic psychological care improves mood and enhances the quality of life in critically ill patients.AIM To study the impact of combining 222-nm ultraviolet(UV)disinfection with empathetic psychological care on emotional states,nosocomial infection rates,and quality of life in critically ill patients.METHODS A total of 202 critically ill patients admitted to Beijing Ditan Hospital(December 2023 to May 2024)were randomly assigned to control(Ctrl,n=101)or observation groups(Obs,n=101).The Ctrl group received 222-nm UV disinfection and routine care,while the Obs group received 222-nm UV disinfection with empathetic psychological care.Emotional states[Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS)],hospital infection rates,quality of life(36-Item Short Form Health Survey),and patient satisfaction were evaluated.RESULTS At baseline,there were no significant differences in SAS and SDS scores between the groups(P>0.05).Following care,both groups demonstrated reductions in SAS and SDS scores,with the Obs group exhibiting a significantly greater reduction(P<0.05).The Obs group also experienced a significantly lower overall hospital infection rate(P<0.05).Similarly,while baseline 36-Item Short Form Health Survey scores did not differ significantly between the groups(P>0.05),post-care scores improved in both groups,with a greater improvement observed in the Obs group(P<0.05).Additionally,the Obs group reported higher patient satisfaction ratings(P<0.05).CONCLUSION The combination of 222-nm UV disinfection and empathetic psychological care improves emotional states,reduces hospital infection rates,enhances the quality of life,and increases patient satisfaction among critically ill patients.展开更多
Objectives:Nurses working in critical care units may encounter substantial work-related strain,and elevated levels of stress can lead to burnout,ultimately impacting both the quality of nursing care and their overall ...Objectives:Nurses working in critical care units may encounter substantial work-related strain,and elevated levels of stress can lead to burnout,ultimately impacting both the quality of nursing care and their overall working experience.This study aimed to assess job burnout and determine the factors that contribute to it among critical care nurses in the Eastern Province of Saudi Arabia.Methods:This study employed a descriptive,exploratory,cross-sectional research design.A total of 220 nurses employed in the critical care units of 5 private hospitals in the eastern region were selected for participation in this study using a convenience sample method.An electronic survey was distributed to critical care nurses in the Eastern Province who satisfied the specified inclusion criteria.The job burnout questionnaire utilized in this study was derived from previously conducted research,which has been established as a reliable and valid survey instrument.The process of data analysis was conducted utilizing the SPSS program.The scientific research conducted on human subjects adhered rigorously to all ethical considerations.Results:The highest percentage of nurses at the critical care units reported experiencing moderate levels of job burnout.Nurses exhibiting greater levels of professional experience demonstrated a statistically significant reduction in overall burnout scores when compared to their less experienced counterparts.Furthermore,within the realm of sociodemographic factors,it was found that the only significant independent predictor for job burnout was the level of experience among critical care nurses.Conclusions:The prevalence of burnout among nurses in critical care settings was found to be significant,with most participants reporting moderate levels of burnout which can yield significant ramifications for nurses and healthcare professionals.Consequently,healthcare organizations must accord primacy to the welfare of their staff and adopt proactive strategies to mitigate job burnout.展开更多
It explores the integration of rehabilitation and palliative care in cancer management,advocating for a holistic approach that addresses the diverse needs of patients throughout their treatment journey.Traditional can...It explores the integration of rehabilitation and palliative care in cancer management,advocating for a holistic approach that addresses the diverse needs of patients throughout their treatment journey.Traditional cancer care often prioritizes curative interventions at the expense of overall well-being,leading to a fragmented experience for patients.By combining rehabilitation-focused on restoring function and improving physical health-with palliative care-emphasizing symptom management and quality of life-healthcare providers can create a comprehensive support system.The essay highlights the importance of interdisciplinary collaboration among healthcare professionals,as well as the need for education and training to implement this integrated model effectively.Additionally,it addresses potential barriers such as funding limitations and institutional resistance.Ultimately,the integration of these two disciplines represents a critical evolution in cancer care,enhancing patient outcomes and ensuring that individuals receive compassionate,patient-centered support throughout their journey.展开更多
