Hospitals In Wuhan Research Articles

Community-acquired pneumonia caused by Micrococcus antarcticus: a rare case report

Background Micrococcus antarcticus (M. antarcticus) is an aerobic Gram-positive spherical actinobacterium that was initially isolated from Chinese Great-Wall station in Antarctica in 2000. M. antarcticus was considered to be of low pathogenicity, no previous cases of human infection by this organism have been reported. Here we describe the first report with community-acquired pneumonia (CAP) caused by M. antarcticus.Case presentationAn 87-year-old female was presented to the Central Hospital of Wuhan in November 2023 with a chief complaint of cough, sputum production, and chest tightness for 2 weeks. Microbial culture of the patient’s bronchoalveolar lavage fluid (BALF) and identification of the isolates using Matrix-assisted laser desorption ionization/time of flight mass spectrometry (MALDI-TOF MS) and 16S rRNA gene sequencing revealed M. antarcticus infection. Combined with clinical symptoms, laboratory and imaging examination, the patient was diagnosed with CAP. Then cefoperazone/sulbactam and levofloxacin was administrated, the patient’s condition was improved and she was discharged after a week after admission, no abnormalities were detected during a 5-month follow-up.ConclusionsThis case highlights that M. antarcticus, first identified from a patient with CAP, is an extremely rare pathogenic microorganism. Clinicians should be aware of its potential as a pathogen in the diagnosis and treatment of CAP.

Structural equation modeling analysis of factors influencing decisional conflict between dialysis modality among end-stage kidney disease patients in Wuhan

ObjectivesTo explore the influencing factors and relationships associated with decisional conflict of dialysis modality in End-stage kidney disease (ESKD) patients.MethodsThis study was a survey-based cross-sectional investigation conducted on 150 ESKD patients in a third-class hospital in Wuhan. The general information questionnaire, decisional conflict scale, Montreal cognitive assessment, frail scale, perceived social support scale, and brief health literacy screen were used for investigation. SPSS 25.0 was used to compare the differences between the decisional and non-decisional conflict groups, and AMOS 23.0 was used to construct a structural equation model to explore the influencing factors.ResultsThe incidence of decisional conflict in 150 ESKD patients was 33.3% (50/150). Binary logistic regression analysis showed that the independent risk factors for decisional conflict of dialysis modality in ESKD patients included monthly household income (OR = 0.184), cognitive function (OR = 7.0), social support (OR = 0.891), health literacy (OR = 0.608), the level of eGFR (OR = 1.488), and the level of cTnI (OR = 9.558). The constructed path analysis model had a good fit (x2/df = 1.499, GFI = 0.957, AGFI = 0.911, NFI = 0.906, CFI = 0.967, RMSEA = 0.055). The path analysis showed that health literacy (0.577) had the greatest impact on the decisional conflict, with a direct effect of 0.480 and an indirect effect of 0.097 through cognitive function and monthly household income. Next was social support, with an effect value of 0.434.ConclusionsIn clinical practice, it is important to enhance the health literacy of patients and their families and to provide advanced education on dialysis plans. Additionally, in managing and planning chronic kidney disease progression and dialysis, it is recommended to regularly and systematically assess cognitive function, particularly before the patient’s cognitive impairment worsens or the severity of the disease progresses. Advanced care planning can be established through collaboration between healthcare professionals and patients to ensure appropriate decision-making and management.Implications for the profession and patient careThis paper finds that the factors that influence and relate to dialysis methods in end-stage renal disease patients help nurses exercise autonomy better, assist patients in reducing their decisional conflict, and improve clinical outcomes.Patient or public contributionPatients received a relevant questionnaire survey, and caregivers assisted in conducting the study.

Association between multiple metal exposure and bone mineral density among Chinese adults.

