Table of Content

10 June 2024, Volume 5 Issue 6 Previous Issue    Next Issue

Research Paper

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Development and validation of a dynamic nomogram prediction model for hypoactive delirium risk in ICU patients ZHANG Huan, GAN Xiuni, ZHOU Wen, GAO Yan 2024, 5 (6):  485-492.  doi: 10.3761/j.issn.2096-7446.2024.06.001 Abstract ( )   PDF (1180KB) ( )   Save Objective To develop a dynamic nomogram prediction model for hypoactive delirium risk in ICU patients and verify its predicted effect. Methods A total of 430 patients were selected from the ICU of a tertiary Grade A hospital in Chongqing from October 2022 to November 2023. The Confusion Assessment Methodfor Intensive Care Unit and Richmond Agitation-Sedation Scale were used for delirium assessment and classification. Independent predictors were determined through univariate analysis and multivariate logistic regression analysis,and a dynamic nomogram prediction model was developed. The area under the receiver operating characteristic curve and Hosmer-Lemeshow goodness of fit were used to test the discrimination and calibration of the model,and the internal and external verification of the model was conducted. Results The predictors were electrolyte disorders（OR=2.350）,indwelling catheters≥2（OR=3.529）,use of diuretics（OR=0.342）,Glasgow Coma Scale score（OR=0.183）,concentration of C-reactive protein（OR=1.006）,and urea concentration（OR=1.063）. In modeling group,the AUC was 0.941（95%CI：0.916~0.966）,the sensitivity was 87.9%,the specificity was 90.3%,and the Hosmer-Lemeshow test was P=0.415. In validation group,the AUC was 0.897（95%CI：0.837~0.956）,the sensitivity was 79.6%,the specificity was 86.5%,and the Hosmer-Lemeshow test result showed that P=0.450. Conclusion The dynamic nomogram prediction model constructed in this study can effectively predict the probability of hypoactive delirium in ICU patients,providing an effective tool for medical staff to scientifically predict the occurrence of hypoactive delirium,and is convenient for clinical use. References | Related Articles | Metrics

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Study on the occurrence and influencing factors of feeding tube dependence symptoms in critically ill patients after enteral nutrition therapy DU Jinlei, NIE Chencong, LEI Ling, YE Qun, ZHAO Hongxiang, ZHANG Jiquan, ZHANG Deyue, PENG Gutao 2024, 5 (6):  493-498.  doi: 10.3761/j.issn.2096-7446.2024.06.002 Abstract ( )   PDF (914KB) ( )   Save Objective To investigate the occurrence of feeding tube dependence symptoms after enteral nutrition therapy in critically ill patients from multi-centers,and to conduct a systematic analysis of its influencing factors. Methods From July 10 to July 20,2023,a cross-sectional survey was used to conduct questionnaire survey among critically ill patients after enteral nutrition treatment in 12 tertiary general hospitals from 8 provinces and cities,including Sichuan Province,Zhejiang Province,Jiangsu Province,Guizhou Province and Chongqing and etc. The general data questionnaire and the Tube Feeding Dependence Symptom Assessment Scale were used. Results A total of 225 questionnaires were collected and 221 were valid,with an effective recovery rate of 98%.The incidence of tub-feeding dependence symptoms after enteral nutrition treatment in critically ill patients was 64%. The results of multiple factor regression analysis showed that the number of dysfunction system[OR=4.605,95%CI（1.831~11.581）],the days of sedation and/or analgesic drug use[OR=1.578,95%CI（1.031~2.416）],tube feeding days [OR=1.634,95%CI（1.139~2.345）] and the days of gastric dynamic drugs use[OR=1.908,95%CI（1.089~3.345）] were the independent risk factors for the occurrence of tube feeding tube dependence symptoms after enteral nutrition treatment in critically ill patients. Conclusion The incidence of feeding tube dependence symptoms is high after the enteral nutrition therapy in critically ill patients. Healthcare personnel should establish and improve the prevention and management mechanism applicable to feeding tube dependence symptoms after enteral nutrition therapy in critically ill patients. References | Related Articles | Metrics