Objective:To analyze the burden of caregivers of CHF patients in the current environment,to explore the related burden and influencing factors of caring for patients with chronic heart failure,and to explore the impac...Objective:To analyze the burden of caregivers of CHF patients in the current environment,to explore the related burden and influencing factors of caring for patients with chronic heart failure,and to explore the impact of filial piety values on the burden of caring for patients.Methods:192 caregivers of CHF patients in the hospital were selected as the main objects of this study.The main method was convenient sampling.Through a questionnaire survey of 192 CHF patients'caregivers,a unified investigation was conducted from the aspects of patient"'s general condition,objective burden,anxiety and depression degree and relationship quality,etc.The structural equation model was constructed and adjusted by analyzing data entry and variable correlation.Finally,path analysis was used to conduct inferential research on the direct and indirect influencing factors of control burden.Results:More than half of the patients'caregivers had a caregiving burden,and the practical caregiving dimension had the highest score.The total effect values of patient-related factors,including anxiety degree,number of concomitant diseases and half-year readmission rate,were 0.36,0.31 and 0.20,respectively(P<0.05).The total effect values of filial piety,anxiety degree,average care time and understanding degree of disease directly derived from the caregivers themselves were-0.38,0.29,0.29 and-0.23,respectively(P<0.05).In addition,the influence of filial piety values on the caregiver burden was more obvious,and the direct effect value of the value was-0.41(P<0.001).Conclusion:Most caregivers of CHF patients have a certain objective burden of care,and there are many factors that affect it,among which the degree of filial piety value is the most important.This finding provides a clear goal for caregivers to develop measures to improve the caregiver burden.展开更多
Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic ...Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic illness or disability and their families.Advances in care have improved survival for children with a variety of serious chronic medical conditions such that many who may once have died in childhood now survive well into adulthood with ongoing morbidity.For those with highly complex needs,care is often provided at major paediatric hospitals with expertise,specially trained personnel,and resources to support young people and their families for the first decades of life.At the end of adolescence,however,it is generally appropriate and necessary for young adults and their caregivers to transition to the care of clinicians trained in the care of adults at general hospitals.While there are some well-managed models to support this journey of transition,these are often specific to certain conditions and usually do not involve intensive care.Many patients may encounter considerable challenges during this period.Difficulties may include the loss of established therapeutic relationships,a perception of austerity and reduced amenity in facilities oriented to caring for adult patients,and care by clinicians with less experience with more common paediatric conditions.In addition,there is a risk of potential conflict between clinicians and families regarding goals of care in the event of a critical illness when it occurs in a young adult with major disability and long-term health issues.These challenges present genuine opportunities to better understand the transition from paediatric to adult-based care and to improve processes that assist clinicians who support patients and families as they shift between healthcare settings.展开更多
This study reviewed a combination of health care programs in the metropolitan area of Syracuse, New York. They were designed to improve care, however a major purpose was to support efficiency. The study described a nu...This study reviewed a combination of health care programs in the metropolitan area of Syracuse, New York. They were designed to improve care, however a major purpose was to support efficiency. The study described a number of individual programs that were developed in order to improve the quality and the efficiency of care. These programs were implemented by a combination of local providers and payors. They included the development of outpatient services such as ambulatory surgery, as well as preventive care, case management, telemedicine, and mental health. The impact of these programs was a combination of these services, rather than individual efforts. The impact of these efforts was the product of a range of individual services, especially care management. Additional efforts should make it possible to extend these efforts among providers and payors in the Syracuse area. This approach should make it possible to extend the impact of health care efficiency further.展开更多