Previous studies about metal exposures and bone mineral density (BMD) have mainly focused on individual metals. The objective of this study was to explore the association of single and multiple metal exposures with BMD among Chinese adults. We recruited 2922 participants from Tongji Hospital in Wuhan, China. The urinary concentrations of 21 metals were measured by the inductively coupled plasma mass spectrometer. BMD was measured using dual-energy X-ray absorptiometry. We applied linear regression and Bayesian kernel machine regression (BKMR) to examine the association of single and multiple metal exposure with BMD, respectively. The linear regression model showed that cadmium (Cd) and strontium (Sr) were associated with lower BMD (all P-trend < 0.05). Compared with the lowest quantiles, the β (95% CI) of BMD in the highest quartile of Cd and Sr was - 0.032 (- 0.049, - 0.016) and - 0.033 (- 0.049, - 0.018), respectively. The BKMR results showed that co-exposure to 21 metals was negatively associated with BMD among the total participants and males. Our study suggested that exposure to multiple metals was negatively associated with BMD, particularly among males. More prospective studies are needed to identify these associations and reveal the underlying mechanisms.

The Association Between Elevated Myocardial Injury-Related Biomarker (TnI) and Increased Mortality in Patients With Severe Fever With Thrombocytopenia Syndrome.

The objective of this study was to investigate the dynamic profiles of myocardial injury biomarkers and their association with mortality in patients with severe fever with thrombocytopenia syndrome (SFTS). A retrospective cohort study. Union Hospital in Wuhan, China. A total of 580 patients with SFTS, observed between May 2014 and December 2021, were included in the final analysis. None. In total, 580 patients with SFTS were enrolled in the study, comprised of 469 survivors and 111 nonsurvivors, with a 21-day fatality rate of 19.1%. The elevation of troponin I (TnI) was observed in 61.6% patients (357/580) with SFTS upon admission, and 68.4% patients (397/580) developed an abnormal TnI level during hospitalization. Multivariate logistic regression identified age, viral load, platelet count, creatinine level, and TnI level as potential risk factors for mortality in patients with SFTS. The results of restricted cubic splines revealed that when the TnI level (baseline TnI: 1.55 [lg (ng/L+1)], peak value: TnI 1.90 [lg (ng/L+1)]) exceeded a certain threshold, the predicted mortality of patients with SFTS increased alongside the rise in TnI levels. Mortality rate surpassed 40% among patients with SFTS with TnI greater than or equal to 10 times the upper limit of normal at admission (43.8%) or during hospitalization (41.7%). Older age, a history of cardiovascular disease, and higher d -dimer levels were potential risk factors for elevated TnI levels in patients with SFTS. Elevated TnI levels were prevalent among patients with SFTS and were strongly associated with an increased risk of mortality.

Development of predictive model for post-stroke depression at discharge based on decision tree algorithm: A multi-center hospital-based cohort study

ObjectivePost-stroke depression (PSD) is one of the most common and severe neuropsychological sequelae after stroke. Using a prediction model composed of multiple predictors may be more beneficial than verifying the predictive performance of any single predictor. The primary objective of this study was to construct practical prediction tools for PSD at discharge utilizing a decision tree (DT) algorithm. MethodsA multi-center prospective cohort study was conducted from May 2018 to October 2019 and stroke patients within seven days of onset were consecutively recruited. The independent predictors of PSD at discharge were identified through multivariate logistic regression with backward elimination. Classification and regression tree (CART) algorithm was employed as the DT model's splitting method. ResultsA total of 876 stroke patients who were discharged from the neurology departments of three large general Class A tertiary hospitals in Wuhan were eligible for analysis. Firstly, we divided these 876 patients into PSD and non-PSD groups, history of coronary heart disease (OR = 1.835; 95 % CI, 1.106–3.046; P = 0.019), length of hospital stay (OR = 1.040; 95 % CI, 1.013–1.069; P = 0.001), NIHSS score (OR = 1.124; 95 % CI, 1.052–1.201; P = 0.001), and Mini mental state examination (MMSE) score (OR = 0.935; 95 % CI, 0.893–0.978; P = 0.004) were significant predictors. The subgroup analysis results have shown that hemorrhagic stroke, history of hypertension and higher modified Rankin Scale score (mRS) score were associated with PSD at discharge in the young adult stroke patients. ConclusionsSeveral predictors of PSD at discharge were identified and convenient DT models were constructed to facilitate clinical decision-making.