Commentary

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Construction of emergency and intensive care unit medicine centers in the context of high-quality development of tertiary public hospitals and its inspiration for nursing WANG Shuang, ZHAO Yuxin, CHEN Wei, LIU Lei, FAN Qing, REN Yi, YAO Qi, ZHOU Jianxin 2024, 5 (6):  499-505.  doi: 10.3761/j.issn.2096-7446.2024.06.003 Abstract ( )   PDF (1164KB) ( )   Save With the advancement of high-quality development in public hospitals in China,the construction of emergency and intensive care unit medicine centers has become an important measure in the current national healthcare system reform. Our manuscript reviews the development process and research hotspots in emergency and intensive care medicine in China,summarizes the problems faced in discipline development,and illustrates the construction content and key elements of emergency and intensive care unit medicine centers using Beijing Shijitan Hospital as a case study. It emphasizes the comprehensive development strategic planning of the hospital‘s emergency and intensive care medicine capacity with a clear layout,the seamless coordination with the "Eight Major Emergency Centers",the integration of emergency and intensive care unit medicine resources within the hospital,the interconnection of platform information,and the integration of multiple stages of treatment for critically ill patients,forming a robust and grid-based emergency and intensive care medical system. To adapt to the development of emergency and intensive care medicine,the establishment of specialized scientific research platforms serves as an inexhaustible driving force for the sustainable development of emergency and intensive care unit medicine centers,and we gradually standardize the core technical training system for emergency and intensive care medicine personnel and continuously develop a real-time,efficient,and homogeneous emergency and intensive care monitoring and early warning system. In the future,more high-level emergency and intensive care unit medicine centers will be promoted nationwide,comprehensively improving the level of treatment for critically ill patients and providing safe,efficient,and personalized medical and nursing services for them. References | Related Articles | Metrics

Special Planning—The Practice and Effectiveness of the ActionPlan for Improving Nursing Services

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Construction of communication plan of advance care planning for critically ill patients under family co-decision model ZHANG Liwen, WEI Zhenyan, LIANG Haizhen, QIAO Min, LU Linlin, SUN Qiang, CHEN Xuna 2024, 5 (6):  506-512.  doi: 10.3761/j.issn.2096-7446.2024.06.004 Abstract ( )   PDF (1159KB) ( )   Save Objective To construct the communication plan of advance care planning for critically ill patients under the family co-decision model,and to provide reference for the promotion of advance care planning in critically ill patients. Methods Through literature review and semi-structured interview,the first draft of the communication plan of advance care planning for critically ill patients under the family co-decision model was constructed. Delphi method was adopted for expert consultation to determine the final contents of the plan. Results A total of two rounds of expert consultations were conducted. The effective recovery rates of the questionnaires in the two rounds were 91.30% and 80.95%,the authority coefficients were 0.788 and 0.776,and the Kendall harmony coefficients were 0.184 and 0.110,respectively. Finally,the communication plan included 3 items of first level,11 items of second level and 40 items of third level. Conclusion The communication plan of advance care planning for critically ill patients under the family co-decision model established in this study is reliable and applicable,and can provide some guidance for the implementation of advance care planning for critically ill patients. References | Related Articles | Metrics

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Advance care planning readiness and influencing factors in emergency frail elderly patients XU Yan, ZHANG Mengxia, ZHENG Jili 2024, 5 (6):  513-518.  doi: 10.3761/j.issn.2096-7446.2024.06.005 Abstract ( )   PDF (997KB) ( )   Save Objective To describe the current status of advance care planning（ACP） readiness in emergency frail elderly patients in a tertiary class A hospital in Shanghai and to explore its influencing factors. Methods Advance Care Planning Readiness Scale,the General Information Questionnaire,the Chinese version of the FRAIL scale,and the Apprehension Social Support Scale were used as survey instruments to investigate 157 emergency geriatric frail patients in a tertiary class A hospital in Shanghai. Multiple linear stepwise regression was used to analyze the influencing factors of ACP readiness. Results The total ACP readiness score was（80.38±9.75） among 157 elderly frail patients,of which the scores of attitude,belief,and motivation dimensions were（33.59±7.14）,（19.34±3.42）,and（27.46±4.17）,respectively. Highest education,health care payment method,duration of illness,willingness to treat,social support,and objective support were statistically significant in the univariate analysis. Multivariate analysis showed that highest education,duration of illness,and willingness to treat were factors influen-cing ACP readiness in elderly frail patients in the emergency setting（P<0.05）. Conclusion Advance care planning readiness in the group of emergency frail elderly patients is generally moderate to high. Healthcare professionals should facilitate the expression of their end-stage care needs by developing proven intervention strategies. References | Related Articles | Metrics

