摘要：
AIMS: This study aims to explore the experiences of rehabilitation specialist nurses in providing bowel care to stroke patients and to identify the factors that either facilitate or hinder their practice. DESIGN: This was a descriptive qualitative design study. METHODS: Between May 2022 and October 2022, we conducted in-depth and semi-structured interviews with 12 rehabilitation specialist nurses from two tertiary hospitals in Changsha, China. Thematic analysis was employed to analyse the interview transcripts. FINDINGS: Three key themes were revealed from our analysis: (1) acceptance of bowel care as a process, (2) high level of recognition improves the experience and (3) challenges stemming from limited knowledge and rights. Acceptance of bowel care as a dynamic process, coupled with a high level of recognition, enabled nurses to prioritize the health and safety of patients over personal feelings and achieve professional accomplishments. However, they encountered challenges in terms of professional development and restricted prescribing rights for bowel care. CONCLUSION: The experiences of rehabilitation specialist nurses in providing bowel care are dynamic. These findings have important implications for healthcare improvement, including the need for collaboration with healthcare professionals and nurturing nurses' self-identity, comprehensive training plans, innovative programs and expanding the scope of rehabilitation specialist nurses' rights. IMPACT: This study enhances our understanding of the challenges faced by rehabilitation specialist nurses caring for stroke patients with neurogenic bowel dysfunction. The findings provide insights into how to enhance bowel care experience and develop further in this field. REPORTING METHOD: This study adhered to the EQUATOR guideline and utilized the COREQ checklist. PATIENT OR PUBLIC CONTRIBUTIONS: This study involved participants who were registered nurses, and there were no contributions from patients or public.
作者机构：
[Huang, Chunhua; Ding, Hanqi] Univ South China, Coll Architecture & Design, Hengyang 421001, Peoples R China.;[Liu, Luyun; Wang, Zhiyuan] Cent South Univ Forestry & Technol, Coll Landscape Architecture, Changsha 410004, Peoples R China.;[Huang, Chunhua] Hunan Hlth City Construction Engn Technol Res Ctr, Hengyang 421001, Peoples R China.;[Bedra, Komi Bernard] Cent South Univ, Sch Architecture & Art, Changsha 410083, Peoples R China.
通讯机构：
[Huang, CH ] U;[Wang, ZY ] C;Univ South China, Coll Architecture & Design, Hengyang 421001, Peoples R China.;Cent South Univ Forestry & Technol, Coll Landscape Architecture, Changsha 410004, Peoples R China.;Hunan Hlth City Construction Engn Technol Res Ctr, Hengyang 421001, Peoples R China.
关键词：
carbon pressure;economic growth;decoupling effect;driving factors;urban agglomeration in the middle reaches of the Yangtze River
摘要：
Coordination between regional economic development and carbon pressure is essential for sustainable regional development. However, existing research on carbon pressure and studies on the relationship between economic growth and carbon pressure needs to be more comprehensive. This study analyzes the decoupling impact of economic growth and carbon pressure in different regions of urban agglomeration in the middle reaches of the Yangtze River by revealing the evolution of the geographical and temporal characteristics of carbon pressure from 2000 to 2020. We investigate the drivers of carbon pressure in the middle reaches of the Yangtze River urban agglomeration using the LMDI index decomposition model. The results show that (1) the carbon pressure in the urban agglomeration of the middle reaches of the Yangtze River and its three sub-city agglomerations shows a declining tendency at the beginning and later exhibits an increasing tendency; (2) from 2000 to 2020, the carbon pressure of the majority of cities increased, with Wuhan and Ezhou in the high carbon pressure area and Ji'an, Fuzhou, and Shangrao in the carbon sink surplus area; (3) the rate of decoupling climbs from 45% to 96% over time, then declines to 67%, and reaches 90% by 2020; and (4) the most prominent influence on carbon pressure in the 31 cities is energy consumption, followed by economic expansion. The research in this paper is beneficial for cities to explore solutions to coordinate economic development and carbon pressure despite the constraints of imposed by the two.
摘要：
Background Subsyndromal delirium (SSD) is a clinical manifestation between delirium and nondelirium. There is no established guideline for diagnosing SSD, with a few different tools used for diagnosis.To construct and verify the risk prediction model for subdelirium syndrome in patients with advanced malignant tumors and explore its application value in risk prediction.A total of 455 patients admitted to the Oncology Department in a tertiary grade A hospital in Hengyang City were recruited from December 2020 to May 2021. They were selected as the modeling group. The model was constructed by logistic regression. A total of 195 patients with advanced malignant tumors from June 2021 to July 2021 were selected to validate the developed model.The predictors incorporated into the model were opioids (odds ratio [OR], 1.818), sleep disorders (OR, 1.783), daily living ability score (OR, 0.969), and pain (OR, 1.810). In the modeling group, the Hosmer-Lemeshow goodness-of-fit test was P = .113, the area under the receiver operating characteristic curve was 0.884, the sensitivity was 0.820, and the specificity was 0.893. In the validation group, the Hosmer-Lemeshow goodness-of-fit test P = .108, the area under the receiver operating characteristic curve was 0.843, the Yuden index was 0.670, the sensitivity was 0.804, and the specificity was 0.866.This model has excellent precision in the risk prediction of subdelirium in patients with advanced malignant tumors.The model we developed has a guiding significance for specialized tumor nurses to care for patients with advanced malignant tumors and improve their quality of life.Subsyndromal delirium (SSD), the precursor of delirium, is a clinical manifestation between delirium and nondelirium characterized by inattention, altered consciousness, and cognitive dysfunction.1 As early as 1983, scholars proposed the concept of SSD2 and began to attach importance to and conduct in-depth research on the subject. It presents only one or several symptoms usually associated with delirium and may or may not progress to delirium.3 Once subdelirium progresses to delirium, it will lead to the cognitive decline of patients and impairment of function, increase the occurrence of nursing adverse events such as falling and tube/intravenous complications, and affect the quality of life of patients.3 It has, however, been classified as part of a neurocognitive disorder known as attenuated delirium syndrome. Studies have found that the incidence of SSD in clinical patients can be 12.6% to 60.9%.4 Studies suggest that 20% to 35% of SSD patients suffer a complete conversion to delirium.5 Some scholars point out that early identification of risk factors of subdelirium is critical for its prevention.6 These factors can result in misdiagnosis and eventually cause the subdelirium to progress to delirium and cause unnecessary hardship for the patients and their families.7,8In recent years, China's research on delirium has gradually increased. However, currently, there is no established guideline for diagnosing SSD, with a few different tools used for diagnosis. Examples include the Intensive Care Delirium Screening Checklist and the Confusion Assessment Method.5 In addition, attempts have been made to develop a tool for predicting subdelirium occurrence, but there is no established standard.9 After searching the existing literature, it was also found that no validated model of SSD, specifically among adults with cancer, currently exists. The objective of the present study was to develop and verify a risk prediction model of subdelirium based on the risk factors related to patients with advanced malignant tumors. Such a tool will allow healthcare providers to treat patients at risk of developing subdelirium well in advance and prevent and reduce its occurrence.The present study was a prospective case-control study. The study protocols were approved by the ethics committees of the First Affiliated Hospital of the University of South China and the partner hospitals. Patients and their families consented and voluntarily participated in the study.Background Subsyndromal delirium (SSD) is a clinical manifestation between delirium and nondelirium. There is no established guideline for diagnosing SSD, with a few different tools used for diagnosis.To construct and verify the risk prediction model for subdelirium syndrome in patients with advanced malignant tumors and explore its application value in risk prediction.A total of 455 patients admitted to the Oncology Department in a tertiary grade A hospital in Hengyang City were recruited from December 2020 to May 2021. They were selected as the modeling group. The