First-class Hospital Research Articles

Comparative analysis of hospital-acquired and community-acquired infections at a tertiary hospital in China before and during COVID-19: A 7-year longitudinal study (2017-2023)

This 7-year longitudinal survey (2017-2023) assessed the point prevalence of hospital-acquired infections (HAIs) and community-acquired infections (CAIs) at a first-class tertiary hospital in China, both prior to and during the Corona Virus Disease 2019 (COVID-19) pandemic. Patients were stratified into prepandemic and pandemic periods, as well as into stringent and relaxed infection prevention and control (IPC) phases, to compare the point prevalence of HAIs and CAIs. The overall point prevalence of HAIs was 1.50% (95% confidence interval [CI], 1.32%-1.71%), showing a significant downward trend (P=.021). Among patients receiving pathogen testing, the point prevalence of HAIs significantly declined during the pandemic (6.26% vs9.89%, P<.001). The point prevalence of CAIs demonstrated a notable increase in 2023 compared with 2020 to 2022 among pathogen-tested patients (81.37% vs74.18%, P=.001). Multivariate analysis identified hospitalization during the pandemic as a protective factor against HAIs (adjusted odds ratio 0.49, 95% CI, 0.36-0.67). The comprehensive IPC strategy implemented during the COVID-19 pandemic at this tertiary hospital significantly reduced the point prevalence of HAIs. However, CAIs exhibited a rising trend following the relaxation of COVID-19 IPC measures.

Characterizing pituitary adenomas in clinical notes: Corpus construction and its application in LLMs.

Objective: Faced with the challenges of differential diagnosis caused by the complex clinical manifestations and high pathological heterogeneity of pituitary adenomas, this study aims to construct a high-quality annotated corpus to characterize pituitary adenomas in clinical notes containing rich diagnosis and treatment information. Methods: A dataset from a pituitary adenomas neurosurgery treatment center of a tertiary first-class hospital in China was retrospectively collected. A semi-automatic corpus construction framework was designed. A total of 2000 documents containing 9430 sentences and 524,232 words were annotated, and the text corpus of pituitary adenomas (TCPA) was constructed and analyzed. Its potential application in large language models (LLMs) was explored through fine-tuning and prompting experiments. Results: TCPA had 4782 medical entities and 28,998 tokens, achieving good quality with the inter-annotator agreement value of 0.862-0.986. The LLMs experiments showed that TCPA can be used to automatically identify clinical information from free texts, and introducing instances with clinical characteristics can effectively reduce the need for training data, thereby reducing labor costs. Conclusion: This study characterized pituitary adenomas in clinical notes, and the proposed method were able to serve as references for relevant research in medical natural language scenarios with highly specialized language structure and terminology.

Investigation on the contaminate of hand washing activities on the surface of environmental objects in intensive care unit

To detect the contaminate of faucets in hospitals and the splash during hand washing, and to explore the reasonable layout of hand washing pools. Two faucets with roughly the same spatial layout in the ICU of a third-class first-class general hospital were selected, and the farthest splashing distance and specific splashing points were measured by color paper. Samples were detected by ATP detection technology and routine microbial detection method, and the contaminate of faucets was analyzed. After 72 h of daily hand-washing activities, the furthest distance to the splash point was about 100 cm around the faucet, and the place 40–110 cm around the faucet was contaminated seriously. The farthest distance that the splash point reached was about 80 cm around the faucet with the center of the circle, and the area 40–60 cm around the faucet was heavily contaminated. The distance from the water outlet of the long handle and the short handle faucet to the detection point had a high negative correlation (r = − 0.811, P < 0.001) and a moderate negative correlation (r = − 0.475, P = 0.001) with the number of splash points, respectively. The qualified rates of ATP detection and microbial culture were 25% and 15%, respectively. Pseudomonas aeruginosa, Staphylococcus epidermidis, and other pathogenic bacteria were detected in the water outlet of the faucet and the surrounding environment. Safe hand hygiene facilities are one of the important guarantees of hand hygiene effect. Clean objects and objects related to patients should not be placed within 1 m range near the water outlet of faucet. Anti-splash baffle should be installed as much as possible when conditions permit to reduce the contaminate caused by splash during hand washing.