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Analysis of the current situation and influencing factors of hospitalization experience among ICU awake patients LIU Yanping, XIONG Jie, HUANG Sufang, SHANG Weiwei, DENG Juan, ZOU Dengxiu, XIAO Qi 2024, 5 (6):  519-524.  doi: 10.3761/j.issn.2096-7446.2024.06.006 Abstract ( )   PDF (1092KB) ( )   Save Objective To investigate the current situation of hospitalization experience of ICU awake patients and explore the influencing factors. Methods Using Patient General Data Survey Form and Hospitalization Experience of Awake ICU Patients,292 awake ICU patients who met the inclusion criteria in 7 hospitals in Hubei Province were investigated. The current situation of hospitalization experience among awake ICU patients was analyzed,and multiple linear regression analysis was conducted to explore the influencing factors. Results 292 valid questionnaires were received,with an effective response rate was 98.6%. The top three items in the actual experience of hospitalization experience were：“The professional level of medical staff”（4.86±0.42） points,“Medical staff‘s friendly and polite language,clean and standardized dressing”（4.85±0.43） points,“Fresh air in the ward”（4.81±0.54） points. The last three items were：“Medical staff often communicate with me about my condition and treatment,and allow me and my families involved in treatment decision”（3.42±0.90） points,“Medical staff actively tell my family about the treatment expenses and reimbursement information,and I feel very comfortable”（3.46±1.01） points,“Rest and sleep is well protected”（3.67±0.87） points. Multiple linear regression analysis showed that length of stay more than 14 days and bedside visit of relatives were the factors affecting the hospitalization experience in the ICU awake patients（R2=0.128,F=3.676,P<0.001）. Conclusion ICU awake patients had good experience of medica staff‘s service attitude,professional level,and some parts of environments in ICU,but relatively poor experience of doctor-patient communication,participation in decision-making,financial pressure,and family companionship. The length of ICU stay and relative visit mode are the influencing factors of the hospitalization experience of ICU awake patients. It is suggested that we can optimize hospitalization experience from optimizing the way of visiting,reasonably shortening the ICU stay length. References | Related Articles | Metrics

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The non-local emergency medical treatment experience in migratory elders：a qualitative study YANG Lu, LIN Bin, ZENG Yan, ZHOU Ming, ZHOU Shiming, ZHANG Hua, GAO Shuhong 2024, 5 (6):  525-529.  doi: 10.3761/j.issn.2096-7446.2024.06.007 Abstract ( )   PDF (1007KB) ( )   Save Objective To understand the real experience of migratory elders with non-local emergency medical treatment,and provide reference for strengthening the guarantee of non-local emergency medical treatment for migratory elders and improving their medical experience. Methods Purposive sampling method was used to select migratory elders who received non-local emergency medical treatment in a tertiary Class A Hospital of Hainan province from January 2022 to February 2023. Semi-structured in-depth interviews were conducted,and the Colaizzi 7-step analysis was adopted to analyze,summarize,and refine the interview data into themes. Results The experience of non-local emergency medical treatment among the migratory elders could be summarized into three sub-themes：gap between emergency services and patient needs,the policy of non-local medical insurance reimbursement needs to be further implemented,establishing positive cognition. Conclusion Migratory elders seeking non-local emergency medical treatment face many challenges,management departments at all levels should strengthen the guarantee for migratory elders who received non-local medical treatment,enhance social support and participation,assist patients in coping with difficulties during the process of receiving non-local medical treatment,providing the best care for migratory elders. References | Related Articles | Metrics