model was constructed by logistic regression. A total of 195 patients with advanced malignant tumors from June 2021 to July 2021 were selected to validate the developed model.The predictors incorporated into the model were opioids (odds ratio [OR], 1.818), sleep disorders (OR, 1.783), daily living ability score (OR, 0.969), and pain (OR, 1.810). In the modeling group, the Hosmer-Lemeshow goodness-of-fit test was P = .113, the area under the receiver operating characteristic curve was 0.884, the sensitivity was 0.820, and the specificity was 0.893. In the validation group, the Hosmer-Lemeshow goodness-of-fit test P = .108, the area under the receiver operating characteristic curve was 0.843, the Yuden index was 0.670, the sensitivity was 0.804, and the specificity was 0.866.This model has excellent precision in the risk prediction of subdelirium in patients with advanced malignant tumors.The model we developed has a guiding significance for specialized tumor nurses to care for patients with advanced malignant tumors and improve their quality of life.Subsyndromal delirium (SSD), the precursor of delirium, is a clinical manifestation between delirium and nondelirium characterized by inattention, altered consciousness, and cognitive dysfunction.1 As early as 1983, scholars proposed the concept of SSD2 and began to attach importance to and conduct in-depth research on the subject. It presents only one or several symptoms usually associated with delirium and may or may not progress to delirium.3 Once subdelirium progresses to delirium, it will lead to the cognitive decline of patients and impairment of function, increase the occurrence of nursing adverse events such as falling and tube/intravenous complications, and affect the quality of life of patients.3 It has, however, been classified as part of a neurocognitive disorder known as attenuated delirium syndrome. Studies have found that the incidence of SSD in clinical patients can be 12.6% to 60.9%.4 Studies suggest that 20% to 35% of SSD patients suffer a complete conversion to delirium.5 Some scholars point out that early identification of risk factors of subdelirium is critical for its prevention.6 These factors can result in misdiagnosis and eventually cause the subdelirium to progress to delirium and cause unnecessary hardship for the patients and their families. 7,8In recent years, China's research on delirium has gradually increased. However, currently, there is no established guideline for diagnosing SSD, with a few different tools used for diagnosis. Examples include the Intensive Care Delirium Screening Checklist and the Confusion Assessment Method.5 In addition, attempts have been made to develop a tool for predicting subdelirium occurrence, but there is no established standard.9 After searching the existing literature, it was also found that no validated model of SSD, specifically among adults with cancer, currently exists.The objective of the present study was to develop and verify a risk prediction model of subdelirium based on the risk factors related to patients with advanced malignant tumors. Such a tool will allow healthcare providers to treat patients at risk of developing subdelirium well in advance and prevent and reduce its occurrence.The present study was a prospective case-control study. The study protocols were approved by the ethics committees of the First Affiliated Hospital of the University of South China and the partner hospitals. Patients and their families consented and voluntarily participated in the study.Background Subsyndromal delirium (SSD) is a clinical manifestation between delirium and nondelirium. There is no established guideline for diagnosing SSD, with a few different tools used for diagnosis.To construct and verify the risk prediction model for subdelirium syndrome in patients with advanced malignant tumors and explore its application value in risk prediction.A total of 455 patients admitted to the Oncology Department in a tertiary grade A hospital in Hengyang City were recruited from December 2020 to May 2021. They were selected as the modeling group. The model was constructed by logistic regression. A total of 195 patients with advanced malignant tumors from June 2021 to July 2021 were selected to validate the developed model.The predictors incorporated into the model were opioids (odds ratio [OR], 1.818), sleep disorders (OR, 1.783), daily living ability score (OR, 0.969), and pain (OR, 1.810). In the modeling group, the Hosmer-Lemeshow goodness-of-fit test was P = .113, the area under the receiver operating characteristic curve was 0.884, the sensitivity was 0.820, and the specificity was 0.893. In the validation group, the Hosmer-Lemeshow goodness-of-fit test P = .108, the area under the receiver operating characteristic curve was 0.843, the Yuden index was 0.670, the sensitivity was 0.804, and the specificity was 0.866.This model has excellent precision in the risk prediction of subdelirium in patients with advanced malignant tumors.The model we developed has a guiding significance for specialized tumor nurses to care for patients with advanced malignant tumors and improve their quality of life.Subsyndromal delirium (SSD), the precursor of delirium, is a clinical manifestation between delirium and nondelirium characterized by inattention, altered consciousness, and cognitive dysfunction.1 As early as 1983, scholars proposed the concept of SSD2 and began to attach importance to and conduct in-depth research on the subject. It presents only one or several symptoms usually associated with delirium and may or may not progress to delirium.3 Once subdelirium progresses to delirium, it will lead to the cognitive decline of patients and impairment of function, increase the occurrence of nursing adverse events such as falling and tube/intravenous complications, and affect the quality of life of patients. 3 It has, however, been classified as part of a neurocognitive disorder known as attenuated delirium syndrome. Studies have found that the incidence of SSD in clinical patients can be 12.6% to 60.9%.4 Studies suggest that 20% to 35% of SSD patients suffer a complete conversion to delirium.5 Some scholars point out that early identification of risk factors of subdelirium is critical for its prevention.6 These factors can result in misdiagnosis and eventually cause the subdelirium to progress to delirium and cause unnecessary hardship for the patients and their families.7,8In recent years, China's research on delirium has gradually increased. However, currently, there is no established guideline for diagnosing SSD, with a few different tools used for diagnosis. Examples include the Intensive Care Delirium Screening Checklist and the Confusion Assessment Method.5 In addition, attempts have been made to develop a tool for predicting subdelirium occurrence, but there is no established standard.9 After searching the existing literature, it was also found that no validated model of SSD, specifically among adults with cancer, currently exists.The objective of the present study was to develop and verify a risk prediction model of subdelirium based on the risk factors related to patients with advanced malignant tumors. Such a tool will allow healthcare providers to treat patients at risk of developing subdelirium well in advance and prevent and reduce its occurrence.The present study was a prospective case-control study. The study protocols were approved by the ethics committees of the First Affiliated Hospital of the University of South China and the partner hospitals. Patients and their families consented and voluntarily participated in the study.Background Subsyndromal delirium (SSD) is a clinical manifestation between delirium and nondelirium. There is no established guideline for diagnosing SSD, with a few different tools used for diagnosis.To construct and verify the risk prediction model for subdelirium syndrome in patients with advanced malignant tumors and explore its application value in risk prediction.A total of 455 patients admitted to the Oncology Department in a tertiary grade A hospital in Hengyang City were recruited from December 2020 to May 2021. They were selected as the modeling group. The model was constructed by logistic regression. A total of 195 patients with advanced malignant tumors from June 2021 to July 2021 were selected to validate the developed model.The predictors incorporated into the model were opioids (odds ratio [OR], 1.818), sleep disorders (OR, 1.783), daily living ability score (OR, 0.969), and pain (OR, 1.810). In the modeling group, the Hosmer-Lemeshow goodness-of-fit test was P = .113, the area under the receiver operating characteristic curve was 0.884, the sensitivity was 0.820, and the specificity was 0.893. In the validation group, the Hosmer-Lemeshow goodness-of-fit test P = .108, the area under the receiver operating characteristic curve was 0.843, the Yuden index was 0.670, the sensitivity was 0.804, and the specificity was 0.866.This model has excellent precision in the risk prediction of subdelirium in patients with advanced