Objective To regulate nutrition support nursing, facilitate the development of nursing specialty, cultivate nutrition support nurse. Methods Establish nursing specialist team on nutrition support. 30 nurses received theory training, skill training, clinical practice, and completion reporting. Conduct nutrition knowledge management survey. Establish standardized wards of nutrition support nursing and conduct special inspection. Results Nursing specialist team on nutrition support was established, and 29 nutrition support nurses were cultivated. Before training, nurses' knowledge of nutrition and nutrition nursing management score were (3.46 ± 0.47), (0.70 ± 0.24) points, and the score were (4.63±0.14), (0.90±0.27) points after training, results was statistically significant (t=12.848, 2.981, P<0.01). Before and after special inspection of enteral nutrition, enteral nutrition pump and special infusion tube cases were 106,60 and 106, 60, results were statistically significant (χ2=4.747, 4.471, P<0.05). Before and after special inspection of parenteral nutrition, correct infusion and speed cases were 90, 92 and 61, 54, results were statistically significant (χ2=4.642, 7.644, P<0.05 or 0.01). Conclusions The development of nursing specialty of nutrition support was promoted, nurses′ comprehensive ability and self-identity was improved, management quality of nutrition support was.

Objective To investigate the clinical prognostic value of neutrophils to lymphocyte ratio(NLR)in patients with ST-segment elevation myocardial infarction(STIMI)who underwent percutaneous coronary intervention(PCI). Meth?ods A total of 326 patients with acute ST segment elevation myocardial infarction were enrolled. According to the neutro?phils to lymphocyte ratio, patients were divided into group T1(≤3.46), group T2(3.47-6.75)and group T3(>6.75). Basic clinical data,laboratory indexes,coronary angiography results, TIMI grading and left ventricular ejection fraction(LVEF) were collected in all groups. Incidence of adverse events in hospital such as acute heart failure, thrombosis, ventricular tachy?cardia and ventricular fibrillation, atrial fibrillation, atrioventricular block and cardiogenic shock, were recorded. Major ad?verse cardiac events(MACE), death of all causes, non-fatal MI, ischemic stroke and readmission due to heart failure at the 6-month follow-up were also noted. Results The incidence of heart failure, atrial fibrillation, ventricular tachycardia/ven?tricular fibrillation and cardiogenic shock was higher in group T3 than those in the other two groups(P < 0.05).The inci?dence of multivessel coronary artery disease was significantly higher in group T3 than that in group T1 (54.1% vs 37.0%, P<0.05). The percentage of TIMI grade 3 in post-operative infracted artery was significantly lower than that in group T1 (83.5%vs 94.4%). Left ventricular ejection fraction was significantly lower in group T3 than that of group T1 during hospital?ization (0.48 ± 0.10 vs 0.52 ± 0.10). There was no significant difference in the incidences of death, non-fatal MI, ischemic stroke at 6 month follow up. But the rate of readmission due to heart failure was significantly higher in group T3 than that in the group T1(P<0.05). Conclusion Neutrophils to lymphocyte ratio may be a useful marker to predict the prognosis of pa?tients with heart failure due to acute myocardial infarction.