The congruence between the preferred and actual places of death among terminal cancer patients in China.

Dying in a preferred place is important for a good death. Currently, no study has evaluated the extent to which the preferences for the place of death (PoD) are met among terminal cancer patients in China. This study examined the congruence between the preferred and actual PoD and its predictors among terminal cancer patients in China. Between 2015 and 2023, 845 terminal cancer patients from four tertiary hospitals in Wuhan, China, were enrolled and followed till death. Face-to-face surveys at baseline and telephone-based interviews in the last month of patients' lives were combined to learn patients' preferred PoD. Data on patients' actual PoD were collected from families within 1 month after patients' death. Of the 410 patients who died, 62.7% of them died in hospitals. The agreement between patients' preferred and actual PoD was fair (κ = 0.221). The congruence between patients' preferred and actual PoD was 63.0, 36.6%, and 0 for hospital death, home death, and hospice facility/nursing home death separately. Patients were more likely to die in their preferred places if their preferred place and family caregivers' belief of patients' preferred PoD was congruent (odds ratio [OR] = 6.464, p = 0.001), or if caregivers had a medically related occupation (OR = 4.577, p = 0.003); if patients were hospitalized at least twice in the last month of life (OR = 0.422, p = 0.000), or the quality of care received by patients in the last 48 h was rated good by the families (OR = 0.373, p = 0.011), patients were less likely to die in their preferred places. The congruence between patients' preferred and actual PoD was fair. Advance care planning (ACP) needs to be popularized in China, and the quality of care in hospice facilities and nursing homes should be improved. The necessary policy support for hospice care should be made to respect cancer patients' end-of-life (EoL) care preferences in China.

Prognosis and risk factor assessment of patients with advanced lung cancer with low socioeconomic status: model development and validation

BackgroundLung cancer, a major global health concern, disproportionately impacts low socioeconomic status (SES) patients, who face suboptimal care and reduced survival. This study aimed to evaluate the prognostic performance of traditional Cox proportional hazards (CoxPH) regression and machine learning models, specifically Decision Tree (DT), Random Forest (RF), Support Vector Machine (SVM), and Extreme Gradient Boosting (XGBoost), in patients with advanced lung cancer with low SES.DesignA retrospective study.MethodThe 949 patients with advanced lung cancer with low SES who entered the hospice ward of a tertiary hospital in Wuhan, China, from January 2012 to December 2021 were randomized into training and testing groups in a 3:1 ratio. CoxPH regression methods and four machine learning algorithms (DT, RF, SVM, and XGBoost) were used to construct prognostic risk prediction models.ResultsThe CoxPH regression-based nomogram demonstrated reliable predictive accuracy for survival at 60, 90, and 120 days. Among the machine learning models, XGBoost showed the best performance, whereas RF had the lowest accuracy at 60 days, DT at 90 days, and SVM at 120 days. Key predictors across all models included Karnofsky Performance Status (KPS) score, quality of life (QOL) score, and cough symptoms.ConclusionsCoxPH, DT, RF, SVM, and XGBoost models are effective in predicting mortality risk over 60–120 days in patients with advanced lung cancer with low SES. Monitoring KPS, QOL, and cough symptoms is crucial for identifying high-risk patients who may require intensified care. Clinicians should select models tailored to individual patient needs and preferences due to varying prediction accuracies.Reporting methodThis study was reported in strict compliance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline.Patient or public contributionNo patient or public contribution.

What’s behind thoracic surgery explosion in young patients under the age of 40 in Wuhan after COVID-19 outbreak?