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Evidence summary of discharge preparation services for patients undergoing transcatheter heart valve surgery YANG Qiaozhen, WANG Huafen, CHEN Xia, ZHENG Li, HUANG Aoli, XU Danni 2024, 5 (6):  530-537.  doi: 10.3761/j.issn.2096-7446.2024.06.008 Abstract ( )   PDF (1192KB) ( )   Save Objective To search,screen,evaluate,and integrate relevant evidence on discharge preparation services for patients undergoing transcatheter heart valve surgery at home and abroad,in order to provide evidence-based basis for standardizing clinical nursing practice of discharge preparation services for patients undergoing transcatheter heart valve surgery. Methods We systematically searched domestic and foreign databases for clinical decision-making,recommended practices,evidence summary,clinical practice guidelines,systematic reviews,expert consensus,and randomized controlled studies related to discharge preparation services for patients undergoing transcatheter heart valve surgery. The search deadline was from the establishment of the database to April 2023. Two researchers conducted a methodological quality evaluation of the literature,and extracted and summarized evidence based on the theme. Results A total of 14 articles were included,including a clinical decision,a guideline,three best practices,three systematic reviews,three expert consensuses,two evidence summaries,and a randomized controlled study. 31 best pieces of evidence were summarized from five aspects,including effectiveness evaluation upon admission,during hospitalization,before discharge,after discharge,and post discharge. Conclusion This study summarizes the best evidence for discharge preparation services for patients undergoing transcatheter heart valve surgery. In the subsequent evidence transformation process,targeted selection of evidence should be combined with specific clinical situations to improve patient readiness for discharge and improve patient satisfaction. References | Related Articles | Metrics

Emergency Care Research

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Emergency nursing care of severe asthma complicated with silent lung CHEN Juanying, WU Chunya, QU Jianmin, GAO Aifeng, ZHOU Xiaoyu 2024, 5 (6):  538-541.  doi: 10.3761/j.issn.2096-7446.2024.06.009 Abstract ( )   PDF (812KB) ( )   Save To summarize the experience of emergency nursing for a case of severe asthma complicated with silent lung with fulminant attack characteristics. In view of the rapid progression of the patient‘s disease,it was necessary to identify the silent lung in time to shorten the attack time. Emergency tracheal intubation,clustered airway management strategy,refined analgesia and sedation,grasping the time of ventilator withdrawal and active treatment of related complications were adopted. After 7 days of rescue and nursing,the patient was transferred from the ICU to the general ward and discharged on the 15th day of admission. Follow up for 3 months,the patient took medication according to the doctor‘s instructions and was in good condition. References | Related Articles | Metrics

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Nursing care of thrombus removal under extracorporeal membrane oxygenation in a patient with postoperative acute pulmonary embolism after paraplegia caused by fall from height XUAN Yejing, LIANG Jiangshuyuan, ZENG Fei 2024, 5 (6):  541-544.  doi: 10.3761/j.issn.2096-7446.2024.06.010 Abstract ( )   PDF (683KB) ( )   Save To summarize the nursing experience of thrombus removal under the support of extracorporeal membrane oxygenation（ECMO） in a patient with postoperative acute pulmonary embolism after paraplegia caused by fall from height. The main nursing points included paying close attention to the recovery of cardiac function after cardiogenic shock,strengthening the nursing during ECMO support,implementation of sequential anticoagulation management,formulation of emergency plans for massive airway bleeding,and implementation of phased holistic rehabilitation training programs. After 13 days of treatment and nursing in the comprehensive intensive care unit,the patient‘s condition was stable and she was transferred back to the orthopaedic ward for further rehabilitation treatment. References | Related Articles | Metrics

Critical Care Research

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Perioperative nursing of a patient with giant ovarian mucinous cystadenoma LI Zhengrong, XU Meihong, QIAN Weiming, YANG Lin 2024, 5 (6):  545-548.  doi: 10.3761/j.issn.2096-7446.2024.06.011 Abstract ( )   PDF (851KB) ( )   Save To summarize the perioperative nursing experience of a patient with giant ovarian mucinous cystadenoma. A giant ovarian tumor can lead to serious complications such as spontaneous rupture and compression of the tumor,leading to organ dysfunction. In terms of the huge tumor size,severe anemia,malnutrition,and emotional instability in the patient,we adopted comprehensive preoperative assessment,took measures to improve anemia and provide timely psychological counseling. Effective intraoperative management was implemented and preventive measures were developed for postoperative recurrent pulmonary edema,stress ulcer bleeding,deep vein thrombosis,and pulmonary embolism through cross departmental medical and nursing team discussions. After active treatment and meticulous nursing care,the patient was successfully discharged on the 6th day after surgery and had a good prognosis during 6 months of follow-up. References | Related Articles | Metrics