ObjectiveTo evaluate the effects of Esmolo on the hemodynamic and tissue oxygenation of the patients with septic shock and tachycardia.MethodsSeventy four septic shock patients with tachycardia were enrolled and randomized into Esmolo-treated group and control group after early goal-directed therapy (EGDT).The patients in Esmolo group were given intravenous Esmlol to decrease the heart rate to below 110 beats per minute.Hemodynamic data and tissue oxygenation parameters,such as Heart rate (HR),Mean Artery Pressure ( MAP),Central Venous Pressure ( CVP),Cardiae Index ( CI),Stroke Volume Index ( SVI),Systemic Vascular Resistance Index (SVRI),Lactate,Centrol Venous Oxygen Saturation (SCVO2 ) were recorded before and 2,3,4 hours after the Esmolol treatment.Results Heart rate of Esmolol group was reduced at all time points after treatment,The difference of that from the control group was significant ( H R: [ 108 ± 16 ] beats/min vs.[ 132 ± 18 ] beats/min,[ 101 ± 14] beats/min vs.[ 135 ± 19 ] beats/min,[ 106 ± 21 ] beats/rin vs.[ 129 ± 14]beats/min,all P ＜ 0.01 ).Compared to the control group,Stroke Volume Index of Esmolol group was significantly increased at each time point ( SVI: [32 ± 12] ml/m2 vs.[22 ±8] ml/m2,[34 ± 14] ml/m2 vs.[21 ±6] ml/m2,[37 ± 10] ml/m2vs.[23 ±9] ml/m2,all P ＜0.05).Lactate of Esmolol group was significantly decreased at the end of the 3rd,4th hour of Esmolol treatment ( lactate: [ 1.6 ± 1.1 ] mmol/L vs.[ 2.7 ± 1.2 ]mmol/L,[ 1.3 ± 0.9 ] mmol/Lvs.[ 2.8 ± 1.4 ] mmol/L,both P ＜ 0.01.There were no significant differences in MAP,CI,SVRI,SCVO2 between the two groups at each time point ( all P ＞ 0.05 ).Conclusion Esmolol can reduce heart rate significantly,improve cardiac work and tissue perfusion in septic shock patients with tachycardia.It is a feasible and safe treatment for this kind of patients.

Objective: To reduce the noise level of surgical intensive care unit through quality improvement program based on one-meter rule. Methods: Measure the status quo of noise level and find out the main noise resources. Implement one-meter rule for three weeks and retest the noise level for a period of seven days. Investigate the satisfaction of medical staff and patients. T-test was performed to compare the noise level and satisfaction. Results: The mean noise level were (58.58±0.95) dB before implementation of quality improvement program and was lowered to (55.89±0.92)dB. There was a significant difference(t=4.890, P=0.001). The five time points except eleven o′clock during which the noise levels were over 60 dB decreased significantly after implementation of one-meter rule (t=2.858-6.643, P<0.05). After intervention, satisfaction related to noise level of medical staff and patients scored 10.97±0.93 and 10.63±1.15 respectively, which were higher than before (8.68±1.49, 8.13±1.18) and there were significant differences (t=-11.231,-10.701,P<0.01). Conclusions One-meter rule intervention can decrease the noise level significantly, and increase medical staff′s and patients′ satisfaction, which is worthy of extensive promotion and application.

Objective To explorepredictive factors of psychological stress reaction of medical staff members with blood-occupational exposure and to provides scientific basis for the hospital administrators toprovide psychological support and interventionfor medical staff members with blood-occupational exposure. Methods Seventy-eight medical staff members with blood-occupational exposure were recruited as participants. The Socio-demographic Questionnaire, Posttraumatic Stress Disorder Checklist-5, the Perceived Stress Scale, the Hospital Anxiety and Depression Scale, the Ruminative Responses Scale and the Emotion Regulation Questionnaire were used to evaluate the participants' psychological stress reactionat different stages and the styles of their emotion regulation. Correlation analysis and Hierarchical Regression analysis were used to analyze the predictive factors of psychological stress reaction of medical staff members with blood-occupational exposure. Results Ruminative thinking and emotion regulation can predict the psychological stress reaction of medical staff members with blood-occupational exposure at different stages. Conclusions According to the psychological stress reaction and ruminative thinking of medical staff members with blood- occupational exposure, psychological intervention should be implemented within one month to decrease the psychological trauma of medical staff members with blood-occupational exposure.

Nursing intervention classification (NIC) is an effective system in documenting nursing work, which can improve nursing quality, strengthen the standard of nursing charging, and promote nursing education and research. In addition, it can be used as a standardized nursing language to satisfy the needs of electronic computerized nursing record. The authors introduced the content of NIC, as well as the advantages found in overseas application and the status of application and research at home. Also presented are the application prospect, research approaches and advices on how to apply the NIC system in clinical practice at home.