Introduction: In Africa, care during childbirth depends on routine practices to the detriment of quality. The aim of this study was to assess the quality of delivery care at the Coronthie CMC. Methods: The study was c...Introduction: In Africa, care during childbirth depends on routine practices to the detriment of quality. The aim of this study was to assess the quality of delivery care at the Coronthie CMC. Methods: The study was carried out at the Coronthie Community Medical Center. It was a cross-sectional, descriptive and analytical study lasting 6 months, from July 01 to December 31, 2021. Parturients whose term was ≥28 SA and who agreed to participate in the study were included. Excluded were those with a term Results: The frequency of quality care is 36.7%. The average age of parturients was 28.6 ± 5 years. Most parturients (89.7%) were married women with secondary education (35%) and self-employed (32%). Pauciparous women accounted for 43.80%, and most parturients (59.8%) were delivered by Caesarean section. We found that 21.5% of parturients had developed complications. These complications were perineal trauma and post-partum haemorrhage. There were no maternal deaths, and the neonatal mortality rate was 20/1000 NV. Acute fetal distress was the main cause of perinatal death. Conclusion: Correct management of factors influencing childbirth could improve maternal and neonatal prognosis.展开更多
The sea cucumber is a highly esteemed source of nourishment,recognized as one of the“Eight Treasures of the Sea.”The bioactive compounds derived from sea cucumbers exhibit diverse physiological activities,including ...The sea cucumber is a highly esteemed source of nourishment,recognized as one of the“Eight Treasures of the Sea.”The bioactive compounds derived from sea cucumbers exhibit diverse physiological activities,including anti-tumor,antioxidant,anti-coagulation,anti-viral,anti-fatigue,immune enhancement,cognitive improvement,and metabolic regulation.Notably,within the skincare sector,these compounds demonstrate significant anti-aging,moisturizing,whitening,wrinkle reduction,repair and inhibition of melanin production properties.This article assesses the current state of sea cucumber aquaculture in China and the utilization of its bioactive ingredients in skincare formulations.The objective is to furnish additional raw materials and semi-finished products for China’s skincare and pharmaceutical industries,to advance the integration of sea cucumber bioactive components within these sectors,and to invigorate the rapid development of the tropical sea cucumber breeding industry.展开更多
BACKGROUND At present,China has become the country with the largest number of individuals with diabetes mellitus(DM)in the world,with a total of approximately 140 million patients,the majority of whom have type 2 DM(T...BACKGROUND At present,China has become the country with the largest number of individuals with diabetes mellitus(DM)in the world,with a total of approximately 140 million patients,the majority of whom have type 2 DM(T2DM).Based on conven-tional nursing methods,community home care has important clinical significance in controlling blood sugar and disease progression.AIM To explore the impact of community public health nursing on treatment effect,health cognition,and self-management in patients with T2DM.METHODS One hundred patients with T2DM were selected as the research subjects.The patients were divided into either a conventional nursing group or community nursing(CN)group using the random number table method.The conventional nursing group(50 cases)received routine care,while the CN group(50 cases)received community public health care in addition to routine care as that for the conventional nursing group.The rate of excellent and good blood glucose control,fasting blood glucose before and after care,2-h postprandial blood glucose,health cognition,and self-management ability,and patient satisfaction were compared between the two groups.RESULTS The CN group had a higher rate of excellent blood sugar control than the conventional nursing group(88%vs 70%,P<0.05).Before care,there was no significant difference in fasting blood glucose or 2-h postprandial blood glucose between the two groups of patients(P>0.05).After nursing,fasting blood glucose and 2-h postprandial blood glucose were reduced to varying degrees in both groups,and both blood glucose levels in the CN group were lower than those of the conventional nursing group(P<0.05).Compared with the scores before care,the cognitive level score for diabetes and self-management ability score improved after care in both groups.The cognitive level and self-management ability of patients in the CN group were higher than those of the conventional nursing group(P<0.05).The overall satisfaction of the CN group was better than that of the conventional nursing group(98%vs 86%,P<0.05).CONCLUSION Community public health care based on conventional care of T2DM can achieve better blood sugar control,and improve patients’health cognitive level and self-management ability.展开更多