A new classification for emergency critically ill patients and analysis of their adverse events during intrahospital transport: A cluster analysis.

Critical patients may experience various adverse events during transportation within hospitals. Therefore, quickly evaluating and classifying patients before transporting them from the emergency department and focusing on managing high-risk patients are critical. At present, no unified classification method exists; all the current approaches are subjective. To ensure transportation safety, we conducted a cluster analysis of critically ill patients transferred from the emergency department to the intensive care unit. Single-centre cohort study. This study was conducted at a comprehensive first-class teaching hospital in Beijing. Convenience sampling and continuous enrolment were employed. We collected data from 1 January 2019, to 31 December 2021. All patients were transferred from the emergency department to the intensive care unit, and cluster analysis was conducted using five variables. A total of 584 patients were grouped into three clusters. Cluster 1 (high systolic blood pressure group) included 208 (35.6%) patients. Cluster 2 (high heart rate and low blood oxygen group) included 55 (9.4%) patients. Cluster 3 (normal group) included the remaining 321 (55%) patients. The oxygen saturation levels of all the patients were lower after transport, and the proportion of adverse events (61.8%) was the highest in Cluster 2 (p < .05). This study utilized data on five important vital signs from a cluster analysis to explore possible patient classifications and provide a reference for ensuring transportation safety. Before transferring patients, we should classify them and implement targeted care. Changes in blood oxygen levels in all patients should be considered, with a focus on the occurrence of adverse events during transportation among patients with high heart rates and low blood oxygen levels.

Analysis of the current status of "pseudo" unplanned endotracheal extubation in ICU patients in China's tertiary hospitals

To analyze the current status of "pseudo" unplanned endotracheal extubation in ICU patients in China's tertiary hospitals and to provide a reference for improving the quality of medical care. Through the National Nursing Quality Data Platform, unplanned endotracheal extubation data reported by ICUs in China's tertiary hospitals from 2019 to 2022 were analyzed. The situation of reported hospitals, causes, and the current status of "pseudo" unplanned endotracheal extubation in ICU patients was analyzed. The indicator of unplanned endotracheal extubation in ICUs of China’s tertiary hospitals is mainly from first-class tertiary hospitals (74.9%), most of which are self-extractions by patients (74.6%). The proportion of "pseudo" unplanned endotracheal extubation is 45.1%. "Pseudo" unplanned endotracheal extubation is common in the ICUs of China's tertiary hospitals. As such, management blind spots deserve attention from managers and clinical staff.

The practice and evaluation of antifungal stewardship programs at a tertiary first-class hospital in China

BackgroundThe sharp increase in fungal infections, insufficient diagnostic and treatment capabilities for fungal infections, poor prognosis of patients with fungal infections as well as the increasing drug resistance of fungi are serious clinical problems. It is necessary to explore the implementation and evaluation methods of antifungal stewardship (AFS) to promote the standardized use of antifungal drugs.MethodsThe AFS programme was implemented at a tertiary first-class hospital in China using a plan-do-check-act (PDCA) quality management tool. A baseline investigation was carried out to determine the utilization of antifungal drugs in pilot hospitals, analyse the existing problems and causes, and propose corresponding solutions. The AFS programme was proposed and implemented beginning in 2021, and included various aspects, such as team building, establishment of regulations, information construction, prescription review and professional training. The management effectiveness was recorded from multiple perspectives, such as the consumption of antifungal drugs, the microbial inspection rate of clinical specimens, and the proportion of rational prescriptions. The PDCA management concept was used for continuous improvement to achieve closed-loop management.ResultsIn the first year after the implementation of the AFS programme, the consumption cost, use intensity and utilization rate of antifungal drugs decreased significantly (P < 0.01). The proportion of rational antifungal drug prescriptions markedly increased, with the proportion of prescriptions with indications increasing from 86.4% in 2019 to 97.0% in 2022, and the proportion of prescriptions with appropriate usage and dosage increased from 51.9 to 87.1%. In addition, after the implementation of the AFS programme, physicians’ awareness of the need to complete microbial examinations improved, and the number of fungal cultures and serological examinations increased substantially. Statistics from drug susceptibility tests revealed a decrease in the resistance rate of Candida to fluconazole.ConclusionThis study indicated that the combination of AFS and the PDCA cycle could effectively reduce antifungal consumption and promote the rational use of antifungal drugs, providing a reference for other health care systems to reduce the overuse of antifungal drugs and delay the progression of fungal resistance.

