This prognostic study compares the diagnostic equivalence of patient-collected lower nasal specimens with that of health care worker–collected oropharyngeal specimens for sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. However, specimen collection must be done by health care workers and requires extensive use of personal protective equipment. To minimize the risk of exposure during testing, reduce personal protective equipment use, and increase access to testing, we compared the diagnostic equivalence of a modified specimen collection method, patient-collected lower nasal swabs, with that of the current clinical standard, health care worker–collected oropharyngeal swabs. If the 2 methods proved to be diagnostically equivalent, patients would be able to collect specimens themselves without exposing health care workers to respiratory secretions.Since the emergence of the sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in Wuhan, China, in December 2019, the virus has spread to 173 countries, resulting in 3 855 788 confirmed cases and 265 862 deaths as of May 9, 2020.STARD) reporting guideline.This prognostic study was approved by the Stanford University institutional review board. Participants provided oral informed consent to clinical research coordinators and then signed a consent form with the physician who collected the oropharyngeal swab. This study complies with the Standards for Reporting of Diagnostic Accuracy , a physician-collected lower nasal swab , and a physician-collected oropharyngeal swab . During the visit, participants received a $20 incentive. The 3 specimens were placed in separate 3-mL tubes of viral transport medium , stored in a cooler, and delivered to the Stanford Clinical Virology Laboratory. Specimens were tested for SARS-CoV-2 using reverse transcriptase–polymerase chain reaction targeting the envelope or open reading frame 1 ab genes.We report participant demographic characteristics, sensitivity and specificity, and discordant probabilities with 95% binomial CIs of patient-collected lower nasal compared with physician-collected oropharyngeal specimens. All analyses were performed with SAS statistical software version 9.4 (SAS Institute). Data analysis was performed in May 2020.Of 129 eligible SARS-CoV-2–infected patients, 30 participated in the study . We do not have reasons for refusal for nonparticipants. Participants were predominantly white (20 participants [66%]), with no sex or age group predominance. Twelve participants (40%) self-reported possible exposure to SARS-CoV-2. Cough (20 participants [67%]), fever (13 participants [43%]), and sore throat (8 participants [27%]) were commonly reported symptoms during the first visit. Approximately one-half of the participants had documentation of chronic medical conditions (16 participants [53%]), and 5 participants (17%) tested positive for coinfections with other respiratory viruses .We observed diagnostic equivalence across the 3 methods of specimen collection . Eleven 4 that lists patient-collected lower nasal swab as an acceptable specimen collection method for SARS-CoV-2 testing. Self-collected lower nasal swabs could also be used for home- or office-based testing of asymptomatic patients. However, these preliminary findings are limited by small sample size, have limited generalizability, and need to be validated further in diverse clinical settings. These validation efforts are currently under way at our institution.These findings contribute to the recently released US Food and Drug Administration guidance


The dentinogenic ghost cell tumor (DGCT), a locally invasive benign neoplasm, is one of the rarest odontogenic tumors, usually developing in the maxilla or mandible. It can be classified into 2 types: intraosseous  and extraosseous . Here, we describe the first case of a peripheral DGCT located in the ethmoid sinus.An 8-year-old boy presented to our department with a longer than 7-month history of nasal obstruction, purulent secretion, and reduction in sense of smell in the right nasal cavity.The patient was diagnosed with peripheral DGCT of the ethmoid sinus based on computed tomography scan and pathology.Functional endoscopic sinus surgery was performed.With 2 years of follow-up, there was no evidence of recurrence.Peripheral DGCT can occur in the paranasal sinus and the need to consider this entity as a possible diagnosis by the clinicians. The dentinogenic ghost cell tumor (DGCT) is the solid variant of CCOT and is characterized by ameloblastoma-like epithelial cells associated with ghost cells and dysplastic dentin.The calcifying cystic odontogenic tumor (CCOT), a term formally used since it was named by the World Health Organization in 2005, The intraosseous DGCT is reported to be locally invasive, and patient age ranges from 12 to 75 years, whereas the extraosseous type is extremely rare and less aggressive, with an age range of 7 to 92 years. No matter what type, the DGCT usually occurs in the maxilla and mandible.,5The DGCT is one of the rarest odontogenic tumors, regarded as a locally invasive benign neoplasm. It may present as an intraosseous  or extraosseous  process.Here, we present a case of peripheral DGCT located in the right ethmoid sinus in an 8-year-old child. To our knowledge, this is the first report of a primary DGCT in the paranasal sinus in the available English literature. The patient's parents have provided informed consent for publication and this report was also approved by the Ethics committee of the West China Hospital, Sichuan University.2An 8-year-old boy presented to the pediatric department with a longer than 7-month history of nasal obstruction, purulent secretion, and reduction in sense of smell in the right nasal cavity. After drug treatment was ineffective, he was advised to visit our Ear, Nose, and Throat department. The patient had no history of nasal foreign bodies, fever, headache, facial pain, or bloody secretion. No lymphadenopathy was noted.Considering that the patient might not be able to cooperate with nasal endoscopy, a computed tomography (CT) examination was performed and revealed soft tissue density mixed with multiple discrete hyperdense calcification in the right posterior ethmoid sinus, without bony destruction Fig. . Based oWe performed endoscopic sinus surgery for the patient under general anesthesia, and found that the lesion was a solid mass of about 1.9 cm × 1.2 cm × 1.1 cm with a smooth surface involving the olfactory area. After complete resection, the specimens were sent for histopathological analysis. The hematoxylin and eosin-stained section showed proliferative surface epithelium without any dysplasia and 1 or 2 islands of odontogenic epithelium with eosinophilic material resembling dentin and numerous ghost cells  and extraosseous .DGCT is a locally aggressive neoplasm that usually develops in the maxilla or mandible, accounting for less than 1% of all odontogenic tumors.,9 Most peripheral DGCTs originate from the gingiva in dentate patients and alveolar mucosa in edentulous patients, usually appear as a sessile, sometimes pedunculated, exophytic mass.,10 In our case, the lesion might be derived from the mucosa of the nasal or ethmoid sinus, and involved the nasal cavity and olfactory area. Therefore, nasal symptoms similar to the symptoms of chronic sinusitis became the chief complaints. Nasal congestion and reduction in sense of smell caused by mechanical obstruction, and the purulent secretion might be complicated with the maxillary sinusitis. In addition, DGCTs usually appear radiographically as a cystic lesion or soft mass mixed radiolucent–radiopaque lesion depending upon the degree of calcification, which are easily confused with the CT features of fungal ball in nasal sinus. Therefore, it might be misdiagnosed as fungal sinusitis. However, fungal sinusitis in children is very rare, so differential diagnosis should be considered, such as ameloblastoma, ossifying fibroma, and osteodysplasia fibrosa.The central DGCTs are usually located centrally in the bone (the maxilla and mandible), mainly occur in the canine to first molar region and exhibit as an asymptomatic swelling, although some may present with slight numbness and pain.,11 The ghost cells appear as eosinophilic epithelial cells that have lost their nuclei. The islands of ameloblastoma-like epithelium with ghost cells can distinguish DGCT from ossifying fibroma and osteodysplasia fibrosa but they may be difficult to separate from ameloblastoma. If it happens, dysplastic dentin can provide more information because the dentin and ghost cells are generally not present in ameloblastoma simultaneously. Lack of cystic structure and atypical mitosis can be used to distinguish from CCOT and ghost cell odontogenic carcinoma, respectively.Accurate diagnosis depends on pathological findings. Actually, both central and peripheral variants of DGCTs exhibit similar histological features in that the tumors are composed of ameloblastoma-like islands of odontogenic epithelium with clusters of ghost cells and variable amounts of dentinoid material in the surrounding tissue or near the epithelium. Peripheral DGCTs are less aggressive and can be controlled by local complete excision. No recurrences have been reported.,12 Regardless of the type, radiotherapy and chemotherapy are not recommended. On rare occasions, the DGCT transforms into ghost cell odontogenic carcinoma. Therefore, a long-term follow-up of no less than 3 years is suggested. There are no significant differences in clinical manifestations, pathology, and treatment between adults and children, according to current reports.Therapeutically, central DGCTs have an aggressive behavior and a high recurrence so that extensive surgical resection with an adequate safety margin is recommended.In summary, peripheral DGCT can occur in both adults and children without gender predilection. The sinus DGCT may be confused with fungal sinusitis based on the clinical manifestations, which reminds clinicians to consider this entity as a possible diagnosis.Conceptualization: Guo Liu.Data curation: Guo Liu, Jin-nan Li.Methodology: Feng Liu.Resources: Feng Liu.Supervision: Feng Liu.Writing – original draft: Guo Liu.Writing – review and editing: Feng Liu.


