Objective To investigate the occurrence of intraoperative occupational exposure to blood among sur-geons in a hospital,so as to make effective precaution measures.Methods Combined with questionnaires,the mo-nitoring data of occupational exposure to blood among surgeons from June 2011 to June 2013 were analyzed statisti-cally.Results A total of 49 surgeons sustained 115 times of occupational exposure to blood,including 42 times (36.52%)in general surgery surgeons,36 (31 .30%)in orthopedic surgeons,31 (26.96%)in obstetrics and gyne-cology surgeons,and 6(5.22%)in urinary surgery surgeons.The main occupational exposure were sharp injuries (n=71 ,61 .74%),blood and body fluid splashing were 44 times (38.26%);the top two exposed sites were hands (49.57%)and faces (17.39%).88.70% of exposed cases were given emergent treatment,and 55.65% of exposed cases were reported.The follow-up found no surgeons were infected after the prompt and correct treatment. Conclusion Surgeons are at high risk of occupational exposure.Occupational precaution should be strengthened, occupational awareness and ability of HCWs should be enhanced,and post-exposure treatment should be improved.

In September 2012, the Assessment for Ethics Review of Traditional Chinese Medicine (TCM) Re-search with Human Participants (named CAP, Chinese medicine assessment human research protection system) was officially commissioned to the World Federation of Chinese Medicine Societies to organize by the State Ad-ministration of TCM. Through the assessment of 20 medical institutions, a comprehensive analysis on ethical re-view platform was conducted. Combined with current regulatory system of ethics in the U.S., this article discussed independent assessment on important CAP features of local brands, the practice and benefit of construction pro-motion based on assessment and continuous improvement, as well as the importance of vigorously promote CAP assessment .

From the point of view of ethics review work situation of our country, the existing capacity of our review of ethical problems in development are analyzed, a preliminary summary of the Chinese medicine ethics review ca-pacity development, systematically analyzes the Assessment Human Research Protection System of TCM and Chinese medicine clinical research ethics review platform evaluation work, and to improve the ethical review system to perfect supervision system, improve the medical ethics review standards and guidelines, carrying out the innovation and con-struction of ethical review professional knowledge training, to promote Chinese medicine ethics review certification and accreditation system construction work and Chinese medical ethics review of the clinical research objective, the practice of ethical review management of Chinese medicine are discussed.

Objective To explore the application effect of management by objectives in teaching of obstetrics nursing. Methods From September 2012 to September 2013, 50 nursing students practice in our hospital obstetrics were chosen, the application of traditional teaching mode of teaching were set up as the control group, the other 50 nursing students from September 2013 to September 2014 practiced in our hospital obstetrics with application of target management method for teaching were set up as the observation group, the theory of target, operation skill objectives, service objec-tives of each item score and comprehensive effect evaluation were compared. Results The theory of observation target, groups of patients with operation skill objectives, service target scores were (88.12±6.45), (85.42±7.32), (83.72±8.45), significantly higher than that in control group, with statistically significant differences (P<0.05). The good rate of comprehensive evaluation in observation group was 80.0%, significantly higher than the control group (56.0%), and poor rate of comprehensive evaluation of patients in observation group only of 4.0%, was significantly lower than that in the control group (30.0%), with statistically significant difference (P<0.05). Conclusion The clinical application of management by objectives in obstetrics teaching process is conducive to improve nursing students' level of theoretical knowledge, operation skill level and service attitude, with a crucial role in improving the comprehensive quality and en-sure the quality of clinical teaching of nursing students.

Objective To identify the risk factors of ventilator-associated pneumonia (VAP) in infants after surgical correction for tetralogy of Fallot (TOF).Methods This study performed at Guangdong general hospital in China,130 infants (less than 12 months,mechanical ventilation time≥48 h) undergoing surgical correction for TOF were included between January 2013 and December 2017.Ventilator-associated pneumonia was defined according to the CDC/NHSN definitions guidelines issued in 2008.T test or Wilcoxon rank sum test was used in univariate analysis,and the variables with P ＜ 0.05 in the univariate analysis were added to a multiple logistic regression to identify the risk factors of VAP in infants after surgical correction for Tetralogy of Fallot.The area under the receiver operating characteristic (ROC) curve was calculated as a measure of accuracy.Results A total of 130 infants were included,however,VAP was found in 34 (26.2％) infants.The single variables significantly associated with a risk of VAP were:pre-operative hypoxic,pre-operative pneumonia,pre-operative mechanical ventilation support,prolonged cardiopulmonary bypass time,reintubation,pulmonary atelectasis,pleural effusion hydrothorax,prolonged mechanical ventilation support time,low cardiac output and transfusion of erythrocyte concentrate or fresh frozen plasma.Multiple logistic regression analysis showed prolonged cardiopulmonary bypass time (OR =1.02),reintubation (OR =16.111),pulmonary atelectasis (OR =8.133),low cardiac output (OR =7.649) and prolonged mechanical ventilation support time (OR =1.014) were independent risk factors for VAP in infants after TOF surgical correction.The area under the curve demonstrates the accuracy of the model.Conclusion The occurrence rate of VAP was high and risk factors for VAP after TOF surgical correction were complex.These results can be used to prevent and reduce the occurrence of VAP.

Objective    To explore the risk factors and predictive value of acute kidney injury (AKI) after total aortic arch replacement. Methods    The clinical data of patients undergoing total aortic arch replacement in our hospital from January 2018 to June 2019 were retrospectively analyzed, and patients receiving preoperative renal replacement therapy and missing creatinine values were excluded. According to whether postoperative AKI occurred, patients were divided into an AKI group and a control group. The univariate and multivariate analyses (logistic regression) were used to explore the independent risk factors of AKI. The receiver operating characteristic curve was used to analyze the significant factors in predicting the occurrence of AKI after total aortic arch replacement. Results    A total of 162 patients were included in the study, including 135 (83.3%) males and 27 (16.7%) females, with an average age of 52.61±9.90 years (range: 22 to 73 years). The incidence of AKI was 68.5% (n=111). The results of univariate and multivariate analyses showed that the postoperative serum cystatin C level (OR=76.145, 95%CI 15.575-372.260, P<0.01) was an independent risk factor for AKI after total aortic arch replacement. When its cut-off value was above 1.08 mg/L, the specificity for predicting postoperative AKI was 70.59%, and the sensitivity was 85.59%. Conclusion    The postoperative cystatin C level is an independent risk factor for AKI after total aortic arch replacement and has predictive value.