A quality assessment tool for home care is an indicator system used to evaluate the quality of home care service. The unified and standardized quality indicators for home care can not only help to judge the quality of home care service, but more importantly, it can help identify the gaps and problems in the process, so as to improve the quality of home care service. This article summarizes some of the advanced assessment tools that have been internationally applied for the home health care and to discuss the direction for development of the assessment tools in China.

Objective To maintain the good psychological state of new nurses, stabilize nursing troop and improve nursing quality, we investigate the work pressure source and mental health of new nurses and analyze the correlation among work pressure, mental resilience and mental health. Methods According to the principle of convenience sampling,a total of 116 new nurses who get the job less than one year in the first hospital of Jilin university were investigated using the method of questionnaire survey. The Conner Davidson Resilience Scale (CD-RISC), Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were involved in the questionnaire. Results Mental resilience scores of new nurses were (63.73±15.11), the scores of anxiety and depression were (34.49±6.45) and (35.59±7.24). Work pressure was negatively correlated with mental resilience (P<0.01) and positively correlated with anxiety and depression (P<0.01). New nurses worried about making mistakes in the work accounted for 89.42 percents (93/104), which was the highest score in the stress source. Conclusions New nurses have good mental resilience and psychological health level, but work pressure has certain impact on mental resilience and mental health. Hospital managers should take active measures which include reducing pressure and improving the ability to help the new nurses through the adaptation as soon as possible.

Objective To evaluate the curative effect by using transmission straight wire appliance in treatment of adult patients with protruding,to compare with MBT straight wire technique,and to discuss their similarities and differences.Methods Totally 40 protruding patients were assigned into two groups randomly:the transmission straight wire technique group were treated with transmission straight wire appliance,and the MBT straight wire technique group were treated with MBT appliance together with extraoral arch or screw implant anchorage.Cephalometric measurements were compared before and after treatment.Results Average period of treatment was (19 ±4) months for transmission group and (23 ± 4) months for MBT group.The difference was statistically significant (P＜0.05).After treatment,U1/SN,U1/NA,U1-NA,L1/NB,L1-NB,U1-AP,L1-AP,UL-EP,LL-EP were significantly reduced for both patients groups (P＜0.01).U1/L1,nasolabial angle and z angle were increased for both groups (P＜0.05).MP/SN increased by 1.93°(P＜0.05)for transmission group vs.0.81° (P＞0.05) for MBT group.There was no statistically significant difference between the two groups (P＞0.05) except MP/SN (P＜0.05).However,the retraction of anterior teeth in transmission group was greater than that of MBT group,and U1/NA changed (-20.95±8.79)° in transmission group vs.(-16.00 ± 6.52)° in MBT group.Conclusions Both techniques can achieve satisfactory results for protruding cases.The transmission technology can improve soft tissue profile quicker,but anterior teeth have excessive vertical trend,where attention should be paid to control torque on anterior teeth.

A total of 180 community medical staff in Jiangning District of Nanjing received continuous education in practical emergency medicine through theory teaching,practice and scene simulation once a year from 2011 to 2013.And the training outcomes were evaluated before and after training and the feedbacks of community medical staff collected each time.The assessment results of theory and practical skills after training in 2013 were better than before training in 2011 [theory:(61.72 ± 5.03) vs.(92.11 ± 5.56) points ; operation skills (55.28 ± 6.18) vs.(93.33 ± 3.45) points] (P ＜ 0.05).And the total satisfaction rate was 98.0％.

Objective To investigate and evaluate the change and efficacy of Active-wing Appliance in patients with lingual tipping deep overbite of Angle classⅡdivision 2 malocclusion.Methods Twenty patients with lingual tipping deep overbite of Angle classⅡdivision 2 malocclusions were selected for our study. Among the twenty patients, fifteen are girls and five are boys, whose age are from 16.0 to 23.0 years old with average of 18.8 years old . The patients were treated with Active-wing technique and all of them were non-extracted.Cephalometric films were taken before and after treatment to assess the effect of treatment . Eleven angular and thirteen linear measurements were taken. Paired t test was performed to analyze and evaluate the effects before and after treatment. Results Active-wing Appliance have advantage of easy operat-ing with short treatment cycle for treatment of deep overbite of Angle class Ⅱ division 2 malocclusion. It only takes 11 months in average for the treatment. After treatment, mandibular plane angle were increased (23.00° ± 6.76° vs 21.59° ± 5.32°),overbite were decreased [ (1.02±0.81) mm vs (5.67±1.22) mm] to reach normal level;incisors were labial incline sig-nificantly with increased protrusion and inclination;Post treatment parameter improvement also include:U 1-NA distance in-creased (4.67±1.21 ) mm vs (1.24±1.37) mm;U1-NA angle increased (24.40°±6.36° vs 11.70°±6.87°);lower incisors were significantly intruded[ (37.16 ± 1.81) mm vs(38.90 ± 1.84)mm];L6-MP were extruded [(31.68 ± 2.87) mm vs (30.38 ± 3.45) mm]; The cuspid and molar relationships were changed from Class Ⅱ to ClassⅠ occlusion. Conclusion The Active-wing Appliance can quickly open overbite and correct incisor lingual tipping for Angle class II division 2 with lingual tipping deep overbite. It is easy to operate and has been improved as efficient and shortened treatment. Meanwhile, it also saves arch wire. The Active-wing Appliance is especially powerful for lingual tipping deep overbite. However, the deficiency in torque control of premolars might be noticed.