Trajectories and influencing factors of social anxiety in postoperative breast cancer patients

BackgroundSocial anxiety among postoperative breast cancer patients is a prevalent concern, with its intensity fluctuating throughout the course of treatment. The study aims to describe the trajectory of social anxiety in postoperative breast cancer patients, explore the influencing factors, and provide theoretical support for the construction of future intervention programs.MethodsThis study was conducted from June 2022 to January 2023, encompassing 213 breast cancer patients from three first-class hospitals in China. Data collection occurred at four distinct time points. A growth mixture model was employed to identify latent categories representing the trajectories of social anxiety changes among patients. A multiple regression analysis was utilized to explore predictive factors associated with different latent trajectory categories.ResultsThe trajectory of social anxiety changes in postoperative breast cancer patients includes five potential categories: maintaining mild social anxiety group, changing from mild to moderate social anxiety group, maintaining moderate social anxiety group, changing from moderate to severe social anxiety group, and maintaining severe social anxiety group. Cluster analysis results indicated three types: positive, negative, and low. Logistic regression analysis revealed that younger age, spouses concerned about postoperative appearance, chemotherapy with taxol-based drugs, opting for modified radical surgery or radical mastectomy surgical approaches, and breast cancer patients with negative rumination were factors that influenced patients’ social anxiety (P < 0.05).ConclusionThe trajectory of social anxiety in postoperative breast cancer patients comprises five potential categories. In clinical practice, it is essential to strengthen the management of high-risk populations susceptible to experiencing social anxiety emotions, including younger age, spouses concerned about postoperative appearance, chemotherapy with taxol-based drugs, opting for modified radical surgery or radical mastectomy surgical approaches, and breast cancer patients with negative rumination.

The DIKWP (Data, Information, Knowledge, Wisdom, Purpose) Revolution: A New Horizon in Medical Dispute Resolution

The doctor–patient relationship has received widespread attention as a significant global issue affecting people’s livelihoods. In clinical practice within the medical field, applying existing artificial intelligence (AI) technology presents issues such as uncontrollability, inconsistency, and lack of self-explanation capabilities, even raising concerns about ethics and morality. To address the problem of doctor–patient interaction differences arising from the doctor–patient diagnosis and treatment, we collected the textual content of doctor–patient dialogues in outpatient clinics of local first-class hospitals. We utilized case scenario analysis, starting from two specific cases: multi-patient visits with the same doctor and multi-doctor interaction differences with the same patient. By capturing the external interactions and the internal thought processes, we unify the external expressions and internal subjective cognition in doctor–patient interactions into interactions between data, information, knowledge, wisdom, and purpose (DIKWP) models. We propose a DIKWP semantic model for the doctor–patient interactions on both sides, including a DIKWP content model and a DIKWP cognitive model, to achieve transparency throughout the entire doctor–patient interaction process. We semantically–bidirectionally map the diagnostic discrepancy space to DIKWP uncertainty and utilize a purpose-driven DIKWP semantic fusion transformation technique to disambiguate the uncertainty problem. Finally, we select four traditional methods for qualitative and quantitative comparison with our proposed method. The results show that our method performs better in content and uncertainty handling. Overall, our proposed DIKWP semantic model for doctor–patient interaction processing breaks through the uncertainty limitations of natural language semantics in terms of interpretability, enhancing the transparency and interpretability of the medical process. It will help bridge the cognitive gap between doctors and patients, easing medical disputes.

