The majority of patients have experienced pain or discomfort associated with surgery or mechanical ventilation in intensive care unit (ICU), and the use of analgesic drugs can relieve patients' anxiety, improve sleep, promote the disease recovery, reduce the use of sedative drug dosage and the occurrence of delirium. Because of less adverse reactions of the non opioid analgesic drugs, in recent years gradually the doctors in ICU have paid attention to them. In this study, the related literatures have been reviewed to realize the present situation of applying non opioid analgesic drugs in ICU. It was found that nowadays the application of commonly used non opioid drugs in ICU (including ketamine, non-steroidal anti-inflammatory drugs, tramadol, lidocaine, tramadol and gabapentin) can all decrease the use of sedative drugs and opioids, reduce the incidence of adverse reactions, and gradually they will obtain more and more attention.

Objective To investigate the influence of health care workers’(HCWs)hand hygiene intervention in healthcare-associated infection(HAI)in an intensive care unit(ICU).Methods Intervention measures of hand hygiene were adopted,effective supervision and management systems were established,hand hygiene compliance and HAI rate be-fore intervention(January-December 2012)and after intervention (the first stage:January-June 2013;the second stage:Ju-ly-December 2013)were compared.Results A total of 4 066 patients were surveyed,HCWs’hand hygiene compliance rate before intervention was 50.03%,the first and second stage after intervention was 61.80% and 64.57% respectively,there was increasing trend (rs=1.00,P<0.001).HAI before intervention was 5.48%,the first and second stage after inter-vention was 3.86% and 3.30% respectively,there was decreasing trend (rs=-1.00,P<0.001).Significant decreasing trends were found in rates of catheter-related bloodstream infection(CRBSI),catheter-associated urinary tract infection (CAUTI)and ventilator-associated pneumonia(VAP)(rs=-1.00,P<0.001).There were negative correlations between hand hygiene compliance rate and the infection rate of ICU,infection rate of CRBSI,CAUTI and VAP (P<0.05 ). Conclusion The improvement of hand hygiene compliance can effectively reduce the incidence of HAI in ICU ward.

Objective To understand the occurrence and risk factors of healthcare-associated infection(HAI) in a neonatal intensive care unit(NICU).Methods Neonates who were admitted to the NICU of a hospital from January 2012 to December 2014 were investigated retrospectively,risk factors for HAI were performed univariate analysis.Results A total of 760 neonates were included in the investigation,198 neonates developed 259 times of HAI,incidence of HAI was 26.05％,case incidence of HAI was 34.08％,incidence of HAI per 1 000 patient days was 9.50‰;the main infection site was lower respiratory tract (n =92,35.52％);among 259 cases of HAI,172 strains of pathogenic bacteria were isolated,the major pathogen was Acinetobacter spp.(n =40,23.26％);incidence of HAI was high in neonates with gestational age ≤32 weeks,birth weight≤1 500 g,length of hospital stay ≥10 days,duration of antimicrobial use≥10 days,mechanical ventilation,deep venous catheterization,and feeding intolerance,difference was statistically significant (all P＜0.001).Conclusion Incidence of HAI in NICU is high,effective prevention and control measures should be formulated according to its risk factors,so as to reduce the occurrence of HAI in neonates.

Anaplastic large cell lymphoma (ALCL) represe nt s a distinct category of large cell lymphomas defined by a strong expression of the cytokine receptor CD30 on neoplastic cells and a so-called anaplastic cytol ogy. This review will address the recent progress in understanding ALCL.

The records of 10 consecutive cases that sustaining traumatic CCF were retrospectively reviewed.The age of cases ranged from 18 to 55 years old, and all of them were complicated with fracture of orbit and base of skull.The causes of injuries, the characteristics of ocular manifestations,the findings in CT or cerebral angiography, and methods of treatment of CCF were analysed. The results showed that 9 cases were cured by operation (90%). The cavernous sinus fistulae were closed. The ocular signs such as exophthalmos, vascular murmur in eyelid and conjunctival swelling disappeared.One case had remaining exophthalmos.Nine patients who were cured were followed up for 6 months to 10 years.No ocular signs recurred in all cases. In 2 cases there were mild complications.It suggested that the pulsating exophthalmos,vessel murmur in eyelid and marked conjunctival vessel dilatation were the characteristics of ocular manifestations in CCF. Endovascular embolization with detachable balloon or spring coil is currently the treatment of choice and it is efficacious and safe in traumatic CCF.

Objective To study the risk factors for catheter-related bloodstream infection (CRBSI)in an intensive care unit (ICU),and provide scientific evidence for CRBSI prevention and control.Methods 1 677 ICU patients with central venous catheterization (CVC)for>48 hours between January 2008 and December 2012 were divided in-to CRBSI group and non-CRBSI group,risk factors for CRBSI were analyzed.Results The utilization rate of CVC was 92.88% (21 041 d);86 (5.13%)patients developed CRBSI,the incidence of CRBSI per 1 000 catheterization-day was 4.02,the mortality of CRBSI group was significantly higher than non-CRBSI group (58.14% [50/86]vs 36.83%[586/1 591])(χ2 =15.74,P <0.01 ).Multivariate logistic regression analysis showed that the risk factors for CRBSI in-cluded length of stay in ICU>5 days,CVC>5 days,the episode of CVC>1 (P <0.01).Conclusion Realizing the occur-rence status and risk factors of CRBSI in ICU patients can provide reference for further targeted monitor and implementation of zero tolerance goal of the CRBSI.

