Nurses′ experience and reality dilemma in advance care planning:a qualitative meta-synthesis / 中国实用护理杂志

Objective:To systematically evaluate and integrate the qualitative research of the practical experience and practical difficulties of advance care planning (ACP), so as to provide a reference for subsequent clinical nurses to better carry out ACP.Methods:PubMed, Web of Science, Embase, Cochrane Library, CINAHL, CNKI, Wanfang, VIP, Chinese Biomedical Literature Database were collected the qualitative research on the practical experience and practical difficulties of nurses′advance care planing, and the search time was the database establishment until August 1, 2022. Literature quality evaluation was conducted by the Joanna Briggs Institute (JBI) (2016), and the results were summarized using Meta integration method.Results:A total of 13 studies were included, and 39 studies were summarized into 11 new categories, forming 4 integrated results: nurses′ cognition of ACP practice, emotional experience of nurses′ ACP practice, personal factors that hinder ACP practice, and external environmental factors that hinder ACP practice.Conclusions:In ACP practice, nurses should be actively guided to have positive cognitive and emotional experience to improve their competence in ACP practice. At the same time, government departments should be united to support, integrate hospitals, society and other forces to formulate coping strategies against obstacles, so as to promote the development and practice of ACP.

Qualitative research on home-based hospice care experiences of nurses: a Meta-synthesis / 中国实用护理杂志

Objective:To systematically review the experience of nurses′ in providing home-based hospice care, so as to provide a basis for improving the quality of home-based hospice care and the nursing service system.Methods:Qualitative researches on nurses′ experience of providing home-based hospice care were retrieved from the Cochrane Library, PubMed,Web of Science, EBSCO, Medline, China National Knowledge Internet, China Biomedical Literature Database, Wanfang Database, VIP Database from inception to April 1, 2022. Adopting Joanna Briggs Institute Critical Appraisal Tool (2016) to evaluate the quality of included studies, the Meta-synthesis was used to explain and integrate the research results.Results:A total of 9 articles were included. This study extracted 23 clear results, 8 new categories, and 3 integrated results, including the significance of nurses′ acceptance of home-based hospice care; positive and negative emotions coexist when nurses provide home-based hospice care; challenges in implementing home-based hospice care.Conclusions:The development of home-based hospice care service is helpful to provide continuous care for the terminally ill patients and improve their quality of life, but at the same time, the ability of home-based hospice care of nurses should be further improved and the related policy guarantee should be perfected to promote the steady development of home-based hospice care in China.

Genetic analysis of a child with D bifunctional protein deficiency born to a consanguineous pedigree / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic etiology of a child with D bifunctional protein deficiency (DBPD) born to a consanguineous pedigree.@*METHODS@#A child with DBPD who was admitted to the First Affiliated Hospital of Hainan Medical College on January 6, 2022 due to hypotonia and global developmental delay was selected as the study subject. Clinical data of her pedigree members were collected. Peripheral blood samples of the child, her parents and elder sisters were collected and subjected to whole exome sequencing. Candidate variant was validated by Sanger sequencing and bioinformatic analysis.@*RESULTS@#The child, a 2-year-and-9-month-old female, had featured hypotonia, growth retardation, unstable head lift, and sensorineural deafness. Serum long-chain fatty acids were elevated, and auditory brainstem evoked potentials had failed to elicit V waves in both ears with 90 dBnHL stimulation. Brain MRI revealed thinning of corpus callosum and white matter hypoplasia. The child's parents were secondary cousins. Their elder daughter had a normal phenotype and no clinical symptoms related to DBPD. Elder son had frequent convulsions, hypotonia and feeding difficulties after birth, and had died one and a half month later. Genetic testing revealed that the child had harbored homozygous c.483G>T (p.Gln161His) variants of the HSD17B4 gene, for which both of her parents and elder sisters were carriers. Based on the guidelines from the American College of Medical Genetics and Genomics, the c.483G>T (p.Gln161His) was rated as a pathogenic variant (PM1+PM2_Supporting+PP1+PP3+PP4).@*CONCLUSION@#The homozygous c.483G>T (p.Gln161His) variants of the HSD17B4 gene caused by the consanguineous marriage probably underlay the DBPD in this child.

Effects of bevacizumab injection on immune function and drug safety in patients with non-small cell lung cancer / 中国医师进修杂志

