Explore the vast range of titles available.

The Surviving Sepsis Campaign (SSC) believed that early identification of septic shock, aggressive fluid resuscitation and maintenance of effective perfusion pressure should be carried out. However, some of the current research focused on a single death factor for sepsis patients, based on a limited sample, and the research results of the relationship between comorbidities and sepsis related death also have some controversies. Therefore, our study used data from a large sample of 9,544 sepsis patients aged 18-85 obtained from the MIMIC-IV database, to explore the risk factors of death in patients with sepsis. We used the general clinical information, organ dysfunction scores, and comorbidities to analyze the independent risk factors for death of these patients. The death group had significantly higher organ dysfunction scores, lower BMI, lower body temperature, faster heart rate and lower urine-output. Among the comorbidities, patients suffering from congestive heart failure and liver disease had a higher mortality rate. This study helps to identify sepsis early, based on a comprehensive evaluation of a patient's basic information, organ dysfunction scores and comorbidities, and this methodology could be used for actual clinical diagnosis in hospitals.

Background Reasonable dietary management is the most important and effective treatment for citrin deficiency. However, as this is a chronic and lifelong disease, managing citrin deficiency requires not only early diagnosis and the use of lactose-free or low-carbohydrate formula but also sustained adherence to a lifelong low-carbohydrate diet. This study aimed to investigate the dietary challenges faced by caregivers, particularly in non-familial settings such as schools, during children’s social development. Results Seventeen participants were recruited for our study, comprising 16 mothers and 1 grandmother. We applied constructivist grounded theory to explore the dietary management challenges faced by caregivers. Four focused codes were developed through analysis of caregivers’ interviews: (1) Upon entering school, concealment is the best choice; (2) reality has rendered it unfeasible for me to maintain command over the situation; (3) teachers and peers are gradually participating in food management; and (4) children need to establish their own individual identities within society. The findings revealed that as children entered school, caregivers shifted from direct to indirect involvement in dietary management. The involvement of teachers and peers, along with the development of children’s autonomy, reduced the level of caregiver control over dietary management. Conclusions After the children began school, the caregivers’ involvement in dietary management gradually decreased. The presence of teachers and peers complicates dietary management for preschool and school-age children with citrin deficiency, progressively diminishing caregiver control.

Objectives Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, particularly among the elderly, resulting in high rates of intensive care unit (ICU) admissions. Malnutrition is common in elderly patients and has been associated with poor prognosis in patients with COPD. However, its impact in the ICU setting remains incompletely defined. The objective of this study is to examine the association between malnutrition, as measured by the Geriatric Nutritional Risk Index (GNRI), and adverse outcomes in older patients with COPD in the ICU. Methods A cohort study of 2,824 older COPD patients admitted to the ICU from 2008 to 2019 was conducted. The association between GNRI scores and outcomes including in-hospital mortality, risk of pressure injuries, and length of ICU stay was evaluated. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. A causal mediation analysis was employed to identify potential mediating variables and to calculate the proportion mediated. Results The median age of study participants was approximately 75 years, with 1,281 (45.4%) being female. Lower GNRI scores (GNRI ≤ 98) were significantly associated with increased in-hospital mortality (OR: 1.48, 95% CI: 1.08–2.05, p  = 0.015), higher incidence of pressure injuries (OR: 1.97, 95% CI: 1.54–2.54, p  < 0.001), and longer ICU stays (OR: 1.51, 95% CI: 1.18–1.94, p  = 0.001). Mediation analysis indicated that pressure injury accounted for approximately 22.9% of the association between malnutrition and in-hospital mortality. Conclusions Lower GNRI scores, indicative of malnutrition, are associated with adverse outcomes in elderly ICU patients with COPD. The findings highlight the importance of early nutritional assessment and intervention in this high-risk group to improve survival and reduce complications.

Purpose A comprehensive health history contributes to identifying the most appropriate interventions and care priorities. However, history-taking is challenging to learn and develop for most nursing students. Chatbot was suggested by students to be used in history-taking training. Still, there is a lack of clarity regarding the needs of nursing students in these programs. This study aimed to explore nursing students’ needs and essential components of chatbot-based history-taking instruction program. Methods This was a qualitative study. Four focus groups, with a total of 22 nursing students, were recruited. Colaizzi's phenomenological methodology was used to analyze the qualitative data generated from the focus group discussions. Results Three main themes and 12 subthemes emerged. The main themes included limitations of clinical practice for history-taking, perceptions of chatbot used in history-taking instruction programs, and the need for history-taking instruction programs using chatbot. Students had limitations in clinical practice for history-taking. When developing chatbot-based history-taking instruction programs, the development should reflect students’ needs, including feedback from the chatbot system, diverse clinical situations, chances to practice nontechnical skills, a form of chatbot (i.e., humanoid robots or cyborgs), the role of teachers (i.e., sharing experience and providing advice) and training before the clinical practice. Conclusion Nursing students had limitations in clinical practice for history-taking and high expectations for chatbot-based history-taking instruction programs.