Objective:To provide reference for future research based on bibliometric analysis on research status and developing trend of the application of ultrasonography for insertion of naso-intestinal tubes in China.Methods:All published literatures on the application of ultrasonography for insertion of naso-intestinal tubes were retrieved from CNKI, Wanfang Database, CBM and VIP before September 2019.Results:A total of 54 effective literatures were included and published in 40 Chinese journals and the number of literatures increased year by year. The core journals accounted for 57.41% and the fund literature accounted for 25.93% of the total literature. Experimental and quasi-experimental studies, accounted for 88.89% of the total literature. The main subjects were adult critically ill patients, accounting for 98.15%. The main research contents of the included studies were ultrasound-guided naso-intestinal tube placement and ultrasonic naso-intestinal tube localization.Conclusions:Studies on the ultrasonography for insertion of naso-intestinal tubes in China is still in its initial stage and are developing rapidly. While the distribution of the research area is unbalanced, the depth and scope of the studies are not enough, and the research types and contents are relatively limited. In the future, it is necessary to carry out multicenter and large sample research, combine quantitative research with qualitative research, pay more attention to the application of nasal-intestinal tube in critically ill children to broaden the breadth and scope of the research content.

Objective:To evaluate the optimization strategy of anesthesia for liver cancer resection using serratus anterior plane block-posterior rectus sheath block-general anesthesia.Methods:One hundred patients, aged 30-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with liver function Child-Pugh grade A or B, scheduled for elective liver cancer resection under general anesthesia, were divided into serratus anterior plane block combined with posterior rectus sheath block group (group S, n=50) and thoracic paravertebral block group (group T, n=50) using a random number table method.Ultrasound-guided serratus anterior plane block (20 ml) combined with posterior rectus sheath block (10 ml) was performed using 0.375% ropivacaine in group S. Ultrasound-guided paravertebral block was performed at T 7 and T 9(15 ml for each site) with 0.375% ropivacaine in group T. Anesthesia was induced with intravenous midazolam, propofol, sufentanil and cisatracurium and maintained with intravenous infusion of propofol and remifentanil and intermittent intravenous boluses of cisatracurium.BIS value was maintained at 40-60 during operation.Patient-controlled intravenous analgesia (PCIA) was performed with sufentanil and flurbiprofen at the end of operation, and oxycodone 5 mg was intravenously injected as rescue analgesic when the VAS score>3.The onset time and operation time of nerve block were recorded.The intraoperative consumption of sufentanil and remifentanil and occurrence of cardiovascular events within 30 min after skin incision were recorded.The effective pressing times of PCA and requirement for rescue analgesia within 48 h after operation were recorded.The recovery quality was measured using the 40-item quality of recovery questionnaire at 24 h before surgery and 24 and 48 h after surgery.Peripheral venous blood samples were collected at 24 h before surgery and 24 h and 7 days after surgery to determine the concentrations of interleukin-17 and interferon-gamma in serum.The postoperative time to first flatus, first ambulation time, and length of hospital stay were recorded.The nausea and vomiting, respiratory depression, skin itching, puncture site infection, pneumothorax and other adverse reactions were recorded within 48 h after operation. Results:Compared with group T, the operation time of nerve block was significantly shortened, the incidence of intraoperative hypotension was decreased ( P<0.05), and no significant change was found in the onset time of nerve block, intraoperative consumption of sufentanil and remifentanil, postoperative requirement for rescue analgesia, effective pressing times of PCA, time to first flatus, first ambulation time, and length of hospital stay, and 40-item quality of recovery scores and serum concentrations of interleukin-17 and interferon-gamma at each time point in group S ( P>0.05). No postoperative adverse reactions were found in either group. Conclusions:Compared with thoracic paravertebral nerve block combined with general anesthesia, serratus anterior plane block-posterior rectus sheath block-general anesthesia has shorter operation time and lower incidence of intraoperative hypotension when used for liver cancer resection.

