Background: Delirium is a common postoperative complication among patients who undergo Stanford Type A aortic dissection (TAAD). It is associated with increased mortality, as well as other serious surgical outcomes. This study aimed to analyze the risk factors for delirium in TAAD patients. Methods: Pubmed, Web of science, Embase, the Cochrane Library and CINAHL were searched by computer to collect literatures on risk factors for postoperative delirium (POD) after TAAD. The retrieval period was from the establishment of the database to September 2022. After literature screening, two reviewers independently assessed the quality of the included studies using the Newcastle–Ottawa Scale (NOS). Data were extracted according to standard protocols, and then meta-analysis was performed using Revman 5.3 software. Results: A total of 9 articles, comprising 7 case–control studies and 2 cohort studies, were included in this analysis. The sample size consisted of 2035 patients. POD was associated with increased length of ICU stay (MD 3.24, 95% CI 0.18–6.31, p = 0.04) and length of hospital stay (MD 9.34, 95% CI 7.31–11.37, p < 0.0001) in TAAD patients. Various perioperative risk factors were identified, including age (MD 4.40, 95% CI 2.06–6.73, p = 0.0002), preoperative low hemoglobin levels (MD − 4.44, 95% CI − 7.67 to − 1.20, p = 0.007), body mass index (MD 0.92, 95% CI 0.22–1.63, p = 0.01), history of cardiac surgery (OR 3.06, 95% CI 1.20–7.83, p = 0.02), preoperative renal insufficiency (OR 2.50, 95% CI 1.04–6.04, p = 0.04), cardiopulmonary bypass (CPB) duration (MD 19.54, 95% CI 6.34–32.74, p = 0.004), surgery duration (MD 44.88, 95% CI 5.99–83.78, p = 0.02), mechanical ventilation time (SMD 1.14, 95% CI 0.34–1.94, p = 0.005), acute physiology and chronic health evaluation (APACHE II) score (MD 2.67, 95% CI 0.37–4.98, p = 0.02), postoperative renal insufficiency (OR 2.82, 95% CI 1.40–5.68, p = 0.004), electrolyte disturbance (OR 6.22, 95% CI 3.08–12.54, p < 0.0001) and hypoxemia (OR 3.56, 95% CI 1.70–7.44, p = 0.0007). Conclusions: POD can prolong ICU stay and hospital stay in TAAD patients. This study identified a number of risk factors for POD after TAAD, suggesting the possibility of early identification of high-risk patients using relevant data.

Background: One of the most drastic complications of median sternal incision is deep sternal wound infection (DSWI), as it can lead to prolonged hospitalization, increased expected costs, re-entry into the ICU and even reoperation. Since the pectoralis major muscle flap (PMMF) technique was proposed in the 1980s, it has been widely used for sternal reconstruction after debridement. Although numerous studies on DSWI have been conducted over the years, the literature on DSWI in Chinese population remains limited. The purpose of this study was to investigate the clinical characteristics of DSWI in patients and the clinical effect of the PMMF at our institution.Methods: This study retrospectively analyzed all 14,250 consecutive patients who underwent cardiac surgery in the Department of Cardiothoracic Surgery of Drum Tower Hospital from 2001 to 2020. Ultimately, 134 patients were diagnosed with DSWI.,31 of whom had recently undergone radical debridement and transposition of the PMMF in the cardiothoracic surgery or burns and plastic surgery departments because of DSWIs, while the remaining patients had undergone conservative treatment or other methods of dressing debridement.Results: In total, 9,824 patients were enrolled in the study between 2001 and 2020, of whom 134 met the DSWI criteria and 9690 served as controls. Body mass index (OR = 1.08; P = 0.02; 95% CI, 1.01∼1.16) and repeat sternotomy (OR = 5.93; P < 0.01; 95% CI, 2.88∼12.25) were important risk factors for DSWI. Of the 134 patients with DSWI, 31 underwent the PMMF technique, and the remaining 103 served as controls. There were significant differences in coronary artery bypass grafting (CABG) (P < 0.01), valve replacement (P = 0.04) and repeat sternotomy (P < 0.01) between the case group and the control group. The postoperative extubation time (P < 0.001), ICU time (P < 0.001), total hospitalization time (P < 0.001) and postoperative hospitalization time (P < 0.001) in the PMMF group were significantly lower than those in the control group. The results of multivariate regression analysis showed that PMMF surgery was an important protective factor for the postoperative survival of DSWI patients (OR = 0.12; P = 0.04; 95% CI, 0.01∼0.90).Conclusions: Staphylococcus aureus was the most common bacteria causing DSWI, which was associated with BMI and reoperation, and can be validly treated with PMMF.

