Objective To investigate the detection of multidrug-resistant organisms (MDROs)in a hospital, evaluate the efficacy of multi-disciplinary team(MDT)on management of MDROs,and provide guidance for effective control on MDRO infection.Methods From October 2013 to September 2014,compliance to comprehensive inter-vention measures in clinical departments in different stages as well as detection of MDROs from patients were com-pared respectively.Results Compliance to comprehensive intervention measures showed an overall upward trend from the fourth quarter of 2013 to the first,second,and third quarters of 2014,difference was statistically signifi-cant (all P <0.001 ).From the fourth quarter of 2013 to the third quarter of 2014,the percentage of the major MDRO strains in the same species of bacteria were:methicillin-resistant Staphylococcus aureus (MRSA)52.34%, 45.45%,48.95%,and 26.25% respectively;carbapenem-resistant Acinetobacter baumannii (CRAB)64.42%, 63.07%,59.87%,and 43.09% respectively;multidrug-resistant Pseudomonas aeruginosa (MDRPA)42.11 %, 41 .82%,29.33%,and 17.52% respectively;the detection rate of MRSA,CRAB,and MDRPA showed an overall downward trend,difference among different stages were statistically significant (all P <0.001 ).Detection rates of carbapenem-resistant Enterobacteriaceae (CRE)and vancomycin-resistant Enterococcus (VRE)were both low (<5%),difference among different stages were not statistically significant (all P >0.05).Conclusion MDT on man-agement of MDROs is helpful for reducing the emergence and spread of MDROs.

OBJECTIVE:To provide reference for drug consultation of Chinese patent medicine(CPM)in pregnancy. METH-ODS:Package inserts of CPM in our hospital during Jan.-Jun. 2016 were collected. Referring to the prohibited,contraindicated and caution materials and decoction pieces in Chinese Pharmacopoeia(part 1,2015 edition),based onnoteitem in Chinese Pharma-copoeia and Clinical Application Guidelines(2010 edition),problems existing in pregnancy contraindication labeling of package in-serts were compared and analyzed. RESULTS:There were 99 kinds of prohibited,contraindicated and caution materials and decoc-tion pieces in Chinese Pharmacopoeia. There were 210 package inserts of CPM except for the special medicine for children,in which 32 contained prohibited materials,61 contained caution materials,only 21 were in line with the contained materials. Among the package inserts of 93 CPM containing prohibited or caution materials,27 were included in Chinese Pharmacopoeia,13 in Clini-cal Application Guidelines only,17 in both,but only 6 had the same contraindication labeling. Among the package inserts of 32 CPM containing prohibited materials,6 were explicitly labeled prohibited,17 labeled contraindicated or caution,and 9 labeled none. Among the package inserts of 61 CPM containing caution materials,29 were labeled prohibited or contraindicated,15 la-beled caution,and 17 labeled none. Among the package inserts of 117 CPM containing no prohibited,contraindicated or caution materials,8 were labeled contraindicated in pregnancy,and 18 labeled prohibited in pregnancy. CONCLUSIONS:The pregnancy contraindications of most CPM are not normative,showing poor consistency with Chinese Pharmacopoeia or Clinical Application Guidelines. Except for providing drug consultation by complying with Chinese Pharmacopoeia,Clinical Application Guidelines and package insert,pharmacists can judge the CPM without labeled pregnancy contraindication by analyzing its classification of con-tained materials. Using TCM does not indicate safety drug use,in addition,some CPM contain western medicine ingredients. There-fore,pharmacists should conduct medication education for patients who used CPM in pregnancy. Considering the new and severe adverse reactions of TCM injections are more,its adverse reactions exist unpredictability,so that pregnant patients should be sug-gested to avoid using TCM injections by pharmacists.