Analysis of current status of and barriers to exercise participation among patients on maintenance hemodialysis

ABSTRACT Objective: The objective of this study was to analyze the current status of barriers to exercise participation (EP) among patients on maintenance hemodialysis (MHD). Materials and Methods: A cross-sectional study was conducted on 277 outpatients undergoing MHD in 2 tertiary first-class hospitals in Beijing from February 2023 to June 2023 who were selected using convenience sampling method. The data of patients on MHD were collected using the general information questionnaire, Physical Activity Rating Scale, Exercise Benefits/Barriers Scale (EBBS), and Exercise Self-Efficacy Scale (ESES). The relationship between EP and barriers to EP was analyzed through univariate and multivariate linear regression models. Results: Patients on MHD had a low exercise volume score of 13.71 ± 0.68 points and a medium EBBS score of 63.36 ± 0.40 points. Multivariate logistic analysis showed that exercise volume was significantly related to the following four aspects, including low monthly household income per capita (odds ratio [OR] = 86.741, 95% confidence interval [CI] [1.164–6.465], P = 0.042), primary underlying disease of diabetic nephropathy (OR = 45.993, 95% CI [1.353–1.564], P = 0.033), the belief that “fatigue in lower extremities hinders exercise” (OR = 4.697, 95% CI [1.127–19.585], P = 0.034), and the belief that “physical exercise bringing optimistic and positive life attitude” (OR = 0.074, 95% CI [0.007–0.830], P = 0.035). Conclusions: Since patients on MHD had low physical exercise volume, the health-care provider should pay more attention on the controllable factors that affect the EP of patients on MHD. Therefore, feasible and effective intervention measures can be formulated based on ESES in clinical nursing.

Prediction and the influencing factor study of colorectal cancer hospitalization costs in China based on machine learning-random forest and support vector regression: a retrospective study.

As people's standard of living improves, the incidence of colorectal cancer is increasing, and colorectal cancer hospitalization costs are relatively high. Therefore, predicting the cost of hospitalization for colorectal cancer patients can provide guidance for controlling healthcare costs and for the development of related policies. This study used the first page of medical record data on colorectal cancer inpatient cases of a tertiary first-class hospital in Shenzhen from 2018 to 2022. The impacting factors of hospitalization costs for colorectal cancer were analyzed. Random forest and support vector regression models were used to establish predictive models of the cost of hospitalization for colorectal cancer patients and to compare and evaluate. In colorectal cancer inpatients, major procedures, length of stay, level of procedure, Charlson comorbidity index, age, and medical payment method were the important influencing factors. In terms of the test set, the R2 of the Random forest model was 0.833, the R2 of the Support vector regression model was 0.824; the root mean square error (RMSE) of the Random forest model was 0.029, and the RMSE of the Support vector regression model was 0.032. In the Random Forest model, the weight of the major procedure was the highest (0.286). Major procedures and length of stay have the greatest impacts on hospital costs for colorectal cancer patients. The random forest model is a better method to predict the hospitalization costs for colorectal cancer patients than the support vector regression.

Risk Factors and Predictive Nomogram for Carbapenem-Resistant Klebsiella pneumoniae in Children in a Grade 3 First-Class General Hospital in Central China.

This study determined risk factors for Carbapenem-resistant Klebsiella pneumoniae (CRKP)in children admitted to a grade 3 first-class general hospital and developed an individualized line graph predictive model. The clinical data of 185 children infected with Klebsiella pneumoniae from January 2015 to December 2019 were analyzed retrospectively. Patients were grouped according to carbapenem resistance: CRKP group (50 cases) and CSKP (carbapenem-sensitive Klebsiella pneumoniae) group (135 cases). Risk factors for CRKP in children were screened by logistic regression analysis. The predictive model was established using R software and validated using the Bootstrap method. Age (odds ratio [OR]=0.104, 95% confidence interval [CI]: 0.026-0.408), intensive care unit admission (OR =2.829, 95% CI: 1.138-7.030), mechanical ventilation (OR =7.510, 95% CI: 3.140-17.961), surgery history (OR =5.005, 95% CI: 1.507-16.618) and glucocorticoid (OR =0.235, 95% CI: 0.099-0.557) were independent risk factors for CRKP in children (P < 0.05), The total risk score of each factor was 362.5, and the risk rate was 0.1-0.9. In receiver-operating characteristic curve analysis, the area under the curve of CRKP predicted by the total risk score was 0.872 (95% CI=0.844-0.901; P < 0.001). The correction curve indicated that the consistency between the observed value and the predicted value was good. This study successfully established a model based on the risk factors, with high accuracy and good predictive value for CRKP in children. Hospitals should take necessary preventive measures against the risk factors for drug-resistant bacteria, such as optimizing the configuration of ICU space, timely isolation of infected children, and adequate disinfection of ICU equipment. Which may reduce CRKP infection rate.