Background Dietary management is the most important and effective treatment for citrin deficiency, as well as a decisive factor in the clinical outcome of patients. However, the dietary management ability of caregivers of children with citrin deficiency is generally poor, especially in East Asia where carbohydrate-based diets are predominant. The aim of this study was to identify the difficulties that caregivers encounter in the process of home-based dietary management, and the reasons responsible for these challenges. Results A total of 26 caregivers of children with citrin deficiency were recruited, including 24 mothers, one father, and one grandmother. Grounded theory was employed to identify three themes (covering 12 sub-themes) related to the dilemma of dietary management: dietary management that is difficult to implement; conflicts with traditional concepts; and the notion that children are only a part of family life. The first theme describes the objective difficulties that caregivers encounter in the process of dietary management; the second theme describes the underlying reasons responsible for the non-adherent behavior of caregivers; the third theme further reveals the self-compromise by caregivers in the face of multiple difficulties. Conclusions This study reflects the adverse effects of multi-dimensional contradictions on the adherence of caregivers to dietary management. These findings reveal that the dietary management of citrin deficiency is not only a rational process, rather it is deeply embedded in family, social, and dietary traditions.

This study aimed to evaluate the reliability of a self-administered oral nutritional supplement adherence assessment scale for patients with colorectal cancer. A presurvey was conducted with 25 colorectal cancer patients already taking nutritional supplements, obtained using purposive sampling to assess the comprehensibility and linguistic expression of the scale items. Following this, 310 questionnaires were distributed during the main survey, with 303 validly returned, yielding a validity rate of 97.74%. The scale underwent linguistic debugging, resulting in a final version comprising 3 dimensions and 28 items. Exploratory factor analysis (EFA) demonstrated statistically significant KMO values ranging from 0.864 to 0.902 for the three dimensions (p<0.001). Two common factors were extracted from the knowledge dimension, contributing to a cumulative variance of 66.22%. One common factor was extracted from the belief dimension, with a cumulative variance contribution of 66.29%. The behavior dimension also demonstrated a cumulative variance contribution of 61.78%. The scale exhibited a Cronbach's α coefficient of 0.904, split-half reliability of 0.857, a retest reliability coefficient of 0.859, and a content validity index (S-CVI) of 0.903. The developed oral nutritional supplement adherence assessment scale for colorectal cancer patients demonstrated strong reliability and validity, making it an effective tool for evaluating adherence to oral nutritional supplementation. This scale can serve as a reference for the future development of related assessment tools and may contribute to improving nutritional management and clinical outcomes for patients with colorectal cancer.

Mechanical bowel preparation (MBP), a routine nursing procedure before paediatric bowel surgery, is widely should in clinical practice, but its necessity remains controversial. In a systematic review and meta‐analysis, we evaluated the effect of preoperative MBP in paediatric bowel surgery on postoperative wound‐related complications in order to analyse the clinical application value of MBP in paediatric bowel surgery. As of November 2023, we searched four online databases: the Cochrane Library, Embase, PubMed, and Web of Science. Two investigators screened the collected studies against inclusion and exclusion criteria, and ROBINS‐I was used to evaluate the quality of studies. Using RevMan5.3, a meta‐analysis of the collected data was performed, and a fixed‐effect model or a random‐effect model was used to analyse OR, 95% CI, SMD, and MD. A total of 11 studies with 2556 patients were included. Most of studies had moderate‐to‐severe quality bias. The results of meta‐analysis showed no statistically significant difference in the incidence of complications related to postoperative infections in children with MBP before bowel surgery versus those with No MBP, wound infection (OR 1.11, 95% CI:0.76 ~ 1.61, p = 0.59, I2 = 5%), intra‐abdominal infection (OR 1.26, 95% CI:0.58 ~ 2.77, p = 0.56, I2 = 9%). There was no significant difference in the risk of postoperative bowel anastomotic leak (OR 1.07, 95% CI:0.68 ~ 1.68, p = 0.78, I2 = 12%), and anastomotic dehiscence (OR 1.67, 95% CI:0.13 ~ 22.20, p = 0.70, I2 = 73%). Patients' intestinal obstruction did not show an advantage of undergoing MBP preoperatively, with an incidence of intestinal obstruction (OR 1.95, 95% CI:0.55 ~ 6.93, p = 0.30, I2 = 0%). Based on existing evidence that preoperative MBP in paediatric bowel surgery did not reduce the risk of postoperative wound complications, we cautiously assume that MBP before surgery is unnecessary for children undergoing elective bowel surgery. However, due to the limited number of study participants selected for this study and the overall low quality of evidence, the results need to be interpreted with caution. It is suggested that more high quality, large‐sample, multicenter clinical trials are required to validate our findings.

