Intracavitary electrocardiogram guidance for peripherally inserted central catheter placement in a patient with persistent left superior vena cava: A case report.

Intracavitary electrocardiogram (IC-ECG) guidance is widely used for peripherally inserted central catheter (PICC) placement. The P wave variation has rarely been reported in persistent left superior vena cava (PLSVC). Here, we report a PLSVC case of P wave variation in PICC placement guided by IC-ECG. In this case, the P wave variation of the PLSVC was quite different from that of the right superior vena cava (RSVC). The tip of the catheter was located at the lower segment of the left superior vena cava according to postoperative radiography examination. PICC functioned normally, and no complications occurred.

Characteristics and associated factors of health information-seeking behaviour among patients with inflammatory bowel disease in the digital era: a scoping review.

BACKGROUND: Health Information-Seeking Behaviour (HISB) is necessary for self-management and medical decision-making among patients with inflammatory bowel disease (IBD). With the advancement of information technology, health information needs and seeking are reshaped among patients with IBD. This scoping review aims to gain a comprehensive understanding of HISB of people with IBD in the digital age. METHODS: This scoping review adhered to Arksey and O'Malley's framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews frameworks (PRISMA-ScR). A comprehensive literature search was conducted in PubMed, Embase, Web of Science, PsycINFO, CINAHL, and three Chinese databases from January 1, 2010 to April 10, 2023. Employing both deductive and inductive content analysis, we scrutinized studies using Wilson's model. RESULTS: In total, 56 articles were selected. Within the information dimension of HISB among patients with IBD, treatment-related information, particularly medication-related information, was identified as the most critical information need. Other information requirements included basic IBD-related information, daily life and self-management, sexual and reproductive health, and other needs. In the sources dimension, of the eight common sources of information, the internet was the most frequently mentioned source of information, while face-to-face communication with healthcare professionals was the preferred source. Associated factors were categorized into six categories: demographic characteristics, psychological aspects, role-related or interpersonal traits, environmental aspects, source-related characteristics, and disease-related factors. Moreover, the results showed five types of HISB among people with IBD, including active searching, ongoing searching, passive attention, passive searching, and avoid seeking. Notably, active searching, especially social information seeking, appeared to be the predominant common type of HISB among people with IBD in the digital era. CONCLUSION: Information needs and sources for patients with IBD exhibit variability, and their health information-seeking behaviour is influenced by a combination of diverse factors, including resource-related and individual factors. Future research should focus on the longitudinal changes in HISB among patients with IBD. Moreover, efforts should be made to develop information resources that are both convenient and provide credible information services, although the development of such resources requires further investigation and evaluation.

Barriers and facilitators of adherence to awake prone positioning: a qualitative study using the COM-B model.

BACKGROUND: Awake prone positioning (APP) is a recommended therapy for non-intubated ARDS patients, but adherence can be challenging. Understanding the barriers and facilitators of adherence to APP is essential to increase the adherence of therapy and improve patient outcomes. The objective of this study was to explore the barriers and facilitators of adherence to awake prone ventilation using a qualitative approach and the Capability, Opportunity, Motivation-Behavior (COM-B) model. METHODS: Semi-structured, in-depth interviews were conducted with patients involved in awake prone ventilation. Data were analyzed using an adapted inductive thematical approach and mapped onto the COM-B model to identify barriers and facilitators to adherence of APP. RESULTS: Nineteen patients were interviewed (aged 55-92 years). Fifteen themes were identified and mapped directly on to the six COM-B constructs, with "physical challenges" related to physical capability being the primary barrier. These COM-B sub-items reflected five other barriers, including low self-efficacy(M), treatment environment(O), availability of time(O), misconceptions about the treatment(C), and insufficient knowledge(C). Key facilitators in adhering to APP were ability to identify and overcome obstacles(C), availability and affordability of treatment(O), family influences(O), beliefs and trust in treatment(M), fear about the disease(M), and perceived benefits(M). In addition, three factors played the role of both facilitator and barrier, such as media influences(O), healthcare influences(O), and behavioral habits(M). CONCLUSION: The COM-B model was proved to be a useful framework for identifying the barriers and facilitators of adherence to awake prone ventilation. The findings suggest that adherence behavior is a dynamic and balanced process and interventions aimed at improving adherence to APP should address the barriers related to capability, opportunity, and motivation. Healthcare providers should focus on providing proper guidance and training, creating a comfortable environment, and offering social support to improve patients' capability and opportunity. Additionally, promoting patients' positive beliefs and attitudes towards the treatment and addressing misconceptions and fears can further enhance patients' motivation to adhere to the treatment plan.