malignant tumors.The model we developed has a guiding significance for specialized tumor nurses to care for patients with advanced malignant tumors and improve their quality of life. Subsyndromal delirium (SSD), the precursor of delirium, is a clinical manifestation between delirium and nondelirium characterized by inattention, altered consciousness, and cognitive dysfunction.1 As early as 1983, scholars proposed the concept of SSD2 and began to attach importance to and conduct in-depth research on the subject. It presents only one or several symptoms usually associated with delirium and may or may not progress to delirium.3 Once subdelirium progresses to delirium, it will lead to the cognitive decline of patients and impairment of function, increase the occurrence of nursing adverse events such as falling and tube/intravenous complications, and affect the quality of life of patients.3 It has, however, been classified as part of a neurocognitive disorder known as attenuated delirium syndrome. Studies have found that the incidence of SSD in clinical patients can be 12.6% to 60.9%.4 Studies suggest that 20% to 35% of SSD patients suffer a complete conversion to delirium.5 Some scholars point out that early identification of risk factors of subdelirium is critical for its prevention.6 These factors can result in misdiagnosis and eventually cause the subdelirium to progress to delirium and cause unnecessary hardship for the patients and their families.7,8In recent years, China's research on delirium has gradually increased. However, currently, there is no established guideline for diagnosing SSD, with a few different tools used for diagnosis. Examples include the Intensive Care Delirium Screening Checklist and the Confusion Assessment Method.5 In addition, attempts have been made to develop a tool for predicting subdelirium occurrence, but there is no established standard.9 After searching the existing literature, it was also found that no validated model of SSD, specifically among adults with cancer, currently exists.The objective of the present study was to develop and verify a risk prediction model of subdelirium based on the risk factors related to patients with advanced malignant tumors. Such a tool will allow healthcare providers to treat patients at risk of developing subdelirium well in advance and prevent and reduce its occurrence.The present study was a prospective case-control study. The study protocols were approved by the ethics committees of the First Affiliated Hospital of the University of South China and the partner hospitals. Patients and their families consented and voluntarily participated in the study.Background Subsyndromal delirium (SSD) is a clinical manifestation between delirium and nondelirium. There is no established guideline for diagnosing SSD, with a few different tools used for diagnosis.To construct and verify the risk prediction model for subdelirium syndrome in patients with advanced malignant tumors and explore its application value in risk prediction.A total of 455 patients admitted to the Oncology Department in a tertiary grade A hospital in Hengyang City were recruited from December 2020 to May 2021. They were selected as the modeling group. The model was constructed by logistic regression. A total of 195 patients with advanced malignant tumors from June 2021 to July 2021 were selected to validate the developed model.The predictors incorporated into the model were opioids (odds ratio [OR], 1.818), sleep disorders (OR, 1.783), daily living ability score (OR, 0.969), and pain (OR, 1.810). In the modeling group, the Hosmer-Lemeshow goodness-of-fit test was P = .113, the area under the receiver operating characteristic curve was 0.884, the sensitivity was 0. 820, and the specificity was 0.893. In the validation group, the Hosmer-Lemeshow goodness-of-fit test P = .108, the area under the receiver operating characteristic curve was 0.843, the Yuden index was 0.670, the sensitivity was 0.804, and the specificity was 0.866.This model has excellent precision in the risk prediction of subdelirium in patients with advanced malignant tumors.The model we developed has a guiding significance for specialized tumor nurses to care for patients with advanced malignant tumors and improve their quality of life.Subsyndromal delirium (SSD), the precursor of delirium, is a clinical manifestation between delirium and nondelirium characterized by inattention, altered consciousness, and cognitive dysfunction.1 As early as 1983, scholars proposed the concept of SSD2 and began to attach importance to and conduct in-depth research on the subject. It presents only one or several symptoms usually associated with delirium and may or may not progress to delirium.3 Once subdelirium progresses to delirium, it will lead to the cognitive decline of patients and impairment of function, increase the occurrence of nursing adverse events such as falling and tube/intravenous complications, and affect the quality of life of patients.3 It has, however, been classified as part of a neurocognitive disorder known as attenuated delirium syndrome. Studies have found that the incidence of SSD in clinical patients can be 12.6% to 60.9%.4 Studies suggest that 20% to 35% of SSD patients suffer a complete conversion to delirium.5 Some scholars point out that early identification of risk factors of subdelirium is critical for its prevention.6 These factors can result in misdiagnosis and eventually cause the subdelirium to progress to delirium and cause unnecessary hardship for the patients and their families.7,8In recent years, China's research on delirium has gradually increased. However, currently, there is no established guideline for diagnosing SSD, with a few different tools used for diagnosis. Examples include the Intensive Care Delirium Screening Checklist and the Confusion Assessment Method.5 In addition, attempts have been made to develop a tool for predicting subdelirium occurrence, but there is no established standard.9 After searching the existing literature, it was also found that no validated model of SSD, specifically among adults with cancer, currently exists.The objective of the present study was to develop and verify a risk prediction model of subdelirium based on the risk factors related to patients with advanced malignant tumors. Such a tool will allow healthcare providers to treat patients at risk of developing subdelirium well in advance and prevent and reduce its occurrence.The present study was a prospective case-control study. The study protocols were approved by the ethics committees of the First Affiliated Hospital of the University of South China and the partner hospitals. Patients and their families consented and voluntarily participated in the study.Background Subsyndromal delirium (SSD) is a clinical manifestation between delirium and nondelirium. There is no established guideline for diagnosing SSD, with a few different tools used for diagnosis.To construct and verify the risk prediction model for subdelirium syndrome in patients with advanced malignant tumors and explore its application value in risk prediction.A total of 455 patients admitted to the Oncology Department in a tertiary grade A hospital in Hengyang City were recruited from December 2020 to May 2021. They were selected as the modeling group. The model was constructed by logistic regression. A total of 195 patients with advanced malignant tumors from June 2021 to July 2021 were selected to validate the developed model.The predictors incorporated into the model were opioids (odds ratio [OR], 1.818), sleep disorders (OR, 1.783), daily living ability score (OR, 0.969), and pain (OR, 1.810). In the modeling group, the Hosmer-Lemeshow goodness-of-fit test was P = .113, the area under the receiver operating characteristic curve was 0.884, the sensitivity was 0.820, and the specificity was 0.893. In the validation group, the Hosmer-Lemeshow goodness-of-fit test P = .108, the area under the receiver operating characteristic curve was 0.843, the Yuden index was 0.670, the sensitivity was 0.804, and the specificity was 0.866.This model has excellent precision in the risk prediction of subdelirium in patients with advanced malignant tumors.The model we developed has a guiding significance for specialized tumor nurses to care for patients with advanced malignant tumors and improve their quality of life.Subsyndromal delirium (SSD), the precursor of delirium, is a clinical manifestation between delirium and nondelirium characterized by inattention, altered consciousness, and cognitive dysfunction.1 As early as 1983, scholars proposed the concept of SSD2 and began to attach importance to and conduct in-depth research on the subject. It presents only one or several symptoms usually associated with delirium and may or may not progress to delirium.3 Once subdelirium progresses to delirium, it will lead to the cognitive decline of patients and impairment of function, increase the occurrence of nursing adverse events such as falling and tube/intravenous complications, and affect the quality of life of