The authors first make an analysis of the problems in clinical nursing quality control, including maintaining conservative points of view, sticking to backward quality control criteria, ignoring patients feelings, neg lecting clinical practice, and letting quality inspection become a mere formality. Then they argue that nursing quality managers should update their points of view and make constant innovations, revise quality evaluation criteria and emphasize the practical results of patient care, pay great attention to the psychological needs of the patients, and improve nursing expertise so as to render nursing quality control more rational, standardized and scientific.

Virtual reality simulators and surgical demonstration were used in laparoscopic teaching combining teacher' guiding with students' practice to improve the teaching effectiveness hecause of the limitations of the traditional apprenticeship teaching methods.The new method was applied for 2 cycles and for 6 weeks.The results showed that the teaching methods of virtual reality simulators combined with surgical demonstration can significantly improve the effectiveness of laparoscopic teaching and shorten the initial learning curve,therefore it is worth promoting in laparoscopic operation training and teaching.

Objective To investigate the current situation of healthcare-associated infection(HAI)management in secondary and above medical institutions in Shaanxi Province,analyze development trend,and put forward sugges-tions for improvement.Methods In May-June,2016,170 secondary and above hospitals in 10 cities were selected for surveying through stratified random sampling method.Survey content included basic situation of hospitals,HAI management,HAI monitoring,and so on.Results Available questionnaires were obtained from 165 hospitals (43 tertiary hospitals,and 122 secondary hospitals).Of 165 hospitals,more than 90% have established HAI manage-ment organizations and regulations,but hospital risk management should be paid more attention,only 63.03% of hospitals perfected the risk management system and 66.06% conducted risk assessment.99.09% of hospitals im-plement training on HAI to all staff regularly and 88.41% conducted effective feedback.In the aspect of staff alloca-tion,88.48% of the hospitals assigned enough professionals for HAI management,but only 34.55% have specific training programme for these personnel.Only 33.94% of hospitals have special funds for HAI control;in the aspect of monitoring on HAI,21.21% of hospital installed and used HAI monitoring software;In the aspect of implemen-tation of monitoring programme,about 90% of hospitals developed monitoring on HAI cases and environmental hy-giene,but only 34.55% and 23.64% of hospitals conducted targeted monitoring on intensive care unit and neonatal intensive care unit respectively.Conclusion Organizational structure of HAI management in Shaanxi Province is perfect,relevant rules and regulations are basically established,basic monitoring projects are universal,but the awareness of risk management needs to be strengthened,professional allocation and professional quality develop-ment are both imbalance,informational monitoring is inadequate.

Objective To investigate the causes of an outbreak of healthcare-associated infection with methicillin-resist-ant Staphylococcus aureus (MRSA)in a neurosurgical intensive care unit(NSICU).Methods Epidemiological investigation on 8 patients with lower respiratory tract infection (LRTI)in a NSICU between June 15 and June 28,2104 were performed by combination methods of prospective and retrospective survey.Results The attack rate of MRSA LRTI in NSICU patients was 22.86%,a total of 16 MRSA isolates were detected from patients’clinical specimens,nasal vestibule,as well as hospital surroundings during the period,pulsed-field gel electrophoresis (PFGE)result revealed that infection outbreak was caused by two subtypes of MRSA;risk factors analysis showed that long length of stay in ICU and aspiration of spu-tum through bronchoscopy were risk factors for MRSA LRTI.Conclusion Contamination of bronchoscope was the key factor for this epidemic spread of healthcare-associated MRSA infection.

Objective To understand the effect of improving compliance rate to multidrug-resistant organism (MDRO)prevention and control measures on reducing MDRO transmission in the intensive care unit (ICU ). Methods All patients in 5 ICUs of a hospital in March-June 2014 were chosen,March 1-April 30,2014 was base-line survey stage,May 1-June 30,2014 was intervention stage (comprehensive intervention measures were taken), the implementation of patients contact isolation measures,as well as awareness of MDRO-related knowledge among health care workers(HCWs)in 5 ICUs before and after intervention were compared respectively. Results HCWs' awareness rates of MDRO transmission modes,contact isolation measures,and informing of department transfer after intervention were all higher than before intervention(100.00% vs 67.22% ,98.89% vs 61.11% ,93.33% vs 45 .56% ,respectively);except single-room isolation,compliance rates to other prevention and control measures (including doctor's advice on isolation,bedside isolation,wearing isolation gowns,adding isolation logo)were all higher than before intervention(>70% vs <50% ,all P<0.01). Detection rate of MDROs after intervention was lower than before intervention (7.16% [90/1257]vs 9.65% [117/1212],χ2= 5.00,P= 0.03). Conclusion Com-prehensive intervention measures can improve HCWs'compliance to prevention and control measures on MDROs, and reduce the transmission of MDROs.

The reconstructive method and layout of medical train is studied,especially in reconstruction of the sick and wounded ward,medical room and train carriage.Safe protection for the wounded and methods for equipment constancy are introduced.It is expected to serve as a reference for enhancing medical treatment efficiency and quality.

Objective To investigate in vitro activity of antimicrobial agents against Enterococcus spp . isolated from clinic specimens in a hospital.Methods 188 Enterococcus spp . isolates from specimens sent by clinic depart-ments in June 2013-July 2014 were identified and performed antimicrobial susceptibility testing.Results Of 188 En-terococcus spp . isolates,119 were Enterococcus faecium (E.faecium),60 were E.faecalis ,and 9 were E.avium, these strains were mainly isolated from urine (34.57%)and blood specimens (19.15% ).No daptomycin and linezolid-resistant strain was detected;resistant rates of E.faecium to vancomycin was 1 .68%,to penicillin, ampicillin,high concentration gentamycin,erythromycin,and levofloxacin were all > 70%;except tetracycline, resistant rates of E.faecalis to the other antimicrobial agents were all lower than E.faecium,resistant rates of E. faecalis to penicillin and ampicillin were 16.67% and 13.33% respectively.Conclusion Daptomycin has high activity against Enterococcus spp . in this hospital.

Objective To evaluate the therapeutic efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of portal hypertension of patients with hepatocellular carcinoma.Methods Ninety-five portal hypertension patients with hepatic carcinoma were enrolled.TIPS was performed in 63 patients and the other 32 patients received support medical care.The data referred to survival time of the 95 patients after treatment was collected by follow-up visit.The informations about success rate of TIPS,hepatic encephalopathy,rebleeding and causes of death were assessed.The Kaplan-Meier method was used to compare the survival time between two groups.The association of survival time with Child-Pugh classification and model for end-stage liver disease (MELD) score was analyzed.Results The success rate of TIPS was 97.8% with reduction of mean portal vein pressure of 13.6 cmH2O(1 cmH2O=0.098 kPa).The incidence of hepatic encephalopathy was 20.6% and rebleeding was 26.3% six months after TIPS treatment.Fifty-six patients treated with TIPS died at the end of follow-up.Twelve of which were died of variceal bleeding complicated with portal hypertension.The median survival time of TIPS group (3.67 months) was significantly longer than that of control group (1 month). Moreover, the median survival time in patients with low MELD score (≤13) was significantly longer than that in those with high MELD seore (＞13, x2=4.71,P=0.03). Whereas the median survival time was decreasing from Child-Pugh A to C(x2=15.6,P=0.00). Conclusions TIPS is one of effective and safe therapeutic methods to control portal hypertension. However, liver function is an important factor for selcetion of TIPS.