Midline catheter tip position and catheter-related complications in antimicrobial therapy: A multi-center randomized controlled trial.

BACKGROUND: The use of midline catheters (MCs) in intravenous therapy has increased over the last few years; however, scientific evidence is scarce. The recommendations for its specific tip position and safe use in antimicrobial therapy are not well established, which increases the risk of catheter-related complications. OBJECTIVE: This study aimed to provide evidence for selecting MC tip positions for safe use in antimicrobial therapy. DESIGN: This prospective, randomized controlled trial compared catheter-related complications with different tip positions. Participants were assigned to three different catheter tip groups, and the relationship between the tip position and catheter-related complications was observed during antimicrobial therapy. SETTING: Multicenter trial based in intravenous therapy centers at six Chinese hospitals. PARTICIPANTS: A fixed-point continuous convenience sampling method was used to enroll 330 participants. Three different study groups with equal numbers of participants (n = 110) were established using a randomization technique. METHODS: The incidence of catheter-related complications and catheter retention time was compared among the three groups. The catheter measurement data between the three groups were compared using one-way ANOVA or the Kruskal-Wallis tests. Counting data were compared using chi-square tests, Fisher's exact tests, and Kruskal-Wallis tests. Post-hoc tests were conducted to compare the incidence of complications among the three groups. We followed a time-to-event analysis approach and used Kaplan-Meier curves and log-rank tests to analyze the relationship between catheter-related complications and different tip positions. RESULTS: The total incidence of catheter-related complications in Experimental Groups 1 and 2 as well as the control group were 10.09%, 17.98%, and 33.73%, respectively. Statistically significant differences existed between the groups (p < 0.0001). In pairwise comparisons of the three groups, significant differences were evident in the incidence of complications between Experimental Group 1 and the control group (RD 19.40%, confidence interval 7.71-31.09). No statistical significance in the incidence of complications between Experimental Group 1 and Experiment Group 2 (RD -4.93%, confidence interval -14.80-4.95) and in the incidence of complications between Experimental Group 2 and the control group (RD 14.47%, confidence interval 1.82-27.12) were noted. CONCLUSION: Catheter-related complications were reduced when the tip of the Midline Catheter was located in the subclavian or axillary vein of the chest wall. TRIAL REGISTRATION: NCT04601597(https://clinicaltrials.gov/ct2/show/NCT04601597). Registration date: September 1, 2020.

Discrimination of Cell Death Types with an Activatable Fluorescent Probe through Visualizing the Lysosome Morphology.

Cell death plays a vital role in body development, maintenance of tissue function, and homeostasis. Accurate evaluation of cell death types is of great importance for pharmacological and pathological research. However, there is a lack of efficient fluorescent probes to discriminate various cell states. Here, we design and synthesize a novel activatable fluorescent probe PNE-Lyso to detect intracellular pH and hexosaminidases with two kinds of fluorescence signals. PNE-Lyso could distinguish dead cells from healthy cells based on a dual-color mode by targeting the lysosome and evaluating lysosomal hexosaminidase activity. Significantly, PNE-Lyso could also discriminate apoptotic and necrotic cells through visualizing lysosome morphology that is adjusted by the integrity of the lysosome membrane. Moreover, probe PNE-Lyso was successfully applied to investigate the drug-induced cell death process. To the best of our knowledge, this work is the first time cell death types have been distinguished based on a single fluorescent probe.