Facing the lack of the health service management professionals'vocational adaptability in medical college,we should improve their ability of professional practice,communication skills,professional knowledge and awareness of social responsibility in order to achieve the training objectives.

Objective In order to construct the standards of review for oncology nursing professional training base by aggregating the requirement of the professional training base in multiple regions in China.Methods Delphi expert consultation method by self-designed questionnaire were conducted among 21 nursing educators in medical university,nursing administrators,oncology clinicians,oncology clinical nurse specialists in hospitals.Results The Cr,Cronbach's α was 0.825,0.980.A standards of review for oncology nursing professional training base included 5 first-level indicators,19 second-level indicators and 76 third-level indicators after three rounds of consultation.Conclusions The 100-item for standards of the review is reliable and valid,which can provide objective and quantitative standards for evaluation,assessment and access of oncology nursing professional training base.

Objective To compare the efficacy and safety of oral ibuprofen and indomethacin for the closure of patent ductus arteriosus (PDA) in preterm infants and investigate the factors affecting the effect of indomethacin.Methods Two hundred and four preterm infants with symptomatic PDA were enrolled in this retrospective study.They were divided into two groups accroding to the admission date.From Jan.1,2007 to Dec.30,2009,44 infants orally administered ibuprofen (one course:first dose was 10 mg/kg,followed by two doses of 5 mg/kg at 24 h intervals) were as ibuprofen group.From Dec.31,2009 to Jan.31,2011,160 infants orally administered indomethacin (one course:0.2 mg/kg,at 12 h and 24 h intervals for three times) were as indomethacin group.Chisquare test,t test and rank sum test were used to compare the rate of ductal closure,side effects and complications of two groups.Influence factors of indomethacin therapy were analyzed with Logistic regression.Results There were no differences of overall ductal closure rate [77.3％ (34/44) vs 70.6％ (113/160),x2 =0.757,P＞0.05],one course therapy [68.2％ (30/44) vs 63.8％(102/160),x2=0.297,P＞0.05] and two courses therapy closure rate [9.1％ (4/44) vs 6.9％(11/160),x2 =0.030,P＞0.05] between i buprofen group and indomethacin group.The incidences of oliguria [＜1 ml/(kg ? h)] and high serum creatinine (＞88 μmol/L) of indomethacin group were higher than those in ibuprofen group [21.3％ (34/160) vs 6.8％ (3/44),x2=4.841,P=0.028;26.9％ (43/160) vs 9.1％ (4/44),x2=6.156,P=0.013].Logistic regression analysis showed that small gestational age (OR=2.563,95％CI:1.099-5.976,P=0.029),neonatal respiratory distress syndrome (OR=2.407,95％CI:1.023-5.664,P=0.044)and septicemia (OR=4.575,95％CI:1.782-26.768,P=0.009) were unfavorable factors for ductal closure in preterm infants underwent indomcthacin therapy,while antenatal steroid (OR=0.530,95％CI:0.312-0.901,P=0.018) was a favorable factor.Conclusions Oral ibuprofen have the same effects as indomethacin on PDA treatment in preterm infants,but with fewer side effects on renal function in terms of urine output and serum creatinine level.Some factors such as septicemia may affect the theraputic effects.

Objective To investigate the treatment of symptomatic patent ductus arteriosus (PDA) in very low birth weight preterm infants. Methods From January 1, 2008 to December 31, 2010, 78 very low birth weight preterm infants (birth weight＜1500 g) were diagnosed as symptomatic PDA. Among which, 42 cases administered orally with indomethacin (0.2 mg/kg, every 12 hrs for three times) were taken as treatment group, while five cases in this group who failed to indomethacin treatment were interrupted with video-assisted thoracoscopic surgery. And 36 cases who did not receive treatment for ductus arteriosus were taken as control group. The clinical outcomes, complications and prognosis of these patients were observed. Results There were no significant differences between the gentle percentage, gestational age, diameter of ductus arteriosus, rate of complicated with heart failure, sepsis, neonatal respiratory distress syndrome and intraventricular hemorrhage of two groups (P>0.05, respectively). The ductus arteriosus closed in 33 patients of treatment group (78.6%) and in nine patients of control group (25.0%)(χ2=22.39,P=0.000). There were no significant differences in serum creatinine level and platelet count between before and after the treatment in treatment group(P>0.05). Compared with control group, the treatment group had lower incidence of intraventricular hemorrhage (z=1.167, P=0.030), shorter duration of oxygen therapy [(8.0±5.5) d vs (13.3±9.3) d, t=2.225, P=0.032] and shorter hospital stay [(39.0±7.7) d vs (43.6±10.6) d, t=2.229, P=0.029]; while the incidence of bronchopulmonary dysplasia and necrotizing enterocolitis were similar (P>0.05). The five cases of PDA who received video-assisted thoracoscopic surgery were successfully interrupted with no residual shunt left, while three of them had lung infections and one had pleural effusion, but no pneumothorax and infant death associated with surgery occurred. Conclusions Symptomatic PDA of very low birth weight preterm infants should be treated actively. Oral indomethacin was an effective and safe method to cure the PDA in these infants. Surgical ligation under video-assisted thoracoscopic surgery after failure of indomethacin treatment might be a good option.