patients.3 It has, however, been classified as part of a neurocognitive disorder known as attenuated delirium syndrome. Studies have found that the incidence of SSD in clinical patients can be 12.6% to 60.9%.4 Studies suggest that 20% to 35% of SSD patients suffer a complete conversion to delirium.5 Some scholars point out that early identification of risk factors of subdelirium is critical for its prevention.6 These factors can result in misdiagnosis and eventually cause the subdelirium to progress to delirium and cause unnecessary hardship for the patients and their families.7,8In recent years, China's research on delirium has gradually increased. However, currently, there is no established guideline for diagnosing SSD, with a few different tools used for diagnosis. Examples include the Intensive Care Delirium Screening Checklist and the Confusion Assessment Method.5 In addition, attempts have been made to develop a tool for predicting subdelirium occurrence, but there is no established standard.9 After searching the existing literature, it was also found that no validated model of SSD, specifically among adults with cancer, currently exists.The objective of the present study was to develop and verify a risk prediction model of subdelirium based on the risk factors related to patients with advanced malignant tumors. Such a tool will allow healthcare providers to treat patients at risk of developing subdelirium well in advance and prevent and reduce its occurrence.The present study was a prospective case-control study. The study protocols were approved by the ethics committees of the First Affiliated Hospital of the University of South China and the partner hospitals. Patients and their families consented and voluntarily participated in the study. Background Subsyndromal delirium (SSD) is a clinical manifestation between delirium and nondelirium. There is no established guideline for diagnosing SSD, with a few different tools used for diagnosis.To construct and verify the risk prediction model for subdelirium syndrome in patients with advanced malignant tumors and explore its application value in risk prediction.A total of 455 patients admitted to the Oncology Department in a tertiary grade A hospital in Hengyang City were recruited from December 2020 to May 2021. They were selected as the modeling group. The model was constructed by logistic regression. A total of 195 patients with advanced malignant tumors from June 2021 to July 2021 were selected to validate the developed model.The predictors incorporated into the model were opioids (odds ratio [OR], 1.818), sleep disorders (OR, 1.783), daily living ability score (OR, 0.969), and pain (OR, 1.810). In the modeling group, the Hosmer-Lemeshow goodness-of-fit test was P = .113, the area under the receiver operating characteristic curve was 0.884, the sensitivity was 0.820, and the specificity was 0.893. In the validation group, the Hosmer-Lemeshow goodness-of-fit test P = .108, the area under the receiver operating characteristic curve was 0.843, the Yuden index was 0.670, the sensitivity was 0.804, and the specificity was 0.866.This model has excellent precision in the risk prediction of subdelirium in patients with advanced malignant tumors.The model we developed has a guiding significance for specialized tumor nurses to care for patients with advanced malignant tumors and improve their quality of life.Subsyndromal delirium (SSD), the precursor of delirium, is a clinical manifestation between delirium and nondelirium characterized by inattention, altered consciousness, and cognitive dysfunction.1 As early as 1983, scholars proposed the concept of SSD2 and began to attach importance to and conduct in-depth research on the subject. It presents only one or several symptoms usually associated with delirium and may or may not progress to delirium.3 Once subdelirium progresses to delirium, it will lead to the cognitive decline of patients and impairment of function, increase the occurrence of nursing adverse events such as falling and tube/intravenous complications, and affect the quality of life of patients.3 It has, however, been classified as part of a neurocognitive disorder known as attenuated delirium syndrome. Studies have found that the incidence of SSD in clinical patients can be 12.6% to 60.9%.4 Studies suggest that 20% to 35% of SSD patients suffer a complete conversion to delirium.5 Some scholars point out that early identification of risk factors of subdelirium is critical for its prevention.6 These factors can result in misdiagnosis and eventually cause the subdelirium to progress to delirium and cause unnecessary hardship for the patients and their families.7,8In recent years, China's research on delirium has gradually increased. However, currently, there is no established guideline for diagnosing SSD, with a few different tools used for diagnosis. Examples include the Intensive Care Delirium Screening Checklist and the Confusion Assessment Method.5 In addition, attempts have been made to develop a tool for predicting subdelirium occurrence, but there is no established standard.9 After searching the existing literature, it was also found that no validated model of SSD, specifically among adults with cancer, currently exists. The objective of the present study was to develop and verify a risk prediction model of subdelirium based on the risk factors related to patients with advanced malignant tumors. Such a tool will allow healthcare providers to treat patients at risk of developing subdelirium well in advance and prevent and reduce its occurrence.The present study was a prospective case-control study. The study protocols were approved by the ethics committees of the First Affiliated Hospital of the University of South China and the partner hospitals. Patients and their families consented and voluntarily participated in the study.Background Subsyndromal delirium (SSD) is a clinical manifestation between delirium and nondelirium. There is no established guideline for diagnosing SSD, with a few different tools used for diagnosis.To construct and verify the risk prediction model for subdelirium syndrome in patients with advanced malignant tumors and explore its application value in risk prediction.A total of 455 patients admitted to the Oncology Department in a tertiary grade A hospital in Hengyang City were recruited from December 2020 to May 2021. They were selected as the modeling group. The model was constructed by logistic regression. A total of 195 patients with advanced malignant tumors from June 2021 to July 2021 were selected to validate the developed model.The predictors incorporated into the model were opioids (odds ratio [OR], 1.818), sleep disorders (OR, 1.783), daily living ability score (OR, 0.969), and pain (OR, 1.810). In the modeling group, the Hosmer-Lemeshow goodness-of-fit test was P = .113, the area under the receiver operating characteristic curve was 0.884, the sensitivity was 0.820, and the specificity was 0.893. In the validation group, the Hosmer-Lemeshow goodness-of-fit test P = .108, the area under the receiver operating characteristic curve was 0.843, the Yuden index was 0.670, the sensitivity was 0.804, and the specificity was 0.866.This model has excellent precision in the risk prediction of subdelirium in patients with advanced malignant tumors.The model we developed has a guiding significance for specialized tumor nurses to care for patients with advanced malignant tumors and improve their quality of life.Subsyndromal delirium (SSD), the precursor of delirium, is a clinical manifestation between delirium and nondelirium characterized by inattention, altered consciousness, and cognitive dysfunction.1 As early as 1983, scholars proposed the concept of SSD2 and began to attach importance to and conduct in-depth research on the subject. It presents only one or several symptoms usually associated with delirium and may or may not progress to delirium.3 Once subdelirium progresses to delirium, it will lead to the cognitive decline of patients and impairment of function, increase the occurrence of nursing adverse events such as falling and tube/intravenous complications, and affect the quality of life of patients.3 It has, however, been classified as part of a neurocognitive disorder known as attenuated delirium syndrome. Studies have found that the incidence of SSD in clinical patients can be 12.6% to 60.9%.4 Studies suggest that 20% to 35% of SSD patients suffer a complete conversion to delirium.5 Some scholars point out that early identification of risk factors of subdelirium is critical for its prevention.6 These factors can result in misdiagnosis and eventually cause the subdelirium to progress to delirium and cause unnecessary hardship for the patients and their families. 