OBJECTIVE To study the effect and development of centralizing management of the overall recycled medical instruments toward the hospital nursing management by the Center for Sterilization,Supply and Distribution.METHODS The centralizing method and decentralizing method toward the recycled handling of the medical instruments were adopted and compared their effect toward nursing management quality,vocational safety,hospital infection management,and of the two methods cost and benefit management,respectively.RESULTS The centralizing management group had distinct advantage than the decentralizing one on the qualified rate of cleaning,packaging,the qualified rate of the sampled incubation of the aseptic products and work efficiency.CONCLUSIONS Through the centralizing management of the Center for Sterilization,Supply and Distribution toward the overall recycled hospital instruments,it can improve the hospital′s nursing staff resource utilization and nursing quality,help to perfect the nursing staff′s vocational safety;decline the hospital infection risk;increase the output of the hospital nursing work and reduce its operational cost;and can make for improving and protecting the environment.

Objective To investigate the efficacy of ultrashort and short-acting insulin after subcutaneous insulin infusion pump under glucose monitoring in treatment of diabetes.Methods 110 cases with type 2 diabetes were selected,they were randomly divided into two groups with a random number table:the study group and the control group,55 cases in each group.The study group was treated with short -acting insulin after subcutaneous injection of insulin pump,the control group was treated with short -acting subcutaneous insulin infusion by insulin pump therapy, glucose monitoring system was used to monitor glucose during treatment of the two groups.The clinical efficacy after a month of treatment was observed.Results Before treatment,fasting blood glucose(FPG),postprandial 2 h blood glucose(2h PG),bedtime blood glucose of the two groups had no statistically significant differences.After treatment, FPG and 2hPG,bedtime blood glucose in the study group were (6.01 ±1.06)mmol/L,(7.90 ±0.50)mmol/L, (7.13 ±0.95)mmol/L respectively,which of the control group were (5.98 ±1.04)mmol/L,(7.91 ±0.48)mmol/L, (7.14 ±0.94)mmol/L,which were significantly lower than before treatment (t =9.843,23.669,13.569,9.683, 22.881,13.710,P <0.05),the two groups after treatment showed no significant differences(P >0.05).The blood glucose time and insulin dosage in the study group were (5.59 ±1.30)d,(39.98 ±11.01)u/d,which of the control group were (6.98 ±1.40)d,(51.89 ±11.97)u/d,and there were significant differences between the two groups(t =1.825,5.431,P <0.05).The mean blood glucose,blood glucose standard deviation,time percentage of blood glucose≥10 mmol/L,time percentage of blood glucose≤3.9 mmol/L in the study group were (5.95 ±0.61 )mmol/L, (1.28 ±0.25)mmol/L,(14.16 ±2.13)%,(6.35 ±1.45)%,which in the control group were (6.59 ±0.94)mmol/L, (1.54 ±0.29)mmol/L,(15.15 ±2.14)%,(7.96 ±1.42)% respectively,and the differences were statistically significant between the two groups(t =4.236,503.6,2.432,5.883,P <0.05).Conclusion Glucose monitoring system in monitoring blood glucose is accurate and reliable,ultra -short -acting insulin after subcutaneous insulin pump infusion in treatment of diabetes is better than short -acting insulin.

Objective To investigate the relationship between bacteria biofilm and bacterial culture in patients with chronic rhinosinusitis (CRS). Methods Ninety patients with CRS were enrolled in the study. Five patients with deviation of nasal septum and 10 healthy subjects served as controls. Mucosa of uncinate process or near the ostium of the maxillary sinus was obtained during endoscopic sinus surgery. All specimens were processed for bacterial culture and scanned by electron microscopy. Pearson test was performed to analyze the relationship between the presence of bacterial biofilm and the results of bacteria culture. Results The scanning electron microscopy showed bacterial biofilms in 64 (71.1%) out of 90patients with CRS, while the positive rate of bacteria culture in the study group was 66.7% (60/90). No bacterial biofilm and bacterium was detected in the control group and 26 culture-negative individuals in study group. Pearson correlation analysis showed a statistically association between bacterial biofilm and bacterial culture in CRS ( r = 0. 901, P = 0. 000). Conclusion Positive results of bacteria culture are highly correlated with the presence of bacterial biofilm in CRS patients.