IntroductionThe COVID-19 pandemic was associated with a dramatic increase of chest CT scanning in Wuhan. This was partly a COVID effect: some private and public employers required employees to have CT examinations to confirm they were healthy before going back to work. But it also likely reflects the growing enthusiasm for low-dose computed tomography (LDCT) screening. This investigation examines the resulting impact in the under 40 population. MethodsThe relevant de-identified information of the patients under age 40 who had also received thoracic surgery from 2018 to 2022 was analyzed using the medical record information system of Tongji Hospital in Wuhan. ResultsThe volume of thoracic surgeries increased continuously in young patients under the age of 40, from 219 in 2018 to 732 in 2022. The number of surgeries for pulmonary nodules or masses in this group increased over 6-fold, from 91 to 576. The number of surgeries leading to a diagnosis of adenocarcinoma of the lung increased more than 15-fold, from 26 to 415. The median adenocarcinoma size fell in half (from 15 mm to 7 mm) and the most common stage changed from Stage I invasive (46 % of adenocarcinomas in 2018) to microinvasive (60 % of adenocarcinomas in 2022). 70 % of lung adenocarcinomas were found in females. ConclusionsThere had been an explosion of thoracic surgery for adenocarcinomas among the under-40 population in Wuhan. The decrease in tumor size and the increase in microinvasive and in situ lesions in this young age group suggest considerable overdiagnosis. We should be vigilant about the risk of overdiagnosis and overtreatment especially in young women.

Association between apathy and caregiver burden in patients with amyotrophic lateral sclerosis: a cross-sectional study

ObjectivesTo investigate the relationship among patients’ apathy, cognitive impairment, depression, anxiety, and caregiver burden in amyotrophic lateral sclerosis (ALS).DesignA cross-sectional study design was used.SettingThe study was conducted at a tertiary...

The risk factors for burnout among nurses: An investigation study.

The objective of this investigation study is to examine the levels of burnout and work engagement among nurses working on the front lines of the COVID-19 pandemic. Additionally, we aim to analyze the risk factors associated with nurse burnout. This investigation study included a sample of 1764 registered nurses from 6 tertiary comprehensive hospitals in Wuhan. A total of 1800 questionnaires were distributed via email between January 2021 and July 2021, and 1764 completed questionnaires were returned. Nurses who had been on the front lines of the COVID-19 fight for more than six months were included in the study. The Maslach Burnout Inventory-General Survey (MBI-GS) scale was utilized to assess burnout levels among all nurses. Work engagement was measured using the Utrecht Work Engagement Scale (UWES). The general health of the nurses was evaluated using the General Health Questionnaire-12 (GHQ-12) score. Demographic and clinical data, including age, sex, hospital, department, education, years of experience, daily overtime, weekly rest time, number of night shifts per month, smoking or drinking habits, marital status, etc, were also collected. Statistical analyses were performed using SPSS 25.0. The GHQ-12 scores in the FC group were significantly higher than those in the non-frontline COVID-19 (NFC) group. Compared to the average value of the 2 groups, we found that the dimension 2 average value of UWES in NFC group (3.52 ± 1.07) were remarkably higher than that in FC group (3.40 ± 1.08, P < .05). Furthermore, the dimension 1 (emotional exhaustion) average value and dimension 2 (depersonalization) average value of MBI-GS in NFC group were remarkably declined than that in FC group. Spearman rank correlation showed that negative correlation among the average value of each dimension and the overall average values between MBI-GS and UWES. Logistic regression analysis showed that daily Overtime, fight against COVID-19, GHQ-12 score and dimension 2 of UWES were the risk factors for nurse burnout. In summary, this study showed that the dimension 1 (emotional exhaustion) average value and dimension 2 (depersonalization) average value of MBI-GS in NFC group were remarkably declined than that in FC group. This study may provide some basis for addressing nurse burnout.