A retrospective observational study on maintenance and complications of totally implantable venous access ports in 563 patients: Prolonged versus short flushing intervals.

OBJECTIVES: To assess whether the extension of the flushing interval will increase risks of complications associated with totally implantable venous access port (TIVAP) in the off-treatment period. METHODS: A retrospective single-center observational study was performed. Patients with a TIVAP in the off-treatment period that underwent regular flushing in our clinic were included. Data concerning patients and their TIVAPs were recorded. Patient baseline characteristics and TIVAP-related complications were analyzed. Continuous variables were analyzed by ANOVA or the Kruskal-Wallis H test. To compare the occurrence of TIVAP-related complications, the chi-square test was used; if needed, Fisher's exact test was used. RESULTS: Totally 607 patients were reviewed, and 563 patients were finally included. Thirteen complications were recorded, including 11 cases of catheter occlusion (1.95%), one case of port cannula rotation (0.18%), and one case of catheter tip malposition (0.18%). No device-related infection or venous thrombosis was recorded. Among these patients, the average flushing interval was 35.27 ± 13.09 days. Patients were divided into three groups according to the flushing interval: every 28 days or less (Group 1, n = 133); every 29-44 days (Group 2, n = 350); and every 45 days or more (Group 3, n = 80). No significant difference in catheter-related complications was found among the three groups (P > 0.05). CONCLUSIONS: In the TIVAP off-treatment period, patients without any history of TIVAP-related complications during approximately one year can attempt to prolong the flushing interval to more than 4 weeks; we further suggest that 5-6 weeks may be an appropriate option for these patients.

Blood sampling from peripherally inserted central catheter is effective and safe for patients with head and neck cancers.

OBJECTIVE: To evaluate the validity of laboratory tests for blood sampling from a peripherally inserted central catheter. METHODS: A total of 22 patients diagnosed with head and neck cancers were enrolled. In total, 101 paired blood samples were taken both via venipuncture and peripherally inserted central catheter for hematology and biochemistry testing. Paired t tests and linear correlation analysis were used to evaluate the results. Blood sampling-related pain was recorded by visual analogue scales and numerical rating scales. Infusion occlusion, hemolysis, and catheter-related blood stream infection were also recorded. RESULTS: The peripherally inserted central catheter-associated test results were slightly lower than those with venipuncture. Some parameters differed more than others. However, the degree of difference was less than 5% for every pair. There was a high correlation between the test results with two methods of blood sampling with the representative equation approximately being "y = x." According to visual analogue scales and numerical rating scale analysis, the pain degree with peripherally inserted central catheter was significantly lower than that of the venipuncture (p < 0.001). No case of infusion occlusion, catheter-related blood stream infection was reported with both methods. Hemolysis rate in blood samples from peripherally inserted central catheter (1/101) was much lower than that seen with venipuncture (11/101) with significant difference (p = 0.0056). CONCLUSION: Blood sampling via peripherally inserted central catheter and venipuncture showed equivalent reliability in laboratory testing. Compared with venipuncture, blood sampling via peripherally inserted central catheter causes less pain and is safer. Blood sampling via peripherally inserted central catheter is strongly recommended for clinical use.

Detection of peripherally inserted central catheter (PICC) in chest X-ray images: A multi-task deep learning model.