Psychological status and related factors of resident physicians during the release of COVID-19 pandemic restrictions in China.

Resident physicians at the standardized training stage had undergone significant physical and mental stress during the release of the COVID-19 pandemic restrictions at the end of 2022 in China. This study aimed to investigate the psychological status (including anxiety, depression, somatic symptoms, job burnout, and vicarious trauma) of resident physicians and identify its influencing factors under these special periods. Survey was conducted one month after the release of the COVID-19 pandemic restrictions on resident training physicians from a tertiary first-class hospital in Zhejiang, China. Resident physicians completed the psychological status questionnaire. Chi-square tests, Mann-Whitney U tests, and logistic regression analyses were used to estimate the group differences and variable associations. The prevalence of anxiety, depression, and somatic discomfort in this study was 20.88, 28.53, and 41.47%, respectively. Female resident physicians were more likely to experience somatic symptoms [adjusted odds ratio (OR) = 2.36, 95% confidence interval (CI): 1.33-4.18]. Resident physicians with problem-focused coping styles were less prone to psychological health issues [depression (adjusted OR = 0.92, 95% CI: 0.88-0.96), anxiety (adjusted OR = 0.94, 95% CI: 0.90-0.98), somatic symptoms (adjusted OR = 0.93, 95% CI: 0.89-0.97), job burnout (adjusted OR = 0.91, 95% CI: 0.87-0.96) and vicarious trauma (adjusted OR = 0.94, 95% CI: 0.90-0.98)]. Inversely, resident physicians with emotion-focused coping styles and experienced negative life events were more prone to psychological health issues. Resident training physicians had a high risk of anxiety, depression, and somatic symptoms under the special COVID-19 pandemic restriction release period. Females, with lower training stages, degrees, negative life events, and emotion-focused coping styles had a disadvantaged effect on psychological status. The medical teaching management department needs to monitor and reduce the workload and working hours of resident physicians, ensure sufficient sleep time, and pay attention to the psychological status of resident physicians. By strengthening regular communication and mental health education or intervention, which can help them improve their ability to cope with complex tasks.

Association Between Serum Ferritin Levels in Early Pregnancy and Thyroid Function and Pregnancy Outcomes in Chinese Population.

The relationship of iron deficiency and thyroid hormone has been researched a lot among pregnant or other healthy population. However, invisible iron deficiency, namely shortage of serum ferritin (sFer) level, has been barely investigated among Chinese pregnant women. This study aimed to explore the effects of sFer status on thyroid function and pregnancy outcomes in a population-based upper first-class hospital. A total of 781 singleton pregnant women of gestation in Shanghai General Hospital took part in this retrospective cohort study. The participants were divided into four groups by quartiles of serum ferritin levels (Q1-4). Binary logistic regressions were used to examine the strength of association between the different traits and the serum ferritin (sFer) quartiles separately, where Q1 (lowest ferritin quartile) was taken as the base reference. One-way ANOVA was adopted to compare the averages of the different variables across sFer quartiles. Categorical measures were compared by Fisher exact test or chi-square test. As the sFer concentration rises, incidence of premature birth (15.8%vs 12.3% vs 9.20% vs 6.20% p = 0.016) as well as threatened miscarriage (14.8% vs 7.2% vs 8.70% vs 6.70% p = 0.021) presented a downward trend. Compared with the other sFer group, subjects of the low sFer group were older, more often to be found to have lower serum γT3 and FT4 levels in early pregnancy but not in middle pregnancy. sFer concentration in the first trimester can affect thyroid function. The correction of invisible iron deficiency with inadequate sFer status prior to pregnancy or during early pregnancy is imperative, not only to prevent anemia, but also for maintaining optimum thyroid function and normal fetal development. For clinicians, sFer status of pregnant women should be attached great importance apart from attention to iron level.