Objective:This study aimed to explore the strategies used by acute care hospitals in implementing a national standard for comprehensive care.Methods:A qualitative descriptive study was conducted with 28 care professio...Objective:This study aimed to explore the strategies used by acute care hospitals in implementing a national standard for comprehensive care.Methods:A qualitative descriptive study was conducted with 28 care professionals(20 nurses,two doctors,and six allied health professionals)recruited from a broad range of Australian acute care hospitals.Data were collected using semi-structured interviews from March to August 2023.The interviews were audio-recorded,transcribed,and thematically analyzed.Results:Strategies for implementing the Comprehensive Care Standard(CCS)vary,even within a health service organization.We identifiedstrategies hospitals used regarding the implementation team and plan,communication,education and training,documentation system,patient care plan,networking,incentives and pressure,feedback,and reflectingand evaluating.Conclusions:This interview study sheds light on the various strategies adopted by hospitals in implementing the CCS,providing a practical foundation to inform implementation efforts both within Australia and internationally.展开更多
Introduction: Reducing and maintaining viral load is crucial to reducing morbidity and mortality associated with HIV infection in children. The aim of this study was to determine the factors influencing the maintenanc...Introduction: Reducing and maintaining viral load is crucial to reducing morbidity and mortality associated with HIV infection in children. The aim of this study was to determine the factors influencing the maintenance of children and adolescents on antiretroviral therapy in the continuum of care. Methodology: This was a descriptive and analytical cross-sectional study conducted from August 1 to August 31, 2023. It included all children living with HIV, under 15 years of age, with at least two viral load results and whose parents consented to participate in the study. Participants were recruited during their child’s treatment renewal consultations. Results: The study included 143 children, mostly boys (55.2%), with a mean age of 11.54 years (±2.8). More than half (55.2) were unaware of their HIV-positive status, and most treatments were administered by parents (60.8%). Of the 99 children with an undetectable viral load at the first test, 23 (23.2%) showed a viral rebound at the last test, mainly due to poor treatment compliance (p Conclusion: Virological rebound after suppression in children is worrying. It is crucial that the national AIDS program improves Therapeutic Education, trains health workers to communicate results and encourages ongoing dialogue with young people to reinforce adherence and maintain viral suppression.展开更多
文摘Background and Objective The development of modern palliative care in China began in the 1980s and is currently in an accelerating phase.However,inconsistencies in terminology and concepts have hindered policy-making,clinical practice,and academic research.The Terminology of Clinical Medicine(2023 edition)has determined huan-he-yi-liao(缓和医疗)and an-ning-liao-hu(安宁疗护)as the formal terms of"palliative care"and"hospice care",respectively.To align with these terms,this study aims to establish expert consensus definitions tailored to the Chinese context.Methods We systematically retrieved and collected domestic and international literature and policy documents related to the definition of palliative care,then deconstructed and analyzed the relevant conceptual elements of these definitions.Core expert panel built the initial recommended definition upon the conceptual elements and consensus definition of palliative care by the International Association for Hospice and Palliative Care(IAHPC)through two rounds of online discussions.After nomination and selection,61 professionals in the field of palliative care in China were invited to participate in the consensus expert group.Two rounds of Delphi consultation were conducted among the consensus experts,who were asked to score their agreement using Likert scale to the items in the initial recommended definition and the definition statements of palliative care and hospice care.Agreement rate of over 80%was considered as reaching consensus for each items.The core expert panel revised the items and the statements of recommended definitions based on the results from Delphi surveys.The final recommended definitions were formulated after feedback from patient and public involvement(PPI)group members.Results The response rates for the first and second round of Delphi surveys were 83.6%and 100.0%,respectively.The agreement rates of the items and statements of the recommended definitions exceeded 90%.Accordingly,the definitions based on Chinese expert consensus are recommended.Palliative care is an active holistic approach aimed at patients of all ages suffering from life-threatening illness and their families and caregivers.It seeks to improve their quality of life by preventing,assessing,and relieving physical,psychological,social,and spiritual suffering.Hospice care is an integral part of palliative care,focusing on holistic care for patients at the end of life and their families and caregivers.Its goal is to help patients to maintain dignity and achieve a good death by alleviating physical,psychological,social,and spiritual distress without intentionally hastening or postponing death,meanwhile improve the quality of life for families and caregivers.Conclusions This study has established the Chinese expert consensus definitions of palliative care and hospice care in China,as well as the relationship between the two.The definitions highlight the holistic nature of palliative care,providing a foundation for discipline development,clinical practice,and public communication.