BACKGROUND AND OBJECTIVE: Peripherally inserted central catheter (PICC) is a novel drug delivery mode which has been widely used in clinical practice. However, long-term retention and some improper actions of patients may cause some severe complications of PICC, such as the drift and prolapse of its catheter. Clinically, the postoperative care of PICC is mainly completed by nurses. However, they cannot recognize the correct position of PICC from X-ray chest images as soon as the complications happen, which may lead to improper treatment. Therefore, it is necessary to identify the position of the PICC catheter as soon as these complications occur. Here we proposed a novel multi-task deep learning framework to detect PICC automatically through X-ray images, which could help nurses to solve this problem. METHODS: We collected 348 X-ray chest images from 326 patients with visible PICC. Then we proposed a multi-task deep learning framework for line segmentation and tip detection of PICC catheters simultaneously. The proposed deep learning model is composed of an extraction structure and three routes, an up-sampling route for segmentation, an RPNs route, and an RoI Pooling route for detection. We further compared the effectiveness of our model with the models previously proposed. RESULTS: In the catheter segmentation task, 300 X-ray images were utilized for training the model, then 48 images were tested. In the tip detection task, 154 X-ray images were used for retraining and 20 images were used in the test. Our model achieved generally better results among several popular deep learning models previously proposed. CONCLUSIONS: We proposed a multi-task deep learning model that could segment the catheter and detect the tip of PICC simultaneously from X-ray chest images. This model could help nurses to recognize the correct position of PICC, and therefore, to handle the potential complications properly.

Application of refined management in prevention and control of the coronavirus disease 2019 epidemic in non-isolated areas of a general hospital.

OBJECTIVE: This article summarizes the experience in the prevention and control of coronavirus disease 2019(COVID-19) epidemic in non-isolated areas in a general hospital. METHODS: Based on refined management theory, we professionally developed the standards for prevention and control of COVID-19 in non-isolated areas, systematically implemented various prevention and control measures, performed gridding audits, effectively communicated among teams and between medical staff and patients assisted by information techniques, and reported results for quality improvement. RESULTS: There was no hospital-acquired COVID-19 infections among staff in the hospital. The rates of mask-wearing, epidemiological history screening, and the medical supplies disinfection were all 100% in the hospital. The accuracy rate of mask-wearing of patients and their families was 73.79% and the compliance rate of their hand hygiene was 40.78%. CONCLUSION: Refined management strategies for the prevention and control of COVID-19 infection in non-isolated areas of the general hospital are effective. The accuracy rate of mask-wearing and hand hygiene compliance of patients and their families need to be further improved.

[Impact of Tourism on Bacterial Communities of Karst Underground River: A Case Study from Two Caves in Fengdu, Chongqing].

In this research, the bacterial community compositions of underground water in a tourist and pristine cave were studied. Xueyu Cave and Shuiming Cave are tourist and pristine caves, respectively, in the same karst cave system located in Chongqing, southwest China. To understand the impact of tourism on bacterial community compositions in underground water that flows through the caves, filtered materials from water were collected, and 16S rDNA gene sequences were obtained by high-throughput sequencing. The Shuiming Cave (the pristine cave) had less diversity than Xueyu Cave (the tourist cave) based on the Shannon's diversity index according to Illumina operational taxonomic units (OTUs). Proteobacteria, represented mostly by γ-Proteobacterium and Bacteroidetes, dominated both systems. OTUs from Shuiming Cave were dominated by 38% Proteobacteria, 24% Chlorobi, and 19% Bacteroidetes. In the Xueyu Cave, OTUs from upstream samples were comprised of 62% Proteobacteria but comprised 64% in the downstream samples. In the Xueyu Cave, Bacteroidetes accounted for 11% of the total OTUs in the upstream sample and 16% in the downstream. Among the γ-Proteobacterium and Bacteroidetes, Acinetobacter, Pseudomonas spp., and Flavobacteriaceae, which are related to potentially pathogenic species, were prevalent in the Xueyu Cave, while Methylococcaceae-uncultured, Methylomonas spp., and Methylobacter, all methane-oxidizing bacteria, had high relative abundances in the Shuiming Cave. These results revealed that potentially more pathogenic bacteria are present in the stream waters from the tourist cave, which has important implications for the protection of tourist caves. The RDA analysis of the environmental factor and bacteria community in groundwater showed that the distribution of pathogenic bacteria was positively correlated with the cave air CO2, and the Spearman correlation analysis of the two environmental factors indicated that the influence of the number of tourists on the structure of the bacterial community in the groundwater was more obvious and led to the disappearance of a large number of native bacteria. We proposed that tourist caves control the number of daily tourists and that they enter in batches and increase the import and export of closed devices to avoid the cave air exchange inside and outside. In addition, it was recommended that they increase the import and export of sterilization devices to reduce tourists with bacteria and organic matter, and avoid leaving garbage in the hole to avoid cave microbial exchange inside and outside. A reduction in the fixed lighting inside caves should be required to reduce long exposure, since the tourists can bring individual source lighting.