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Nursing of a child with monocytopenia and mycobacterial infection syndrome XU Xiaoyan, LÜ Zhanghong, SUN Saijun 2024, 5 (6):  548-551.  doi: 10.3761/j.issn.2096-7446.2024.06.012 Abstract ( )   PDF (755KB) ( )   Save To summarize the nursing experience of a child with monocytopenia and mycobacterial infection（MonoMAC） syndrome. In response to characteristics such as the rare disease,high-risk of transplantation,and unknown prognosis,measures were taken to reduce the risk level of invasive diagnosis and treatment,to assist in diagnosis and clarify the needs for transplantation. And we implemented home lung therapy combined with remote rehabilitation to find the best time for transplantation,multidisciplinary collaboration for long-term follow-up to optimize the prognosis of patients. After repeated biopsy and pathological consultation,the patient was diagnosed with Mycobacterium avium infection,PAS（+）,DPAS（+）,GATA2 gene exon 2 insertion mutation,and was diagnosed with MonoMAC syndrome with pulmonary alveolar proteinosis. In October 2022,a hematopoietic stem cell transplantation was performed. Treatment for MAC lung disease continued after the surgery. Follow-up to the present showed that the interstitial lesions have significantly improved compared to that before the transplantation. The patient continued anti-rejection treatment and is currently studying at home. References | Related Articles | Metrics

Quality and Safety

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Construction and application of early management pathway for acute pain in patients with traumatic fracture in emergency department ZHONG Mengqiu, ZHANG Kebiao, CHEN Zhen, HUANG Feiyue, ZHAO Qinghua 2024, 5 (6):  552-556.  doi: 10.3761/j.issn.2096-7446.2024.06.013 Abstract ( )   PDF (713KB) ( )   Save Objective To construct the early management pathway of acute pain in patients with traumatic fracture in the scene of emergency department and evaluate its application effects. Methods We developed the early management pathway of acute pain in patients with traumatic fracture in emergency department by Delphi expert consultation method,and conducted preliminary application. A total of 46 patients with traumatic fracture who were treated in the Emergency Department of a Class III Grade A hospital in Chongqing from October to November 2023 were selected as the research objects. The early management pathway of acute pain in patients with traumatic fracture was implemented and the assessment rate,reassessment rate,treatment rate and patient satisfaction were evaluated. Results The recovery rates of the two rounds of questionnaires were both 100%,and the proportion of experts who proposed revisions were 35.29% and 11.77%,respectively. The authority coefficients of the two rounds of experts were 0.864 and 0.876,respectively. There were 5 aspects including adequate pain assessment,setting pain treatment goals,pain intervention,pain reassessment,and health education,and 12 specific measures. After clinical application,the acute pain assessment rate increased from 8.71% to 84.78%,the reassessment rate increased from 1.23% to 80.43%,the drug analgesia rate and non-drug analgesia rate increased from 14.81% and 6.50% to 69.57% and 63.04%,respectively. Conclusion The early management pathway of acute pain in patients with traumatic fracture in emergency department is scientific,practical and feasible,which is helpful to improve the assessment rate,reassessment rate and treatment rate of acute pain in patients with traumatic fracture. References | Related Articles | Metrics

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Construction of intelligent chest pain platform and application in patients with ST-segment elevation myocardial infarction TAN Wei, LIU Wei, TANG Dongsan, XIE Xiaohua, PI Lingli, QI Chuyi, WANG Yajuan, LI Yumeng, CHENG Shouzhen 2024, 5 (6):  557-561.  doi: 10.3761/j.issn.2096-7446.2024.06.014 Abstract ( )   PDF (731KB) ( )   Save Objective To construct and apply an intelligent platform for chest pain and explore the impact on the treatment efficiency and clinical prognosis of patients with acute ST-segment elevation myocardial infarction. Methods A multidisciplinary team was formed to manage the chest pain intelligent platform,integrating the pre-hospital emergency system,hospital electronic medical record system,laboratory information system,image archiving and communication system to construct the Chest Pain Intelligent Platform and apply it to the treatment and care of patients with acute ST-segment elevation myocardial infarction. We selected 172 patients with acute ST-segment elevation myocardial infarction who attended the emergency department of a tertiary hospital in Shenzhen from April 2021 to May 2023,and divided them into 86 cases in the control group and 86 cases in the experimental group before and after the application of the intelligent platform for chest pain,compared the differences in the treatment time,efficiency and prognosis of the two groups. Results After the application of the chest pain intelligent platform,the time from onset to first medical contact,the time from first medical contact to guidewire passage,the time from entering the hospital gate to guidewire passage,the time from first medical contact to the use of duplex antiplatelet therapy,and the time from entrance to imaging in the experimental group were all significantly lower than those in the control group（all P<0.05）. Amino-terminal B-type brain natriuretic peptide precursor level at discharge was significantly lower in the experimental group than in the control group（P<0.05）,but there was no difference in left ventricular ejection fraction at discharge between the two groups（P=0.828）. Conclusion The application of chest pain intelligent platform can shorten the time of various aspects of treatment for acute ST-segment elevation myocardial infarction patients,improve the efficiency of treatment,and improve the prognosis of patients. References | Related Articles | Metrics