文摘BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.
文摘BACKGROUND Managing critical care emergencies in children with autism spectrum disorder(ASD)presents unique challenges due to their distinct sensory sensitivities,communication difficulties,and behavioral issues.Effective strategies and protocols are essential for optimal care in these high-stress situations.AIM To systematically evaluate and synthesize current evidence on best practices for managing critical care emergencies in children with ASD.The review focuses on key areas,including sensory-friendly environments,communication strategies,behavioral management,and the role of multidisciplinary approaches.METHODS A comprehensive search was conducted across major medical databases,including PubMed,Embase,and Cochrane Library,for studies published between 2000 and 2023.Studies were selected based on their relevance to critical care management in children with ASD,encompassing randomized controlled trials,observational studies,qualitative research,and case studies.Data were extracted and analyzed to identify common themes,successful strategies,and areas for improvement.RESULTS The review identified 50 studies that met the inclusion criteria.Findings highlighted the importance of creating sensory-friendly environments,utilizing effective communication strategies,and implementing individualized behavioral management plans.These findings,derived from a comprehensive review of current evidence,provide valuable insights into the best practices for managing critical care emergencies in children with ASD.Sensory modifications,such as reduced lighting and noise,visual aids,and augmentative and alternative communication tools,enhanced patient comfort and cooperation.The involvement of multidisciplinary teams was crucial in delivering holistic care.Case studies provided practical insights and underscored the need for continuous refi-nement of protocols.CONCLUSION The review emphasizes the need for a tailored approach to managing critical care emergencies for children with ASD.Sensory-friendly adjustments,effective communication,and behavioral strategies supported by a mul-tidisciplinary team are integral to improving outcomes.Despite progress,ongoing refinement of care practices and protocols is necessary.This ongoing process addresses remaining challenges and engages healthcare professionals in continuous improvement of care for children with ASD in critical settings.
文摘The integration of the digital economy with the traditional sales industry has prompted the robust growth of e-commerce.Live-streaming e-commerce,as a novel business model,has gained immense popularity.However,is⁃sues of regulatory loopholes and inefficacy continue to surface.In live-streaming e-commerce,the head anchor,as host of the live-streaming rooms,wields significant influence in determining the goods to be showcased and marketed.Such influence expands risks such as infringement of intellectual property rights.Yet the uncertainty in law concerning the identity of head anchors results in a lack of accountability.Current norms are inadequate in constraining the group of head anchors.Drawing on the principles of risk control,the alignment between benefit and risk,and the theory of so⁃cial cost control,this paper argues that it is both justifiable and feasible to impose a duty to exercise reasonable care on head anchors.To effectively enshrine this duty in law,it is of great importance to redefine the mechanism of identifying the duty of care of head anchors in live-streaming e-commerce.In particular,the contents of the duty of care under⁃taken by head anchors and the consequences of breaching such a duty of care should be clarified.
基金Supported by Beijing Ditan Hospital Affiliated to Capital Medical University“Sailing Plan”,No.DTQH-202405.
