Objective:To construct the clinical training content system for master of nursing specialist (MNS) in China.Methods:The first draft of clinical training content system for MNS was constructed through literature review, national status survey and semi-structured interview. Delphi expert consultation was used to form the final draft, and analytic hierarchy process was used to determine the weight of indicators at all levels.Results:Two rounds of consultation were conducted among 20 experts. The questionnaire recovery rate was 100% and the expert authority coefficient was 0.93. The Kendall concordance coefficients of the two rounds were 0.499 and 0.387, respectively, with a statistically significant difference ( P<0.001) . The average assigned value of importance of indicators at all levels was 4.60 to 5.00. The final version of the clinical training content system for MNS included 6 first-level items, 17 second-level items and 24 third-level items. Conclusions:The clinical training content system for MNS has good practicability, scientificity and reliability, which can provide reference and guidance for MNS clinical training.

目的 研究脑血氧饱和度(rSO2)在心脏骤停后综合征(PCAS)昏迷患者的目标体温管理(TTM)期间预测神经系统预后的作用.方法 本研究根据PRISMA指南进行报告,检索了Pubmed、Embase、Cochane Library、Web of science、Google Scholar、Clinical gov、万方、维普、CNKI共9个数据库.除外研究类型为病例报告、综述和研究样本量小于5例的研究,收集所有在成人心脏骤停(CA)期间进行近红外光谱(NIRS)测量的研究.两名审稿人评估纳入文章的质量并提取数据.结果 效应使用标准化平均差(SMD)进行标准化.结果 本荟萃分析纳入11项研究,其中2项为随机对照研究,9项为观察性研究.共计681例患者.患者TTM期间NIRS测量的rSO2值在TTM 24 h(低温结束)、TTM 24～36 h(复温阶段)和TTM 36～48 h(初始常温阶段)与神经系统预后相关(TTM 24 h:SMD=0.45,95％CI 0.29～0.61;TTM 24～36 h:SMD=1.17,95％CI 0.85～1.50;TTM 36～48 h:SMD=0.26,95％CI 0.10～0.43),良好的神经系统预后(CPC 1～2)组具有较高的rSO2值.在TTM开始时、TTM期间和TTM 72 h的常温阶段,均未发现NIRS测量的rSO2值与神经系统预后的相关性.结论 对于行TTM的CA患者,在TTM 24～48 h期间良好神经系统预后患者NIRS测量的rSO2值高于神经系统预后不良的患者,其中TTM 24～36 h(复温阶段)与良好神经系统预后有较强的关联.

Objective:To explore the research status and trends of sarcopenic obesity at home and abroad, so as to provide a reference for the nursing staff to carry out related clinical work or research.Methods:The articles on sarcopenic obesity included from January 1, 2000 to December 31, 2021 were retrieved in the Web of Science core database. Bibliometric analysis was performed using CiteSpace software.Results:From 2000 to 2021, there were 1 252 articles related to sarcopenic obesity, and the number of articles published showed an upward trend year by year. Totals of 83 countries or regions participated in the research, and the country with the largest number of publications was the United States (286) . The most published journal was Clinical Nutrition (44) . The author with the most papers was Wolfgang Kemmler (14) , and the institution with the most papers was Korea University (57) . Research hotspots mainly focused on immune resistance, disease risk and nutritional intervention.Conclusions:Bibliometric analysis reveals research patterns and trends in sarcopenic obesity. Foreign countries started early in this research field, and my country is still in its infancy. There is also an urgent need to cultivate research leaders in the field of sarcopenic obesity, form an inter-institutional cooperation mechanism, and carry out multidisciplinary teamwork to promote the health of the elderly.