Objective:To investigate the epidemiological characteristics and late diagnosis of suspected occupational diseases in Guangzhou from 2006 to 2018.Methods:The cases of suspected occupational diseases reported in Guangzhou from January 1, 2006 to December 31, 2018 were collected and followed up to the end of 2018. The cases of suspected occupational diseases were analyzed statistically.Results:A total of 1502 suspected occupational cases were reported in Guangzhou from 2006 to 2018, including suspected occupational otorhinolaryngological and oral diseases (58.59%, 880/1502) , suspected occupational chronic poisoning (25.03%, 376/1502) and suspected occupational pneumoconiosis (11.72%, 176/1502) . The key reporting areas were Huangpu District (27.50%, 413/1502) and Panyu District (20.91%, 314/1502) . The key reporting industries were manufacturing industry (80.36%, 1207/1502) , among which railway, ship, aerospace and other transportation equipment manufacturing industry (13.26%, 160/1207) , automobile manufacturing industry (12.51%, 151/1207) and general equipment manufacturing industry (10.19%, 123/1207) were the main industries. The main type of reported economy was private economy (39.95%, 600/1502) . The scale of the key reporting enterprises was medium and small-sized enterprises (31.09%, 467/1502 and 34.62%, 520/1502) . As of December 31, 2018, 263 cases were diagnosed with occupational diseases, and the diagnosis rate was 17.51%.Conclusion:The number of suspected occupational diseases reported in Guangzhou from 2006 to 2018 is large, and the overall diagnosis rate of suspected occupational diseases is low. It is necessary to strengthen the supervision and management of key diseases, key regions, and key industries of suspected occupational diseases. It is suggested that the reporting system of suspected occupational diseases should be standardized as soon as possible.

Objective:To investigate the epidemiological characteristics and late diagnosis of suspected occupational diseases in Guangzhou from 2006 to 2018.Methods:The cases of suspected occupational diseases reported in Guangzhou from January 1, 2006 to December 31, 2018 were collected and followed up to the end of 2018. The cases of suspected occupational diseases were analyzed statistically.Results:A total of 1502 suspected occupational cases were reported in Guangzhou from 2006 to 2018, including suspected occupational otorhinolaryngological and oral diseases (58.59%, 880/1502) , suspected occupational chronic poisoning (25.03%, 376/1502) and suspected occupational pneumoconiosis (11.72%, 176/1502) . The key reporting areas were Huangpu District (27.50%, 413/1502) and Panyu District (20.91%, 314/1502) . The key reporting industries were manufacturing industry (80.36%, 1207/1502) , among which railway, ship, aerospace and other transportation equipment manufacturing industry (13.26%, 160/1207) , automobile manufacturing industry (12.51%, 151/1207) and general equipment manufacturing industry (10.19%, 123/1207) were the main industries. The main type of reported economy was private economy (39.95%, 600/1502) . The scale of the key reporting enterprises was medium and small-sized enterprises (31.09%, 467/1502 and 34.62%, 520/1502) . As of December 31, 2018, 263 cases were diagnosed with occupational diseases, and the diagnosis rate was 17.51%.Conclusion:The number of suspected occupational diseases reported in Guangzhou from 2006 to 2018 is large, and the overall diagnosis rate of suspected occupational diseases is low. It is necessary to strengthen the supervision and management of key diseases, key regions, and key industries of suspected occupational diseases. It is suggested that the reporting system of suspected occupational diseases should be standardized as soon as possible.

Objective? To explore effects of CoughAssist on sputum excretion efficacy among patients with intensive care unit-acquired weakness (ICU-AW). Methods? From January 2016 to December 2017, we selected 84 ICU-AW patients with mechanical ventilation of ICU in Hu'nan Provincial People's Hospital by convenience sampling. All of the patients were divided into control group and observation group with the random number table, 42 cases in each group. Two groups all received routine treatment and nursing. On this basis, observation group carried out CoughAssist therapy. We compared the sputum excretion effects, results of sputum smear/sputum culture, arterial blood gas indexes, respiratory mechanics indexes, the incidence of ventilator-associated pneumonia (VAP), time of mechanical ventilation, hospital days in ICU and the score of Medical Research Council (MRC) of patients between two groups. Results? There were no statistical difference in the volume of sputum excretion of patients in two groups before dividing groups (P＞0.05). One to three days after treatment, the volume of sputum excretion and number of effective sputum excretion patients in observation group were more than those in control group; the positive rate of sputum culture of patients in observation group was lower than that in control group; the differences were all statistical (P＜ 0.05). The partial pressure of oxygen (PaO2) of observation group was higher than that of control group; the partial pressure of carbon dioxide (PaCO2) of observation group was lower than that of control group; the differences were all statistical (P＜0.05). The pressure support/pressure control (PS/PC) and airway resistance of observation group were lower than those of control group;and the compliance and cough peak flow (PCF) were higher than those of control group with statistical differences (P＜ 0.01). The incidence of VAP, time of mechanical ventilation and hospital days in ICU of observation group were lower than those of control group (P＜0.05). There was no statistical difference in the scores of MRC between two groups (P＞0.05). Conclusions? The application of CoughAssist in ICU-AW patients with mechanical ventilation can improve the sputum excretion effects as well as respiratory function and shorten the time of mechanical ventilation and hospital days in ICU, and improve the clinical effects.