文摘BACKGROUND Empathetic psychological care improves mood and enhances the quality of life in critically ill patients.AIM To study the impact of combining 222-nm ultraviolet(UV)disinfection with empathetic psychological care on emotional states,nosocomial infection rates,and quality of life in critically ill patients.METHODS A total of 202 critically ill patients admitted to Beijing Ditan Hospital(December 2023 to May 2024)were randomly assigned to control(Ctrl,n=101)or observation groups(Obs,n=101).The Ctrl group received 222-nm UV disinfection and routine care,while the Obs group received 222-nm UV disinfection with empathetic psychological care.Emotional states[Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS)],hospital infection rates,quality of life(36-Item Short Form Health Survey),and patient satisfaction were evaluated.RESULTS At baseline,there were no significant differences in SAS and SDS scores between the groups(P>0.05).Following care,both groups demonstrated reductions in SAS and SDS scores,with the Obs group exhibiting a significantly greater reduction(P<0.05).The Obs group also experienced a significantly lower overall hospital infection rate(P<0.05).Similarly,while baseline 36-Item Short Form Health Survey scores did not differ significantly between the groups(P>0.05),post-care scores improved in both groups,with a greater improvement observed in the Obs group(P<0.05).Additionally,the Obs group reported higher patient satisfaction ratings(P<0.05).CONCLUSION The combination of 222-nm UV disinfection and empathetic psychological care improves emotional states,reduces hospital infection rates,enhances the quality of life,and increases patient satisfaction among critically ill patients.
文摘Objectives:Nurses working in critical care units may encounter substantial work-related strain,and elevated levels of stress can lead to burnout,ultimately impacting both the quality of nursing care and their overall working experience.This study aimed to assess job burnout and determine the factors that contribute to it among critical care nurses in the Eastern Province of Saudi Arabia.Methods:This study employed a descriptive,exploratory,cross-sectional research design.A total of 220 nurses employed in the critical care units of 5 private hospitals in the eastern region were selected for participation in this study using a convenience sample method.An electronic survey was distributed to critical care nurses in the Eastern Province who satisfied the specified inclusion criteria.The job burnout questionnaire utilized in this study was derived from previously conducted research,which has been established as a reliable and valid survey instrument.The process of data analysis was conducted utilizing the SPSS program.The scientific research conducted on human subjects adhered rigorously to all ethical considerations.Results:The highest percentage of nurses at the critical care units reported experiencing moderate levels of job burnout.Nurses exhibiting greater levels of professional experience demonstrated a statistically significant reduction in overall burnout scores when compared to their less experienced counterparts.Furthermore,within the realm of sociodemographic factors,it was found that the only significant independent predictor for job burnout was the level of experience among critical care nurses.Conclusions:The prevalence of burnout among nurses in critical care settings was found to be significant,with most participants reporting moderate levels of burnout which can yield significant ramifications for nurses and healthcare professionals.Consequently,healthcare organizations must accord primacy to the welfare of their staff and adopt proactive strategies to mitigate job burnout.
文摘It explores the integration of rehabilitation and palliative care in cancer management,advocating for a holistic approach that addresses the diverse needs of patients throughout their treatment journey.Traditional cancer care often prioritizes curative interventions at the expense of overall well-being,leading to a fragmented experience for patients.By combining rehabilitation-focused on restoring function and improving physical health-with palliative care-emphasizing symptom management and quality of life-healthcare providers can create a comprehensive support system.The essay highlights the importance of interdisciplinary collaboration among healthcare professionals,as well as the need for education and training to implement this integrated model effectively.Additionally,it addresses potential barriers such as funding limitations and institutional resistance.Ultimately,the integration of these two disciplines represents a critical evolution in cancer care,enhancing patient outcomes and ensuring that individuals receive compassionate,patient-centered support throughout their journey.
文摘Objective:To analyze the burden of caregivers of CHF patients in the current environment,to explore the related burden and influencing factors of caring for patients with chronic heart failure,and to explore the impact of filial piety values on the burden of caring for patients.Methods:192 caregivers of CHF patients in the hospital were selected as the main objects of this study.The main method was convenient sampling.Through a questionnaire survey of 192 CHF patients'caregivers,a unified investigation was conducted from the aspects of patient"'s general condition,objective burden,anxiety and depression degree and relationship quality,etc.The structural equation model was constructed and adjusted by analyzing data entry and variable correlation.Finally,path analysis was used to conduct inferential research on the direct and indirect influencing factors of control burden.Results:More than half of the patients'caregivers had a caregiving burden,and the practical caregiving dimension had the highest score.The total effect values of patient-related factors,including anxiety degree,number of concomitant diseases and half-year readmission rate,were 0.36,0.31 and 0.20,respectively(P<0.05).The total effect values of filial piety,anxiety degree,average care time and understanding degree of disease directly derived from the caregivers themselves were-0.38,0.29,0.29 and-0.23,respectively(P<0.05).In addition,the influence of filial piety values on the caregiver burden was more obvious,and the direct effect value of the value was-0.41(P<0.001).Conclusion:Most caregivers of CHF patients have a certain objective burden of care,and there are many factors that affect it,among which the degree of filial piety value is the most important.This finding provides a clear goal for caregivers to develop measures to improve the caregiver burden.