Background and Purpose: Radiation therapy has long been contemplated as an important mode in the treatment of rectal cancer. However, there are few ideal tools available for clinicians to make a radiotherapy decision at the time of diagnosis for rectal cancer. The purpose of this study was to assess whether biomarkers expressed in the biopsy could help to choose the suitable therapy and provide predictive and/or prognostic information. Experimental Design: In total, 30 biomarkers were analyzed in 219 biopsy samples before treatment to discover the possibility of using them as an indicator for radiotherapy selection, diagnosis, survival and recurrence. Results: Twenty-two biomarkers  had diagnostic value. For survival, four biomarkers  were significant in regulating gene promoter activity and overall survival, while four had a trend . Three biomarkers  correlated with disease-free survival, while eight had a trend . Four biomarkers  were independent prognostic factors for recurrence. NFKBP65 and SIRT6 were significantly correlated with lymph node metastasis regardless of radiation. Patients with high AEG1, LOX, NFKBP65, PPAR and SATB1 had or showed a positive trend for better survival after radiotherapy, while those with positive PINCH and WRAP53 expression would not benefit from radiotherapy. Conclusions: AEG1, LOX, NFKBP65cyto, PPAR and SATB1 could be used as indicators for choosing radiotherapy. COX2-RT, COX2-NonRT and some other biomarkers may provide additional help for diagnosis. Multidisciplinary management has improved the prognosis of rectal cancer in recent years. The role of radiotherapy in the treatment of rectal cancer has also been initiated in the last few decades. Advances in preoperative radiotherapy have reduced the disease relapse and markedly increased the survival. However, there are few ideal tools available for the clinicians to make a treatment decision at the time of diagnosis. In this study, we analyzed the Astrocyte elevated gene-1 (AEG-1), CD163, COX2, Forkhead box M1 (FOXM1), ki-67, LIVIN, lysyl oxidase (LOX), Musashi-1 (MSI-1), nuclear factor-kappa Bp65 (NFKBP65), particularly interesting new cysteine-histidine-rich protein (PINCH), peroxisome proliferator-activated receptor (PPAR), PRb2/P130, p53, p73, phosphatase of regenerating liver (PRL), RNA-binding motif protein 3 (RBM3), special AT-rich sequence binding protein 1 (SATB1), sirtuin 6 (SIRT6), Tafazzin (TAZ) and WRAP53 biomarkers in 219 biopsy samples before treatment to discover the possibility of using them as an indicator for radiotherapy selection, diagnosis and prognosis. The results indicate that five biomarkers could serve as potent indicators for radiotherapy. Some biomarkers may provide additional aid for diagnosis, especially for those cases that are difficult to draw conclusions on with the traditional Hematoxylin–Eosin staining. Only a few biomarkers could provide prognostic information for survival or recurrence, suggesting that it is unsuitable to predict prognosis excessively depending on the biomarkers in the biopsy. This study provides valuable information for the predictive or prognostic significance of biomarkers in biopsy and may give useful information to clinical practice.Colorectal cancer is among the three most common cancer diagnoses and causes of cancer death in women and men in Sweden and China ,2. MultiAccurate diagnosis and preoperative staging are essential to determine the optimal therapeutic plan for a patient. Computer tomography (CT) or magnetic resonance imaging (MRI) for polyp characterization is standard for preoperative staging but sub-optimal sensitivity and specificity values for detection of nodal metastasis are reported ,8,9. To Although alterations in numerous genes and pathways such as the APC/β-catenin/Tcf pathway have been indicated as possible risk factors for RC progression, the studies were mainly focused on tumor specimens obtained after operation and might be of little value to the initial management of the patients ,12. BiopAssessing the status of biomarkers in biopsy samples may provide additional diagnostic and predictive information, compared to traditional diagnosis with histopathology ,17. Howen = 127) or surgery alone . RT was given at 25 Gy in 5 fractions during a median of 6 days . Surgery was performed within a median of 8 days after RT . The expression of different biomarkers in biopsy samples  and in surgical samples including distant normal mucosa , primary tumor (PT) and lymph node metastasis (LNM) were determined by immunohistochemistry. The number of the samples varied for different biomarkers depending on available pathological material. The required informed consent was given by all participants. None of the patients received preoperative or adjuvant chemotherapy. There were no significant differences between the RT group and Non-RT group concerning the clinicopathological characteristics  was performed at our laboratory for the following proteins: astrocyte elevated gene-1 , CD163 , COX2 , Forkhead box M1 (FOXM1), Ki-67 , LIVIN, lysyl oxidase , Musashi-1 , nuclear factor-kappaBp65 , particularly interesting new cysteine-histidine-rich protein , peroxisome proliferator-activated receptor , PRb2/P130 , P53 , P73 , phosphatase of regenerating liver , RNA-binding motif protein 3 , special AT-rich sequence binding protein 1 , sirtuin 6 (SIRT6), Tafazzin/wwtr1  and WRAP53 . The IHC with the different antibodies was performed on the same patient samples at our laboratory. The intensity of staining was classified as 0 (negative staining: ≤5% positive cells), 1 (weak staining: weak yellow), 2 (moderate staining: yellow-brown) and 3 (strong staining: brown) and/or the proportion of staining was scored into five grades as 0%, 1–25%, 26–50%, 51–75% and 56–100%. A case was evaluated as positive if it contained any positive cancer cells and negative otherwise. The staining patterns were graded as cytoplasmic, nuclear or stromal staining. The immunostaining was independently evaluated by two researchers including one pathologist without clinical and pathological knowledge about the patients. In the case of discrepant scoring results, a consensus score was reached after re-examination. The re-analysis was performed as described previously ,19,20,21n = 63) and RT group (n = 56), respectively, to exactly evaluate their predictive and diagnostic significance and, more importantly, find out whether the biomarkers in BS could be used as RT indicators. For the protein expressed in the cytoplasm, nucleus and/or stroma, we distinguishingly named them as “-cyto”, “-nucl” and “-strom” in “-RT” or “-NonRT” group, respectively, e.g., “FOXM1cyto-NonRT” and “FOXM1nucl-RT”. Thus, with 30 biomarkers in each group, in total 60 biomarkers were analyzed.We mainly implemented the study on three different levels. Firstly, we evaluated whether the radiation had an impact on the expression of the biomarkers. Secondly, we compared the staining of the different biomarkers BS, DN, PT and LNM between the Non-RT group and RT group, respectively, to see whether there was a correlation among those samples. Thirdly, we compared the expression of biomarkers in matched samples (the samples from the same patients) in Non-RT group (2) test or Fisher’s exact test. For ranked data, a nonparametric test is a suitable statistical option [p-value < 0.05 was considered to be statistically significant. All statistical analyses were performed using IBM SPSS Statistics 23.0 software.The clinicopathological characteristics between RT and Non-RT groups were analyzed by Chi-square (χl option  The diffp = 0.007), MSI1 , RBM3cyto , RBM3nucl , TAZ  and WRAP53cyto   . The exp= 0.010) .We analyzed the difference of 60 biomarkers  between BS and PT in the unmatched or matched cases to find out whether BS can represent PT, especially focused on those in the matched samples, as the results from the matched samples would be more dependable.p < 0.05; 10/60, 16.67%), while the expression of the other biomarkers in BS were equal to or more than those in PT tissue . This additionally confirmed that, in most cases, biomarkers in BS could be those of PT.Then, we used correlation analysis to further discover the relationship between BS and PT in the RT group or Non-RT