Objective The purpose of this study was to compare the differences of job satisfaction degree between contract nurses and formal nurses. Methods 350 incumbency clinical nurses were ob-tained from 3 provincial and grade three A hospitals(including nurses in internal medicine, surgical,gyne-cologic,pediatric,emergency departments and ICU). Research instruments used in this study included the self-designed demographic questionnaire and the nurses' job satisfaction scale. Results The level of the overall job satisfaction degree among contract nurses was lower than that of the formal nurses. Of all job satisfaction subscales, the scores of professional opportunities, performance and responsibility,salary and welfare, administration and hospital policy, interpersonal relationships among contract nurses were lower than those of formal nurses. But the scores of scheduling and work conditions, professional traits were higher than those of formal nurses. Conclusions It is advocated to adopt different management and incentive mechanisms to improve the job satisfaction degree for contract nurses according to the differ- ences between contract nurses and formal nurses, so that the nursing staff can be stabilized.

Objective To explore the change in nutritional status of perioperative gastrointestinal cancer patients. Methods The nutritional status of 207 gastrointestinal cancer patients who were to undergo elective radical surgery was evaluated by SGA within 48h of admission and 7 days after operation. The investigation results went through analysis. Results Body weight was significantly decreased 7 days after operation compared with 48h of admission, the prevalence of malnutrition 7 days after operation was higher than 48h of admission; weight loss, change of food intake and decreased functional activity were the related factors of change in nutritional status of perioperative gastrointestinal cancer patients. Conclusions There was a decreased nutritional status among perioperative gastrointestinal cancer patients, and appropriate nutrition intervention program and treatment should be taken to improve clinical outcomes according to the risk factors.

ObjectiveTo investigate the prevalence of preoperative malnutrition and nutrition support among gastrointestinal cancer patients.MethodsA retrospective study was conducted based on the nutritional status and nutrition support of 336 gastrointestinal cancer patients who received elective radical surgery in Peking Union Medical College Hospital from April to December 2009.ResultsMalnutrition was found in 34.6％ gastric cancer patients,23.8 ％ colorectal cancer patients,and 23 ％ esophageal and cardiac cancer patients.The patients with worse nutritional status were given longer duration of nutrition support and higher energy intake.Conclusion Malnutrition occurs in gastrointestinal cancer patients,yet sometimes treated with inappropriate nutrition support.

Objective To construct a scientific and feasible evaluation indicator system of health education effect of our country′s hospitalized patients with diabetes. Methods On the basis of literature review and semi-structured interview combined with group discussion, alternative index system were determined,and then the Delphi method were used for two round consultation with 30 diabetes experts to finally determine indicator evaluation system. Results Positive coefficient of the two rounds consultation were 86.7% (26/30) and 100.0% (26/26) respectively, experts′ authority coefficient was 0.889,and the Kendall W coefficients of concordance were 0.447,0.369 and 0.302 respectively (P<0.01). The evaluation indicator system of health education effect was consisted of 6 fisrt-level indicators, 24 second-level indicators and 55 third-level indicators. Conclusions The evaluation indicator system of health education effect is reliable and scientific, which can provide objective and quantitative standards for health education effect of hospitalized patients with diabetes in our country.

