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Background Cardiotoxicity is a leading cause of mortality among breast cancer patients treated with chemotherapy. Therefore, an early risk assessment is vital for the clinical prevention and treatment of cardiotoxicity in breast cancer patients treated with chemotherapy, although a recognized tool is scant in our country. Objective To develop a cardiotoxic risk assessment scale for breast cancer patients undergoing chemotherapy and to test its reliability and validity. Methods Through reviewing relevant domestic and international literatures, a pool involving items to assess the risk of cardiotoxicity in breast cancer patients treated with chemotherapy was created. Semi-structured interviews with healthcare providers at Jiangsu Cancer Hospital from September to October 2022 were performed by purposive sampling, thus primarily forming a tool of items for the cardiotoxic risk assessment scale. In addition, breast cancer patients treated with chemotherapy in Jiangsu Cancer Hospital were randomly selected for a pre-survey and validation of the reliability and validity of the scale. Ranked by the score of the cardiotoxic risk assessment scale, the top 27% of participants were assigned into the high-score group, and the remaining were in the low-score group. Cronbach's α coefficient was used to evaluate the internal consistency of the scale. Validity of the scale was verified by measuring the item-level content validity index (I-CVI) and scale-level content validity index (S-CVI). Exploratory factor analysis was performed to assess the structural validity. Receiver operating characteristic (ROC) curves were plotted, and the area under tcurve (AUC) was calculated to determine the predictive validity. Results Twenty healthcare providers were included in the semi-structured interviews. After two rounds of expert consultations, a 19-item cardiotoxic risk assessment scale in breast cancer patients treated with chemotherapy was developed. In this study, there were 79 patients in the low-score group and 83 in the high-score group. No significant differences in the history of smoking, endocrine treatment and immunotherapy were detected between the two groups (P>0.05). Correlation analysis showed that the history of smoking and immunotherapy was not significantly correlated with the total scores (P>0.05). Eventually, three items of smoking history, history of endocrine treatment and history of immunotherapy were removed, forming a 16-item scale. The Cronbach's α coefficient, test-retest reliability and inter-rater reliability were 0.739, 0.983 and 0.984, respectively. Content validity results showed that I-CVI ranged from 0.83 to 1.00, and S-CVI was 0.98. Predictive validity results showed the AUC of 0.887 (95%CI=0.827-0.947, P

Objective To analyze the clinical distribution of Klebsiella pneumoniae isolates, screen for the multidrug resistance of Klebsiella pneumoniae strains to commonly used antimicrobial drugs, and provide reference for the prevention and control of hospital-acquired infections and rational clinical use of antimicrobial drugs. Methods Various clinical specimens collected from January 2018 to December 2022 at the Zhongda Hospital Affiliated to Southeast University were cultured to isolate bacteria. The VITEK automated microbial analyzer was used to identify the bacterial species. A total of 3 342 non-repetitive Klebsiella pneumoniae isolates were obtained during this period. Each Klebsiella pneumoniae strain was subjected to drug susceptibility testing using automated antimicrobial systems, disk diffusion methods, or standard broth microdilution methods to determine the antibiotic resistance profiles of Klebsiella pneumoniae. The detection rate of Klebsiella pneumoniae in clinical specimens and its association with specimen sources or department categories were analyzed. Results Klebsiella pneumoniae isolates were obtained from sputum (42.07%), urine (14.81%), and blood (10.29%). The departments with higher detection rates of Klebsiella pneumoniae were Intensive Care Unit (ICU) (35.19%), Neurosurgery (6.28%), and Respiratory and Critical Care Medicine (5.42%). The resistance identification results showed the highest resistance rate to ampicillin (100.00%) and the lowest resistance rate to amikacin (4.22%). Annual analysis of resistance rates to carbapenems in Klebsiella pneumoniae isolates from 2018 to 2021 revealed an increasing trend: 2.94%, 4.66%, 7.90%, and 15.35%, respectively. However, in 2022, the resistance rate started to decrease (5.38%). Carbapenem-resistant Klebsiella pneumoniae strains were predominantly of the KPC type, and there was a statistically significant difference in the resistance rates to commonly used antimicrobial drugs between carbapenem-resistant Klebsiella pneumoniae and carbapenem-sensitive Klebsiella pneumoniae(P＜0.01). Conclusion Klebsiella pneumoniae maintains a high level of clinical isolation rate, along with high resistance rates. Therefore, it is necessary to strengthen the prevention and control of hospital-acquired bacterial infections and surveillance of drug resistance. Rational selection of antimicrobial drugs should be employed for the treatment of Klebsiella pneumoniae infections.

Objective To observe the practice of standard management of outpatient complaints and improve the quality of outpatient medical care. Methods Total of 72 cases of outpatient complaints received from July 2020 to august 2020 were included as the control group, and another 72 cases of outpatient complaints received from September 2020 to October 2020 were included as the observation group. Cases of outpatient complaints in the control group were addressed by using a conventional method, and those in the observation group were addressed by using a standard management procedure. The incidence of medical dispute and patient satisfaction were compared between two groups. Results There were 6 cases of medical dispute reported in the control group. T he satisfaction rate was 98. 61%(71/72) in the observation group, which was higher than 84. 72%(61/72) in the control group. Conclusion Standardized treatment of outpatient complaints not only mediate doctor-patient disputes, but also protect the rights and interests of both sides. The practice of standardized treatment may improve the overall service quality of the hospital and the satisfaction of patients. (目的 探讨门诊投诉规范化处理的实践效果。方法 将2020年7月—8月接收的72份投诉案例设为对照组, 将2020年9月—10月接收的72份投诉案例设为观察组。对照组采取常规方法接待和处理, 观察组严格执行门诊投诉规范处置。统计2组医疗纠纷发生情况, 比较2组当事患者对处置过程的满意度。结果 观察组未发生医疗纠纷, 对照组发生医疗纠纷6(8. 33%)起。观察组当事患者对处置流程的满意度为98. 61%(71/72), 对照组为84. 72%(61/72)。结论 规范处置门诊投诉, 能够有效控制医患纠纷, 保障医患双方的权益, 有助于提高医院整体服务质量, 提升患者满意度。)