Objective To investigate the scale and educational-level composition of nursing education in Guangdong Province,identify the issues in the development process,and provide suggestions accordingly.Methods Data on the scale and education level of nursing education were obtained from the Ministry of Education of China.Results Scale of nursing education at three levels for entering nursing (secondary diploma,advanced diploma,and baccalaureate degree) expanded rapidly during 2006～2010 in Guangdong,with 25.6 thousand recruitments totally in 2010,which as 2.05 times as in 2006.The portion of students recruited in secondary diploma programs had increased gradually,resulted in 83.53％ in 2010 (9.41％ for recruitments in advanced diploma programs and 7.06％ for baccalaureate degree programs).179 and 16 students were recruited in master's and doctoral programs in Guangdong,respectively,during 2006～ 2010.Conclusions The current scale and composition of nursing education in Guangdong should be improved according to the dynamic supply-need relationship of nursing workforce.Initial nursing education should be upgraded by increasing the recruitments of advanced diploma and baccalaureate programs and decreasing the recruitments of secondary diploma programs,expand graduate education,and ensure the quality of education.

VE: Chitosan and sodium tripolyphosphate were used as Complex matrix material for preparing pellets loading sodium diclofenac and its properties were studied. METHODS Chitosantripolyphosphate sodium polyelectrolyte was prepared according to the principle of static electricity polymerization. Its properties and structure characteristics were further investigated. The preparation process, effective factors and the optimal condition for the pellets loading sodium diclofenac were studied. RESULTS IR indicated that the structure of compound contained -NH3+-O-P group. DTA demonstrated that polyelectrolyte had an exothermic peak. There was no interaction between the drug and expedient. SEM showed that the surface of the pellets was regular, dense and the structure of the surface wasn't consistent with the inner. The pellets prepared by this method were uniform, round, well-distributed, hardy, good-mobility and its average diameter was about 10mm. CONCLUSION Chitosan-tripolyphosphate sodium polyelectrolyte could be used as a good matrix material for preparing pellets.

Objective To explore the influence of different testing methods on detecting value of to-tal cell volume. Methods 60 reusable dialyzers(low-flux dialyzer and high-flux dialyzer were 30 respec-tively) were enrolled. They were divided into the traditional testing group, the modified testing group and the automatic dialyzer reuse group with 20 dialyzers in each group according to different detecting methods, the results underwent analysis. Results The basic total cell volume of the traditional testing group, the modified testing group and the automatic dialyzer reuse group were (100.10±0.25) ml, (100.13±0.50) ml and (102.00±1.41) ml in 6LR dialyzer, while in 17R dialyzer, they were (113.67±1.30) ml, (118.67±1.30) ml and (119.93±1.77)ml respectively. The total cell volume of the dialyzer reuse in the traditional testing group, the modified testing group and the automatic dialyzer reuse group were (95.20±7.76) ml, (96.20± 7.22) ml and (102.80±4.26) ml in 6LR dialyzer, while in 17R dialyzer, they were (100.00±11.48) ml, (114.35±3.31 ) ml and (117.07±2.96) ml respectively. There was significant difference between the tradi-tional and the modified testing groups in high-flux dialyzers reuse. Conclusions The modified testing method can improve the accuracy of the testing of total cell volume in high-flux dialyzer reuse.

Objective To explore the influence of automatic and semi-automatic hemodialyzer reuse method on hemodialyzer reuse effect. Methods 1728 dialyzers were randomly divided into automatichemodialyzer reuse group and semi- automatic hemodialyzer reuse group with 864 dialyzers in each group. Thetime of douching and testing, the cost of sterilization,the frequency of the pyrphgen reaction,the broken dialyzer membrane and re-examined dialyzer between the two groups were measured. Results The time of douching dialyzer, testing of total cell volume and pressure in the semi- automatic hemodialyzer reuse group was (26.443±3.237), (2.172±0.128) and (2.157±0.090) minutes respectively,while the automatic hemodialyzer reuse group was (5.793±0.193), (1.257±0.118) and (1.110±0.076) minutes respectively. The frequency of re-examined dialyzer in testing total cell volume and pressure was 499(57.755%), 243(28.125%) respectively. At the same time, all dialyzer in semi-automatic hemodialyzer reuse group could be examined successfully at a time. The cost of sterilization in automatic henmdialyzer reuse group was (9.330±0.138)yuan. No pyrogen reaction and broken dialyzer membrane happened. Conclusions The semi-automatic bemodialyzer reuse group can retrench cost during perfusion,but consumes long douching time, lacks matching detection equipment, difficult to detect, and is not easy to read data and has high re- examination rate. while in the automatic hemodialyzer group, it is convenient of douching and detection, but the cost of sterilization and equipment is high, and clinical demand can be fulfilled only when the dialysis center can allocate reasonable number of the machines.