Background: This study aims to analyze the risk factors associated with prolonged mechanical ventilation (PMV) in patients following surgical treatment for acute type A aortic dissection (ATAAD). The objectives include constructing a predictive model for risk assessment and validating its predictive efficacy.Methods: A total of 452 patients diagnosed with ATAAD and undergoing surgical procedures at a tertiary hospital in Nanjing between January 2021 and April 2023 were selected using a convenience sampling method. Patients were categorized into two groups: PMV group (n = 132) and non-PMV group (n = 320) based on the occurrence of prolonged mechanical ventilation (PMV), and their clinical data were compared. The data were randomly divided into a modeling set and a validation set in a 7:3 ratio. Risk factors for PMV were identified in the modeling group using logistic regression analysis. A risk prediction model was constructed using R 4.1.3 software, visualized via a column chart. Receiver Operating Characteristic (ROC) curves were generated using the validation set to assess model differentiation. Calibration curves were plotted to evaluate accuracy and consistency, and Decision Curve Analysis (DCA) was applied to evaluate clinical utility.Results: The logistic regression analysis identified age, body mass index, preoperative white blood cell count, preoperative creatinine, preoperative cerebral hypoperfusion, and cardiopulmonary bypass time as significant risk factors for postoperative PMV in patients with ATAAD. The area under the curve (AUC) for the validation set ROC curve was 0.856, 95% confidence interval (0.805–0.907), indicating good discrimination. Calibration curves revealed strong alignment with the ideal curve, and the Hosmer-Lemeshow goodness-of-fit test indicated a well-fitted model (P = 0.892). The DCA curve demonstrated a high net benefit value, highlighting the model's strong clinical utility.Conclusions: The risk prediction model developed in this study for PMV in patients undergoing surgery for ATAAD exhibits robust predictive performance. It provides valuable insights for healthcare practitioners in predicting the likelihood of PMV and devising timely and personalized intervention strategies.

Background: The aim of this study was to estimate the potential influencing factors of postoperative constipation in patients undergoing cardiovascular surgery. Methods: This study included a cohort of 379 patients who underwent cardiovascular surgery at Nanjing Drum Tower Hospital. The patient cohort was stratified into two groups based on the presence or absence of postoperative constipation. Utilizing logistic regression analysis, both univariate and multivariate analyses were conducted to elucidate the factors influencing defecation problems. The predictive accuracy of the findings was subsequently evaluated through the receiver operating characteristic (ROC) curve. Results: Among the cohort of 379 patients subjected to cardiovascular surgery, a noteworthy 20.8% (n = 79) reported incidences of postoperative defecation issues. A multivariate logistic regression analysis showed that age (odds ratio (OR) = 1.063, 95% confidence interval (CI) 1.034–1.097, p < 0.001), operation time (OR = 1.004, 95% CI: 1.000–1.008, p = 0.028), ventilator usage time (OR = 1.032, 95% CI: 1.010–1.055, p = 0.004), polypharmacy (OR = 2.134, 95% CI: 1.069–4.321, p = 0.032), use of cough medicine (OR = 2.981, 95% CI: 1.271–6.942, p = 0.011) and psychological or behavioral barriers to defecation in the hospital environment (OR = 31.039, 95% CI: 14.313–73.179, p < 0.001) were independent risk factors for postoperative constipation in patients undergoing cardiovascular surgery. The area under the curve (AUC) for predicting postoperative constipation was 0.885. Conclusion: In the pursuit of optimizing postoperative recovery and mitigating postoperative constipation incidence, a targeted approach is imperative. Specifically, a focused intervention directed towards elderly patients, extended operation and prolonged ventilator durations, polypharmacy regimens, use of cough medicine, and those with psychological or behavioral barriers to defecation within the hospital milieu emerges as pivotal.

This study aimed to investigate the impact of applying the CDIO teaching model, incorporating the Rosenthal effect, on the development of core competencies in nursing interns during clinical training. Possessing core competencies is of crucial importance for nursing students. Although new teaching methods have emerged, an effective model for the internship stage is still in demand. The CDIO model has demonstrated promise in nursing education and the Rosenthal Effect can significantly boost students' motivation. Therefore, this study combines the two to fill this gap. This study is a single-center, prospective, non-randomized concurrent controlled study. From August 2022 to April 2023, six units were selected from a hospital, with three designated as the intervention unit. Nursing interns were assigned to either the experimental group (n = 50) or the control group (n = 50). The experimental group received instruction based on the CDIO model combined with the Rosenthal effect, while the control group followed traditional clinical teaching methods. The outcomes were assessed using the Nursing Student Core Competence Scale, case assessments and theoretical examinations. The experimental group showed significantly higher scores in core competencies and case assessments compared with the control group (P < 0.05). Although the experimental group also achieved higher scores in the theoretical examination, the difference was not statistically significant (P > 0.05). The integration of the CDIO model with the Rosenthal effect effectively enhances the core competencies of nursing interns. However, further research is required to optimize the acquisition of theoretical knowledge in specialized areas.

Purpose: This study aimed to test a hypothesized model of benefit finding (BF) of patients with lung cancer to explore how resilience, social support and coping affect BF. Methods: 301 lung cancer patients hospitalized in two tertiary hospitals in Jiangsu pronvice were selected by convenient sampling method from July 2020 to February 2021. General information questionnaire, benefit finding scale, the Connor-Davidson resilience scale, social support rating scale and medical coping modes questionnaire were used to conduct in the investigation. Structural equation modelling was used to explore the effects of related factors on BF. Results: The fit index of the hypothesized model was satisfactory. Resilience, social support, confrontation coping and acceptance-resignation coping had direct effects on BF. Moreover, social support had an indirect effect on BF through resilience, confrontation coping, acceptance-resignation coping and resilience-acceptance coping, resilience also had an indirect effect on BF through acceptance coping. Conclusions: our results showed that the level of BF of lung cancer patients is low. Based on the results of model, medical staff should help them make good use of the social support system, enhance their resilience, correctly recognize the disease and face it positively, so as to improve the level of patients' BF and improve their quality of life.