Mechanical bowel preparation (MBP), a routine nursing procedure before paediatric bowel surgery, is widely should in clinical practice, but its necessity remains controversial. In a systematic review and meta‐analysis, we evaluated the effect of preoperative MBP in paediatric bowel surgery on postoperative wound‐related complications in order to analyse the clinical application value of MBP in paediatric bowel surgery. As of November 2023, we searched four online databases: the Cochrane Library, Embase, PubMed, and Web of Science. Two investigators screened the collected studies against inclusion and exclusion criteria, and ROBINS‐I was used to evaluate the quality of studies. Using RevMan5.3, a meta‐analysis of the collected data was performed, and a fixed‐effect model or a random‐effect model was used to analyse OR, 95% CI, SMD, and MD. A total of 11 studies with 2556 patients were included. Most of studies had moderate‐to‐severe quality bias. The results of meta‐analysis showed no statistically significant difference in the incidence of complications related to postoperative infections in children with MBP before bowel surgery versus those with No MBP, wound infection (OR 1.11, 95% CI:0.76 ~ 1.61, p  = 0.59, I 2  = 5%), intra‐abdominal infection (OR 1.26, 95% CI:0.58 ~ 2.77, p  = 0.56, I 2  = 9%). There was no significant difference in the risk of postoperative bowel anastomotic leak (OR 1.07, 95% CI:0.68 ~ 1.68, p  = 0.78, I 2  = 12%), and anastomotic dehiscence (OR 1.67, 95% CI:0.13 ~ 22.20, p  = 0.70, I 2  = 73%). Patients' intestinal obstruction did not show an advantage of undergoing MBP preoperatively, with an incidence of intestinal obstruction (OR 1.95, 95% CI:0.55 ~ 6.93, p  = 0.30, I 2  = 0%). Based on existing evidence that preoperative MBP in paediatric bowel surgery did not reduce the risk of postoperative wound complications, we cautiously assume that MBP before surgery is unnecessary for children undergoing elective bowel surgery. However, due to the limited number of study participants selected for this study and the overall low quality of evidence, the results need to be interpreted with caution. It is suggested that more high quality, large‐sample, multicenter clinical trials are required to validate our findings.

Background The role of current pharmacological treatment after laparoscopic sleeve gastrectomy (LSG) is limited. The incidence of postoperative nausea and vomiting (PONV) after LSG remains high. Auricular acupressure (AA) is believed to relieve PONV after laparoscopic surgeries, but its role in patients with obesity after LSG has yet to be confirmed. Methods Ninety-five female patients who underwent LSG were randomized into two groups: AA combined with conventional anti-nausea medication (AA group, 47 patients) or conventional anti-nausea medication group (control group, 48 patients). Index of nausea and vomiting and retching (INVR) scores, postoperative anti-vomiting medication use, time of first anus exhausting, time of first fluid intake, and time of first to get out of bed were collected within 48 h after surgery. Results Demographic data of patients in both groups were balanced and comparable. INVR score ( F = 7.505, P = 0.007), vomiting score ( F = 11.903, P = 0.001), and retching score ( F = 12.098, P = 0.001) were significantly lower in the AA group than that in the control group within 48 h postoperatively. Use of metoclopramide was significantly less in the AA group than in the control group (4.7 [5.5]) vs. 8.8 [7.6], P = 0.004); time to first anus exhausting was significantly less in the AA group than in the control group (17.50 [6.00] vs. 20.42 [8.62], P = 0.020). Conclusions AA combined with conventional anti-vomiting agents can alleviate PONV in female patients after LSG, and AA can promote gastrointestinal exhaustion. Trial Registration The trial has been registered in the Chinese Clinical Trial Registry (ChiCTR) with the registration no. ChiCTR2100047381 on June 13, 2021. Graphical Abstract

Background Postoperative nausea and vomiting (PONV) is the most common side effect after laparoscopic sleeve gastrectomy (LSG), affecting patients’ postoperative recovery and increasing the medical and economic burden. This study aimed to analyze the relationship between serum pepsinogen and PONV. Methods Patients with obesity who underwent LSG in our center between January 2021 and December 2022 were divided into PONV and NoPONV groups and analyzed retrospectively. Binary logistic regression analysis was used to determine the independent risk factors for PONV. Results 219 female patients were enrolled, with an average BMI of 36.74 ± 8.34 kg/m 2 and aged 32.61 ± 6.18 years. PONV occurred in 157 patients (71.7%). The influencing factors of PONV with different severity were analyzed, and the results showed that the severity of postoperative pain (χ2 = 13.169, p -values = 0.004), PGI (χ2 = 14.625, p -values = 0.002), PGII (χ2 = 25.916, p -values = 0.000), and PGR (χ2 = 17.697, p -values = 0.001) had statistical significance. Binary logistic regression showed that PGI was a risk factor for PONV with a OR (ng/mL) value of 1.013 (95% CI: 1.001–1.024, p -values = 0.037), while PGR was a protective factor for PONV with an OR(ng/mL) value of 0.952 (95% CI: 0.925–0.979, p -values = 0.001). Conclusions The incidence of PONV after LSG is high. Higher PGI may be a risk factor for promoting PONV after LSG. The higher the preoperative PGI, the later the onset of PONV; the longer the duration, the more serious the degree.