Objective To study the influence of mild hypothermia on pulmonary vascular permeability in patients with acute respiratory distress syndrome (ARDS) induced by infection.Methods A prospective randomized controlled trial was conducted.Patients with ARDS induced by infection satisfied criteria including age 18-70 years,endotracheal intubation and mechanical ventilation (MV),and without severe coagulation disorder admitted to intensive care unit (ICU) of the First Affiliated Hospital of Guangxi Medical University from May 2012 to November 2015 were enrolled,excluding tumor,burn,cardiac disease,vascular disease,and endovascular surgery within 3 months.The patients enrolled were randomly divided into non-temperature controlled group and mild hypothermia group.The primary diseases in all patients were treated according to the treating principles,including respiratory support,integrated treatment of organ support and symptomatic treatment.Besides,the patients in the mild hypothermia group were administered with systemic hypothermia,and the patients' core body temperature (nasopharyngeal temperature) was rapidly decreased to 34-35 ℃ within 1 hour.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,oxygenation index (PaO2/FiO2),extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) in two groups at 1,24,48,and 72 hours after treatment or core temperature up to standards were monitored respectively.Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of vascular endothelial growth factor (VEGF) in venous blood as well as tumor necrosis factor-α (TNF-α) and surfactant apoprotein A (SP-A) in bronchoalveolar lavage fluid (BALF),and circulating endothelial cell (CEC) was counted.The duration of mechanical ventilation and 7-day survival rate were recorded.Results Fifty-six patients were enrolled,with 32 in non-temperature controlled group and 24 in mild hypothermia group.There was no difference in baseline variables including gender,age,APACHE Ⅱ score,PaO2/FiO2 between two groups.APACHE Ⅱ score,EVLWI,PVPI,VEGF,CEC,and TNF-α in both groups were gradually increased with treatment time prolongation,and PaO2/FiO2 and SP-A were gradually decreased.Compared with non-temperature controlled group,APACHE Ⅱ score (16.34±4.27 vs.19.24 ± 5.95),EVLWI (mL/kg:12.17 ± 2.26 vs.12.39 ± 4.71),PVPI (15.40 ± 10.95 vs.16.08 ± 10.24),VEGF (ng/L:127.92 ± 31.49 vs.159.12 ± 40.67),CEC (cells/μL:4.15 ± 1.79 vs.5.70 ± 2.38),and TNF-α (ng/L:147.18 ± 48.85 vs.257.17 ±40.84) in mild hypothermia group were significantly decreased from 24 hours (all P ＜ 0.05),and PaO2/FiO2 [mmHg (1 mmHg =0.133 kPa):175.03± 12.64 vs.162.53 ± 14.15] and SP-A (μg/L:80.85 ± 16.18 vs.62.06 ± 17.28) were significantly increased (both P ＜ 0.05),the duration of mechanical ventilation was significantly shortened (days:10.38 ± 1.50 vs.15.74 ± 3.06,P ＜ 0.01),and 7-day survival rate was significantly increased (75.0％ vs.46.9％,P ＜ 0.05).Conclusion Mild hypothermia can reduce the pulmonary vascular permeability,and improve pulmonary function in early phase in patients with ARDS,as well as shorten the duration of mechanical ventilation,and decrease short-term mortality.

Objective To investigate the effect of hypothermia on the expression Toll-like receptor 2 (TLR2),myeloid differentiation factor 88(MyD88),nuclear factor-κBp65(NF-κBp65),plasminogen activator inhibitor-1(PAI-1)in the TLR2/MyD88 pathway in rats with acute lung injury(ALI)induced by lipopolysaccharide (LPS)inhalation. Methods Ninety male Sprague-Dawley(SD)rats were randomly divided into control group (n=18),hypothermia group(n=24),temperature controlled group(n=24),and temperature-uncontrolled group(n=24). The ALI model was reproduced by 0.5 mL/kg LPS intratracheal instillation,while only normal saline was instilled intratracheally for control group. Arterial blood was collected and physical cooling was started 1 hour after instillation. The body temperature was lowered to 32-34 ℃in hypothermia group and 36-37 ℃in temperature controlled group,and no intervention was used for temperature-uncontrolled group and control group. The arterial blood gas was determined in all the groups before and 1 hour after instillation of saline or LPS and 1,6, 12 hours after intervention. Rats were sacrificed respectively at 1,6 and 12 hours after temperature control therapy, the morphological changes in lung tissue were observed under light microscope. The protein expression of PAI-1 in bronchoalveolar lavage fluid(BALF)was determined by enzyme linked immunosorbent assay(ELISA). TLR2 mRNA and MyD88 mRNA transcriptional level were determined by reverse transcription-polymeras chain reaction (RT-PCR). NF-κBp65 protein level was determined by Western Blot. Results After instillation of LPS,the oxygenation index(PaO2/FiO2)of each group was decreased obviously,the damage of lung tissues was aggravating,the lung injury score was increased significantly,PAI-1 protein in BALF and the expressions of TLR2 mRNA,MyD88 mRNA, NF-κBp65 protein in lung tissues were increased obviously. Each index was improved by therapeutic Hypothermia, the effect of which was best in using a cooling period in the 1-6 hours,while might be benefit at 6-12 hours. Compared with temperature controlled group,PaO2/FiO2(mmHg,1 mmHg=0.133 kPa)at 1 hour and 6 hours of hypothermia group was improved(1 hour:402.49±38.61 vs. 324.36±28.93,6 hours:349.72±98.20 vs. 284.35±13.68, both P<0.01),the lung injury score at 1,6 and 12 hours were significantly decreased(1 hour:6.04±0.74 vs. 7.96±0.65,6 hours:9.09±0.80 vs. 13.13±1.02,12 hours:10.79±1.42 vs. 13.42±0.68,all P<0.01),the PAI-1 protein(ng/L)in BALF at 1,6 and 12 hours were significantly decreased(1 hour:121.36±4.62 vs. 197.74±9.42, 6 hours:230.53±10.76 vs. 294.06±16.60,12 hours:270.48±13.20 vs. 319.40±10.24,all P<0.01),TLR2 mRNA and MyD88 mRNA expressions(2-ΔΔCt)in the lung tissues at 1,6 and 12 hours were significantly decreased (TLR2 mRNA 1 hour:2.18±0.26 vs. 3.04±0.39,6 hours:4.09±0.29 vs. 4.90±0.35,12 hours:6.02±0.43 vs. 7.10±0.54;MyD88 mRNA 1 hour:2.25±0.41 vs. 3.04±0.30,6 hours:5.67±0.55 vs. 7.01±0.76,12 hours:7.14±0.60 vs. 8.87±0.54,all P<0.01),NF-κBp65 protein expression(A value)at 6 hours and 12 hours was significantly decreased(6 hours:0.31±0.08 vs. 0.53±0.12,12 hours:1.05±0.17 vs. 1.76±0.35,both P<0.01). There was no difference in each index between temperature controlled group and temperature-uncontrolled group. Conclusion Hypothermia can down-regulate the expression of TLR2 mRNA,MyD88 mRNA,NF-κBp65 protein and PAI-1 in the TLR2/MyD88 pathway to protect lung tissue of rats with ALI induced by LPS inhalation from injury.