Investigation on the psychological impact of grade B or C pancreatic fistula of post pancreatoduodenectomy (PD) on surgeon-in-chief and its related factors

BackgroundPostoperative pancreatic fistula (POPF) is the most common complication of pancreatoduodenectomy (PD), and it is the main cause of mortality. A survey was conducted among hepatobiliary pancreatic surgeons to understand the experience of the surgeon-in-chief in PD and POPF, focusing on the psychological impact of POPF on the surgeon-in-chief, related factors, and factors to alleviate psychological pressure. MethodsA 21-question questionnaire was conducted among hepatobiliary and pancreatic surgeons, adopting the method of a retrospective cross-sectional survey. The questionnaire was distributed through Wechat, and the software platform was questionnaire star. Count data were expressed in absolute values or percentages, and the x2 test was used in univariate analysis. ResultsA total of 97 hepatobiliary and pancreatic surgeons completed the questionnaire. Eighty-six out of the ninety-seven (88.66%) participants were from third-level first-class hospitals, and participants from hospitals below third-level first-class made up 11/97 (11.34%). Ninety-two out of ninety-seven (94.85%) participants felt uneasy, nervous, or anxious after their patients suffered from grade B or C POPF. Participants making 67/97 (69.07%) suffered from sleeplessness, and 56/97(57.73%) participants' decision-making ability for treatment was affected. Participants making a total of 73/97(75.26%) were worried about grade B or C POPF when performing PD again, becoming overly alert. ConclusionsWhether hepatobiliary and pancreatic surgeons in hospitals of Third-Level First Class or below, whether they have PD experience, and whether they have experienced grade B or C POPF will have a psychological impact on the surgeon-in-chief.

Effect of application of short-form video health education on the health knowledge and satisfaction with nursing care of patients with lower extremity fractures

BackgroundVideo health education has been increasingly adopted in the clinic to expand patient guidance and improve perioperative outcomes. To date, however, it is unclear whether the use of short-form videos and web-based clinician-created forums actually improve the perioperative experience of patients.ObjectiveTo evaluate the effect of application of short-form video health education on the health knowledge and satisfaction with nursing care of patients with lower extremity fractures.MethodsThis study is a quasi experimental study, using convenient sampling method and grouping according to historical control., one hundred and twenty-two patients admitted with lower limb fractures to the orthopedic ward of a tertiary first-class general hospital in Fujian, China were enrolled in this study. Based on their admission order, patients admitted from September 2021 to November 2021 were enrolled into the control group (n = 61) and patients admitted from December 2021 to March 2022 were enrolled in the intervention group (n = 61). Both groups received identical admission-based patient education, perioperative care, and discharge rehabilitation instructions. The control group received the traditional education method while the intervention group received a short-form educational video in addition to the traditional education method. Patient perioperative health knowledge and patient satisfaction with nursing care during treatment of lower limb fractures were compared across the two groups.ResultsPreoperative health knowledge in the intervention group was 95.1%, compared to 82.0% in the control group (χ2 = 3.954, P<0.05). The Newcastle satisfaction with nursing scales score in the intervention group was (80.902 ± 7.016) points, compared to (78.131 ± 8.213) points in the control group. These group differences were statistically significant (P < 0.05).ConclusionThe application of a short-form educational video during the perioperative care of patients with lower limb fractures may improve patients’ understanding of perioperative health and increase satisfaction with nursing care.