Retrospective data about the catheter-related complications and management in massive bus burn casualties.

PURPOSE: This is a single-center, descriptive report of the management and complications of venous catheter use in 19 severely burned passengers from a bus fire that occurred on July 5, 2014, in Hangzhou. METHODS: We recorded the parameters of the catheters insertion and indwelling. Sampling of each removed catheter was conducted to monitor for catheter-related infections. Bedside ultrasound screening was performed for recording central venous catheter (CVC)-related complications. RESULTS: Of the 174 venous accesses placed, 108 were CVCs. 27 (25.0%) catheter tip cultures (CTC) were positive; 12 (11.1%) were catheter-related blood stream infections (CRBSI). Acinetobacter baumannii was the most prominent bacterial infection for both CTC- (55.56%) and CRBSI- (75.00%) positive catheters. CTC- and CRBSI-positive rates were higher during the emergency stage, and both dropped rapidly after reform measures (chi-square test, p = 0.003), and all were negative after the no.8 catheters. Accumulative regression results indicated that total body surface area burned (TBSA), number of catheters, days of indwelling, and bloodstream infections were independently associated with CTC results, while gender and number of catheters were independently associated with CRBSI results. 1 femur vein thrombosis was detected and cured. CONCLUSIONS: Bedside ultrasound and professional IV team for CVC management are pivotal for massive burn victims. Their intervention helps control CVC-related infections and other complications. A. baumannii was the most frequent bacterial infection found in both CTC- and CRBSI-positive catheters. Several most important factors associated with catheter-related infections were concluded. This information alerts us to watch for patients with such warning factors.

Clinical evaluation of the use of an intracardiac electrocardiogram to guide the tip positioning of peripherally inserted central catheters.

The use of peripherally inserted central catheters (PICCs) provides important central venous accesses for clinical treatments, tests and monitoring. Compared with the traditional methods, intracardiac electrocardiogram (ECG)-guided method has the potential to guide more accurate tip positioning of PICCs. This study aimed to clinically evaluate the effectiveness of an intracardiac ECG to guide the tip positioning by monitoring characteristic P-wave changes. In this study, eligible patients enrolled September 2011 to May 2012 according to the inclusion and exclusion criteria received the catheterization monitored by intracardiac ECG. Then chest radiography was performed to check the catheter position. The results revealed that, with 117 eligible patients, all bar one patient who died (n = 116) completed the study, including 60 males and 56 females aged 51.2 ± 15.1 years. Most (n = 113, > 97%) had characteristic P-wave changes. The intracardiac ECG-guided positioning procedure achieved correct placement for 112 patients (96.56%), demonstrating 99.12% sensitivity and 100% specificity. In conclusion, the intracardiac ECG can be a promising technique to guide tip positioning of PICCs. However, since the sample size in this study is limited, more experience and further study during clinical practice are needed to demonstrate achievement of optimal catheterization outcomes.

[Impacts of Land Use on the Source of Dissolved Fatty Acids in Epikarst Spring During Rainy Season].

Fatty acids were quantitatively analyzed by gas chromatography-mass spectrometer (GC-MS). Dissolved fatty acids were collected from Nanchuan epikarst spring. The results of BQ, LQ, HQ showed that the average contents of fatty acids were 14870, 12912 and 8801 ng·L-1 from May to July, respectively, and followed the order of SFA> MUFA> BrFA> PUFA. The monomers with highest content were C16:0 and C18:0. From May to July, the fatty acid content increased in BQ , LQ, HQ. The differences in vegetation coverage and bedrock bare rate, as well as the interaction of the dilution effect and soil transfer increase, led to the changes in content and the composition of the fatty acids. Based on the molecular characteristic indices of fatty acids, like H/L, CPIh, TARFA about BQ, LQ, HQ, and contents of fatty acids which were mainly originated from bacteria, phytoplankton or terrigenous higher plant, it was indicated that fatty acids were mainly originated from higher plant in LQ in May, from phytoplankton input in HQ in July, while from bacteria in the other months in LQ, HQ and from May to July in BQ.