Evidence Synthsis Research

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Summary of the best evidence of perioperative nutritional support for liver transplant recipients LI Tianzi, ZHANG Huifang, HUANG Yuehua, MO Hongping, CAI Min, QIU Yihong 2024, 5 (6):  562-569.  doi: 10.3761/j.issn.2096-7446.2024.06.015 Abstract ( )   PDF (1094KB) ( )   Save Objective To systematically search the related research on perioperative nutrition management of liver transplant recipients and summarize the best evidence. Methods According to the "6S" model of evidence-based resources,BMJ best practice,UpToDate and other source databases were searched from top to bottom,and the research on perioperative nutrition management of liver transplant recipients was included up to April 2023,including Chinese and English related literatures on clinical decision-making,evidence summary,guidelines,expert consensus and systematic reviews. Two researchers conducted independent screening and quality evaluation of the related literatures to include the literature finally,and extracted summarized the evidence. Results A total of 12 literature were included,including 1 clinical decision,4 guidelines,4 expert consensuses and 3 meta-analyses. Thirty pieces of evidence were summarized,which were categorized to seven aspects：establishment of multidisciplinary team,nutrition screening and evaluation,preoperative nutrition intake goals and types,postoperative nutrition intake goals and types,postoperative nutrition intake starting time,nutrition support methods and requirements,and follow-up. Conclusion In clinical practice,the relevant norms of perioperative nutritional support for liver transplant recipients can be formulated according to evidence,and nutritional support can be given according to the specific situation of recipients in practice to ensure that the perioperative nutritional needs of liver transplant recipients can be met. References | Related Articles | Metrics

Review

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The perioperative rescue nursing for complicated pericardial tamponade in arrhythmia patients undergoing radiofrequency ablation：a scoping review ZHAO Fei, CHEN Jieying, SHAO Cuimei, FENG Jia, JIN Jingfen 2024, 5 (6):  570-576.  doi: 10.3761/j.issn.2096-7446.2024.06.016 Abstract ( )   PDF (992KB) ( )   Save Objective To review the risk factors and rescue nursing for perioperative cardiac tamponade in patients with arrhythmia undergoing radiofrequency ablation,so as to provide a reference for improving perioperative management and prognosis of patients. Methods Using Arksey and O ‘Malley‘s scoping review approach as a framework,CNKI,CBM,VIP Database,Wanfang Database,Cochrane Library,PubMed,Web of science,Embase,CINAHL database were searched for relevant studies on cardiac tamponade after radiofrequency ablation in patients with arrhythmia. The search time limit was from the establishment of the database to January 31,2024. The included literature was screened and summarized,the risk factors were summarized,and the rescue and nursing countermeasures for risk factors were obtained. Results Among the 11 included studies,the study designs were mainly case-control study,most studies included cardiac tamponade during and after radiofrequency ablation,and a few studies only included intraoperative cardiac tamponade. The incidence of perioperative cardiac tamponade in patients with arrhythmia undergoing radiofrequency ablation was 0.61% to 2.3%,and there is little difference in the incidence reported by different research centers. The influencing factors mainly included patient factors,combined diseases and treatment factors,radiofrequency ablation procedure-related factors and organizational factors. The rescue nursing strategies included rapid identification and accurate treatment of cardiac tamponade,personnel and equipment preparation,application of rescue nursing technology. Conclusion Complicated cardiac tamponade of radiofrequency ablation in patients with arrhythmia is affected by the patient,surgical operation and organizational factors. In the future,the risk prediction model of cardiac tamponade can be built based on the existing research,providing references for early clinical risk identification and corresponding prevention strategies. References | Related Articles | Metrics