Effects of the online and offline hybrid continuous group care on maternal and infant health: a randomized controlled trial

BackgroundThe group care is a well-established maternal care model that has been widely used in many developed countries, but in China, it is confined to prenatal care services. In addition, affected by traditional birth culture, Chinese women tend to focus more on their fetuses and newborns but lack attention to their own intrapartum and postpartum care. The aim of this study was to construct and implement a prenatal, intrapartum, and the postpartum continuous group care model that combines online and offline service in Hainan Province, China, and to evaluate the effect on maternal women and newborns.MethodsThis study was a randomized controlled trial involving 144 pregnant women in a first-class tertiary general hospital in Hainan Province, China. Women were divided into an intervention group and a control group using the random number table, with 72 women in each group. The control group received routine maternal care services, and the intervention group received the continuous group care based on the routine maternal care services. Count data such as rate of cesarean section and incidence rate of fetal macrosomia were analyzed with the chi-square test or Fisher’s exact test, and the General Self-efficacy Scale scores were analyzed by repeated measures ANOVA. P < 0.05 was considered statistically significant, with two-sided probability values.ResultsCompared with the control group, the rate of excessive prenatal weight gain, cesarean section, and 42-day postpartum depression were significantly lower in the intervention group (P < 0.05), and higher General Self-efficacy Scale scores (in the expectant period and 42 days postpartum) and exclusive breastfeeding rate (42 days postpartum) (P < 0.05). The incidence of fetal macrosomia was significantly lower in the intervention group (P < 0.05). But there was no significant difference in birth weight, preterm birth, the incidence of low-birth-weight infants and 1-min Apgar score (P > 0.05).ConclusionThe continuous group care with online and offline service can effectively control the gestational weight gain, reduce the rate of cesarean section, macrosomia, and postpartum depression. It can improve the self-efficacy of women and the rate of exclusive breastfeeding effectively.Trial registrationChinese Clinical Trial Regestry (ChiCTR2200065765, 04/11/2022, Retrospectively registered).

Diagnosis-intervention packet-based Pareto chart of the proportion of high-cost cases and the analysis of the structure of hospitalization expenses.

In order to prevent the occurrence of high-cost cases, it is necessary to know the proportion of high-rate cases and the hospitalization cost of patients. Through the analysis of the high-rate cases of various specialties in a first-class hospital in a province, the profit and loss situation of medical institutions under the diagnosis-intervention packets (DIP) payment reform was discussed to seek a more effective way of medical insurance payment reform. Data of 1955 inpatients who participated in DIP settlement in January 2022 were retrospectively selected. The Pareto chart was used to analyze the distribution trend of high-cost cases and the composition of hospitalization expenses in each specialty. The high-cost cases are the main reason for the loss of medical institutions at the time of DIP settlement. Neurology, respiratory medicine and other specialties are the focus of high-cost cases. The cost composition of inpatients with high-cost cases is in urgent need of optimization and adjustment. DIP payment method can control the use of medical insurance funds more effectively, which is the guarantee for the refined management of medical institutions.

A prediction model for moderate to severe cancer-related fatigue in colorectal cancer after chemotherapy: a prospective case‒control study.

The study aims to develop a model to predict the risk of moderate to severe cancer-related fatigue (CRF) in colorectal cancer patients after chemotherapy. The study population was colorectal cancer patients who received chemotherapy from September 2021 to June 2022 in a grade 3 and first-class hospital. Demographic, clinical, physiological, psychological, and socioeconomic factors were collected 1 to 2days before the start of chemotherapy. Patients were followed up for 1 to 2days after the end of chemotherapy to assess fatigue using the Piper Fatigue Scale. A random sampling method was used to select 181 patients with moderate to severe CRF as the case group. The risk set sampling method was used to select 181 patients with mild or no CRF as the control group. Logistic regression, back-propagation artificial neural network (BP-ANN), and decision tree models were constructed and compared. A total of 362 patients consisting of 241 derivation samples and 121 validation samples were enrolled. Comparing the three models, the prediction effect of BP-ANN was the best, with a receiver operating characteristic (ROC) curve of 0.83. Internal and external verification indicated that the accuracy of prediction was 70.4% and 80.8%, respectively. Significant predictors identified were surgery, complications, hypokalaemia, albumin, neutrophil percentage, pain (VAS score), Activities of Daily Living (ADL) score, sleep quality (PSQI score), anxiety (HAD-A score), depression (HAD-D score), and nutrition (PG-SGA score). BP-ANN was the best model, offering theoretical guidance for clinicians to formulate a tool to identify patients at high risk of moderate to severe CRF.