7,8In recent years, China's research on delirium has gradually increased. However, currently, there is no established guideline for diagnosing SSD, with a few different tools used for diagnosis. Examples include the Intensive Care Delirium Screening Checklist and the Confusion Assessment Method.5 In addition, attempts have been made to develop a tool for predicting subdelirium occurrence, but there is no established standard.9 After searching the existing literature, it was also found that no validated model of SSD, specifically among adults with cancer, currently exists.The objective of the present study was to develop and verify a risk prediction model of subdelirium based on the risk factors related to patients with advanced malignant tumors. Such a tool will allow healthcare providers to treat patients at risk of developing subdelirium well in advance and prevent and reduce its occurrence.The present study was a prospective case-control study. The study protocols were approved by the ethics committees of the First Affiliated Hospital of the University of South China and the partner hospitals. Patients and their families consented and voluntarily participated in the study.Background Subsyndromal delirium (SSD) is a clinical manifestation between delirium and nondelirium. There is no established guideline for diagnosing SSD, with a few different tools used for diagnosis.To construct and verify the risk prediction model for subdelirium syndrome in patients with advanced malignant tumors and explore its application value in risk prediction.A total of 455 patients admitted to the Oncology Department in a tertiary grade A hospital in Hengyang City were recruited from December 2020 to May 2021. They were selected as the modeling group. The model was constructed by logistic regression. A total of 195 patients with advanced malignant tumors from June 2021 to July 2021 were selected to validate the developed model.The predictors incorporated into the model were opioids (odds ratio [OR], 1.818), sleep disorders (OR, 1.783), daily living ability score (OR, 0.969), and pain (OR, 1.810). In the modeling group, the Hosmer-Lemeshow goodness-of-fit test was P = .113, the area under the receiver operating characteristic curve was 0.884, the sensitivity was 0.820, and the specificity was 0.893. In the validation group, the Hosmer-Lemeshow goodness-of-fit test P = .108, the area under the receiver operating characteristic curve was 0.843, the Yuden index was 0.670, the sensitivity was 0.804, and the specificity was 0.866.This model has excellent precision in the risk prediction of subdelirium in patients with advanced malignant tumors.The model we developed has a guiding significance for specialized tumor nurses to care for patients with advanced malignant tumors and improve their quality of life.Subsyndromal delirium (SSD), the precursor of delirium, is a clinical manifestation between delirium and nondelirium characterized by inattention, altered consciousness, and cognitive dysfunction.1 As early as 1983, scholars proposed the concept of SSD2 and began to attach importance to and conduct in-depth research on the subject. It presents only one or several symptoms usually associated with delirium and may or may not progress to delirium.3 Once subdelirium progresses to delirium, it will lead to the cognitive decline of patients and impairment of function, increase the occurrence of nursing adverse events such as falling and tube/intravenous complications, and affect the quality of life of patients. 3 It has, however, been classified as part of a neurocognitive disorder known as attenuated delirium syndrome. Studies have found that the incidence of SSD in clinical patients can be 12.6% to 60.9%.4 Studies suggest that 20% to 35% of SSD patients suffer a complete conversion to delirium.5 Some scholars point out that early identification of risk factors of subdelirium is critical for its prevention.6 These factors can result in misdiagnosis and eventually cause the subdelirium to progress to delirium and cause unnecessary hardship for the patients and their families.7,8In recent years, China's research on delirium has gradually increased. However, currently, there is no established guideline for diagnosing SSD, with a few different tools used for diagnosis. Examples include the Intensive Care Delirium Screening Checklist and the Confusion Assessment Method.5 In addition, attempts have been made to develop a tool for predicting subdelirium occurrence, but there is no established standard.9 After searching the existing literature, it was also found that no validated model of SSD, specifically among adults with cancer, currently exists.The objective of the present study was to develop and verify a risk prediction model of subdelirium based on the risk factors related to patients with advanced malignant tumors. Such a tool will allow healthcare providers to treat patients at risk of developing subdelirium well in advance and prevent and reduce its occurrence.The present study was a prospective case-control study. The study protocols were approved by the ethics committees of the First Affiliated Hospital of the University of South China and the partner hospitals. Patients and their families consented and voluntarily participated in the study.Background Subsyndromal delirium (SSD) is a clinical manifestation between delirium and nondelirium. There is no established guideline for diagnosing SSD, with a few different tools used for diagnosis.To construct and verify the risk prediction model for subdelirium syndrome in patients with advanced malignant tumors and explore its application value in risk prediction.A total of 455 patients admitted to the Oncology Department in a tertiary grade A hospital in Hengyang City were recruited from December 2020 to May 2021. They were selected as the modeling group. The model was constructed by logistic regression. A total of 195 patients with advanced malignant tumors from June 2021 to July 2021 were selected to validate the developed model.The predictors incorporated into the model were opioids (odds ratio [OR], 1.818), sleep disorders (OR, 1.783), daily living ability score (OR, 0.969), and pain (OR, 1.810). In the modeling group, the Hosmer-Lemeshow goodness-of-fit test was P = .113, the area under the receiver operating characteristic curve was 0.884, the sensitivity was 0.820, and the specificity was 0.893. In the validation group, the Hosmer-Lemeshow goodness-of-fit test P = .108, the area under the receiver operating characteristic curve was 0.843, the Yuden index was 0.670, the sensitivity was 0.804, and the specificity was 0.866.This model has excellent precision in the risk prediction of subdelirium in patients with advanced malignant tumors.The model we developed has a guiding significance for specialized tumor nurses to care for patients with advanced malignant tumors and improve their quality of life. Subsyndromal delirium (SSD), the precursor of delirium, is a clinical manifestation between delirium and nondelirium characterized by inattention, altered consciousness, and cognitive dysfunction.1 As early as 1983, scholars proposed the concept of SSD2 and began to attach importance to and conduct in-depth research on the subject. It presents only one or several symptoms usually associated with delirium and may or may not progress to delirium.3 Once subdelirium progresses to delirium, it will lead to the cognitive decline of patients and impairment of function, increase the occurrence of nursing adverse events such as falling and tube/intravenous complications, and affect the quality of life of patients.3 It has, however, been classified as part of a neurocognitive disorder known as attenuated delirium syndrome. Studies have found that the incidence of SSD in clinical patients can be 12.6% to 60.9%.4 Studies suggest that 20% to 35% of SSD patients suffer a complete conversion to delirium.5 Some scholars point out that early identification of risk factors of subdelirium is critical for its prevention.6 These factors can result in misdiagnosis and eventually cause the subdelirium to progress to delirium and cause unnecessary hardship for the patients and their families.7,8In recent years, China's research on delirium has gradually increased. However, currently, there is no established guideline for diagnosing SSD, with a few different tools used for diagnosis. Examples include the Intensive Care Delirium Screening Checklist and the Confusion Assessment Method.5 In addition, attempts have been made to develop a tool for predicting subdelirium occurrence, but there is no established standard.9 After searching the existing literature, it was also found that no validated model of SSD, specifically among adults with cancer, currently exists.The objective of the present study was to develop and verify a risk prediction model of subdelirium based on the risk factors related to patients with advanced malignant tumors. Such a tool will allow healthcare providers to treat patients at risk of developing subdelirium well in advance and prevent and reduce its occurrence.The present study was a prospective case-control study. The study protocols were approved by the ethics committees of the First Affiliated Hospital of the University of South China and the partner hospitals. Patients and their families consented and voluntarily participated in the study.
