Objective To evaluate the current knowledge and practice of evidence-based nursing for preventing ventilator-associated pneumonia (VAP) and its influencing factors in ICU nurses. Methods Selfadministered structured questionnaire was used in 101 ICU nurses working in one grade three A hospital of Jiangsu province by convenient sampling method. The results underwent statistical description and variance analysis. Results The mean score of knowledge about evidence-based nursing to prevent VAP was (4.75±1.42) (total score=10),the mean score of practice was (3.32±0.32) (total score=4). The influencing factors of knowledge in ICU nurses were different divisions and ICU working years. Different ICU working years resulted in different behavior of nurses. Most nurses considered that nursing work was too busy due to serious condition of patients, which was the principal interfering factor in practice of evidence-based nursing for preventing VAP. Conclusions Further expertise of ventilator-associated pneumonia training and evidence-based nursing education are urgently required. The best-practice guidelines for preventing VAP are more often consummated. Whilst encouraging the reasonable personnel disposition and the essential facilities are priority. Effective fulfillmere in evidence-based practice to prevent VAP may be achieved by broader adjustment of the medical system and the medical cost structure, so that evidence-based nursing for preventing VAP can be put into effect.

OBJECTIVE:To explore the method of pharmaceutical care for antifungal drug treatment of new type crypto-coccal meningitis by clinical pharmacist. METHODS:Clinical pharmacist participated in the drug treatment process for a pa-tient with new type cryptococcal meningitis. Clinical pharmacist provided pharmaceutical care in following aspects:assisting doctor to optimize antifungal drugs treatment plan,providing patients pharmaceutical monitoring and medication education, etc. During amphotericin B treatment,the patient developed refractory hypokalemia. Clinical pharmacists suggested doctors to reduce the dose of amphotericin B and additionally use voriconazole for antifungal treatment. RESULTS:The patient devel-oped refractory hypokalemia no more after the plan was adjusted. After 11 weeks of systematic antifungal treatment,the pa-tient was on the mend. CONCLUSIONS:The participation of clinical pharmacist in antifungal treatment of new type cryptococ-cal meningitis indicates that following the instructions,but not lost flexible disposal;providing service actively,and details is guarantee of safety.

Objective:To analyze one case of drug-induced liver injury to provide reference for clinical pharmacists participating in the clinical practice. Methods: Through the participation in the diagnosis and therapy of one patient with drug-induced liver injury, clinical pharmacists found the correlation between the suspected drugs and the disease, which provided basis for the clinical diagnosis and therapy. Results:Clinical pharmacists actively assisted physicians by providing reasonable defining characteristics and drug therapy scheme for the patient free from drug interactions and adverse reactions. The function of the patient recovered after the treatment. Con-clusion:Clinical pharmacists participating in clinical practice can make use of pharmacy knowledge to search causes of diseases and optimize therapeutic scheme.

Objective To explore the risk factors for community-acquired pneumonia (CAP) in the elderly,in order to provide the basis for clinical prevention and treatment.Methods 168 elderly patients with CAP (observation group) and 100 elderly patients without CAP (control group) were chosen from our hospital from Jan.2013 to Dec.2014.The clinical data were investigated,and the risk factors for CAP were analyzed.Results Single factor analysis showed that there were significant differences between the two groupsin serum protein level,pets-raising,smoking,dust exposure,bronchial disease,renal dysfunction and diabetes mellitus (all P＜0.05).Multivariate logistic regression analysis showed that serum protein level,pets-raising,smoking,bronchial disease and diabetes were the independent risk factors for CAP in the elderly (OR=2.793,2.578,3.017,3.168 and 2.643,all P＜0.05).Conclusions The community-acquired pneumonia is related with many risk factors in the elderly.The clinical corresponding prevention and treatment for the risk factors should be developed,which have an important significance in the early diagnosis,early treatment and prognostic improvement in community-acquired pneumonia.

Objective To study the effect of Shenqiwan and vitamin E on mtDNA 4834 deletion in a mimetic aging rat model .Methods Forty rats three months old ,were randomly divided into four groups :group A ,which was treated with hypodermic 5 % D -galactose for 8 weeks ,and group B (shenqiwan group ,n=10) which was treated daily with Shenqiwan for 2 weeks after hypodermic 5 % D -galactose for 6 weeks ,group C (vitamin E group ,n = 10) which were treated daily with Vitamin E for 2 weeks after hypodermic 5 % D -galactose for 6 weeks ,group D were given saline only .Auditory brainstem response (ABR) was used to detect the hearing thresh-old of rats before and after the treatment .The inner ear tissue was harvested and mitochondrial DNA was amplified to identify the 4834 bp deletion mutation by nested primer polymerase chain reaction (nested PCR) technique .Re-sults The threshold of ABR in the group A ,B and C were significant higher than that in group D .However the difference in shift of ABR threshold between group A ,B ,C and group D was not significant .The mtDNA4834 de-letion rate in three modeled groups (group A ,B ,C) was significant high than that of in group D .There was statis-tically significant difference between the treated group (group B ,C) and the model group (group A) on mtDNA4834 deletion in cochlea ,but the difference between the treated groups on mtDNA 4834 deletion in cochlea was not statistically significant .Conclusion Shenqiwan and vitamin E can reduce the aging induced mtDNA 4834 deletion in aging rats inner ear .