Objective:To investigate the effects of bevacizumab injection on immune function and drug safety in patients with non-small-cell lung cancer (NSCLC).Methods:A total of 80 NSCLC patients admitted to Liaocheng Second People′s Hospital from August 2018 to August 2020 were selected as study subjects. They were divided into the observation group and the control group by random number table method, each group with 40 cases. The control group received routine chemotherapy and the observation group received bevacizumab injection as adjuvant therapy on the bases of control group. Short-term efficacy, serum T lymphocyte subsets, vascular endothelial growth factor (VEGF), basic fibroblast growth factor (b-FGF) levels and the incidence of adverse reactions were compared between the two groups.Results:The total effective rate and disease control rate in the observation group were significantly higher than those in the control group: 77.5%(31/40) vs. 55.0%(22/40), 92.5%(37/40) vs. 75.0%(30/40), χ2 = 4.53, 4.50, P<0.05. After the treatment, the levels of CD 3+, CD 4+, CD 8+ and CD 4+/CD 8+ in the observation group were increased ( P<0.05), while those in the control group were decreased ( P<0.05), the levels of CD 3+, CD 4+, CD 8+ and CD 4+/CD 8+ in the observation group after treatment were higher than those in the control group ( P<0.05). After the treatment, the levels of serum VEGF and b-FGF in both groups were decreased ( P<0.05), and the above indicators in the observation group were significantly lower than those in the control group ( P<0.05). The rate of adverse reactions in two groups had no significant differences ( P>0.05). Conclusions:Bevacizumab injection is safe and effective in the treatment of NSCLC, which can significantly improve the immune function of patients and reduce their serum VEGF and b-FGF levels.

Process improvement on the synthesis of atomoxetine / 中国药科大学学报

@#Atomoxetine is a highly selective norepinephrine reuptake inhibitor. Based on the analysis of the literature methods, the synthesis process of atomoxetine was improved. Using 3-chloropropiophenone-1 as the raw material, optically pure target product was obtained by asymmetric reduction, Mitsunobu reaction and condensation reaction in three steps, with a total yield of 26%. The third-step methylation sealing operation was changed to the reaction under normal pressure, which increased the feasibility of industrialization. The improved process operation was simplified and the reaction conditions were mild, which would provide a new method for the preparation of atomoxetine.

Selection of anticoagulant for continuous renal replacement therapy / 中华实用儿科临床杂志

Continuous renal replacement therapy( CRRT)is one of the commonly used organ functional su﹣pport methods in critical disease. It is an essential tool to rescue all kinds of critically ill children. Currently,it is Widely used in the treatment of renal and non－renal diseases. In order to avoid coagulation in the filter or pipeline and ensure the smooth completion of CRRT,anticoagulation treatment is required. The selection of anticoagulant program should folloW the principle of individualization and be comprehensively judged according to the patients＇oWn disease condition, blood coagulation condition,available appropriate drugs and medical staff＇s experience.

Analysis of human genetic resources management / 中华医学科研管理杂志

Objective To explore the management of human genetic resources in our university,propose relevant suggestions for promoting the appropriate protection and scientific management of human genetic resources.Methods Based on the existing regulations and policies,discuss the potential problems relevant to how to strengthen management of human genetic resources in China at institute level.Results Main problems identified including the management scope of human genetic resources is not clear,the inconsistence of application materials,the informed consent and its process involved in biobank and lack of the management of whole process of human genetic resources exploration.Conclusions With the rapid development of biotechnology,the economic value and strategic significance of human genetic resources have become increasingly prominent.Enhancement of training and whole process management,as well as the improvement of informed consent for biobank play important roles in effectively improve the protection of human genetic resources.

Multicenter investigation of extracorporeal membrane oxygenation application in pediatric intensive care unit in China / 中华儿科杂志

Objective@#To survey the conduction and evaluate the effectiveness of extracorporeal membrane oxygenation (ECMO) therapy in pediatric intensive care unit (PICU) in China mainland.@*Methods@#In a questionnaire-based survey, we retrospectively reviewed the application of ECMO in children's hospital and general hospital in China mainland to summarize and analyze the categories of diseases and prognosis of children treated with ECMO therapy.@*Results@#By December 31, 2017, a total of 23 hospitals using ECMO, including 22 tertiary referral hospitals and 1 secondary hospital, among which 16 were children′s hospitals and 7 were general hospitals. Thirty-seven ECMO equipment was available. A total of 518 patients treated with ECMO, within whom 323 (62.4%) successfully weaned from ECMO and 262 (50.6%) survived to discharge. Among 375 pediatric patients, 233 (62.1%) were successfully weaned from ECMO and 186 (49.6%) survived to discharge. Among 143 newborn patients, 90 (62.9%) successfully weaned from ECMO, 76 (53.1%) survived to discharge. ECMO was applied in veno-arterial (VA) mode to 501 (96.7%) patients, veno-venous (VV) mode to 14 (2.7%) patients, and VV-VA conversion mode to 3 (0.6%) patients. Sixty-nine patients required extracorporeal cardiopulmonary resuscitation (ECPR), including 20 newborn patients (29.0%) and 38 pediatric patients (71.0%), who were all with cardiovascular disease. Neonatal respiratory distress syndrome (26/61), persistent pulmonary hypertension of the newborn (PPHN) (12/61), and meconium aspiration syndrome (MAS) (11/61) are the most common pulmonary diseases in newborn patients; among whom, infants with PPHN had highest survival rate (10/12), followed by MAS (9/11). Among newborn patients with cardiovascular diseases, those who admitted were after surgery for congenital cardiac disease were the most common (54/82), while those with septic shock had the highest survival rate (2/3). In pediatric pulmonary diseases, acute respiratory distress syndrome was the most common (42/93), while plastic bronchitis was with the highest survival rate (4/4), followed by viral pneumonia (13/16). Among pediatric cardiovascular diseases, congenital cardiac defect was the most common (124/282), while fulminant myocarditis had the highest survival rate (54/77).@*Conclusion@#The application of ECMO as a rescue therapy for children with severe cardiopulmonary failure has dramatically developed in China mainland.