Objective:To compare the clinical characteristics and analyze the prognostic factors between human immunodeficiency virus (HIV)-infected patients and non-HIV-infected immunocompromised patients with pneumocystis pneumonia (PCP) complicated with acute respiratory failure (ARF) in intensive care unit (ICU).Methods:The clinical data of patients with PCP complicated with ARF admitted in ICU of The First Affiliated Hospital of Zhengzhou University and The Sixth People′s Hospital of Zhengzhou City between May 2018 and October 2020 were retrospectively reviewed. All subjects were divided into HIV-infected group and non-HIV-infected immunocompromised group. General characteristics and underlying diseases of patients in the two groups were analyzed. Laboratory parameters, treatment and outcomes between two groups were compared. Independent sample t test, Mann-Whitney U test and chi-square test were used for statistical analysis, and univariate and multivariate logistic regression models were used to identify the risk factors for the clinical outcome. Results:A total of 129 PCP complicated with ARF patients were enrolled, including 75 HIV-infected patients and 54 non-HIV-infected immunocompromised patients. Only 10.7%(8/75) patients of HIV-infected group received anti-retroviral therapy (ART), but none of the patients in either groups had previously received trimethoprim-sulfamethoxazole (TMP-SMX) for PCP prophylaxis. Acute physiology and chronic health evaluation (APACHE) Ⅱ score of HIV-infected group was 18.7±6.0, which was higher than that in non-HIV-infected immunocompromised group (13.1±4.4) when admitted in ICU ( t=-5.45, P<0.001). Hypoproteinemia was common in both groups. Ninety-six percent (72/75) of HIV-infected patients had CD4 + T lymphocyte counts lower than 200/μL and 84.0%(63/75) of patients had CD4 + T lymphocyte counts even lower than 50/μL, while 5.74%(31/54) of patients in non-HIV-infected immunocompromised group had CD4 + T lymphocyte counts lower than 200/μL. The CD4 + /CD8 + T lymphocyte counts ratio was 0.05(0.02, 0.12) in HIV-infected group, which was lower than that in non-HIV-infected immunocompromised group (0.96(0.64, 1.44)), and the difference was statistically significant ( Z=-9.16, P<0.001). The length of ICU stay and hospital stay of non-HIV-infected immunocompromised patients were 10.0(7.0, 14.0) days and 18.0(11.8, 32.5) days, respectively, which were both longer than those in HIV-infected patients (7.0(4.0, 9.0) days and 13.0(7.0, 23.0) days, respectively), and the differences were both statistically significant ( Z=-3.58 and -2.73, respectively, both P<0.050). The hospital mortality of HIV-infected patients was 57.3%(43/75), which was significantly higher than that in non-HIV-infected immunocompromised patients (38.9%, 21/54) ( χ2=4.27, P=0.039). Multivariable logistic regression identified that lactic dehydrogenase (LDH), C-reactive protein (CRP) and APACHE Ⅱ score were the risk factors for the clinical outcome of HIV-infected patients (odds ratio ( OR)= 1.006, 1.015 and 1.736, respectively, all P<0.050). The partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen (PaO 2/FiO 2), LDH and CD4 + T lymphocyte counts were the risk factors for the clinical outcome of non-HIV infected immunocompromised patients ( OR=0.970, 1.008 and 0.989, respectively, all P<0.050). Conclusions:PCP patients with ARF are critically ill with high mortality rate. LDH, CRP and APACHEⅡscore are predictors for prognosis of HIV-infected patients with PCP, while PaO 2/FiO 2, LDH and CD4 + T lymphocyte counts are predictors for prognosis of non-HIV infected immunocompromised patients with PCP.

By analyzing the present situation, advantages and challenges of the development of new nurses training in hospitals in the Massive Open Online Course (MOOC) era, it is suggested that the intelligent development of MOOC can not only meet the training needs of new nurses in the new situation, but also promote the application of MOOC in nursing inservice education. It is suggested that we should break the barriers, promote the sharing of high quality resources, improve the construction of curriculum system, strengthen the training supervision and assessment system, increase the policy support, strengthen the cultivation of MOOC technical personnel and technical innovation, and explore the "mixed teaching" model and other initiatives to promote MOOC science and its efficient development.