文摘Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic illness or disability and their families.Advances in care have improved survival for children with a variety of serious chronic medical conditions such that many who may once have died in childhood now survive well into adulthood with ongoing morbidity.For those with highly complex needs,care is often provided at major paediatric hospitals with expertise,specially trained personnel,and resources to support young people and their families for the first decades of life.At the end of adolescence,however,it is generally appropriate and necessary for young adults and their caregivers to transition to the care of clinicians trained in the care of adults at general hospitals.While there are some well-managed models to support this journey of transition,these are often specific to certain conditions and usually do not involve intensive care.Many patients may encounter considerable challenges during this period.Difficulties may include the loss of established therapeutic relationships,a perception of austerity and reduced amenity in facilities oriented to caring for adult patients,and care by clinicians with less experience with more common paediatric conditions.In addition,there is a risk of potential conflict between clinicians and families regarding goals of care in the event of a critical illness when it occurs in a young adult with major disability and long-term health issues.These challenges present genuine opportunities to better understand the transition from paediatric to adult-based care and to improve processes that assist clinicians who support patients and families as they shift between healthcare settings.
文摘This study reviewed a combination of health care programs in the metropolitan area of Syracuse, New York. They were designed to improve care, however a major purpose was to support efficiency. The study described a number of individual programs that were developed in order to improve the quality and the efficiency of care. These programs were implemented by a combination of local providers and payors. They included the development of outpatient services such as ambulatory surgery, as well as preventive care, case management, telemedicine, and mental health. The impact of these programs was a combination of these services, rather than individual efforts. The impact of these efforts was the product of a range of individual services, especially care management. Additional efforts should make it possible to extend these efforts among providers and payors in the Syracuse area. This approach should make it possible to extend the impact of health care efficiency further.
文摘Introduction: In Africa, care during childbirth depends on routine practices to the detriment of quality. The aim of this study was to assess the quality of delivery care at the Coronthie CMC. Methods: The study was carried out at the Coronthie Community Medical Center. It was a cross-sectional, descriptive and analytical study lasting 6 months, from July 01 to December 31, 2021. Parturients whose term was ≥28 SA and who agreed to participate in the study were included. Excluded were those with a term Results: The frequency of quality care is 36.7%. The average age of parturients was 28.6 ± 5 years. Most parturients (89.7%) were married women with secondary education (35%) and self-employed (32%). Pauciparous women accounted for 43.80%, and most parturients (59.8%) were delivered by Caesarean section. We found that 21.5% of parturients had developed complications. These complications were perineal trauma and post-partum haemorrhage. There were no maternal deaths, and the neonatal mortality rate was 20/1000 NV. Acute fetal distress was the main cause of perinatal death. Conclusion: Correct management of factors influencing childbirth could improve maternal and neonatal prognosis.
文摘The sea cucumber is a highly esteemed source of nourishment,recognized as one of the“Eight Treasures of the Sea.”The bioactive compounds derived from sea cucumbers exhibit diverse physiological activities,including anti-tumor,antioxidant,anti-coagulation,anti-viral,anti-fatigue,immune enhancement,cognitive improvement,and metabolic regulation.Notably,within the skincare sector,these compounds demonstrate significant anti-aging,moisturizing,whitening,wrinkle reduction,repair and inhibition of melanin production properties.This article assesses the current state of sea cucumber aquaculture in China and the utilization of its bioactive ingredients in skincare formulations.The objective is to furnish additional raw materials and semi-finished products for China’s skincare and pharmaceutical industries,to advance the integration of sea cucumber bioactive components within these sectors,and to invigorate the rapid development of the tropical sea cucumber breeding industry.