目的:评估关于近红外光谱（near-infrared spectroscopy, NIRS）的测量值（初始值、平均值和最高值）在接受心肺复苏患者中预测自主循环恢复（return of spontaneous circulation, ROSC）方面的潜在作用。方法:本研究根据PRISMA准则进行，检索Pubmed、Embase、Cochane Library、Web of science、Clinical gov、万方、维普、CNKI共8个数据库，收集所有在成人心脏骤停（cardiac arrest, CA）期间进行NIRS监测的观察性研究，并排除病例报告、综述和研究样本量小于5例的研究。两名作者评估纳入文章的质量并提取数据，结果效应使用标准化平均差（standardized mean difference, SMD）进行标准化。结果:本综述纳入22项观察性研究，共计3 578例患者（304例患者发生院内CA，3 274例患者发生院外CA）。研究发现患者的NIRS rSO 2初始值（SMD=0.72，95% CI: 0.50~0.94）、平均值（SMD=1.12，95% CI: 0.86~1.37）和最高值（SMD=1.86，95% CI: 0.77~2.96）均与患者发生ROSC相关，ROSC组具有较高的脑氧饱和度测量值。不管是院外还是院内发生CA患者，其NIRS的平均rSO 2测定值与ROSC均有关联性(SMD=0.94，95% CI: 0.68~1.19；SMD=1.65，95% CI: 0.85~2.45)，院外发生CA患者与院内发生CA患者的平均rSO 2测定值与ROSC的关联差异无统计学意义（ P=0.10）。 结论:不管是院内还是院外发生CA，恢复ROSC的患者在整个复苏过程中的NIRS脑血氧饱和度均显著高于非ROSC患者，其中平均NIRS rSO 2测定值与ROSC具有相对较强的关联。

Objective:To construct a clinical training target system for masters of nursing specialist (MNS) , so as to provides references for clinical training of masters of nursing specialist in China.Methods:The index system was preliminarily constructed by literature review, semi-structured interview and preliminary investigation. The convenient sampling method was used to select 20 experts from Beijing, Shanghai, Jiangsu and other regions from August to October 2020 to conduct two rounds of expert letter consultation, revise and improve the indicators and establish the clinical training target system for masters of nursing specialist.Results:The valid recovery rates of the two rounds of expert letter consultation questionnaire were both 100.00% (20/20) , and the expert authority coefficient was 0.93. The Kendall's coordination coefficient of total index of the first and second rounds of expert letter consultation questionnaire was 0.461 and 0.317, respectively ( P<0.01) . Finally, the clinical training objective system for masters of nursing specialist included 3 first-level indicators (quality objectives, knowledge objectives and skills objectives) , 6 second-level indicators and 27 third-level indicators. Conclusions:The clinical training target system for master of nursing specialist established in this study is scientific, credible, comprehensive and practical, which can provide a reference for the clinical training of masters of nursing specialist in China.

Objective:To investigate the relationship between previous bleeding history and poor prognosis of patients with acute upper gastrointestinal bleeding.Methods:This study was a prospective multicentre real-world study (Acute Upper Gastrointestinal Real-word study, AUGUR study). The data of patients with UGIB who were admitted to the emergency department of 20 tertiary hospitals in China from June 30, 2020 to February 10, 2021 were collected. According to the number of previous bleeding history, the patients were divided into three groups (0 time, 1-3 times, and≥4 times). Based on the patient’s demographic data, clinical characteristics, laboratory data, treatment, and outcomes, univariate and logistic regression analysis were performed to investigate the correlation between the number of previous bleeding and the 90-day mortality and rebleeding of patients with gastrointestinal bleeding.Results:A total of 1 072 patients with acute UGIB were included in this study. The all-cause mortality and rebleeding rate of all patients were 10.9% (117/1 072) and 11.8% (129/1 072), respectively. Among them, 712 patients (66.42%) had no previous bleeding, 297 patients (27.71%) had previous bleeding 1-3 times, and 63 patients (5.88%) had previous bleeding≥4 times. In univariate analysis, age, vital signs and consciousness on admission, history of liver cirrhosis, onset with hematemesis, admission hemoglobin, varicose veins bleeding, peptic ulcer bleeding, red blood cell infusion, tracheal intubation and the use of vasopressors after admission were risk factors for the 90-day mortality and rebleeding rate. Multivariate logistic regression analysis showed that patients with previous bleeding≥4 times had a higher risk of the 90-day mortality ( OR=2.17, 95% CI: 1.04-4.57, P=0.040) and rebleeding ( OR=2.32, 95% CI: 1.19-4.53, P=0.013). Conclusions:The history of previous bleeding≥ 4 times can be used as an independent risk factor for the 90-day mortality and rebleeding in patients with acute UGIB.