Analysis of the relationship between VEGF, NLRP3 inflammatory complex, EPO levels, and ocular hemodynamics in patients with primary open-angle glaucoma

ObjectiveOur study aimed to investigate the relationship between vascular endothelial growth factor (VEGF), NOD-like receptor thermal protein domain associated protein 3 (NLRP3) inflammatory complex, erythropoietin (EPO) levels, and ocular hemodynamics in patients diagnosed with primary open-angle glaucoma (POAG).MethodsThis is a prospective observational study. Patients diagnosed with POAG at The Sixth Hospital of Wuhan hospital between November 2022 and February 2023were enrolled.The patients were categorized into three groups based on the average visual field defect (mean deviation, MD) value: severe injury group (MD > 12 dB, 93 cases), moderate injury group (7 ≤ MD ≤ 12 dB, 89 cases), and mild injury group (MD < 7 dB, 85 cases). The levels of VEGF, NLRP3 inflammatory complex, EPO, and ocular hemodynamics were compared among the groups. Furthermore, the relationship between VEGF, NLRP3, EPO levels, and ocular hemodynamics in patients with POAG was analyzed using Pearson correlation analysis. After adjusting for confounding factors such as age and gender, multivariate Logistic regression analysis was performed with the ocular hemodynamics indexes being used as dependent variables, and VEGF, NLRP3, ASC, Caspase-1, and EPO being used as independent variables.ResultsA total of267 patients with POAG were enrolled. There were no significant differences in sex, age, body mass index, systolic blood pressure, diastolic blood pressure, smoking, alcohol consumption, and blood glucose between the two groups (P > 0.05). The levels of NLRP3, ASC, Caspase-1, and EPO in the severe and moderate injury groups were higher than those in the mild injury group, whereas the VEGF levels were lower in the severe and moderate groups compared to the mild group, showing significant differences (P < 0.05). The severe group exhibited higher levels of NLRP3, ASC, Caspase-1, and EPO than the moderate group, while the VEGF levels were lower in the severe group compared to the moderate group, showing significant differences (P < 0.05). The peak systolic velocity(PSV) and resistance index (RI) were higher in the severe and moderate groups than in the mild group, whereas the EDV was significantly lower in the severe and moderate groups compared to the mild group (P < 0.05). The severe group exhibited higher PSV and RI values compared to the moderate group, while the EDV was lower in the severe group compared to the moderate group, showing significant differences (P < 0.05). Pearson correlation analysis was performed to examine the relationship between VEGF, NLRP3, EPO levels, and ocular hemodynamics in patients with POAG. VEGF, NLRP3, ASC, Caspase-1, and EPO showed positive correlations with PSV and RI, and negative correlations with EDV in patients with POAG. Regression analysis showed that VEGF, NLRP3, ASC, Caspase-1 and EPO were significantly correlated with ocular hemodynamics in POAG (all P < 0.001).ConclusionWe demonstrated that the levels of VEGF, NLRP3 inflammatory complex, and EPO were highly associated with ocular hemodynamics in patients diagnosed with POAG.

Care preparedness of family caregivers of maintenance hemodialysis patients: a cross-sectional study

With the increasing number of maintenance hemodialysis (MHD) patients, growing attention has been paid to the quality of care. Strengthening care preparedness of family caregivers is essential to improving the nursing quality. The purpose of this study is to explore the care preparedness level of family caregivers of MHD patients and its influencing factors, so as to provide guidance for the development of targeted care interventions. A total of 237 family caregivers of MHD patients were recruited from the hemodialysis room of two tertiary hospitals in Wuhan using the Convenience sampling method. They were surveyed by the general data questionnaire, Care Preparedness Scale and Positive Aspects of Caregiving. Statistical analysis was conducted using IBM SPSS software, version 21.0. The statistical tests conducted in this study were two-tailed, and a significance level of P < 0.05 was deemed as statistically significant. The care preparedness and positive aspects of caregiving scores of family caregivers of MHD patients were 19.05 ± 5.64 and 31.28 ± 7.28 points, respectively. The care preparedness level of family caregivers was significantly positively correlated with positive aspects of caregiving (P < 0.01). The results of multiple linear regression analysis showed that the total nursing time and whether family caregivers had chronic diseases and positive aspects of caregiving were the main factors influencing their care preparedness (all P < 0.05). These three factors accounted for 49.6% of the variance. The care preparedness of family caregivers of MHD patients remains to be continuously improved. Medical staff should emphasize the important role of total nursing time, whether the caregiver has a chronic disease, and positive aspects of caregiving in improving care preparedness in this population. To achieve this end, medical staff can provide targeted support and guidance for caregivers according to the influencing factors, such as implementing group psychological education, strengthening the training, offering social support, remote intervention (including family caregivers’ education through the media), and so on. Meanwhile, caregivers should be evaluated dynamically, and information and emotional support should be provided for them.