Objective:To explore the quality evaluation index system of Internet plus nursing service suitable for China's national conditions, aiming to provide a basis for the quality evaluation and monitoring of Internet plus nursing service.Methods:Based on the "structure-process-result" proposed by Donabedian as the theoretical framework, combined with literature retrieval, qualitative interview, group discussion, and referring to the relevant systems and policies of advanced regions in China, the quality evaluation index item pool and initial questionnaire were preliminarily constructed. In the first and second rounds of questionnaires, Delphi method was used to select indicators. In the third round of questionnaires, the expert importance assignment method was used to clarify the weights of the indicators.Results:The 3 rounds of expert positive coefficients were respectively 92%, 100% and 100%, the expert authority coefficients were respectively 0.870, 0.870 and 0.877 and Kendall's W coefficients were 0.101, 0.105 and 0.119. Finally, an Internet plus nursing service quality evaluation index system with 3 first-level indicators, 19 second-level indicators and 176 third-level indicators was formed. Conclusions:For quality evaluation index system of Internet plus nursing service based on quality three-dimensional theory, the expert opinions are relatively concentrated and results are relatively, which can provide a basis for the establishment of quality evaluation standards of Internet plus nursing service for medical institutions and guide and promote the healthy development of Internet plus nursing service in China.

Objective To analyze the correlation between T lymphocyte subsets,neutrophil/lymphocyte ratio(NLR),procalcitonin(PCT)and the severity of sepsis.Methods A prospective research method was adopted.A total of 78 sepsis patients admitted to the department of intensive care medicine of Zibo Central Hospital from January 2021 to December 2022 were selected as the research subjects.Patients were divided into a septic shock group(37 cases)and a sepsis group(41 cases)based on the severity of their condition,with 40 healthy examinees from our hospital as the healthy control group.Using flow cytometry to measure the levels of CD4+ T lymphocytes count(CD4+ T)and CD8+ T lymphocytes count(CD8+ T)in three groups of subjects,calculate the CD4+ T/CD8+ T lymphocyte ratio(CD4+ T/CD8+ T)and NLR.The levels of PCT and interleukin-6(IL-6)were measured using electrochemiluminescence immunoassay,and the levels of C-reactive protein(CRP)were measured using immunoassay turbidimetry.Acute physiology and chronic health evaluationⅡ(APACHEⅡ)score within 24 hours was recorded for the two groups of patients,and the differences in lymphocyte subsets and various inflammatory indicators were compared between the groups.Pearson correlation analysis was used to analyze the correlation between various indicators and APACHEⅡscore.Results The CD4+ T,CD8+ T,and CD4+T/CD8+T levels in the septic shock and sepsis groups were significantly lower than those in the healthy control group[CD4+ T(×106/L):168.27±76.68,266.08±131.57 vs.789.60±173.78,CD8+ T(×106/L):156.50±68.37,205.81±75.60 vs.636.42±90.59,CD4+ T/CD8+ T:1.09±0.39,1.27±0.34 vs.1.44±0.38,all P<0.01],NLR,PCT,CRP and IL-6 were significantly higher than those in the healthy control group[NLR:25.85±11.62,15.94±8.72 vs.2.68±1.31,PCT(μg/L):21.82±15.28,9.09±4.96 vs.0.13±0.10,CRP(mg/L):158.65±62.33,106.97±51.49 vs.6.48±2.08,IL-6(ng/L):1 344.64±899.21,245.31±176.99 vs.3.25±1.83,all P<0.01].The APACHEⅡscore in the septic shock group was significantly higher than that in the sepsis group(32.00±1.00 vs.22.01±1.09,P<0.05).Correlation analysis showed that the levels of CD4+ T,CD8+ T,CD4+ T/CD8+ T in two groups of sepsis patients were negatively correlated with the APACHEⅡscore(r values were-0.571,-0.506,and-0.555,respectively,all P<0.01),while the levels of NLR,PCT,CRP,and IL-6 were positively correlated with the APACHEⅡscore(r values were 0.711,0.709,0.777,and 0.707,respectively,all P<0.01).Conclusions As the levels of T lymphocyte subsets decrease,inflammatory indicators like NLR and PCT rise,indicating a more severe sepsis condition.Therefore,T lymphocyte subsets and levels of various inflammatory indicators can serve as markers for evaluating the severity of sepsis.