文摘BACKGROUND At present,China has become the country with the largest number of individuals with diabetes mellitus(DM)in the world,with a total of approximately 140 million patients,the majority of whom have type 2 DM(T2DM).Based on conven-tional nursing methods,community home care has important clinical significance in controlling blood sugar and disease progression.AIM To explore the impact of community public health nursing on treatment effect,health cognition,and self-management in patients with T2DM.METHODS One hundred patients with T2DM were selected as the research subjects.The patients were divided into either a conventional nursing group or community nursing(CN)group using the random number table method.The conventional nursing group(50 cases)received routine care,while the CN group(50 cases)received community public health care in addition to routine care as that for the conventional nursing group.The rate of excellent and good blood glucose control,fasting blood glucose before and after care,2-h postprandial blood glucose,health cognition,and self-management ability,and patient satisfaction were compared between the two groups.RESULTS The CN group had a higher rate of excellent blood sugar control than the conventional nursing group(88%vs 70%,P<0.05).Before care,there was no significant difference in fasting blood glucose or 2-h postprandial blood glucose between the two groups of patients(P>0.05).After nursing,fasting blood glucose and 2-h postprandial blood glucose were reduced to varying degrees in both groups,and both blood glucose levels in the CN group were lower than those of the conventional nursing group(P<0.05).Compared with the scores before care,the cognitive level score for diabetes and self-management ability score improved after care in both groups.The cognitive level and self-management ability of patients in the CN group were higher than those of the conventional nursing group(P<0.05).The overall satisfaction of the CN group was better than that of the conventional nursing group(98%vs 86%,P<0.05).CONCLUSION Community public health care based on conventional care of T2DM can achieve better blood sugar control,and improve patients’health cognitive level and self-management ability.
基金supported by an Australian Government Research Training Program Scholarshippart of the project“Improving quality of care for people with dementia in the acute care setting(eQC)”which is funded by the National Health and Medical Research Council of the Australian Government(No.APP1140459)。
文摘Objective:This study aimed to explore the strategies used by acute care hospitals in implementing a national standard for comprehensive care.Methods:A qualitative descriptive study was conducted with 28 care professionals(20 nurses,two doctors,and six allied health professionals)recruited from a broad range of Australian acute care hospitals.Data were collected using semi-structured interviews from March to August 2023.The interviews were audio-recorded,transcribed,and thematically analyzed.Results:Strategies for implementing the Comprehensive Care Standard(CCS)vary,even within a health service organization.We identifiedstrategies hospitals used regarding the implementation team and plan,communication,education and training,documentation system,patient care plan,networking,incentives and pressure,feedback,and reflectingand evaluating.Conclusions:This interview study sheds light on the various strategies adopted by hospitals in implementing the CCS,providing a practical foundation to inform implementation efforts both within Australia and internationally.
文摘Introduction: Reducing and maintaining viral load is crucial to reducing morbidity and mortality associated with HIV infection in children. The aim of this study was to determine the factors influencing the maintenance of children and adolescents on antiretroviral therapy in the continuum of care. Methodology: This was a descriptive and analytical cross-sectional study conducted from August 1 to August 31, 2023. It included all children living with HIV, under 15 years of age, with at least two viral load results and whose parents consented to participate in the study. Participants were recruited during their child’s treatment renewal consultations. Results: The study included 143 children, mostly boys (55.2%), with a mean age of 11.54 years (±2.8). More than half (55.2) were unaware of their HIV-positive status, and most treatments were administered by parents (60.8%). Of the 99 children with an undetectable viral load at the first test, 23 (23.2%) showed a viral rebound at the last test, mainly due to poor treatment compliance (p Conclusion: Virological rebound after suppression in children is worrying. It is crucial that the national AIDS program improves Therapeutic Education, trains health workers to communicate results and encourages ongoing dialogue with young people to reinforce adherence and maintain viral suppression.