Factors Associated with Patient–Caregiver Concordance about Life-Sustaining Treatment Preferences among Advanced Cancer Patients: A Cross-Sectional Study

ObjectivesConcordance of preferences for end-of-life care regarding patients between patients with advanced cancer and family caregivers can improve the likelihood of honoring dying patients’ wishes. However, there is a dearth of knowledge in mainland China. The purpose of this study was to examine patient–family caregiver concordance about patients’ life-sustaining treatment preferences and associated factors among patients with advanced cancer in China. MethodsFrom September 2019 to December 2021, a convenience sample of 406 dyads of advanced cancer patient–family caregiver were recruited from 2 tertiary hospitals in Wuhan, China. Participants completed a questionnaire about patient's preferences for life-sustaining treatment, respectively. The concordance was assessed by percent agreement and kappa coefficients. Associated factors were identified by univariate analysis and binary logistic regression. ResultsThe average concordance rate on the preferences for life-sustaining treatment was 56.1%, ranging from 52.9% to 59.3%. Factors associated with a higher level of patient–family caregiver concordance were following: patients who were married, whose educational levels were at college or above, who had not been informed of diagnosis by a physician, who had been informed of the effects and side effects of related drugs by a physician, and who cared for a seriously ill family member or friend and caregivers whose educational level were primary or below. ConclusionsThe patient–family caregiver concordance about patients’ life-sustaining treatment preferences among patients with advanced cancer was poor. Patients’ and caregivers’ understanding of life-sustaining treatment and its efficacy in end-of-life should be facilitated. Relevant conversation should be encouraged between patients and caregivers, thus providing value-concordant end-of-life care for patients with cancer. Implications for Nursing PracticeHealth professionals need to carry out advanced care planning in oncology departments on mainland China to encourage patients and caregivers to discuss patients’ end-of-life care preferences. Facilitating patients’ and caregivers’ understanding of life-sustaining treatment preferences may help improve the patient–caregiver concordance on life-sustaining treatment preferences among patients with advanced cancer.

Development and validation of a prognostic nomogram to predict 30-day all-cause mortality in patients with CRO infection treated with colistin sulfate.

Carbapenem-resistant Gram-negative organism (CRO) infection is a critical clinical disease with high mortality rates. The 30-day mortality rate following antibiotic treatment serves as a benchmark for assessing the quality of care. Colistin sulfate is currently considered the last resort therapy against infections caused by CRO. Nevertheless, there is a scarcity of reliable tools for personalized prognosis of CRO infections. This study aimed to develop and validate a nomogram to predict the 30-day all-cause mortality in patients with CRO infection who underwent colistin sulfate treatment. A prediction model was developed and preliminarily validated using CRO-infected patients treated with colistin sulfate at Tongji Hospital in Wuhan, China, who were hospitalized between May 2018 and May 2023, forming the study cohort. Patients admitted to Xianning Central Hospital in Xianning, China, between May 2018 and May 2023 were considered for external validation. Multivariate logistic regression was performed to identify independent predictors and establish a nomogram to predict the occurrence of 30-day all-cause mortality. The receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC), and the calibration curve were used to evaluate model performance. The decision curve analysis (DCA) was used to assess the model clinical utility. A total of 170 patients in the study cohort and 65 patients in the external validation cohort were included. Factors such as age, duration of combination therapy, nasogastric tube placement, history of previous surgery, presence of polymicrobial infections, and occurrence of septic shock were independently associated with 30-day all-cause mortality and were used to construct the nomogram. The AUC of the nomogram constructed from the above six factors was 0.888 in the training set. The Hosmer-Lemeshow test showed that the model was a good fit (p = 0.944). The calibration curve of the nomogram was close to the ideal diagonal line. Furthermore, the decision curve analysis demonstrated significantly better net benefit in the model. The external validation proved the reliability of the prediction nomogram. A nomogram was developed and validated to predict the occurrence of 30-day all-cause mortality in patients with CRO infection treated with colistin sulfate. This nomogram offers healthcare providers a precise and efficient means for early prediction, treatment management, and patient notification in cases of CRO infection treated with colistin sulfate.