Objective To compare cost-effectiveness between endoscopical esophageal variceal ligation (EVL) combined non-selective beta-receptor blocker strategies and covered-stents transjugular intrahepatic portosystemic shunt (cTIPS) in preventing esophageal variceal rebleeding in liver cirrhosis with portal hypertension.And to explore the threshold of cost-effectiveness in stents in China.Methods According to clinical practice and associated guidelines,a six state Markov-based decision analytic model was established with TreeAge Pro Suite 2014 to compare the cost-effectiveness between two interfering strategies after followed up for seven years.The parameters such as costs,life years (LY),quality-adjusted life-years (QALY) and incremental costeffectiveness ratio (ICER) were directed.Results The results of baseline research in the seven-year follow-up period indicated that the cost of endoscopical EVL combined non-selective beta-receptor blocker B was 7 444.25 United States dollar (USD)/each,and yielded 1.98 QALY.The expected cost of cTIPS was 13 151.69 USD/ each and could have 2.34 QALY.In the 7th year,ICER was 16 001.74 USD.Based on willingness-to-pay (WTP) threshold of China (19 887.00 USD),cTIPS had better cost-effectiveness than endoscopical EVL combined non-selective beta-receptor blocker B.The price of covered stents less than 5 401.52 USD had cost-effectiveness.The results of single factor sensitivity analysis indicated that rebleeding probability of endoscopical EVL combined non-selective beta-receptor blocker B group was the most influential factor in the result of model.The second important factor was the cost of cTIPS.The probabilistic sensitivity analysis reported cTIPS to be the optimal strategy at WTP of 19 887.00 USD in 83％ of the iterations.Conclusions Seven-year follow-up indicates that cTIPS may be a more cost-effective strategy than endoscopical EVL combined non-selective beta-receptor blocker B in preventing esophageal variceal rebleeding.The price of covered stents less than 5 401.52 USD which have cost-effectiveness in China.

Objective:In this study, a simple and easy diagnostic index of sarcopenia based on computed tomography (CT) images, linear skeletal muscle index (LSMI), was proposed and its diagnostic efficiency was verified.Methods:From April 2013 to September 2017, patients with cirrhotic gastroesophageal varices were selected from the Department of Gastroenterology, Zhongshan Hospital, Fudan University. The SMI of the third lumbar lower than 50 cm 2/m 2 in male and 39 cm 2/m 2 in female was defined as sarcopenia. The sensitivity, specificity, positive predictive value, negative predictive value, Youden index and receiver operating characteristic (ROC) curve were used to evaluate the diagnostic efficacy of LSMI in patients with cirrhotic gastroesophageal varices. Results:A total of 115 patients with cirrhotic gastroesophageal varices were finally recruited. All participants were randomly divided into modeling group ( n=58) and validation group ( n=57). In the modeling group, the area under the ROC curve of LSMI was 0.913(95% CI:0.84-0.986, P<0.001) in total population, 0.895(95% CI:0.793-0.997, P<0.001) in male and 0.917(95% CI:0.782-1.000, P<0.008) in female. The cut-off value of LSMI was 24.114 cm 2/m 2 in male and 22.54 cm 2/m 2 in female. According to the diagnostic cut-off value of the modeling group, the area under the ROC curve of LSMI was 0.846(95% CI:0.737-0.954, P<0.001) in the validation group. The sensitivity, specificity, positive predictive value, negative predictive value and Youden index were 88.5%, 80.6%, 79.3%, 89.3% and 0.691, respectively. Conclusions:48.7% of patients with cirrhosis of esophageal and gastric varices have sarcopenia. LSMI is a simple and convenient method for diagnosis of sarcopenia in patients with liver cirrhosis.