PRECEDE-PROCEED model is a new research hotspot in the field of health education in recent years, which has been widely used in many education fields and has achieved good results. This article discussed in detail the theoretical framework, advantages and application status of PRECEDE-PROCEED model in the field of health education, so as to enhance the medical and nursing staff's understanding of this model, and provide a reference for applying this model to clinical work scientifically.

Objective:To explore the reasons for delayed medical treatment in diabetic foot patients using the health ecology model as a framework.Methods:From November of 2021 to March of 2022, descriptive phenomenological research methods was used in 20 patients with diabetic foot who delayed medical treatment were interviewed face-to-face semi-structured in depth, and the data analysis was carried out using the seven-step method of Colaizzi phenomenology to refine the theme.Results:According to the five levels of the health ecology model, the reasons for delayed medical treatment were summarized into 11 themes, and the reasons for the personal trait layer included foot ulcers are not detected promptly, and the perceptual decline of advanced patients. Behavioral characteristics included lack of knowledge of diabetic foot, negative medical psychology. Reasons for the interpersonal network included insufficient family support and lack of social support; reasons for living and working conditions included high economic pressure, low electronic health literacy, and inconvenient medical treatment; the reasons for the policy environment included uneven medical insurance reimbursement ratios and limited medical conditions.Conclusions:The reason for the delay in seeking medical treatment for diabetic foot patients is multi-layered and systematic, and medical staff need to improve the self-management ability of diabetic patients′ feet from the individual level, and also need to guide patients from the system level on how to obtain the best medical resources.

ObjectiveTo explore the effects of companion support on insulin pump therapy in adolescents with type 1 diabetes.Methods A total of 60 patients were randomly divided into experimental group and control group,30 cases respectively. Patients in control group were given routine education,while patients in experimental group received additional intervention of companion support. Changes of blood glucose,the occurrence of negative events during the use of insulin pump and standardized usage of insulin pump were compared between two groups. Blood glucose before sleep in one random day was recorded and the fluctuation of blood glucose was compared between two groups.Results After six months,fasting and postprandial blood glucose,glycated hemoglobin and the occurrence of negative events during the use of insulin pump in experimental group were significantly lower than those in control group (P<0.05). The waveform stability at one random day before sleep of experimental group was better than that of control group.Conclusions Companion support plays curial roles in controlling blood glucose, improves the standardization of insulin pump operation and effectively reduces the negative events in adolescents with type 1 diabetes undergoing temporary insulin pump therapy.

Objective To investigate professional maturity and career planning of nursing students and explore their correlation.Methods Totals of 138 nursing students were investigated by professional maturity scale and career planning scale.Results Both professional maturity and career planning of nursing students were average level,with the score of (3.08 ± 0.24),(3.47 ± 0.41),and professional maturity degree was positively correlated with career planning level (P ＜ 0.05).Conclusions Professional maturity and career planning of nursing students have a certain degree of development,but there is still some gap to mature period,and the imbalance appears in various dimensions.Clinical nursing educators should strengthen the self-confidence of nursing students,and guide career planning according to the degree of professional