[Modeling the Influencing Factors of Karstification and Karst Carbon Cycle in Laboratory].

To analyze the influencing factors of karstification and karst carbon cycle, a simulation experiment was carried out and 6 soil columns were designed. The results showed that the content of H2O4, hydrodynamic condition and thickness of the soil had important influence on karstification and karst carbon cycle. For the soil columns which were covered by the same thickness of soil, the concentrations of Ca2+ + Mg2+ and SO4(2-) followed the order of B20-2 > B20-1 > B20-3, B50-2 > B50-1 > B50-3. This meant that input of H2SO4 enhanced the karstification and increasing infiltration water had significant dilution effect on the chemical properties. For the soil columns with different thickness of soil but with the same slag pile and hydrodynamic conditions, the concentrations of Ca2+ + Mg2+ and SO4(2-) followed the order of B50-1 > B20-1, B50-2 > B20-2, B50-3 > B20-3. It was demonstrated that more carbonate rock was dissolved under the thick soil columns. In addition, the net consumption of CO2 mainly depended on the content of H2SO4 in this experiment due to slight contribution of H2CO3 to carbonate rock dissolution. More content of H2SO4 brought about less net consumption of C02, but B50-2 was an exception. Organic matter and other nutrients might be input into deep soil with the slag pile, and they promoted the production of soil C)2. Therefore, more CO2 was consumed due to the increased contribution of H2CO to karstification.

[Influencing Factors for Hydrochemistry and δ13CDIC of Karst Springs].

To gain more knowledge on the change of karst spring and its influencing factors, the hydrochemistry and δ13CDIC of Baishuwan spring, Lanhuagou spring and Hougou spring were monitored in rainy season (from June 2014 to October 2014) and contrasted with the results obtained in dry season. The results showed that more carbonate rock was dissolved and less CO2 was consumed in rainy season. And for Lanhuagou spring and Hougou spring, the CO2 consumption was less than the production. Compared to other months in rainy season, the least carbonate rock dissolution and the most CO2 consumption were observed in July 2014. Influenced by hydrodynamic condition, carbonate rock dissolved by HNO3 and H2SO4 increased while that dissolved by H2CO3 decreased during the rainy season. The δ13CDIC increased due to the HNO3 and H2SO4 dissolution of carbonate rock and the dehydration of HCO3-. Therefore, δ13CDIC correlated negatively to HCO3- concentration and positively to NO3- + SO(4)2- concentration. It was indicated that the hydrochemistry and δ13CDIC of karst springs were affected by the HNO3, H2SO4 and hydrodynamic condition.

[Difference of Karst Carbon Sink Under Different Land Use and Land Cover Areas in Dry Season].

In order to identify the distinction of soil CO2 consumed by carbonate rock dissolution, Baishuwan spring, Lanhuagou spring and Hougou spring were selected as objects to monitor the hydrochemistry from November 2013 to May 2014. The results showed that the highest HCO3- concentration was observed in Baishuwan spring which is covered by pine forest, while the lowest HCO3- concentration was observed in Hougou spring which is mainly covered by cultivated land. In Baishuwan spring, HCO3- was mainly derived from carbonic acid dissolving carbonate rock and the molar ratio between Ca(2+) + Mg2+ and HCO3- was close to 0. 5; while the molar ratio between Ca(2+) + Mg2+ and HCO3- exceeded 0.5 because the carbonate rock in Lanhuagou spring and Hougou spring was mainly dissolved by nitric acid and sulfuric acid. Because of the input of litter and the fact that gas-permeability of soil was limited in Baishuwan spring catchment, most of soil CO2 was dissolved in infiltrated water and reacted with bedrock. However, in Lanhuagou spring catchment and Hougou spring catchment, porous soil made soil CO2 easier to return to the atmosphere in the form of soil respiration. Therefore, in order to accurately estimate karst carbon sink, it was required to clarify the distinction of CO2 consumption by carbonate rock dissolution under different land use and land cover areas.