Objective To identify the high-touched object surface in different special intensive care units(ICUs) through the observation and statistical analysis on the number of touching with common object surfaces in different ICUs, so as to provide basis for hospital environmental management.Methods Direct observation method was used to observe the daily activities of health care workers, the number of touching with various common object surfaces was recorded, Poisson distribution was adopted to statistically analyze the data.Results The average number of touching from high to low was as follows : medical record folder(n=28.00), chair(n=18.38), emergency rescue cart(treatment cart, n=17.29), bed surface(n=13.90), intravenous infusion line(n=13.76), medical pen(n=13.38), and intravenous transfusion pump(n=11.81), these objects accounted for 64.01% of all surface touching number.Different special ICUs were slightly different, general ICU high-touch object included the first 6 categories;cardiothoracic surgery ICU included the above 7 categories besides keyboard and mouse;internal medicine ICU included the first 6 categories and mobile phone.Conclusion High-touched object surface varied with different special ICUs of the same hospital, hospital should make the corresponding disinfection management measures according to the actual situation of high-touched surface of each department, so as to reduce the incidence of healthcare-associated infection.

Objective To investigate the correlation between clinicopathological features and lymph node metastasis (LNM) in early gastric cancer (EGC).Methods From January 2006 to June 2009,the clinical data of 473 patients with EGC were collected.The data of patients including gender,age,tumor size,tumor number,general classification,differentiation degree,invasion depth,ulcer in tumor,nerve invasion,and lymphatic tumor cell embolus were analyzed.Chi-square test was performed to analyze the correlation between clinicopathological features and LNM in EGC.Logistic regression analysis was used to analyze the independent risk factor of LNM in EGC.Results Among 473 patients with EGC,77 patients had LNM and the metastasis rate was 16.3％.The metastasis rate of the female patients (24.6％,41/167) was higher than that of the male (11.8 ％,36/306).The metastasis rate of the tumors with maximum diameter over 2 cm (22.0％,39/177) was higher than that of the tumors less than 2 cm (12.8％,38/296).The metastasis rate of the elevated lesions (26.1％,6/23) was higher than that of flat and concave lesions (9.0 ％,15/167;19.8％,56/283).The metastasis rate of poorly differentiated tumors was higher than moderate differentiated and high differentiated tumors (12.7 ％,23/181; 7.1％,3/42).The metastasis rate of tumors invading into submucosa (22.9％,41/179) was higher than that of tumors invading into mucosa (12.2％,36/294).The metastasis rate of tumors with lymphatic embolus (40.7％,11/27) was higher than that of tumors without lymphatic embolus (14.8％,66/446) and the differences were statistically significant (x2 =12.960,6.873,10.704,7.382,9.277 and 12.572,all P＜0.05).The results of multifactor analyzed by Logistic regression analysis revealed that female,maximum diameter over 2 cm,poorly differentiated type and invasion to submucosa were the independent risk factors of LNM in EGC (relative risk (RR)=2.53,2.14,1.63 and 2.39,all P＜0.01).Conclusion Female,maximum diameter over 2 cm,poorly differentiated type and invasion to submucosa are the independent risk factors of LNM in EGC.

Objective To explore the prognosis of endoscopic tissue adhesives injection in treating liver cirrhosis patients with esophageal gastric varices (GOV),and to evaluate the effects of various factors on bleeding after treatment.Methods A total of 157 liver cirrhosis patients with GOV treated by endoscopic tissue adhesives injection with or without ligation therapy were retrospectively analyzed.The basic information,liver function and blood biochemical values of patients at enrollment were investigated.The analysis of bleeding after treatment was conducted by Kaplan-Meier.The survival curves comparison was conducted by Log-rank test.Logistic regression model was used for multivariate analysis.The prognosis predictors were evaluated by receiver operating characteristics (ROC) curves and the area under the curve (AUC).Results Rebleeding happened in 26 of 157 patients.The median rebleeding time was 3.4 months.The results of univariate analysis indicated that there were statistical differences in FIB4 scores (Z=-1.282,P=0.100) and the inner diameter of the right portal vein (Z=-1.812,P=0.035) between bleeding group and no bleeding group.The results of multivariate analysis showed that the inner diameter of the right portal vein was independent prognostic factor of rebleeding (OR =1.733,95％ CI:1.045 to 2.874,P =0.033).Optimal diagnostic threshold was 8.5 mm (AUC=0.724,95 ％CI:0.537 to 0.910),sensitivity and specificity was 77.8％ and 66.6％ respectively.Conclusions The inner diameter of the right portal vein was one of the important factors that affected the efficacy of tissue adhesives injection in preventing bleeding and the prognosis.FIB4 score had certain reference value in predicting recurrence or bleeding after treatment.