Clinical outcome assessment of colistin sulphate in children with carbapenem-resistant organism infections: First data from China

ObjectivesColistin sulphate for injection (CSI) became clinically available in China in July 2019. To date, there is no published data regarding its usage in children. Our research group has been following data on the efficacy and safety of CSI in Chinese paediatric patients with carbapenem-resistant organism infections. The purpose of this short communication is to provide a brief overview of the findings to date. MethodsWe reviewed the electronic medical records of paediatric patients (aged 9–17 y) who were administered CSI during their hospital stay at Tongji Hospital in Wuhan, China, between June 2021 and November 2023. Drug efficacy was evaluated based on clinical and microbiological outcomes, while drug safety was assessed using surveillance markers that reflect adverse reactions. ResultsA total of 20 patients met the inclusion criteria. The predominant pathogens were Klebsiella pneumoniae (8 strains), followed by Acinetobacter baumannii (5 strains) and Pseudomonas aeruginosa (2 strains). The clinical response rate of CSI was 85%, with a bacterial clearance rate of 79%. None of the patients experienced colistin-related nephrotoxicity or neurotoxicity during the treatment. ConclusionsIn this real-world setting, CSI demonstrated a high level of clinical response and was well tolerated for the treatment of carbapenem-resistant organism infections in Chinese children.

Anxiety and sleep quality in patients receiving maintenance hemodialysis: multiple mediating roles of hope and family function

The objective of this cross-sectional study was to examine the extent of sleep quality among individuals undergoing maintenance hemodialysis (MHD) and to scrutinize whether hope and family function serve as mediators in the association between anxiety and sleep quality in this cohort. A convenience sampling method was used to recruit 227 patients receiving maintenance hemodialysis from two tertiary hospitals in Wuhan. Participants completed several self-report questionnaires, including the Sociodemographic questionnaire, Hospital Anxiety and Depression Scale, Athens Insomnia Scale, Herth Hope Index, and Family APGAR Index. As per the findings of the chain mediation analysis, it was observed that the sleep quality scores were directly predicted by anxiety. Moreover, anxiety positively predicted sleep quality scores through hope and family function as mediators. The observed types of mediation were partial mediation. The total indirect effect value was 0.354, indicating the mediating effect of hope and family function, while the total effect value was 0.481, representing the overall effect of anxiety on sleep quality. The total effect size was 73.60% (0.354/0.481), indicating that the mediation accounted for a significant portion of the relationship. This study established the chain mediating effect of hope and family function between anxiety and sleep quality in patients receiving maintenance hemodialysis. The findings highlight the importance of addressing anxiety and promoting hope and family function to improve sleep quality in this population. The findings suggest that healthcare professionals should be attentive to the anxiety levels of these patients and implement targeted interventions to help alleviate anxiety, enhance hope, and improve family functioning, with the ultimate goal of improving sleep quality in this population.

Development and validation of an intraoperative hypothermia nomograph model for patients undergoing video-assisted thoracoscopic lobectomy: a retrospective study