group, respectively. The results show that most biomarkers in BS were related to PT, of which 24 biomarkers had close relationships . In other words, they were not suitable for diagnostic analysis since there was no noticeable difference between BS and DN. The other 47 biomarkers were different when compared  and would be further analyzed for their diagnostic value. Comparing the expression of biomarkers between BS and DN highlighted that 22 biomarkers  in BS had diagnostic value for RC patients preoperatively , while the other 48 biomarkers in BS were equal to or higher than those in LNM (80.00%). Further correlation analysis highlighted that, among the 48 biomarkers, six were closely related to those in LNM , P130cyto-NonRT (p = 0.048), PINCH-NonRT (p < 0.001) and PPARcyto-RT (p = 0.049). AEG1-RT (p = 0.074), LOXnucl-RT (p = 0.096), SATB1-NonRT (p = 0.062) and SIRT6nucl-RT (p = 0.052) tended to be related to OS. The other biomarkers in BS had no prognostic value for OS , PINCH-NonRT (p = 0.005) and WRAP53cyto-NonRT (p = 0.007). AEG1-RT (p = 0.091), COX2-NonRT (p = 0.084), Ki67-NonRT (p = 0.089), LOXnucl-RT (p = 0.088), NFKBP65cyto-RT (p = 0.054), PPARcyto-RT (p = 0.067), SATB1-NonRT (p = 0.094) and WRAP53nucl-NonRT (p = 0.077) had the tendency to be related to DFS. Patients with positive expression of these biomarkers had reduced DFS time compared to those with negative tumors , NFKBP65cyto-RT , P130cyto-NonRT  and PPARcyto-RT  in BS were independent prognostic factors for local/distal recurrence; patients with high expression of these four biomarkers in BS were more prone to suffer from tumor recurrence  were not considerably changed by RT, while six biomarkers were significantly increased or reduced in PT after preoperative RT: FOXM1nucl, MSI1, RBM3cyto, RBM3nucl, TAZ and WRAP53cyto. Among them, MSI1 had diagnostic significance in both the Non-RT and RT groups; RBM3nucl trended to have diagnostic significance in patients who received RT; TAZ was helpful for the diagnosis in the Non-RT group; and WRAP53cyto was related to DFS and had a trend with recurrence in Non-RT group patients. We then analyzed the varied expression of biomarkers between BS and PT in different levels  to observe whether BS could represent PT. We observed that the expression of 10 biomarkers in BS was less than those in PT, while the 50 other biomarkers (83.33%) expressed in BS were equal to one or more of those in PT. Correlation analysis showed that most biomarkers in BS were related to PT, of which 24 biomarkers had a close relationship. The results further confirm that, in most cases, BS markers could be of PT, although in 16.67% of cases BS was less than PT.In the last few years, several studies have demonstrated high concordance between biopsy and resection samples in CRC and other cancers using IHC and molecular testing such as cytogenetic testing and microarray analysis . Shia etp < 0.001) in RC patients. Routine forceps biopsy, causing tissue fragmentation in a few cases, was of limited value especially in identifying residual cancer cells after nCRT. (3) The third caveat relates to the possibility that some of the driver mutations are occasionally selected late, and may thus be presented in a sub-clone that has not yet gained dominance when the biopsy is carried out, although that might happen at a very low frequency. (4) IHC performed in tissue microarrays rather than whole-tissue sections may also, to a small extent account, for the different percentages of positive results [The difference might be caused by multiple factors: (1) It could be a result of the less tissue sampled for the biopsy, i.e., the tissue obtained may be insufficient to represent the overall tumor, in addition to CRCs being known for their intra-tumor heterogeneity . The uti results . (5) It Rossum et al.  found thOn the other hand, if the expression of an oncoprotein in BS is lower than that in DN, it does not possess any diagnostic value. We analyzed the diagnostic value of biomarkers in BS and confirmed that 22 factors (36.67%) could be used as diagnostic biomarkers. Four biomarkers (6.67%) had the tendency to be meaningful for diagnosis and might need more studies for further validation.Several research groups have indicated the predictive value of biomarkers in the biopsy of various cancers. Sato et al.  demonstrIn the present study, we revealed that the expression of NFKBP65nucl, SIRT6cyto and SIRT6nucl in BS significantly correlated with those in LNM regardless of RT. Four biomarkers in BS correlated with OS: NFKBP65cyto-RT, P130cyto-NonRT, PINCH-NonRT and PPARcyto-RT. AEG1-RT, LOXnucl-RT, SATB1-NonRT and SIRT6nucl-RT tended to be related to OS. The other 86.67% (52/60) of biomarkers had no predictive value for OS. Among the 60 biomarkers, three were related to DFS: COX2-RT, PINCH-NonRT and WRAP53cyto-NonRT. AEG1-RT, COX2-NonRT, Ki67-NonRT, LOXnucl-RT, NFKBP65cyto-RT, PPARcyto-RT, SATB1-NonRT and WRAP53nucl-NonRT tended to be related to DFS. The patients with positive expression of these biomarkers were observed to have reduced DFS time compared to those with negative tumors. The other 49 biomarkers (81.67%) had no predictive significance for DFS. Further analysis indicated that only four biomarkers (6.67%), COX2-RT, NFKBP65cyto-RT, P130cyto-NonRT and PPARcyto-RT, in BS were independent prognostic factors for local/distal recurrence; the patients with high expression of these biomarkers were more prone to suffer from tumor recurrence. Eight biomarkers had the trend to be related to local/distal recurrence; however, there was no relationship between the other 48 biomarkers (80.00%) and recurrence. The patients with high COX2 or WRAP53cyto expression tended to have worse OS and DFS regardless of RT, while high P130cyto in BS tended to predict better OS and DFS in both Non-RT and RT groups. Importantly, patients with positive AEG1, LOXnucl, NFKBP65cyto, PPARcyto and SATB1 expression had or tended to have better OS and DFS after RT, positive Ki67 expression tend to have a close correlation with better DFS after RT and those with positive SIRT6nucl expression tend to have a better OS after received RT. In contrast, patients with high PINCH and WRAP53nucl did not benefit from RT; thus, these biomarkers might be used as RT indicators.The present analysis confirmed that: (1) Well-known oncogenes including AEG1, LOXnucl, NFKBP65cyto, PPARcyto and SATB1 can also be used as indicators for RT selection. (2) Only a few biomarkers in BS could provide predictive information for survival or recurrence, so we should be vigilant of their limited value. It might be unsuitable to predict prognosis egregiously depending on the expression of biomarkers in BS. (3) Some biomarkers could provide additional information and be helpful for diagnosis, especially for those cases on which it is difficult to draw diagnostic conclusions with routine Hematoxylin–Eosin staining. As many biomarkers in BS were not meant for diagnosis, it is inappropriate for the clinicians to excessively rely on biomarkers in BS to make their diagnosis. (4) Biopsy has limitations in clinical practice, which might be unavoidable but could be improved. Clinicians should be aware of this and reasonably use it.There are several limitations to the present study. The sample size was not large enough due to the fact that biopsy samples were not available for all the subjects we selected from the local cancer registry, which might be not reprehensive of the entire corresponding populations. In addition, due to the paucity of biopsy samples, it was not possible to analyze all the selected biomarkers in all samples. Thirdly, owing to the lack of complete information on the family history, we could hardly evaluate whether there were any special characteristics in hereditary RC such as Lynch syndrome-associated RC.Our results provide valuable information for refining the previously debatable description of the value of biomarkers in biopsy in RC and would give useful information to clinical practitioners. Further studies, focusing on those screened biomarkers in a larger population, are needed to precisely verify the efficiency of pretreatment biopsy specimens in helping the clinician to make a therapeutic selection and predicting the outcome of RC patients.