Objective To explore the willingness ofhemodialysis nurses and current application of indwelling needles for dialysis. Methods Based on the method of random survey and SPSS 22.0 statistical software, 295 hemodialysis nurses from 34 hospitals in Shenzhen were investigated by aself-designed questionnaire in a way to explore and application of indwelling needles for dialysis and the nurses' willingness of using them. Results Among 248 collected valid questionnaires, there were 200 (80.6%) hemodialysis nurses who are willing to use dialysis indwells. Univariate analysis showed the results are influenced by the class of hospitals and the safety of indwelling needles in their mind (P＜ 0.05). Multivariate analysis showed that whether nurses know dialysis indwelling needle and the safety of the dialysis indwelling needles in their mind are the influencing factors of their willingness to use the indwelling needle for dialysis. There were 167 (67.34%) nurses who had never used the dialysis indwelling needle. The first two influence factor of promotion of dialysis indwelling needle were the entrenched operating habits (31.05%) and their department had not applied the usage of them (27.82%).The biggest concern of hemodialysis nurses was the fixation of the indwelling needle (16.13%), followed by the punch/seal problem (8.87%). Conclusions The vast majority of hemodialysis nurses were willing to use dialysis indwelling needle in nursing work, but its promotion and application was not optimistic. Therefore, intervention measures should be carried out at individual, department and hospitallevel, intensifying the training and conceptual changes of department regulators and nurses.

Objective:To explore the relationship between carotid atherosclerosis (CAS) and bone metabolism marker osteocalcin (OC) in patients with type 2 diabetes (T2DM).Methods:A total of 100 patients with T2DM admitted to Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University) from January 2018 to August 2018 were selected as study subjects, and the carotid intima-media thickness (IMT) was detected.The patients were divided into CAS group and normal carotid IMT group (NC group), with 50 cases in each group.The levels of OC, fasting plasma glucose(FPG), fasting insulin(FINS), glycosylated hemoglobin(HbA1c), total cholesterol (TC), triglyceride (TG), high density lipoprotein(HDL-C), low density lipoprotein (LDL-C), insulin resistance index (HOMA-IR) were compared between the two groups.Results:The OC level of the CAS group[(11.86±4.46)ng/mL] was significantly lower than that of the NC group[(23.94±4.52)ng/mL] ( t=-9.640, P=0.001). The LDL-C level of the CAS group[(2.89±0.82)mmol/L] was significantly higher than that of the NC group[(2.55±1.16)mmol/L]( t=2.03, P=0.049). Pearson correlation analysis showed that IMT was positively correlated with age, LDL-C, HbA1c ( r=0.285, 0.190, 0.173; P=0.000, 0.020, 0.035), and negatively correlated with OC ( r=-0.603, P=0.000). Conclusion:CAS in patients with T2DM is closely related to OC, and the reduction of OC levels may be a risk factor for CAS in T2DM patients.

Clinical trial is the gold standard for evaluating the efficacy and safety of interventions; however, it is limited by high costs and long time. Real-world data (RWD) can provide a robust data basis for comparative research, but the quality is uneven. This review introduces the target trial emulation, in which researchers, using RWD and following the design of clinical trials, define exposure and outcome in advance, set eligibility criteria, determine the time zero, estimate sample size, and plan statistical analysis, to enhance the quality of evidence for observational studies. This review preliminarily discusses the standard of evidence quality evaluation in target trial emulation. Then, the target trial emulation is shown through case interpretation.