摘要：
AIM: To evaluate and summarize the evidence for prevention and management of enteral feeding intolerance in critically ill patients and provide reference for clinical practice. DESIGN: This study was an evidence summary followed by the evidence summary reporting standard of Fudan University Center for Evidence-based Nursing. METHODS: Current literatures were systematically searched for the best evidence for prevention and management of enteral feeding intolerance in critically ill patients. Literature types included clinical guidelines, best practice information sheets, expert consensuses, systematic reviews, evidence summaries and cohort studies. DATA SOURCES: UpToDate, BMJ Best Practice, Joanna Briggs Institute, Guidelines International Network, National Institute for Health and Care Excellence, Registered Nurses Association of Ontario, Scottish Intercollegiate Guidelines Network, the Cochrane Library, Embase, PubMed, Sinomed, Web of Science, Yi Maitong Guidelines Network, DynaMed, MEDLINE, CNKI, WanFang database, Chinese Medical Journal Full-text Database, European Society for Clinical Nutrition and Metabolism website, the American Society for Parenteral and Enteral Nutrition website were searched from January 2012 to April 2023. RESULTS: We finally identified 18 articles that had high-quality results. We summarized the 24 pieces of best evidence from these articles, covering five aspects: screening and assessment of the risk of enteral nutritional tolerance; formulation of enteral nutrition preparations; enteral nutritional feeding implementation; feeding intolerance symptom prevention and management; and multidisciplinary management. Of these pieces of evidence, 19 were 'strong' and 5 were 'weak', 7 pieces of evidence were recommended in level one and 4 pieces of evidence were recommended in level two. CONCLUSION: The following 24 pieces of evidence for prevention and management of enteral feeding intolerance in critically ill patients were finally recommended. However, as these evidences came from different countries, relevant factors such as the clinical environment should be evaluated before application. Future studies should focus on more specific symptoms of feeding intolerance and more targeted prevention design applications. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: The clinical medical staffs are recommended to take evidence-based recommendations for the implementation of standardized enteral nutrition to improve patient outcomes and decrease gastrointestinal intolerance in critically ill patients. IMPACT: The management of enteral nutrition feeding intolerance has always been a challenge and difficulty in critically ill patients. This study summarizes 24 pieces of the best evidence for prevention and management of enteral nutrition feeding intolerance in critically ill patients. Following and implementing these 24 pieces of evidence is beneficial to the prevention and management of feeding intolerance in clinical practice. The 24 pieces of evidence include five aspects, including screening and assessment of the risk of enteral nutritional tolerance, formulation of enteral nutrition preparations, enteral nutritional feeding implementation, feeding intolerance symptom prevention and management and multidisciplinary management. These five aspects constitute a good implementation process. Screening and assessment of enteral nutritional tolerance throughout intervention are important guarantees for developing a feasible nutrition program in critically ill patients. This study will be benefit to global medical workers in the nutritional management of critically ill patients. REPORTING METHOD: This evidence summary followed the evidence summary reporting specifications of Fudan University Center for Evidence-based Nursing, which were based on the methodological process for the summary of the evidence produced by the Joanna Briggs Institute (JBI). The reporting specifications include problem establishment, literature retrieval, literature screening, literature evaluation, the summary and grading of evidence and the formation of practical suggestions. This study was based on the evidence summary reporting specifications of the Fudan University Center for the Evidence-based Nursing, the register name is 'Best evidence summary for prevention and management of enteral feeding intolerance in critically ill patients', the registration number is 'ES20231823'.
摘要：
INTRODUCTION: To reduce unhealthy lifestyles in China, it is critical to implement effective strategies. Counseling provided by physicians is important for assisting patients in improving their lifestyles, and general practitioners (GPs) are the main providers of lifestyle counseling to patients. However, few studies have focused on the lifestyle counseling practices by GPs in China, particularly in regard to nutrition and physical activity. OBJECTIVE: The aims of this study are: (i) to examine the current practice of Chinese GPs in counseling patients regarding nutrition and physical activity; (ii) to understand the common barriers to such counseling by Chinese GPs; and (iii) to study the association between GPs' personal lifestyle choices and their practices in lifestyle counseling. METHODS: A cross-sectional, self-reported online questionnaire was conducted among GPs in Hunan province, China. A total of 198 GPs completed the questionnaire. RESULTS: The majority of GPs provide nutrition and physical activity counseling to less than 40% of their patients, spending less than three minutes per counseling session. The main reported barriers to counseling on nutrition and physical activity are inadequate time and a lack of knowledge or experience. GPs primarily acquire knowledge through medical books and journals, followed by science popularization. Furthermore, GPs who maintain healthier lifestyle habits, possess a better understanding of lifestyle guidelines, conduct longer office visits, and exhibit higher self-efficacy are more likely to provide counseling to patients. CONCLUSION: This study highlights the need for improvement in nutrition and physical activity counseling among Chinese GPs. GPs' personal nutrition and physical activity habits may measurably influence their counseling practice. We recommend that GPs themselves adopt healthier lifestyle habits to potentially improve their counseling practice. Moreover, proactive measures should be taken to assist GPs in overcoming barriers encountered with lifestyle counseling.
摘要：
With the development of human society and the acceleration of urbanization, the impact of construction projects on the ecological environment is increasingly attracting attention. Conducting an ecological environmental impact assessment of construction projects is crucial to protect the ecological environment and achieve sustainable development. To estimate how construction projects would affect the value of ecosystem services, this paper develops the China Land Use Feature Data Sets (CLUFS) and uses the Beijing "One Line Four Mines" project as an example. Research found that the project's conservation and restoration zone and the landscape construction zone will significantly enhance the ecosystem regulation services value. The conservation and restoration zone will increase by 30% from the current 1.413 billion yuan per year to 1.836 billion yuan per year, and the landscape construction zone will increase by 69% from the current 400 million yuan per year to 676 million yuan per year. The tourism development zone, dominated by urban construction, will result in a decrease in ecosystem regulation services, from 19.26 million yuan per year to 17.60 million yuan per year by 9%. Overall, the "One Line Four Mines" project achieved a balance of ecological value and surplus. The method proposed in this paper for predicting the impact of ecosystem regulation services value on construction projects can be used to quickly evaluate the effects of different planning schemes on the ecosystem services value of land parcels to help urban planning decision-makers control the condition of land use. It can provide new indicators for the ecological environment department to incorporate ecological benefits into the evaluation system of planning schemes and new methods for evaluating the ecological protection effectiveness of projects.
关键词：
Xiangxi UNESCO Global Geopark;SWOT analysis;geosciences popularization;geotourism
摘要：
The Xiangxi UNESCO Global Geopark (XUGG) contained the largest karst red stone forest landscape and the Global Standard Stratotype-section and Points (GSSPs) in the Cambrian System. Those geoheritage contribute to a better understanding of Earth's evolution. Therefore, it is of great significance to conduct geoscience research and geosciences popularization in the XUGG. In this study, we took the XUGG as the research object, and analyzed the situation of the strengths, weaknesses, opportunities and threats in the development process of geopark popular science tourism by using SWOT analysis method, in order to realize the sustainable development of geoparks in popular science tourism. The results show that: the XUGG continent possesses geoheritage, good facilities and unique advantages of popular science development. In the new era, we should optimize the development of popular science tourism in Geoparks, realize the two-way interactive participation of popular science, explore the community participation model of popular science tourism, and promote the development of rustic areas with unique geological resources. Then, it not only facilitates the broadcasting and popularization of earth sciences, but also contributes to the sustainable development of geotourism.