Combustible tobacco users appear to be at greater risk for serious complications from COVID-19. This study examined cigar smokers’ perceived risk of COVID-19, quit intentions, and behaviors during the current pandemic. We conducted an online study between 23 April 2020 to 7 May 2020, as part of an ongoing study examining perceptions of different health effects of cigars. All participants used cigars in the past 30 days (n = 777). Three-quarters of the sample (76.0%) perceived they had a higher risk of complications from COVID-19 compared to non-smokers. The majority of participants (70.8%) intended to quit in the next six months due to COVID-19, and almost half of the sample (46.5%) reported making a quit attempt since the start of the COVID-19 pandemic. Far more participants reported increasing their tobacco use since COVID-19 started (40.9%) vs. decreasing their tobacco use (17.8%). Black or African American participants, participants who reported using a quitline, and participants with higher COVID-19 risk perceptions had higher intentions to quit using tobacco due to COVID-19, and higher odds of making a quit attempt since COVID-19 started. More research is needed to understand how tobacco users are perceiving COVID-19 risks and changing their tobacco use behaviors. Cigarette, cigar, and other combustible tobacco users appear to be at greater risk for developing serious complications from COVID-19 ,3,4. At Due to the potential negative health outcomes associated with COVID-19, it is possible that many tobacco users feel more vulnerable to its health effects and are trying to quit using tobacco—which aligns with both previous research and theory on risk perception ,13. HoweThe goals of this study were to examine cigar smokers’ perceived risk of COVID-19, quit intentions, and behaviors during the current pandemic. In the United States (US), cigars are one of the most commonly used tobacco products with 7.2% of adults reporting smoking cigars in the past 30 days , and oveWe also examined how other correlates were associated with COVID-19 quit intentions and behaviors, including demographics, such as age and race, and tobacco use variables, such as other tobacco use and nicotine dependence. We did so because research has found several factors in the US to be associated with risk of acquiring COVID-19 and experiencing complications, including race/ethnicity, age, and other comorbidities. Specifically, African Americans in the US are dying of COVID-19 at greater rates than white people, and are experiencing more complications . IncreasWe recruited participants as part of an ongoing study examining perceptions of different health effects of cigars. Specifically, this study presented different text statements about the health effects of cigars  to participants, and asked them to answer if they were aware of this health effect and how effective it was at discouraging their cigar use. This study will be used to develop effective warnings for little cigar and cigarillo packages. We expanded eligibility to include all cigar users to be more representative of the cigar smoking population. Participants were recruited and compensated through Qualtrics Services—a leader in the field of survey software, deployment, methodology, and consumer research. Qualtrics has existing panels that can be used for social science research ,29,30, aWe had two primary outcomes: (1) quit intentions in the next 6 months due to COVID-19 , and , perceived risk of complications due to COVID-19 compared to non-smokers (newly developed item), COVID-19 risk perceptions , and frWe conducted analyses in SAS V.9.3 . We first examined bivariate associations with our two outcomes (quit intentions and quit attempts) and all correlates of interest—participant characteristics, tobacco use variables, and other COVID-19 variables. We then examined bivariate associations among our two primary outcomes and changes in tobacco use since COVID-19 started . Finally, we examined associations among all correlates and our two primary outcomes in separate multivariable models. As our first outcome—quit intentions—was continuous, we entered all participant characteristic, tobacco use, and COVID-19 correlates in a multivariable linear regression model. As our second outcome—quit attempts—was dichotomous, we entered all correlates in a multivariable logistic regression model. We included all correlates in the adjusted multivariate regression models, because we did not have any a-priori hypotheses for which correlates would be associated with our outcomes. While we planned to examine changes in tobacco use as a third outcome in a multivariable, multinomial regression model, we did not run this model due to small cell counts in some of the tobacco use response options. Results from the first model include Beta coefficients (B) and standard errors (SE). If the B is positive, the interpretation is that for every 1-unit increase in the correlate, the outcome variable will increase by the B value. Results from the second model include adjusted odds ratios (aOR) and 95% confidence intervals (CI). An aOR of more than 1 means that there is a higher odds of the outcome happening with exposure to the correlate. An aOR of less than 1 means that there is a lower odds of the outcome happening. For all analyses, we set α = 0.05 and used 2-tailed statistical tests.Participant characteristics and tobacco use variables are presented in COVID-19 variables are presented in p < 0.001 for both comparisons). Similarly, participants who reported decreasing their tobacco use were more likely to report making a quit attempt (63.0%), and participants who reported increasing their tobacco use were also more likely to report making a quit attempt (57.6%), compared to participants who reported keeping their tobacco use the same (28.4%) (p < 0.001). Finally, participants who reported making a quit attempt had higher quit intentions  than participants who did not report making a quit attempt  (p < 0.001). All bivariate associations among correlates of interest and our two outcomes (quit intentions because of COVID-19 and quit attempts since COVID-19 started) are presented in Bivariate associations among our two outcomes with changes in tobacco use are presented in p = 0.002) and had higher odds of making a quit attempt since COVID-19 started , compared to White participants (p = 0.005).Black or African American participants had higher quit intentions due to COVID-19 , compared to participants who smoked cigars and did not smoke cigarettes. In addition, participants who smoked cigars and used smokeless tobacco had higher odds of making a quit attempt since COVID-19 started , compared to participants who smoked cigars and did not use smokeless tobacco.p < 0.001), and had higher odds of making a quit attempt since COVID-19 started , compared to participants who did not report calling a quitline. Participants who believed they had a higher risk of complications due to COVID-19, compared to non-smokers had higher quit intentions due to COVID-19  than participants who believed they had the same risk of complications. In addition, having higher risk perceptions of COVID-19 was associated with higher quit intentions due to COVID-19  and higher odds of making a quit attempt since COVID-19 started . Finally, greater social distancing efforts were associated with higher quit intentions due to COVID-19 .Participants who reported calling a quitline had higher quit intentions due to COVID-19  than decreasing their tobacco use 18%). Only one previous study, to our knowledge, has examined how tobacco users have changed their behaviors in response to COVID-19 and reported similar results. In this study of 345 dual cigarette and e-cigarette users, 30.3% of participants reported increasing their cigarette use and 29.1% reported increasing their e-cigarette use since learning of COVID-19 %. Only o,13. However, we also found that people who reported increasing their tobacco use also reported higher quit intentions and had higher odds of making a quit attempt—in line with research on the “stress hypothesis”. It is possible that these people want to quit, but are stressed or anxious, and are increasing their tobacco use despite their ‘good’ intentions. To this point, we did find that better mental health status was associated with higher intentions to quit. In addition, people may be bored or have stockpiled tobacco products before sheltering in place orders, which could have increased their tobacco use. Finally, it is also possible that people may want to quit but are not able to easily access evidence-based cessation resources like pharmacotherapy or behavioral support . We also found that over a fifth of participants in our sample reported calling a quitline because of COVID-19, and that those who reported calling a quitline had higher quit intentions and attempts. Although the majority of US smokers are aware of quitlines ,42, theyFinally, we identified several characteristics that were associated with COVID-19 quit intentions and attempts. For instance, Black or African American participants had higher quit intentions and attempts due to COVID-19. African Americans in the US are dying of COVID-19 at greater rates than white people and experiencing higher rates of complications . This maThere are several limitations to this study. First, all data were self-reported, which introduces threats of social desirability bias. Second, this was a one-time cross-sectional study, which means that we were unable to assess temporality of associations or trends over time. Future longitudinal research is needed to understand how COVID-19 is changing participants’ smoking and quitting behaviors. Third, all participants were recruited online and are not representative of the US population or of tobacco users, which means that study findings may not apply to other countries or groups of tobacco users. Fourth, since this was a cross-sectional study and there was no possibility of randomizing participants to different exposures, we cannot make any claims of causality. We are careful throughout this article to use language like “correlates” rather than “predictors” and “associated with” rather than “causes.” Fifth, we created several measures in this study that have not been previously used  given the novelty of COVID-19 and the rapid research needed to understand it. Many tobacco users included in our study perceived that they were at risk higher risk of COVID-19 complications, reported intending to quit due to COVID-19, and reported making a quit attempt since COVID-19 started, however, more tobacco users reported increasing their tobacco use due to COVID-19 than decreasing it. More research is needed to understand how tobacco users are perceiving risks of COVID-19 and changing their tobacco use behaviors.