This study aimed to develop and internally validate a nomogram model for assessing the risk of intraoperative hypothermia in patients undergoing video-assisted thoracoscopic (VATS) lobectomy. This study is a retrospective study. A total of 530 patients who undergoing VATS lobectomy from January 2022 to December 2023 in a tertiary hospital in Wuhan were selected. Patients were divided into hypothermia group (n = 346) and non-hypothermia group (n = 184) according to whether hypothermia occurred during the operation. Lasso regression was used to screen the independent variables. Logistic regression was used to analyze the risk factors of hypothermia during operation, and a nomogram model was established. Bootstrap method was used to internally verify the nomogram model. Receiver operating characteristic (ROC) curve was used to evaluate the discrimination of the model. Calibration curve and Hosmer Lemeshow test were used to evaluate the accuracy of the model. Decision curve analysis (DCA) was used to evaluate the clinical utility of the model. Intraoperative hypothermia occurred in 346 of 530 patients undergoing VATS lobectomy (65.28%). Logistic regression analysis showed that age, serum total bilirubin, inhaled desflurane, anesthesia duration, intraoperative infusion volume, intraoperative blood loss and body mass index were risk factors for intraoperative hypothermia in patients undergoing VATS lobectomy (P < 0.05). The area under ROC curve was 0.757, 95% CI (0.714–0.799). The optimal cutoff value was 0.635, the sensitivity was 0.717, and the specificity was 0.658. These results suggested that the model was well discriminated. Calibration curve has shown that the actual values are generally in agreement with the predicted values. Hosmer–Lemeshow test showed that χ2 = 5.588, P = 0.693, indicating that the model has a good accuracy. The DCA results confirmed that the model had high clinical utility. The nomogram model constructed in this study showed good discrimination, accuracy and clinical utility in predicting patients with intraoperative hypothermia, which can provide reference for medical staff to screen high-risk of intraoperative hypothermia in patients undergoing VATS lobectomy.

COVID-19 control protocol for rhinologic surgery

In January 2020, 14 medical staff members engaged in endona- sal endoscopic pituitary surgery at a hospital in Wuhan, China, were infected with a novel infection, coronavirus disease 2019 (COVID-19) (1). Since the nasal mucosa is a potential source of COVID-19 infection (2), close attention has been paid to infection control in rhinologic surgery during the COVID-19 pandemic (3). There are also many reports from other countries on COVID-19 infection among otolaryngologists, and these reports suggest that the risk of COVID-19 transmission is particularly high in rhinologic surgery (4,5). On the other hand, Sanmark et al. showed that the observed aerosol exposure during rhinologic surgery is lower or similar to exposures during coughing (6).

An Investigation of the Knowledge of Infection Control Practices Held by Healthcare Professionals.

Healthcare-associated infections (HAIs), arising from inadequate hygiene practices, significantly increase morbidity and mortality rates in hospitalized patients. This descriptive study involved 350 healthcare workers from private hospitals in Wuhan, China. Participants responded to a questionnaire with close-ended questions, distributed physically and via email. Data were analyzed using SPSS version 25.0. The analysis indicated a gap in healthcare workers' knowledge of infection control, affecting hospital hygiene standards. About 60% of respondents hold a diploma or higher qualification. The findings underscore the importance of targeted training and educational initiatives in infection control procedures. A significant factor in hospitals' inadequate hygiene practices is the gap in staff training and knowledge.

Signs of front-line healthcare professionals' information anxiety during the COVID-19 pandemic: Grounded theory study in a Wuhan hospital.

Being front-line healthcare professionals is associated with possible severe information anxiety during the COVID-19 pandemic. Investigating signs of information anxiety is the first and key step of its targeted medical intervention. This study aims to explore the signs of front-line healthcare professionals' information anxiety during the COVID-19 pandemic. This study is qualitative research. Grounded theory was used to classify information anxiety signs of front-line healthcare professionals. Twenty-four front-line healthcare professionals from a general hospital with over 5000 beds in Wuhan were recruited to participate in semi-structured interviews. According to the frequency and frequency variation of signs appearing in interviews, the trends of signs during the virus encounter, lockdown, flattening and second wave were compared. Based on the interviews, those signs that were conceptually related to each other were extracted to construct a conceptual model. Psychological signs (emotion, worry, doubt, caution, hope), physical signs (insomnia, inattention, memory loss, appetite decreased) and behavioural signs (panic buying of goods, be at a loss, pay attention to relevant information, change habits) could be generalized from 13 subcategories of information anxiety signs. Psychological signs were the most in every period of the pandemic. Furthermore, psychological signs decreased significantly during lockdown, while behavioural and physical signs increased. Finally, severe psychological and behavioural signs were associated with physical signs.