Hemophagocytic lymphohistiocytosis (HLH) is a syndrome characterized by extreme immune activation, resulting in pathologic inflammation. The HLH-2004 diagnostic criteria is used widely based on the data from pediatric patients. However, there are differences between children and adults in the etiology, clinical and laboratory characteristics for HLH. Given these differences, diagnostic scoring systems unique to adult HLH have been proposed. HLH in adults is a much more heterogeneous syndrome requiring a more individualized approach depending on the underlying trigger, disease severity, as well as genetic background.

Acute hypoxic pulmonary vasoconstriction (HPV) plays an important role in physiological regulation. The purpose of this study was to explore the effects of Ilexonin A on hemodynamics and HPV, and their relation to prostaglandins (PG_(?)) and leukotrienes (LT_(?)).The results show that the high pulmonary vascular resistance induced by Ilexonin A in normoxic rats may be partially caused by the increased LTs and have no relation to PGs. Ilexonin A may potentiate HPV at least by two ways: replacing the production of PGs (especially PGI_2) in hypoxic Wistar rats, and increasing LTs production.

Objective: The study examined adolescents' obedience,justifications,and feelings to parental authority as well as their interrelation in parent-adolescent conflict situations.Methods: 538 adolescents aged 10-to 18-year-old were investigated by questionnaires in light of different domains(personal,conventional,and friendship domains)selected from Smetana(2000).Results: ①The results suggested that their obedience to parental authority changed with different domains,as well as their justifications and feelings;②Adolescents' justifications of obedience focused on conventional rules,knowledgeable attributes,reciprocal relationships and physical consequences;③There were more negative feelings than neural or positive ones accompanied with their obedience;④Their justifications and feelings were different between obedience and disobedience groups,the conventional-rule-attribute was significantly correlated with negative feelings in both of obedience and disobedience groups,and the knowledgeable-attribute was significantly correlated with positive feelings in obedience group.Conclusion: Adolescents' conceptions of parental authority are domain-specific,and their obedience,justifications and feelings interrelate with each other.

Anthrax ; diagnosis ; prevention & control ; therapy ; Bacillus anthracis ; growth & development ; Humans ; Microbiological Techniques

OBJECTIVE:To systematically review the efficacy and safety of exenatide in the weight loss of obesity and over-weight,and provide evidence-based reference for clinical treatment. METHODS:Retrieved from Cochrane Library,PubMed,Med-line,EMBase,CJFD,VIP and Wanfang Database,randomized controlled trails (RCT) about exenatide versus placebo or other medicines in the treatment of obesity or overweight were collected. Meta-analysis was performed by using Rev Man 5.3.0 software after data extract and quality evaluation. RESULTS:A total of 25 RCTs were enrolled,involving 5 307 patients. Results of Meta-anal-ysis showed body mass in exenatide groups was significantly lower than placebo group[SMD=-2.06,95%CI(-2.97,-1.15),P<0.001],insulin group [SMD=-3.51,95%CI(-4.52,-2.51),P<0.001],glyburide group [SMD=-3.70,95%CI(-4.28,-3.12),P<0.001],rosiglitazone group [SMD=-1.25,95%CI(-1.71,-0.80),P<0.001] and sitagliptin group[SMD=-0.71,95%CI(-0.93,-0.48),P<0.001],and there was no significant difference with metformin group and tasilutai group. Incidence of ad-verse reactions in exenatide group was significantly higher than insulin group[RR=1.22,95%CI(1.06,1.41),P=0.006] and lower than tasilutai group [RR=0.95,95%CI(0.91,0.99),P=0.02],and there was no significant difference with placebo group and met-formin group. CONCLUSIONS:Exenatide can effectively reduce the body mass of obesity and overweight,however,digestive sys-tem shows more adverse reactions. Due to the limit of methodological quality,more high-quality,large-scale and long-term fol-low-up RCTs are needed for further verification for the conclusion.