The perceived health risks of tobacco products may change during the ongoing COVID-19 pandemic. This study aimed to examine the perceived risks of tobacco use on COVID-19 infection and severity, and possible COVID-related changes in perceptions of tobacco use and overall health.We conducted an online survey of adults in the United States in June 2020 (n=2097). The survey covered cigarettes, cigars, e-cigarettes, and hookah. We also assessed changes in the use of any of the four tobacco products. Multivariate logistic regression models were used to estimate the odds of agreeing with the perceived risks for each risk and each product, with the adjustment of demographic and COVID-19 related variables.For all four tobacco products, the perceived risks to general health were slightly higher during the pandemic than before the pandemic (77% vs 79.5% for cigarettes) and the perceived risk of COVID-19 severity was larger than the perceived risk of COVID-19 infection (73.3% vs 56.2% for cigarettes). All risk measures varied with tobacco products consistently, with the risks highest for cigarettes, then cigars, followed by e-cigarettes and hookah. Females and people with higher income or education were more likely to endorse the risks of tobacco use than their counterparts. People who perceived higher risks of using cigarettes  and cigars  to COVID-19 severity were more likely to have decreased or quit their use.Tobacco/nicotine use was perceived to increase the risk of COVID-19 severity and the perceived risk of tobacco/nicotine use to general health was high during the pandemic, particularly for cigarettes. The change of perceived risks appeared to be prompting harm-reducing changes in tobacco product use. In tobacco regulatory science, findings of health risk misperceptions that can promote harmful tobacco use behaviors are used to prompt and inform corrective action through new public education efforts or new requirements relating to product characteristics (e.g. flavors or appearance), product packaging, and labeling design, advertising and other marketing, warning labels, and educational package inserts5.Perceptions of health risks and harms are associated with tobacco product experimentation, initiation, frequency, and intensity of use, as well as quit attempts7, it is not clear if current smoking is associated with a reduced risk of COVID-19 infection10. This initial research seems to contradict the hypothesis that smokers are at higher risk of disease severity due to mechanisms such as pre-existing lung disease or reduced lung capacity or higher rates of various other diseases among smokers compared to non-smokers, and have an increased transmission risk due to greater contact between fingers and lips and inhaling deeply near one’s fingers. These seemingly controversial findings, together with misleading information on social media, may confuse the public, particularly smokers. Similarly, the influence of other tobacco product use such as cigars, e-cigarettes, and hookah on COVID-19 is largely unknown. The uncertainty and controversy may impact the perceived risk of tobacco use among both tobacco users and non-users.Perceived health risks of tobacco products may change during the ongoing COVID-19 pandemic, given the uncertainty surrounding the association between smoking, vaping, and COVID-19 incidence and outcomes. Preliminary evidence indicates that although smoking may be associated with a higher mortality rate and suffering more severe consequences of COVID-1912. Another study found that the majority of people who used tobacco/nicotine believed that their tobacco/nicotine use did not increase the risk of COVID-19 infection but increased the severity of COVID-19 if infected13. Further, among tobacco/nicotine users, a high perception of the risk of tobacco/nicotine use to COVID-19 was associated with a reduction in tobacco/nicotine use or an increase in the desire to quit tobacco/nicotine use14. However, these studies were conducted either in relatively small regions or having a small sample size thus limiting the generality of their findings.Research on the perceived health risks of tobacco/ nicotine use during COVID-19 pandemic is currently limited. Initial evidence showed the majority of people who used cigarettes and e-cigarettes believed that their tobacco/nicotine use increased their risk of COVID-19 in generalThis study aimed to examine the perceived risks of tobacco/nicotine use on COVID-19 infection and COVID-19 severity, as well as any possible COVID-related changes in perceptions of tobacco-nicotine use and overall health harms and risks. Specifically, we examined how perceived risks were distributed within the population and varied by tobacco products, related factors, and their influence on tobacco use behaviors.https://www.mturk.com/), an online crowdsourcing platform to conduct surveys. Inclusion criteria were: 1) ever use (as of 31 December 2019) of at least one tobacco product among the four categories of cigarettes, cigars , e-cigarettes, and waterpipe (i.e. hookah); 2) residence in the US; and 3) 90% or above approval rating from previous MTurk tasks. Eligible participants were given access to the survey, hosted by Qualtrics . The survey was active in MTurk between 8 and 18 June 2020. Each eligible participant was compensated $0.25. The Institutional Review Board at the University of Memphis approved this study.We conducted a survey of adults in the United States using Amazon Mechanical Turk , participants reported the COVID-19 status of themselves and their family, whether they had experienced a COVID-19 death among family members, friends, or colleagues, and the zip-code where they lived. Using the home zip-code, the urbanization level of the neighborhood was classified as urban, suburban, or rural, using the rural-urban commuting area (RUCA) codesThe survey focused on four types of tobacco-nicotine use: e-cigarettes or smoking either cigarettes, cigars, or hookah – and asked about the perceived risks of each on: 1) likelihood of COVID-19 infection; 2) severity of COVID-19 if infected; and 3) general health. For COVID-19 infection, participants were asked: ‘Do you agree that the use of each of the following tobacco products will increase the risk of getting COVID-19?’, and the response options were based on a 5-point Likert scale . For COVID-19 severity, the question was: ‘If a person gets COVID-19, do you agree that the use of each of the following tobacco products will make him/her sicker, or sicker for a longer period of time?’. For general health, we assessed perceived risk both before and during the COVID-19 pandemic. The questions were: ‘Before the COVID-19 pandemic, for example, during the year of 2019 in general, to what extent did you agree that the use of each of the following tobacco products causes serious illness is very convincing?’ and ‘Right now, to what extent do you agree that the use of one tobacco product causes serious illness is very convincing?’.We also assessed changes in the use of any of the four tobacco products during the COVID-19 pandemic, including new initiation, cessation, switching, or changes in consumption levels.To analyze the data, we first summarized the percent of participants who agreed or strongly agreed with the perceived risks for each tobacco/ nicotine product. Second, multivariate logistic regression models were used to estimate the odds of agreeing with the perceived risks for each risk and each product. Finally, multivariate logistic regression models were used to estimate how the perceived risks influenced the odds of decreasing or quitting the use of each tobacco product compared with increasing or initializing it. All multivariate logistic regression models were adjusted by demographic variables including gender, age, race/ethnicity, educational level, and household income, urbanization level of the neighborhood, COVID-19 related variables such as if any COVID-19 infection for self and family and if any COVID-19 death among social network, and the use status of the specific tobacco/nicotine product in 2019. Analyses were performed using SAS 9.4 .Among the 2097 participants who completed the survey, 53% were male, 57% were aged 18–34 years, 63% were White, 10% were Black, 16% were Hispanic, 8% were Asian, 60% had at least a Bachelor’s degree, and 81% lived in urban areas. Most (91%) participants and their family members did not have any COVID-19 symptoms, and 22% reported a COVID-19 death among family members, friends, or colleagues. Among the participants, the prevalence of ever using (considering both exclusive use and co-use or poly-use with other tobacco products) cigarettes, cigars, e-cigarettes, and hookah in 2019 was 67%, 23%, 39%, and 16%, respectively (Supplementary file Table S1).As As As 18 and less traditional combustible products such as hookah20. For all four products, the perceived risks to general health during the pandemic were higher than the perceived risk to general health before the pandemic. Because the two risks were measured at the same time, the difference may not reflect an increase of the perceived risk of tobacco use to general health. However, such ‘perceived’ increase in perceived risks, although moderate, were consistent across the four major tobacco products and is consistent with the findings that adults generally perceive that tobacco-nicotine use is linked with increased COVID-19 incidence and severity . Unlike smoking-related cancer, heart disease, and lung disease, which generally take decades to develop, thereby obscuring their causal links, the effect of COVID-19 is much more immediate and tangible. The perceived risks of tobacco use, even from exposure to secondhand smoke or e-cigarette aerosols may increase markedly due to COVID-19.For all three risk measures, perceived risks were higher for cigarette and cigar smoking compared with e-cigarette and hookah use, consistent with the general relative perceived risk that traditional combustible tobacco products were more harmful than non-combustible tobacco products22. Likewise, higher income and education are associated with higher awareness of the harms of smoking and nicotine24.We found that females and people with higher income or education level were more likely to endorse the risks of tobacco use. This is consistent with existing literature where perceived risk of tobacco use and many other outcomes rated higher in females than in malesIt was noteworthy that reporting a COVID-19 death within a respondent’s social network was consistently associated with lower perceived risk from tobacco-nicotine use. This may be because those who had a higher perceived risk towards certain tobacco products tend to use less or do not use this product, as persons in their social network. Thus their lower tobacco use may decrease their risk of COVID-19 death. It is also possible that the salience of identifiable risk factors for COVID-19 other than tobacco use among members of one’s social networks reduces the attributions of tobacco as a causal agent for the disease.We found that decreasing or quitting the use of certain tobacco products was associated with a greater perceived risk of severity of COVID-19 infection but not with the perceived risk of COVID-19 infection. This indicated that the concern of the severity of COVID-19 if infected was more effective as a deterrent from using the product than the concern of becoming infected. It could also be that people generally think that avoiding COVID-19 infection is largely a matter of chance or, alternatively, engaging in social distancing, mask-wearing, and handwashing, with tobacco use simply not part of the equation.One limitation of this study is that the study sample was recruited from a crowdsourcing platform. Rather than a national representative sample, our participants tended to be younger and more highly educated compared to the average US adult. Secondly, as a cross-sectional study, we may not be able to accurately capture the changes in the perceived risk of tobacco use to general health. For example, as aforementioned, the perceived risks to general health before the pandemic and during the pandemic were measured at the same time, thus the difference may not reflect a real increase of the perceived risk of tobacco use to general health. Lastly, we did not capture detailed information on the history of tobacco use and current use status, which is potentially correlated with perceived risks. For example, the perceived risk is likely to be different between new and long-term users, between heavy and light users, between people who use one product, and those who are dual and poly-users.13, the perceived risk of tobacco use on COVID-19 severity was much higher than the perceived risk of COVID-19 infection, and the majority of participants endorsed that tobacco use increases COVID-19 severity. Females and people with higher income or education level were more likely to perceive the risks of tobacco use than their counterparts. The finding that the perceived risk of tobacco use to COVID-19 infection fluctuated around 50% for various tobacco products reflects confusion among the adult public. The positive aspect is that these perceptions – whether accurate or not – appear to be prompting harm-reducing changes in tobacco product use14.Overall, COVID-19 is increasing perceived risks among the public from using the four types of tobacco products. Consistent with the initial evidenceClick here for additional data file.