A stewardship intervention program for safe medication management and use of antidiabetic drugs.

BACKGROUND: Diabetes patients are complex due to considerations of polypharmacy, multimorbidities, medication adherence, dietary habits, health literacy, socioeconomic status, and cultural factors. Meanwhile, insulin and oral hypoglycemic agents are high-alert medications. Therefore it is necessary to require a multidisciplinary team's integrated endeavors to enhance safe medication management and use of antidiabetic drugs. METHODS: A 5-year stewardship intervention program, including organizational measures and quality improvement activities in storage, prescription, dispensing, administration, and monitoring, was performed in the Second Affiliated Hospital of Zhejiang University, People's Republic of China, a 3,200-bed hospital with 3.5 million outpatient visits annually. RESULTS: The Second Affiliated Hospital of Zhejiang University has obtained a 100% implementation rate of standard storage of antidiabetic drugs in the Pharmacy and wards since August 2012. A zero occurrence of dispensing errors related to highly "look-alike" and "sound-alike" NovoMix 30(®) (biphasic insulin aspart) and NovoRapid(®) (insulin aspart) has been achieved since October 2011. Insulin injection accuracy among ward nurses significantly increased from 82% (first quarter 2011) to 96% (fourth quarter 2011) (P<0.05). The number of medication administration errors related to insulin continuously decreased from 20 (2011) to six (2014). The occurrence rate of hypoglycemia in non-endocrinology ward diabetes inpatients during 2011-2013 was significantly less than that in 2010 (5.03%-5.53% versus 8.27%) (P<0.01). Percentage of correct management of hypoglycemia by nurses increased from 41.5% (April 2014) to 67.2% (August 2014) (P<0.01). The percentage of outpatient diabetes patients receiving standard insulin injection education increased from 80% (April 2012) to 95.2% (October 2012) (P<0.05). Insulin injection techniques among diabetes outpatients who started to receive insulin were better than indicated in data from two questionnaire surveys in the literature, including the percentage checking injection sites prior to injection (85.6%), priming before injection (98.1%), rotation of injecting sites (98.1%), remixing before use (94.5%), keeping the pen needle under the skin for >10 seconds (99.4%), and using the pen needle only once (88.7%). On-site inspection indicated of great improvement in the percentage of drug-related problems in the antidiabetes regimen between the first and second quarter of 2014 (1.08% versus 0.28%) (P<0.05). CONCLUSION: Quality improvements in safe medication management and use of antidiabetic drugs can be achieved by multidisciplinary collaboration among pharmacists, nurses, physicians, and information engineers.

[Influences of Biological Processes on Geochemical Characteristics: An Example of a Mountain Karst Pool in Spring Season].

Karst hydrologic system is quite sensitive to the surrounding environment, which leads to changes in the quality of karst water within diel, hours even minutes. Many surface water undergoes changes of pH value, dissolved gas, trace elements, nutrition and other hydrochemical parameters in a daily timescale. The Shuifang spring and its draining pool are located in Jinfo Mountain in Chongqing, the middle karst mountain belonging to temperate climate with an elevation of about 2050 m a. s. l. Diel cycles of geochemistry were measured for three days and nights to investigate the influence of biological processes on the geochemistry of the karst pool. Results showed that the geochemistry of Shuifang spring didn't exhibit diel variations, while the pool water appeared diurnal change, even if the variation amplitudes of water temperature, pH value, dissolved oxygen and specific conductance were slight. Under different weather conditions, variation amplitude of the geochemical parameters in the pool appeared discriminatory. pCO2 and concentrations of Ca2+, dissolved inorganic carbon (DIC) decreased during the day time and increased in night, while calcite saturation index (SIc) showed an inverse trend. Those phenomena might be attributed to water temperature change, calcite precipitation or dissolution and the process of metabolism by the aquatic plants in the pool. It was found that the influence of water temperature change on pCO2 accounted for only 0.79% to 10.01% by means of calculation of Henry constants. DIC loss contributed by physical factors, such as temperature and calcite precipitation, accounted for 39%, whereas the metabolism of aquatic plants accounted for 61%.