作者机构：
[Liao, Hui; Tan, Deming] Univ South China, Sch Econ Management & Law, Hengyang 421001, Peoples R China.;[Shu, Chengji; Liao, Hui; Han, Baolong; Wu, Dawei; Wu, Tong] Chinese Acad Sci, Res Ctr Ecoenvironm Sci, State Key Lab Urban & Reg Ecol, Beijing 100089, Peoples R China.;[Wu, Tong] Stanford Univ, Nat Capital Project, 327 Campus Dr, Stanford, CA 94305 USA.;[Wu, Dawei] Univ South China, Solux Coll Architecture & Design, Hengyang 421001, Peoples R China.
通讯机构：
[Baolong Han] S;State Key Laboratory of Urban and Regional Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100089, China<&wdkj&>Author to whom correspondence should be addressed.
关键词：
ecosystem services;eco-space;ecosystem assets;land transfer;rate of return
摘要：
Against a background of high-speed development and the expansion of built land surface, there has been widespread encroachment of natural habitats (henceforth "eco-spaces"). It becomes correspondingly difficult to improve the value of urban ecosystem services, since current assessments of land still primarily focus on use value (e.g., when nature and its products are converted and consumed), while the regulation and non-material services provided by eco-spaces are often ignored. In order to assess the rate of return on land transfers of eco-space, theories such as strong sustainable development, ecological land rental, natural resource ownership and opportunity costs were synthesized to construct an eco-space transfer cost-benefit analysis model, which is based on the value of ecosystem services. This study used the Futian Mangrove Ecological Park in the megacity of Shenzhen as a case study. To estimate the social value, which more comprehensively captures ecosystem services and economic value from eco-space, we used a counterfactual scenario of residential land development (the most plausible alternative land use scenario). This allowed us to calculate the rate of return from eco-space use change. The result of the total and annual rates of return over a projected 70-year timeframe were -10.76% and -0.16%, respectively. Accordingly, we suggest that management of the mangrove park should change the pricing strategy to better align the social benefits that it generates with the payments sustaining it. This case study provides instructive lessons for the management of eco-space in large urban settings.
作者机构：
[Ma, Q.; Liu, H.; Liu, Y.; Guo, Z.] Univ South China, Sch Nursing, Hengyang, Peoples R China.;[Guo, Z.] Univ South China, Inst Pharm & Pharmacol, Hengyang, Peoples R China.
通讯机构：
[Z. Guo] S;School of Nursing, University of South China, Hengyang, China<&wdkj&>Institute of Pharmacy and Pharmacology, University of South China, Hengyang, China
摘要：
Objective: This study aimed to systematically clarify attitudes and influencing factors of the public toward COVID-19 vaccination for children or adolescents. Study design: This was a scoping review. Methods: This scoping review screened, included, sorted, and analyzed relevant studies on COVID-19 vaccination for children or adolescents before December 31, 2021, in databases, including PubMed, Elsevier, Web of Science, Cochrane Library, and Wiley. Results: A total of 34 studies were included. The results showed that the public's acceptance rate toward COVID-19 vaccination for children or adolescents ranged from 4.9% (southeast Nigerian mothers) to 91% (Brazilian parents). Parents' or adolescents' age, gender, education level, and cognition and behavior characteristics for the vaccines were the central factors affecting vaccination. The vaccine's safety, effectiveness, and potential side-effects were the main reasons affecting vaccination. Conclusions: Realizing current public attitudes of COVID-19 vaccination for adolescents or children can effectively develop intervention measures and control the pandemic as soon as possible through herd immunity. (c) 2022 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
摘要：
Background/objectives: Dry skin is a common skin problem in older persons. Aim of this study was to determine the prevalence, associated factors of dry skin in older inpatients.Design: A multicenter cross-sectional study was designed and conducted. Settings/participants: On 31 March and 29 May in 2021 two days, fifty hospitals and two nursing homes in China participated in the study. In total, 33,769 participants were included. The mean age was 73.2 (SD 8.9) years.Methods: A whole-body skin examination and associated data collection were performed by 1067 trained nurses based on a standardized data form and methods. Descriptive and univariable analyses and multivariable logistic regressions were conducted. Results: In total, 11,602 participants had dry skin with a prevalence of 34.4%, mainly located on the upper and lower limbs with very severe skin dryness, 21.2% of the participants reported that their dry skin had pruritus, and 12.5% complained that sleep was affected by dry skin. The stronger predictor for dry skin was nursing homes (OR 5.07, 95% CI 3.99-6.45). Other predictors for dry skin were age, male sex, nutrition, lower activity level, skincare dependence, renal and pulmonary impairment, diabetes mellitus, varicose veins, cardiovascular diseases and Parkinsonism, diuretics, statins and antibiotics. The predictive model of area under ROC curve was 0.628(95% CI 0.622-0.634).Conclusions: The prevalence of dry skin among Chinese older patients was at high level and was associated with multiple factors. Persons with skin dryness have a higher proportion of skin itching and poor sleep. Registration: It has been registered in the Chinese Clinical Trial Registry (ChiCTR2100042893).(c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
作者机构：
[Zhang, Xin; Feng, Tingting; Liu, Huaping] Chinese Acad Med Sci & Peking Union Med Coll, Sch Nursing, 33 Ba Chu Rd, Beijing 100144, Peoples R China.;[Tan, Lingling] Univ South China, Dept Nursing, Affiliated Hosp 2, Hengyang, Hunan, Peoples R China.;[Su, Yuanyuan] Univ South China, Sch Nursing, Hengyang, Hunan, Peoples R China.
通讯机构：
[Liu, Huaping] S;School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, 33 Ba Da Chu Rd. Shijingshan District, 100144, Beijing, China.
关键词：
Near-miss;Organizational learning;Nursing organization;Mixed methods study
摘要：
BACKGROUND: Near-miss organizational learning is important for perspective and proactive risk management. Although nursing organizations are the largest component of the healthcare system and act as the final safety barrier, there is little research about the current status of near-miss organizational learning. Thus, we conducted this study to explore near-miss organizational learning in a Chinese nursing organization and offer suggestions for future improvement. METHODS: This was a mixed methods study with an explanatory sequence. It was conducted in a Chinese nursing organization of a tertiary hospital under the guidance of the 4I Framework of Organizational Learning. The quantitative study surveyed 600 nurses by simple random sampling. Then, we applied purposive sampling to recruit 16 nurses across managerial levels from low-, middle- and high-scored nursing units and conducted semi-structured interviews. Descriptive statistics, structured equation modelling and content analysis were applied in the data analysis. The Good Reporting of A Mixed Methods Study (GRAMMS) checklist was used to report this study. RESULTS: Only 33% of participants correctly recognized near-misses, and 4% of participants always reported near-misses. The 4I Framework of Organizational Learning was verified in the surveyed nursing organization (χ(2) = 0.775, p = 0.379, RMSEA < 0.01). The current organizational learning behaviour was not conducive to near-miss organizational learning due to poor group-level learning (β(GG) = 0.284) and poor learning absorption (β(Misalignment)= -0.339). In addition, the researchers developed 13 codes, 9 categories and 5 themes to depict near-miss organizational learning, which were characterized by nurses' unfamiliarity with near-misses, preferences and the dominance of first-order problem-solving behaviour, the suspension of near-miss learning at the group level and poor learning absorption. CONCLUSION: The performance of near-miss organizational learning is unsatisfactory across all levels in surveyed nursing organization, especially with regard to group-level learning and poor learning absorption. Our research findings offer a scientific and comprehensive description of near-miss organizational learning and shed light on how to measure and improve near-miss organizational learning in the future.