With the continuous deepening of medical reforms and the continuous attempts and explorations of various management models, the traditional health care model is undergoing tremendous changes, and patients' needs for medical institutions are becoming more and more comprehensive. Medical institutions are meeting the needs of providing medical services to patients at the same time. It is even more necessary to change our thinking and enhance the service concept. This article is based on case-based deep learning hospital nursing business process reengineering and the application and feasibility study of integrated nursing information construction in nephrology nursing. This article uses the literature analysis method, the social survey method, and other methods to discuss the construction of integrated nursing information. On the one hand, the content of this article uses the concept of process reengineering to analyze the current development status and existing problems of the hospital care industry and find countermeasures to solve problems. On the other hand, the main research content of this article is the construction of integrated nursing information and its analysis of the application and feasibility of nursing in the nephrology department. At the same time, under the background of the rapid development of the mobile Internet, we will carry out extended thinking on the continuous transformation of the construction of nursing information. According to the survey results, 87.5% of patients in the nephrology department are dissatisfied with the current hospital's work efficiency, and 85.7% of the nursing staff in the nephrology department are generally satisfied with the information management of the current department. After the implementation of the hospital information integration system, patient satisfaction is as high as 98.2%, and the satisfaction of medical staff reached 94.2%. The construction of integrated nursing information has played a great role in the application of nephrology nursing. Under the background of information integration, with the rapid development of computer technology, network technology, and communication technology, information construction has become a hot spot of concern to the whole society. The popularization of the Internet has provided unprecedented opportunities for the development of information technology. While the field brings opportunities, it also intensifies competition. The essence of the integrated construction of nursing information is that many medical systems are integrated horizontally, and data and information are seamlessly linked, so that hospitals, departments, and positions can be interconnected, breaking the traditional medical mode of vertical and gradual information transmission mode . InformaWith the continuous development and progress of society and the reform of the medical system, many experts and scholars began to discuss “how to continuously improve the level of medical care” . This inn = 40 before and after n = 80) was used to measure changes in nurse satisfaction. Whalen et al. believes that when nursing and nursing services are integrated, real-time pickup and agency tasks also increase, which may lead to an increase in database queries, thereby increasing the amount of information transmitted [In recent years, as the informatization has gradually penetrated our daily lives, it has brought us convenience in various fields. All regions are exploring how to use informatization and processes to better provide patients with convenient and effective medical services. The Zhu and Gu study examined the impact of the comprehensive nursing handover system  on nurses' satisfaction with handover and practice changes . Backgronsmitted . It can The integrated construction of nursing information relies on the development of informatization, intelligence, and platformization. The information platform is used to reengineer the conventional traditional business processes effectively and thoroughly, accompanied by the third characteristic of informatization and intelligent technology . The conWith the continuous promotion of the concept of “high-quality nursing service” throughout the country and related research and development, the concept of “consolidating basic nursing and providing satisfactory services” has been continuously deepened and developed in the nursing work of nurses. Nurses continue to improve themselves and perform their duties as nurses. Patients provide effective, high-quality, and satisfactory nursing services. Patient satisfaction has been included in the evaluation process of hospital standardization construction and has become an important index for evaluating hospitals . As an iWith the reform of the medical system and the state's repositioning of the nature of hospitals, competition in the medical industry has become increasingly fierce. Affected by the external environment, the competition among major hospitals has changed from a single factor to a comprehensive factor. Therefore, hospitals must use medical resources scientifically and rationally, and think and solve problems from the perspective of patients, to effectively enhance their competitiveness. The nursing work flow is based on an in-depth understanding and scientific analysis of the main business processes of the organization and is guided by customer needs. Effective planning, reorganization, or modification of the main business processes is carried out to improve the links in the business process to improve the quality of the entire operation, with the purpose of improving labor efficiency and reducing the overall cost of operations . In shorx to x + 1. This process requires analysis [x to x − 1. The first process is the end of the needs analysis. The admission procedure to the discharge procedure is a system, and the general state of the system can be expressed as follows:Tx represents the time distribution of the arrival of customers during the input process, Tp represents the time distribution of the patient's stay in the hospital or the patient's information in the hospital system, and R represents the information system capacity [Rn−1 represents the overall information capacity after excluding the nth patient's remaining capacity [Entering the hospital's information system through the patient's personal information makes the system state from analysis ; when thcapacity . When a capacity .r represents the total nursing business demand after the system is updated [λ, T0) represents the demand status when different patients end business services and start new nursing services. The data is sorted by the genetic algorithm, which can be efficiently arranged for process reengineering after monitoring the data. Process reengineering is just the beginning. Continuous improvement is the core of maintaining process reengineering.Because there is the possibility of another patient's information output at the same time as the patient's information is entered, in order to ensure the effective reintegration or redesign of the overall hospital care business in this situation, we choose to use genetic algorithms to select, cross, and cross over. Mutation and other operations are adjusted to ensure accurate data update. The method of data integration of the genetic algorithm in nursing business process is  as follo updated , and , the solution of the recursive formula is as follows:Equation  is a typThus, the following is obtained:Si represents the reliability index of the parallel system; Fi represents the reliability index of the hybrid system; and Se is the reliability of the individual nursing information or the basic information system of a single patient that makes up the parallel system [It is very convenient to build an integrated nursing information system program with a high-efficiency development program, operation efficiency, and operational functionality . Analyzil system . The nur  Step 1: nephrology patients who meet the diagnostic criteria during the recovery period  Step 2: stable vital signs  Step 3: patients with cognitive dysfunction who cannot cooperate with the investigator are excluded  Step 4: nephrology nursing work for more than half a year  Step 5: pass the annual assessmentInclusion criteria of experimental subjects are as follows:This article investigates the patients' satisfaction of the nursing business process in the nephrology department of a third-class hospital in Guangzhou. Through literature research, expert consultation, and interviews, the preparation of the questionnaire was repeatedly revised, and the questionnaire was designed and carried out for the satisfaction of patients in nephrology and related nursing staff, and the reliability and validity of the questionnaire were tested to ensure the validity of the questionnaire. Through the descriptive statistics of the questionnaire and the satisfaction results of medical and nursing integration, a comprehensive evaluation of the construction of information integration is carried out.Using the nursing business process reengineering theory to build a nursing business process model and using genetic algorithms to analyze the model will have a certain effect on the analysis of the role of integrated nursing information construction, medical staff, and nephrology patients' satisfaction.wo experiments were conducted, which are as follows:  Step 1: expert consultation and interview on information literacy indicators of nursing staff  Step 2: analysis of the missing items of nursing information in the Department of NephrologyThe survey results show that 87.5% of patients in the nephrology department are dissatisfied with the current hospital's work efficiency, and 85.7% of the nursing staff in the nephrology department are generally satisfied with the information management of the current department. After the implementation of the hospital's information integration system, patient satisfaction is as high as 98.2%, and the satisfaction of medical staff reached 94.2%. Through the analysis and design of each function in the mobile nursing system based on the Internet of things, the following functions are mainly realized . The nurThe introduction of modern computer and communication technology into the medical field has extremely practical value. The integrated nursing information system adopts the operation mode of sending and receiving at the same time. It can ensure that the nursing work is carried out in an orderly manner and that the nursing needs of patients are met. Build a network-based medical care information service platform in a short time and gradually integrate relevant information resources of the hospital. The improvement in business management work is a feature of current research for the research of intelligent nursing path information management systems, which has important economic and social value , 32. In The nursing business process model diagram shows that the nursing work is based on the basic information of nephrology patients entered into the hospital database. The patient's medical care information terminal fills in the patient's personal medical record information through the patient's family members and submits medical care online, which shortens the complicated procedures of traditional care and saves manpower and material resources to a large extent. However, the staff is required to classify the patient care information filled out by the patient personnel and then input the data into the computer for data processing –35.Nurses can read or enter patient information through the system at any time, and the computer will generate the dynamic changes of the patient's important physical signs and doctor's orders. While saving manpower, it also avoids the introduction of errors in the transmission and entry process. At the same time, nursing staff can analyze specific problems and flexibly change nursing methods and nursing items so that patient care is more objective and fairer. Nurses can more accurately grasp the doctor's diagnosis and treatment intentions based on computer prompts, and all payment, medicine withdrawal, and dispensing information are entered into the system, reducing communication barriers between departments. In this regard, we compared the work efficiency of nephrology nurses before and after the implementation of integrated information management and recorded the data in According to the comparative analysis of the data compiled in The main function of the system test is to analyze, summarize, and correct the errors of the system in the test so that the functional requirements in the mobile nursing information management can be correctly realized in the system, and the nonfunctional requirements can also be improved. The mature system can better meet people's working habits and make the operation easier. According to the actual operation users of the integrated nursing information system in the overall medical unit, combined with the analysis of the needs of doctors and patients, and combined with various business operations, the specific user roles involved in this research have been determined. They are medical patients and medical staff (this experiment is mainly for nursing staff) and information system managers. This article selects the nephrology department of a third-class hospital in Guangzhou to conduct questionnaire surveys and interviews with patients to study the application of integrated