Repositioning techniques of malpositioned peripherally inserted central catheters.

AIMS AND OBJECTIVES: To describe potential repositioning techniques of malpositioned peripherally inserted central catheters. BACKGROUND: Various repositioning methods have been applied in clinical practice in managing malpositioned peripherally inserted central catheters, and many of them are proved effective. However, little publication reviewed on those literatures describing repositioning techniques to malpositioned peripherally inserted central catheters. DESIGN: Systematic review. The repositioning techniques were classified and concretely described according to different locations of malpositioned peripherally inserted central catheter tips. METHODS: Literature and relevant guidelines were reviewed, focusing on malpositioned locations and incidence, as well as repositioning skills to peripherally inserted central venous catheters. Six databases were searched, including MEDLINE, web of science, CINAHL, Cochrane library, Wanfang database and Chinese National Knowledge Infrastructure. The articles (n = 21) were analysed using inductive content analysis. RESULTS: The malpositioned locations of postplacement peripherally inserted central catheter tips mainly include right atrium, right ventricular, axillary vein, ipsilateral and contralateral internal jugular vein, subclavian vein, brachiocephalic vein, other small venous branches or catheter looped. Repositioning techniques contained automatic reposition, manual repositioning techniques, re-advancing catheters and catheters' replacement according to different malpositioned patterns. CONCLUSIONS: The most appropriate repositioning techniques should be adopted on the basis of malpositioned locations, direction and length of the malpositioned tip, patients' integrated conditions and available medical equipments to maintain the catheter tip in the best position. RELEVANCE TO CLINICAL PRACTICE: The repositioning techniques described in this review can be applied in clinical practice to ensure the infusion therapy through peripherally inserted central catheter more economical and safe.

[Effect of sleep quality on day cycle fatigue in ward nurses].

OBJECTIVE: To explore the effect of sleep quality on day cycle work fatigue in ward nurses. METHODS: Through a cluster sampling of three hospitals, 479 clinical frontline nurses were investigated in Hangzhou, Zhejiang, China. Using Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality; Using self-reported work-related fatigue symptom scale to evaluate day cycle fatigue status; common information was also collected. RESULTS: The sleep quality of ward nurses is generally poor, with total PSQI score 7.31 +/- 3.45. 41.75% ward nurses have total PSQI score over 7, the total PSQI score showed a negative linear correlation with educational background (r = -0.11, P = 0.01), educational background also represented a negative correlation with sleep quality, sleep latency and sleep duration; there are no correlation between sleep and marriage, work age, professional title and duty. Work-related fatigue was closely correlated with sleep quality: Total PSQI score showed a positive correlation with four daytime points fatigue in the next day (r = 0.42, r = 0.34, r = 0.25, r = 0.33, P < 0.01). Total PSQI score is also related to five fatigue factors in four daytime points. There are significant correlation between seven factors of sleep and fatigue levels of four time points. Multiple regression analysis showed that Sleep quality, day function; sleep disturbance and drug use pay important part in work fatigue. There is no correlation between sleep quality and delayed off-work (r = 0.06, P = 0.17). CONCLUSION: Managers should think highly of sleep quality of ward nurses, acknowledge its degree of work fatigue and apply evidence based methods arrange work responsibility and follow sheet, then rationalize human resources management, emphasize sleep hygiene education, improve sleep quality and reduce work fatigue.