Progress and ideas of irritable bowel syndrome animal model construction based on combination of disease and syndrome / 中国药理学通报

Establishment of combination of disease and syndrome animal model is an ideal technology platform in TCM research. Currently, many scholars have prepared matching IBS animal models combined typical animal models with etiology, which em-bodies the advantages of syndrome differentiation and promotes the development of combination disease and syndrome animal model. Even though, there still exists some problems about sub-jective evaluation on syndromes, paying more attention on dis-ease and less on syndromes. Therefore, we should deepen the pathogenesis of diseases and TCM syndromes research on animal model replication and improve the method of construction of combination of disease and syndrome animal model through the biological research of combination of disease and syndrome sys-tem. By this way, the idea of preparation animal models will be more mature and the scientific connotation of TCM will be pres-ented more exactly.

Effects of dexmedetomidine on some hemodynamic indexes and consumption of total intravenous anesthetics of laparoscopic hysterectomy / 中国综合临床

Objective To observe the effects of dexmedetomidine on some hemodynamics indexes and the total dosage of propofol and remifentanil of laparoscopic total hysterectomy.Methods Sixty cases patients with total intravenous anesthesia in laparoscopic total hysterectomy were randomly divided into two groups,30 cases in each group.After induction of anesthesia,in the dexmedetomidine group,10 min before anesthesia induction pumping load dexmedetomidine 0.5 μg/kg,and then continue pumped into the maintenance dose of 0.2 μg/(kg · h),stop the medicine in 40 min before the end of operation.The control group were given the same capacity normal saline.The heart rate (HR),systolic blood pressure (SBP),mean arterial pressure (MAP),the total dosage of propofol and remifentanil at different time of before anesthesia(T0),tracheal intubation (T1),beginning of the operation (T2),extubation (T3) were recorded.Results Compared with the control group,hemodynnmic stability(HR,SBP,MAP) of each time of the dexmedetomidine group were better than the control group's,there were statistically significant differences (P＜0.05).The total dosage of propofol,remifentanil of the dexmedetomidine group were (0.11.3 ± 0.013) mg/(kg · min),(0.098 ± 0.009) μg/(kg · min),of the control group were (0.151±0.012) mg/(kg · min),(0.131±0.011) μg/(kg · min),the total dosage of dexmedetomidine group was less than the control group's,there were significant differences(P=0.038,0.045).Conclusion Small dose of dexmedetomidine used in laparoscopic total hysterectomy patients can reduce the total dosage of propofol and remifentanil,more stable hemodynamics at each point,and can be used as a viable programme for clinical application.

Research in application value of outpatient mobile infusion system in the department of infectious outpatient / 中国实用护理杂志

Objective To observe the effect of the outpatient mobile infusion system in the department of infectious outpatient night infusion.Methods From July to December in 2012,520 patients in department of infectious outpatient infusion in our hospital were selected and were divided into the observation group (using outpatient mobile infusion system)and the control group (adopting conventional infusion) with 260 cases in each group.The infusion effect was compared between two groups.Results The average occupancy per patient care time in the observation group was less than the control group,the difference was statistically significant.The satisfaction degree in the observation group was higher than that of the control group,the difference was statistically significant.There was no nursing error occurred in both of the observation group or the control group.Conclusion The use of outpatient mobile infusion system can significantly improve the nurses work efficiency,ensure nursing safety,improve quality of care and patients' satisfaction degree.

Clinical analysis of neonatal necropsy results of 107 cases / 中国小儿急救医学

Objective To investigate the neonatal death causes and the relationship between the causes and the neonatal age,fetus age and the year in order to reduce neonatal mortality.Methods Data of neonatal autopsy and pathological records from 107 neonates in our hospital from January 1998 to May 2008 were collected,analyzed and summarized.Results 40.2%of the cases died within 24 hours and 72.9%died within 7 days after birth.The main death cause for those who died within 7 days was asphyxia(48.6%),and the main death causes ior those who died after 7 days were deformity(34.5%)and hemorrhage(34.5%).The most common death cause for premature bahies Was hyaline membrane disease(29.7%),and the most common one for term infants was congenital heart disease(23.3%).In the past 5 years.asphyxia Was still the most common death causein our country,those who died of infection were on the rise and the deformed babies increased too;on the contrary.those who died of obstetric causes and hemorrhage decreased.Conclusion Neonatal mortality could be reduced by prenatal management,prevention of premature delivery,improvement of the cooperation between pediatrics and obstetrics,and better management of NICU.