nursing information. The personnel participating in this experiment include the specific user roles in the system, medical patients, medical staff, and system administrators. In the first round of experiment, a questionnaire survey was conducted for medical staff, and the basic statistics of the people who received the questionnaire survey are shown in In the first step of this round of experiment, the 15 questionnaires prepared were distributed to 15 nurses from the clinical nursing department, and they were invited to fill them in truthfully to ensure the authenticity of the experiment. After the subject to be investigated was completed, the content of the questionnaire was evaluated to confirm whether it meets the feasibility standard of this experiment. The evaluation is recorded in In order to follow the principles of goal, science, objectivity, measurability, and simplicity, this questionnaire has a recovery rate of 100% and an effective rate of 100%. The experimental process and experimental results carried out have reference and certain research value.Information literacy is the foundation of evidence-based nursing and the key standard of nursing information ability. In addition, information literacy can improve the lifelong learning skills of nurses. The information ability of nurses requires nurses to have basic information technology skills and use these information technologies to carry out clinical practice and scientific research to achieve the best nursing practice. According to the search data, 73% of nurses in my country currently choose colleagues when they encounter clinical problems, 89% of nurses have never used the hospital library, 73% of nurses do not use survey reports, and 92% of nurses consider problems when they encounter problems. Some of them use the Internet and the World Wide Web, but more than 80% of this group have never used a database. Due to the knowledge gap in information literacy, the limitation of access to high-quality information resources, and the attitude of not paying attention to research, nursing staff are not fully prepared to provide qualified nursing work. To this end, we conducted statistics on the information literacy of these 15 personnel, and the data is recorded in The data shows that 15 nursing staff's ability to acquire nursing information is insufficient. Even though they are aware of the importance of nursing information, under the influence of existing conditions, the use of nursing information and the ability to evaluate it after use cannot be exercised. The level of nursing informatization in our country is still at a low level, and the level of information literacy of nursing staff needs to be improved. The integration of nursing information provides powerful conditions, a broad platform for improvement, and unlimited development space to promote nurses to understand the value of information literacy and improve their own information literacy.In the second round of experiments, in response to the common problems in current nephrology care, such as lack of timely drug supply, insufficient nurse-patient communication, patients not in the ward or uncooperative, or family members interrupted, interviews were conducted with these 15 interviewees. And to sort out and analyze the missing nursing information items in the department of nephrology, the data is sorted in During the interview, it was learned that nurses often ignore patients' physiological symptoms and psychological symptoms such as anxiety and depression. Nursing assessments such as pain assessment, nutritional assessment, psychosocial assessment, adverse reaction assessment, condition observation, and regular assessment need to be carried out regularly due to work. The amount of work is too large, and the work is too complicated to take care of; when arranging the work flow, life care will be placed at the end, and life care is prone to omissions after the treatment operation is completed; the psychological care and the nursing intervention involved in the nursing intervention during the nursing continuation work the end-of-life care is still not enough. With the integrated nursing information system, various detailed nursing work can be carried out in an orderly and stable manner. This conclusion can be demonstrated in Nursing staff can quickly and accurately record the patient's personal information data, which greatly improves the satisfaction of patients and nursing staff. Integrated information can refine and decompose nursing work, optimize each step from the smallest unit of quality problems, and establish a medical model that can be controlled in real time. This can greatly reduce the working time of nursing staff, rationally arrange the work process, and play a role of supervision. The implementation of the integrated information system platform can seamlessly connect medical treatment, dispensing, basic nursing, and other processes. Nurses and patients can share all the patient's medical treatment information so that the communication between doctors and nurses can be more accurate and timelier. The work process was optimized, the cooperation between medical staff was promoted, the health guidance was further implemented, the quality of nursing service was deepened, and the nurses' enthusiasm for work was aroused.As the recipient of the nursing work flow and the director of the nursing staff, the patient occupies an important position in the integrated nursing information system. Five inpatients with renal disease in the department of nephrology were selected using statistical methods to participate in this study on the integration of nursing information in the department of nephrology . We talked with these 5 patients. After the information integration system was adopted, they analyzed the nursing work satisfaction evaluation of the nurse staff and solved the problems of the patients' concerns in nursing work after information integration. According to data analysis, these five interviewees believe that the construction of an information integration system has had a great effect on the nursing work of nurse staff, and that the staff's work is in place; before the information integration management, there is, for example, the caller fails to receive a response from the nursing staff within 5 minutes, fails to monitor on time according to the doctor's advice, lacks health education, and their physical and psychological care needs are not met. These problems have been properly resolved through the integration of nursing information, which has improved patients' satisfaction with treatment.With the development of the social economy and the advancement of medical technology, the medical model centered on diseases in the past is far from being able to meet the medical needs of current patients. The medical model of “bio-psychosocial” centered on patients is more suitable for current medical care. Serving patients and effectively solving the problems encountered by patients in the process of hospital visits is the purpose of the development of an integrated nursing information system, and it is also its primary task. While the system can conveniently display relevant information about patients' visits and hospitalizations, it can also collect detailed patient clinical data information and provide medical staff with the right to retrieve and check patient-related information without being restricted by time and place, so that it can be used by the medical industry. Scientific research, health care, and medical levels provide effective diagnosis and treatment information. The current situation we are facing is a very complex situation with various heterogeneous data and different application systems. The lack of unified planning, unified interface standards, and a unified data storage platform will cause overlap of various functions and duplication of nursing business processes. The integrated information platform is based on the existing information system and established in accordance with the requirements of joint integrated operations. The knowledge and management methods of the medical system can be enhanced through the clinical information management system in the ward. Improving in business management is a feature of current research for the study of integrated nursing information management systems, which has important economic and social value.


In order to improve the nursing effect of emergency general surgery, this paper combines computer algorithms to carry out the intelligent management of general surgery nursing, and realizes the standardization of nursing information, the electronic nursing file, the precision of nursing workload, and the intelligentization of nursing quality control by means of informatization. This truly and objectively reflects the nursing operation and treatment situation, prevents the occurrence of some adverse events, and effectively reduces the workload of nursing care. Moreover, this paper uses a standardized software design method to define the software concept, and then conducts a detailed demand analysis of the nursing display function through detailed investigation, class work, discussion and analysis, and comparison decision-making methods. In addition, this paper compiles the software through strict coding standards, and finally designs test cases to test and improve the software. Through actual case studies, it can be seen that the computer-assisted emergency general surgery nursing method proposed in this paper has a certain progress compared with the traditional nursing method. The pre-examination and triage of emergency general surgery is relatively mature abroad. A large number of studies have proved the effectiveness and practicability of their respective triage standards, and the corresponding emergency triage process and path have been established for clinical use. The establishment of modern triage standards began in the 1990s [These triage standards are all five-level triage, and patients are divided into five levels according to the degree of criticality, of which level I is the most critical and urgent patient, and level V is the mildest nonemergency patient. Regarding the evaluation of the American ESI standard, there are still some studies that indicate that the triage standard is not perfect. Although it is based on the allocation of emergency resources, it still has shortcomings . First oComputer information technology gradually began to be applied to hospital management in the form of a single computer. In the early 1990s, hospitals began to introduce computer health information systems (HIS). The creation and adoption of clinical decision support (CDS) system tools have changed the way medical professionals traditionally manage patient health, disease data, healthcare records, and diagnosis and treatment plans . PrelimiIn order to improve the nursing effect of emergency general surgery, this paper combines computer algorithms to carry out the intelligent management of general surgery nursing so as to improve the nursing effect of general surgery and provide a reference for the further improvement of the quality of follow-up general surgery nursing service.In the early 1970s, hospitals in the United States, Japan, and other hospitals began to try to apply large-scale commercial computers to hospital management, began to research and develop hospital information systems, and established HIS system prototypes. By the mid-1980s, nursing information systems began to be used in some large hospitals in developed countries. With the development and maturity of various new network information technologies, foreign nursing-related information systems have been relatively complete. With the strengthening of the degree of integration of hospital nursing information and hospital management systems, all aspects of hospital nursing can be effectively managed, and the safety of nursing behavior is protected to a certain extent . The earIn general, the nursing system is developing rapidly toward specialization, mobility, and diversification. The nursing system has evolved from a single, submodule subordinate to HIS to an integrated mobile nursing system, that includes traditional nurse workstations, nursing medical records, nursing management, and nursing care. Specialized clinical nursing information systems are being developed for planning and nursing tasks . ForeignWith the continuous improvement of the level of nursing specialization, it has also promoted the development of nursing specialties. Since the introduction of the modified early warning score (MEWS) system in the United Kingdom, the observation and early warning of critically ill patients in nursing work have played a very important role . The MEWThe hospital's intelligent nursing display system is a business system that applies and serves the internal use of the Arab League Central Hospital. At the same time, the hospital also uses the intelligent nursing display system as an important means and tool to promote the improvement of nursing management. From the perspective of the development of medical informatization, the construction of nursing informatization is gradually developing toward mobile, intelligent, and wearable models. The mobile nursing information system uses mobile devices such as tablet computers, PDAs, smart phones, and other portable mobile devices to collect and distribute data. It also includes the use of large-screen display devices for data display and push. This can effectively help medical staff to grasp patient diagnosis and treatment information in a dynamic, comprehensive, and timely manner, scientifically arrange and execute diagnosis and treatment and nursing plans so as to solve the query, and enter vital signs data and medical care data by medical staff anytime and anywhere. Moreover, it helps hospitals realize a patient-centered service concept and a quality-centered management model. The development of the hospital's intelligent nursing display system can enable nurses to perform medical behaviors in clinical nursing work, such as fluid infusion, physical sign collection, intake and output, treatment execution, daily care, etc., to follow the patient to complete the collection work at the bedside. Moreover, the application of mobile nursing information technology rationally optimizes the original work flow, thereby improving the efficiency and the quality of nursing work, meeting the management requirements of high-quality nursing, and handling various emergencies  in a timely and accurate manner.