期刊：
Journal of Psychiatric Research,2022年151:205-216 ISSN：0022-3956
通讯作者：
Yang, Fengrui
作者机构：
[Liu, Xinxin; Yang, Fengrui] Univ South China, Affiliated Huaihua Hosp, Dept Anesthesiol, 144 South Jinxi Rd, Huaihua 418000, Peoples R China.;[Chen, Kemin; Yang, Fengrui; Wang, Yuxia; Hou, Zixin; Qing, Jie] Univ South China, Dept Anesthesiol, Affiliated Hosp 1, Hengyang 421001, Peoples R China.;[Han, Mingming] Univ Sci & Technol China, Affiliated Hosp USTC 1, Dept Anesthesiol, Div Life Sci & Med, Hefei 230036, Anhui, Peoples R China.;[Han, Mingming] Johns Hopkins Univ, Dept Anesthesiol & Crit Care Med, Sch Med, Baltimore, MD 21287 USA.
通讯机构：
[Fengrui Yang] D;Department of Anesthesiology, Affiliated Huaihua Hospital, University of South China, Huaihua, 418000, PR China<&wdkj&>Department of Anesthesiology, The First Affiliated Hospital of University of South China, Hengyang, 421001, PR China
摘要：
Pain comorbid with depression occurred frequently in clinical settings. This study aims to explore the molecular mechanism underlying antidepressant and analgetic effect of salvianolic acid B (SalB) in comorbid pain in depression induced by chronic restraint stress (CRS), which associates with GABAergic neuron activation in the amygdala and the ERK-CREB-BDNF signaling pathway. The differentially expressed genes related to comorbid pain in CRS-induced depression were screened through bioinformatics analysis. After CRS treatment for 3 weeks, depression-like behaviors were developed in GAD2-tdT mice. The retrograde tracer cholera toxin B subunit combined with retrograde tracer CTB-488 was injected into the parafascicular nucleus of thalamus to project GABAergic neurons to observe the labeling of neurons in the whole brain. After treatment with SalB and ERK-CREB-BDNF signaling pathway inhibitor, CRS mice showed a variety of depression-like behaviors, accompanied by enhanced activity of GABAergic neurons in the amygdala projecting to parafascicular nucleus of thalamus. BDNF underexpression occurred in the CRS mice. Overexpressed BDNF activated ERK-CREB-BDNF signaling pathway to alleviate comorbid pain in CRS-induced depression. After intraperitoneal injection of SalB, the depression-like behaviors and pain threshold in CRS mice were alleviated, the effects of which could be eliminated by ERK-CREB-BDNF signaling pathway antagonist. Collectively, SalB inhibits the excitation of GABAergic neurons in the amygdala and activates the ERK-CREB-BDNF signaling pathway through the parafascicular nucleus of thalamus, whereby alleviating comorbid pain in CRS-induced depression in mice.
作者机构：
[Li, Xing; Li, Ao; Yu, Xu-Dong; Zhou, Yu; He, Zhiming; Wang, Le; Shu, Xinhua] Shaoyang Univ, Sch Basic Med Sci, Shaoyang 422000, Peoples R China.;[Tan, Zhoujin; Li, Xiao-Ya] Hunan Univ Chinese Med, Coll Chinese Med, Changsha 410208, Hunan, Peoples R China.;[Shu, Xinhua; Reilly, James] Glasgow Caledonian Univ, Dept Biol & Biomed Sci, Glasgow City G4 0BA, Scotland.;[Xiao, Zhi-Yong] Univ South China, Affiliated Hosp 1, Hengyang Med Sch, Dept Crit Care Med, Hengyang 421001, Hunan, Peoples R China.
通讯机构：
[Zhi-Yong Xiao] T;[Xinhua Shu] S;The First Affiliated Hospital,Department of Critical Care Medicine,Hengyang Medical School, University of South China, 421001, Hengyang, Hunan, China<&wdkj&>School of Basic Medical Sciences, Shaoyang University, 422000, Shaoyang, China<&wdkj&>Department of Biological and Biomedical Sciences, Glasgow Caledonian University, G4 0BA, Glasgow, United Kingdom
摘要：
Trans-urocanic acid (trans-UCA) is an isomer of cis-UCA and is widely distributed in the brain, predominantly in the hippocampus and prefrontal cortex. Previous studies have investigated the role of trans-UCA in non-spatial memory; however, its influence on spatial memory remains unclear. In the present study, network pharmacology strategy and behavioral testing were used to evaluate the role of trans-UCA in spatial memory and predict its possible mechanism. The results showed that there are 40 intersecting targets between trans-UCA and spatial memory identified by several databases and Venn diagram, indicating that trans-UCA may be involved in spatial memory. Behavioral results show that trans-UCA facilitates spatial working memory in the Y-maze test as well as spatial recognition memory acquisition, consolidation and retrieval in an object location recognition (OLR) task. Furthermore, PPI (protein-protein interaction) network analysis, GO (gene ontology) and KEGG (Kyoto encyclopedia of genes and genomes) pathway enrichment analyses show that the molecular mechanisms underlying the enhancing effect of trans-UCA on spatial memory are mainly associated with the regulation of insulin, mitogen-activated protein kinase (MAPK) and nuclear factor Kappa B (NF-κB) signaling pathways, serotonergic synapse and arginine and proline metabolism. The results of this study suggest that trans-UCA facilitates spatial memory in the Y-maze test and OLR task and may offer therapeutic potential for Alzheimer's disease (AD). The underlying mechanisms predicted by network pharmacology should be further verified.
通讯机构：
[Zou, J.; Tan, S.] D;Department of Histology and Embryology, China
关键词：
deep brain stimulation;drug addiction;nucleus accumbens;opioids;substantia nigra pars reticulata
摘要：
Drug addiction is a chronic psychiatric disorder characterized by compulsive drug-seeking and drug-using behavior, and a tremendous socioeconomic burden to society. Current pharmacological and psychosocial methods have shown limited treatment effects for substance abuse. Deep Brain Stimulation (DBS) is a novel treatment for psychiatric disease and has gradually gained popularity in the treatment of addiction. Addiction is characterized by neuroplastic changes in the nucleus accumbens (NAc), a key structure in the brain reward system, and DBS in this region has shown promising treatment effects. In this paper, the research progress on DBS for drug addiction has been reviewed. Specifically, we discuss the mechanism of NAc DBS for addiction treatment and summarize the results of clinical trials on DBS treatment for addiction to psychoactive substances such as nicotine, alcohol, cocaine, opioids and methamphetamine/amphetamine. In addition, the treatment effects of DBS in other brain regions, such as the substantia nigra pars reticulata (SNr) and insula are discussed.