Cognition about emergency management of avulsed incisor in children among dentists in Guangdong province.

This study aimed to evaluate and analyze the current situation of dentists in Guangdong pro-vince regarding the management of avulsed incisors, thereby providing a reference for making treatment strategies for avulsed incisors in the future. A total of 712 dentists with different educational backgrounds and working conditions in Guangdong province were randomly selected to conduct an online questionnaire survey on the cognition of children with avulsed incisors from April 2022 to May 2022. The data were recorded by Excel software and statistics were analyzed on Stata/SE 15.1. A total of 712 dentists were investigated and 701 questionnaires were collected (98.46%). In addition, 65.9% of investigators came from the Department of Stomatology in a First-class Hospital or Stomatological Hospital. The results showed that the average number of avulsed teeth consulted by dentists was less than 20 per year. Although 99.7% of respondents considered normal saline as a suitable storage medium, 3.1% and 23.8% of them had a misunderstanding that the tap/alcohol could be used for root cleaning. Moreover, 93.4% was the correct selection rate of the treatment plan for processing on root surfaces before replanting by investigators. The correct selection rate of the duration using elastic fixation was only 10.7%. Meanwhile, 42.9% of investigators refused to inoculate tetanus immunoglobulin after teeth replanting. Emergency management of dental avulsion (EM) and clinical management of dental avulsion (CM) answered correctly with average scores of 14.60±11.85 and 14.48±2.67, respectively. Multivariate linear regression analysis revealed that working years were negatively correlated with EM and CM scores (P<0.05). There was a positive correlation between CM and EM scores with the number of avulsion cases treated by physicians each year (P<0.05). In terms of the EM score of dentists' learning attitude, investigators who had received enough knowledge were higher than those who had not and insufficient knowledge reserved, and the difference was statistically significant (P<0.05). The scores of investigators who thought they had a certain degree of knowledge about dental trauma were higher than those who thought they "did not understand", and the difference was statistically significant (P<0.05). In terms of CM scores, investigators who thought the knowledge of dental trauma was "very helpful" had higher scores than those who thought it was "not helpful", and the difference was statistically significant (P<0.05). The scores of the investigators who thought they had "relatively sufficient knowledge" of dental trauma were higher than those who thought they had "no knowledge" or "insufficient know-ledge", and the difference was statistically significant (P<0.05). The overall accuracy of the management of avulsed incisors among dentists was low in Guangdong province. Dentists were more likely to have a higher rate of accuracy choice in treatment options for luxation injury and avulsion to enhance the prognosis of replanted teeth.

Pelvic floor dysfunction and its influencing factors during radiotherapy in cervical cancer survivors: A cross-sectional study.

Radiotherapy can negatively affect the pelvic floor function of patients with cervical cancer; however, the impact of different radiotherapy times and other related factors on pelvic floor function in cervical cancer survivors during radiotherapy remains unclear. We aimed to investigate the status of pelvic floor dysfunction (PFD) in cervical cancer survivors during radiotherapy and to analyze the factors influencing PFD. In this cross-sectional study, a convenience sampling method was used to recruit cervical cancer survivors undergoing radiotherapy from January 2022 to July 2022at a tertiary first-class hospital located in northeastern China. The Pelvic Floor Distress Inventory-Short Form 20 was used for participants' self-report of their PFD during radiotherapy. Data from 120 cervical cancer survivors were included in this study. The results showed that the mean PFDI-20 total score was 32.69±7.76. Multiple stepwise linear regression analysis showed that 56.9% of the variance in PFD was explained by age (β=0.25, p<0.001), body mass index (β=0.32, p<0.001), recurrence (β=0.29, p<0.001), number of radiotherapy sessions (β=0.39, p<0.001), and number of deliveries (β=0.35, p<0.001). It is important to pay more attention to the PFD status of cervical cancer survivors receiving radiotherapy. Future therapeutic approaches should involve early identification of relevant risk factors early to provide patients with personalized care at different stages of radiotherapy for reducing their discomfort and improving their health-related quality of life.