Objective:To investigate the efficacy and safety of anlotinib in distant metastatic radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC).Methods:Retrospective analysis was performed on 17 patients with distant metastatic RAIR-DTC (6 males, 11 females, age: 57.0(45.5, 63.0) years) from Affiliated Hospital of Qingdao University between October 2018 and February 2023, including 13 patients receiving first-line treatment and 4 patients receiving second-line treatment with anlotinib. The changes of serum thyroglobulin (Tg) during the treatment of anlotinib, the changes of maximum diameter of the target lesion at the last follow-up compared with the diameter at baseline, the imaging efficacy, and treatment-related adverse events were analyzed. The serological and imaging effects of the first-line treatment group and the second-line treatment group were compared. The Fisher exact test was used to analyze the differences between groups.Results:The follow-up time of 17 patients was 17.3(9.5, 21.4) months, and the objective response rate (ORR) and disease control rate (DCR) were 7/17 and 16/17, respectively. There were no significant differences of ORR (6/13 vs 1/4; P=0.603) and DCR (13/13 vs 3/4; P=0.235) between the first-line and second-line treatment groups. The change rates of serum Tg at 3, 6 weeks and the last follow-up were -30.2%(-61.2%, -15.5%), -64.8%(-90.6%, -32.3%), and -85.8%(-96.1%, -50.7%), respectively. At the last follow-up, the change rate of maximum diameter of target lesions was -20.0%(-45.0%, -5.2%). The incidence of treatment-related adverse reactions was 14/17, and 2 patients (2/17) had grade 3 or above adverse reactions. Conclusion:Anlotinib shows superior efficacy with tolerable toxicity in the first-line treatment of distant metastatic RAIR-DTC, and hopefully plays an important role in second-line treatment for RAIR-DTC resistant to sorafenib.

Objective:To develop a nomogram to predict the probability of prostate cancer after transeperineal prostate biopsy, and verify the diagnostic efficacy and clinical applicable value of the model.Methods:The clinicopathologic data of 475 patients who underwent prostate biopsy at Yijishan Hospital of Wannan Medical College between January 2019 to August 2021 were retrospectively reviewed. Of all the patients, 367 patients from January 2019 to December 2020 were in the development cohort and 108 patients from January 2021 to August 2021 were in the validation cohort. Patients in the development cohort were (68.86±9.00) years old. The tPSA level was 13.6(8.6, 23.3)ng/ml, and Prostate Imaging Reporting and Data System (PI-RADS) score was 4(3, 4) points. Patients in the validation cohort were (68.89±8.67) years old. The tPSA was 13.1(8.7, 25.6)ng/ml, and PI-RADS score was 4 (3, 5) points. Univariate and multivariate logistic regression were used to analyze prostate cancer risk factors in the development cohort. Then the nomogram prediction model was established by the risk factors. The prediction model's performance was evaluated using receiver operating characteristic (ROC) curves, calibration maps, and decision curve (DCA) analysis in the development cohort. The performance of the model was verified in the validation cohort.Results:The pathological results showed 180 patients with prostate cancer and 187 patients without prostate cancer in the development cohort. The validation cohort included 53 patients with and 55 without prostate cancer. Based on the results of the univariate and multivariate logistic regression analysis, this model incorporates factors including age ( OR=1.059, P=0.003), platelet-to-monocyte ratio (PMR) ( OR=0.002, P=0.011), f/tPSA ( OR=0.009, P=0.020), and PI-RADS score ( OR= 3.076, P<0.001). The calibration curve revealed a great agreement. Internal validation of the nomogram showed that the area under the ROC curve was 0.845 (95% CI 0.794-0.895). The Hosmer-Lemeshow test was also performed( χ2=1.476, P=0.224). The validation group with an area under the ROC curve was 0.869 (95% CI 0.797-0.941). The results of the decision curve analysis indicated that the decision curve was located above the positive and negative lines in the threshold range of 10% to 90%, within which the model has clinical application. Conclusions:The nomogram, which combines patient age, PMR, f/t PSA, and PI-RADS scores, has high predictive efficacy for prostate cancer and has clinical application value.