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Abstract Acute gastrointestinal injury (AGI) is common in mechanically ventilated (MV) patients, but the potential association between ventilatory pressure parameters and AGI grade and their impact on mortality remains unclear. This study aimed to explore the association between ventilatory pressure parameters and AGI grade, and their interaction on all-cause mortality in MV patients. This study was a secondary analysis of a multicenter, prospective, observational study that enrolled adult patients with an expected duration of mechanical ventilation ≥ 48 h from 14 general intensive care units in Zhejiang Province between March and August 2014. The AGI grade was assessed daily on the basis of gastrointestinal symptoms, intra-abdominal pressures, and feeding intolerance in the first week of admission to the ICU. This study included 331 patients (69.2% men; mean age, 64.6 ± 18.9 years). Multivariate regression analysis showed that plateau pressure (Pplat) (OR 1.044, 95% CI 1.009–1.081, P = 0.013), serum creatinine (OR 1.003, 95% CI 1.001–1.006, P = 0.042) and APACHE II score (OR 1.035, 95% CI 1.021–1.072, P = 0.045) were independently associated with global AGI grade III/IV within 7 days of ICU admission. Moreover, global AGI grade (HR 2.228, 95% CI 1.561–3.182, P

Background General practice (GP) plays a key role in carrying out the"Healthy China initiative", but the standardized medical quality evaluation involved remains incompletely established. The establishment of an appropriate quality evaluation indicator system for GP has to be settled urgently. Objective To evaluate the medical quality of GP in general hospitals of Chongqing, the medical quality evaluation indicator system for GP is established, and the indicator system would also provide reference for the construction of GP and the research work of Centers for General Medical Quality Control in Chongqing. Methods The evaluation indexes were formulated in February-April 2022 using the literature analysis method. Based on Delphi method, the indicator system was revised according to the correspondence consultation from 25 general practice experts of 20 general hospitals (including clinical residential training bases) in Chongqing. The final draft was combined with the suggestions of experts from the Center for Medical Quality Control of GP. Results Among the selected experts, men accounted for 64.0%, and 76.0% had middle or senior titles. Two rounds of experts' consultation responses were 21 and 20 copies respectively, and the experts' authoritative coefficient were 84.00% and 95.24%. Corresponding degree of authority above 0.85. After two rounds of experts' consultation and the suggestions of the quality control center, the medical quality evaluation indicator system of general practice for general hospital was finally established including 5 first-class indexes, 10 second-class indexes and 28 third-class indexes. Conclusion The evaluation indicator system based on Delphi method is of great significance for standardizing the quality of general practice service in general hospitals, promoting the construction of general practice service in Chongqing and strengthening the supervision of medical quality control center.

Background In standardized residency training for general practice trainees, the rotation time in various clinical specialties is short, and there is a wide range of learning content, requiring enhanced learning autonomy. General practice faculty would be dealing with trainees from a variety of backgrounds, including 5+3, transfer, professional masters, or 3+2 assistant general practitioners, interns, public health trainees. It was necessary to study how to enable different training targets to get what they need and achieve the desired training effect in training needed to be carefully studied. Objective The objective of this study was to explore a training method that addresses structural problems, enhances trainees' learning initiative, and cultivates their ability for deeper thinking. Methods At the end of each learning activity, immediate discussions were organized to address the following questions: "1. What have you learned through the study? 2. What other questions do you have? 3. What are the same or similar experiences that you can share with others? 4. What inspirations do you have for future work?" The paper conducted theoretical analyses of the four questions to elucidate the method's internal logic and trainees' thinking process. Corresponding questionnaires were designed for validation studies conducted in the General Practice Backbone Teachers' Training Class and the Grassroots Talent Class. Results The training method received strong agreement from the trainees, with the composite score ranging between "strongly agreed" and "agreed". After conducting parameter tests, no statistical differences were found in the answers concerning gender, age, title, position, and working experience. However, statistical differences were observed in academic qualifications, work units, and participated training programs (P

In response to the difficulty of measuring fluid pH values in high-acidity, high-pressure, hightemperature, and complex ion environments, this paper proposes a predictive model for in-situ pH values in high-acidity environments. The model considers the influences of eleven factors, including ORP potential, temperature, and pressure, and is capable of calculating the pH value of fluids incorporating the following factors: pressure, temperature, Na+ ion concentration, K+ ion concentration, Ca2+ ion concentration, Mg2+ ion concentration, Cl- ion concentration, HCO3- ion concentration, H2S concentration, CO2 concentration, and ORP potential. Furthermore, the model is optimized to possess variable adaptability, allowing compatibility with cases involving fewer than eleven influencing factors. Test results demonstrate that the predictive model for in-situ pH values in high-acidity environments exhibits high precision, with a maximum prediction error of 6.32%, a minimum of 1.19%, and an average prediction error of 4%. Compared to other existing models, it considers a more comprehensive set of factors, providing a mathematical approach to pH prediction that holds significance for corrosion control in oil and gas pipeline industries.