(1) Comprehensive nursing information integration: It connects various business application systems in the hospital through the hospital data integration platform. Moreover, it integrates multiple systems such as clinical nursing, nursing management, mobile nursing, intensive care, medical order system, inspection, cost accounting, and material management. In addition, it collects relevant data and incorporates it into the clinical data center to form a data warehouse for the main body of nursing information, which solves the problems of repeated data entry and data inconsistency in multiple systems, and displays it on demand after processing. (2) Automatic generation of nursing plan: It is a predefined nursing plan knowledge base, and intelligently formulates nursing plans based on doctors' orders, nursing evaluation results, special physical signs, and patient conditions, and displays the patient's nursing plan dynamically in real time with a graphical interface. (3) Intelligent reminder of emergencies: The system can remind various problems in nursing work in real time, and intelligently, such as drug allergy and drug contraindications, and promptly remind emergency events such as crisis value to avoid medical errors. (4) Multi-level information display: The system can use electronic whiteboards, handheld terminals, tablet computers, electronic large screens, and other intelligent terminal devices to display corresponding information to doctors, responsible nurses, head nurses, and nursing department managers as needed to meet the information needs of people at different levels.The hospital's intelligent nursing display system should combine the development needs of the hospital's clinical business, adhere to the demand-led approach, refer to the best practices of domestic and foreign industry informatization, and explore the informatization development model with low cost, good results, and outstanding highlights. It is necessary to gradually promote the hospital's information planning and construction in clinical diagnosis and treatment, medical quality control, operation management, decision analysis and other related aspects, and introduce scientific, professional, and refined management methods and means to drive the hospital's management innovation and service innovation. At the same time, it is necessary to realize the standardization of the management process, the networking of work communication, the electronicization of documents and materials, the sharing of knowledge and experience, and the openness of public welfare information so as to realize the new work pattern of “orderly management, free communication, and perfect service” in the hospital. At present, nursing information management systems and mobile clinical information systems based on mobile nursing work, electronic nursing documents, and labeling of nursing items have been put into use in many large- and medium-sized hospitals in China. The hospital intelligent nursing display system is a part of the nursing system, and the overall goal of the system is to promote the improvement of the hospital's nursing quality capabilities. With the least participation of the nursing staff, it can provide the nursing staff with the greatest help, or assist the nursing staff to achieve the following functions: (1) It can realize the automatic check of drugs and patients to avoid medical errors; (2) it can greatly reduce the workload of nursing and reduce the work intensity of nurses; (3) it can improve the efficiency and quality of nursing, and improve the level of nursing service; (4) it standardizes the clinical medical care process and improves the hospital's clinical medical care management level; (5) it provides medical and nursing staff message reminders to provide faster nursing assistance for nursing work; (6) it realizes patient review and provides comparison of average admission data for nursing management; (7) it implements a high-quality nursing information technology support platform to ensure that medical staff can communicate with each other anytime and anywhere; (8) it establishes a fair assessment mechanism to increase the enthusiasm of nursing staff. In general, the construction of the hospital's intelligent nursing display system will bring brand-new changes to nursing work, optimize the nursing workflow, and provide patients with better nursing services.The conceptual model design is actually the realization process of the conceptual model. The conceptual model is an abstraction of the real world, i.e., it artificially processes actual people, objects, things, and concepts, extracts the necessary characteristics needed to build the system, ignores some nonessential details, and accurately describes these characteristics with various concepts.The above is a detailed description and research of each functional module in the community intelligent remote monitoring system. Based on the analysis and abstraction of system developers, end users, and customers, it is concluded that the community intelligent remote monitoring system should include six use cases including physiological parameter monitoring, alarm information processing, nursing, information query, information management, and data interface. With reference to the above-detailed analysis of each use case of the system, we gradually refine the data objects of this part of the system, design a partial conceptual model, and determine the relationship between them. The partial conceptual model of the system is shown in The partial conceptual model of the system is mainly composed of the client's basic information object, the client's relative information object, the doctor's information object, and the client's multi-physiological parameter object. The numbers on the relationship line indicate the corresponding relationship between the data objects. For example, there is a one-to-many relationship between basic customer information and multiple physiological parameter data, i.e., a customer object contains multiple physiological parameter information. Through the detailed design of the partial conceptual structure, the relationship between the data objects is truly reflected, and the foundation for the subsequent logical model design is laid.The system hardware framework is shown in The driver framework of 88W8686 is shown in   Risk management for patients: Medical staff need to strengthen the management of neurosurgery emergency, surgery, elderly and critical patients, and use bed guards for patients with inconvenient mobility to prevent patients from falling from beds and other injuries. Therefore, the floor should be kept dry, handrails should be added to the bathroom, related warning signs should be present in wet areas, and the wheels, brakes, and guardrails of the patient's bed should be checked regularly. The nurse's shift needs to be 15 minutes in advance, and the content of the shift at the bedside must be effectively verified. For patients with more serious illnesses, the nursing staff need to strengthen communication with their families and provide relevant psychological counseling.  Risk management for nurses: It is necessary to strengthen professional training and risk management awareness of nurses so as to effectively improve the quality of nursing work. At the same time, it is also necessary to strengthen the communication skills of nurses to promote a more harmonious relationship between the doctors and the patients. Hospital units can regularly organize nurses to conduct neurosurgery technical training and theoretical learning so as to improve the proficiency of nurses in nursing operations. At the same time, it is also necessary to strengthen the nursing level, communication level, and drug use methods of the nursing staff to improve the quality of nursing work. In addition, it is necessary to organize nurses to conduct academic exchange meetings on a regular basis to realize the sharing of information resources. For nursing staff with low qualifications, guidance and supervision need to be strengthened.  Environmental risk management: The environment of the nephrology ward needs to be kept clean and comfortable so as to create a comfortable and quiet atmosphere for patients to recuperate. It is necessary to effectively implement the ward visiting system to prevent patients from being disturbed in their recuperation. At the same time, the environment needs to be disinfected to prevent infections in patients.  Risk management for the pipeline: Patients in the Department of Nephrology generally have more catheters indwelled, and the main purpose is to observe the patient's condition. Therefore, the catheter needs to be kept unobstructed, and a fixing device should be added to prevent the catheter from twisting and pulling. At the same time, it is also necessary to sterilize the pipelines to strengthen the operational hygiene awareness of the medical staff and prevent patients from becoming infected. In addition, the indwelling time of the catheter needs to be communicated with the physician to prevent infection caused by excessive indwelling time.  Risk management for emergency treatment: It is necessary to carry out effective and reasonable treatment of emergency plans for intravenous extravasation of special drugs, emergency plans for blockages, emergency plans for pressure sore prevention, emergency plans for cross-infection, and emergency plans for power outages and water cuts. At the same time, it is necessary to carry out relevant emergency drills to improve the emergency awareness of nurses, strengthen the awareness and understanding of emergency handling, improve proficiency, and effectively guarantee the quality of emergency work. On this basis, the effects of computer-aided care in emergency general surgery are calculated, and the results are shown in Tables 1We select the emergency general surgery inpatients admitted to the emergency department of this hospital from June 2019 to December 2020 as the research sample. According to the method of random allocation, they are divided into the experimental group and the control group. Among them, the control group used traditional general surgical nursing methods, and the experimental group used the intelligent computer-aided nursing system constructed in this paper. In addition, other intervention methods are the same. On this basis, we collect relevant data for comparative analysis.It can be seen from the above research that the computer-assisted emergency general surgery nursing method proposed in this paper has a certain progress compared with the traditional nursing method. Therefore, the system of this paper can be used as an auxiliary nursing system in the follow-up hospital emergency general surgery nursing to improve the nursing effect of emergency general surgery.Emergency Department of General Surgery is a very important department, which is highly specialized and involves many types of diseases. In addition, the condition of some patients with craniocerebral trauma changes rapidly and the onset is more rapid; thus, medical personnel are more required to have skilled emergency handling capabilities and operational skills. The professional nature and the importance of the departments also determine the trend of nurses' high work intensity and workload. Under this highly stressful working state, the occurrence of medical care risks is also increasing. Therefore, nurses need to strengthen the analysis and management of risk factors in nursing work so as to prevent risk events. At the same time, hospital units also need to combine the items complained by patients and medical disputes, strengthen in-depth analysis and investigation of these events, understand and recognize the information content related to risk events, and evaluate the consequences of them so as to summarize the factors associated with risk events. In order to improve the nursing effect of emergency general surgery, this paper combines computer algorithms to carry out the intelligent management of general surgery nursing so as to improve the nursing effect of general surgery. Through actual case studies, it can be seen that the computer-assisted emergency general surgery nursing method proposed in this paper has a certain progress compared with the traditional nursing method.