Objective:To explore the clinical effect of negative pressure wound therapy and to discuss the ethi-cal issues in this therapy and seek a solution. Methods:Sixty patients with negative pressure wound therapy in our hospital were invited to participate in this study. Patients were all with deep pressure ulcers or diabetic foot, of which the Wagner Scores were graded as three or four. They were divided into two groups randomly. The subjects in control group received standard treatment, while those in experimental group were treated by self -designed closed negative pressure drainage settings. The wound healing time, the cost of the treatment and comfort were compared between the two groups. Results:The cost of wound care in the experimental group was less than those in the control group (P<0. 001). There was no significant difference in comfort between two groups (P>0. 05). But the wound healing time was longer in the experimental group than those in the control group. Conclusion:Self-designed closed negative pressure settings can decrease the cost of patient care with the equal patient comfort and acceptance as the standard negative pressure, however, the wound healing time has been extended. So before using negative pressure technique, the medical staff should comprehensively analyze, be guided by medical ethics and choose the appropriate treatment for different patients.

Objective To design a kind of aseptic drainage device with safe practice and accurate measurement for clinical nurses. Methods The experiment group included 63 cases using drainage device with accurate measurement,and control group included 63 cases using disposal drainage bag with scale of visual measurement.The accuracy of drainage liquid measurement was compared between two groups,and bacterial culture was made for the drainage liquid of two groups.Results The measurement error of experiment group and control group was(3.31±1.8)mL and(56.0±5.8)mL,respectively.The difference was significant(t=-4.593,P<0.01).The bacterial culture results showed no obvious difference between two groups(positive rate were 15.9%vs 17.5%,χ2=0.057,P>0.05). Conclusion The accurately measured aseptic drainage device is convenient for nurses to practice in clinics,and its application can reduce workload of nurses and decrease the occurrence of pollution.

Objective To investigate the effect of FOCUS-PDCA program on pressure ulcers nursing quality management. Methods By using the 9 steps of FOCUS-PDCA program of exploring, organizing, clarifying, understanding, selecting, planning, enforcing, checking and executing, we looked into the primarily factors for pressure ulcers and modified and improved our pressure ulcer nursing management system. Then training was done to the nurses, and the pressure ulcer management system was used. The effects in implementation of pressure ulcers prevention, mastery of pressure ulcers prevention knowledge among nurses and occurrence of pressure ulcers in the high-risk patients were studied after applying the program. Results After use of FOCUS-PDCA program, the qualification rate of pressure ulcers prevention implementation and mastery of pressure ulcers prevention knowledge were both higher than before the use. The occurrence rate of pressure ulcers in the high-risk patients was lower than before the use (P<0.05). Conclusion By using the FOCUS-PDCA program in the nursing quality management for patients with pressure ulcers, we can effectively improve the implementation of pressure ulcers preventive measures, enhance the nursing staff to master knowledge on pressure ulcers and reduce the incidence of pressure ulcers.

Objective:To investigate the impact of nursing simulation training combined with mentor responsibility system teaching on the thinking ability and core competence of interns receiving surgical nursing training.Methods:A total of 96 nursing students who were trained in Department of General Surgery in our hospital were selected as subjects, and they were randomly divided into control group (conventional teaching+mentor responsibility system) and observation group (nursing simulation training+mentor responsibility system) using a random number table, with 48 students in each group. The two groups were compared in terms of assessment score, clinical thinking ability, creative ability, core competence, and degree of satisfaction with teaching. SPSS 24.0 was used for the t-test, the chi-square test, and the Fisher's exact test. Results:After teaching, the observation group had significantly higher theoretical[(75.92±1.15) vs. (73.01±0.89)] and skill test scores[(16.96±1.17) vs. (15.10±1.03)] than the control group ( P<0.05). After teaching, both groups had significant increases in the scores of evidence-based thinking, critical thinking, and systematic thinking abilities, and the observation group had significantly higher scores than the control group ( P<0.05). After teaching, both groups had significant increases in the scores of curiosity, adventure, challenge, and imagination, and the observation group had significantly higher scores than the control group ( P<0.05). After teaching, both groups had significant increases in the scores of practical ability, organization and communication, quality evaluation improvement, critical thinking, scientific research innovation, and training guidance, and the observation group had significantly higher scores than the control group ( P<0.05). After teaching, the observation group had significantly higher scores of each dimension of teaching satisfaction than the control group ( P<0.05). Conclusion:Nursing simulation training combined with mentor responsibility system teaching can effectively improve the teaching quality of surgical nursing training, enhance clinical thinking ability and core competence, and increase the degree of satisfaction with teaching.

OBJECTIVETo investigate the abnormal changes in the testes and semen parameters in patients with varicose veins and analyze the possible relationship between clinical varicocele and infertility.

METHODSWe retrospectively reviewed the records of 172 male patients consulting for varicocele in our hospital since 2003. All these patients were examined for the size of the testes with scrotal ultrasound. The semen samples of the patients with varicocele except for 5 under the age of 17 years were collected and analyzed, using the data of semen analyses of 163 healthy young male volunteers (aged 18-29 years) as control.

RESULTSAll the 172 patients had left-sided varicose veins. Sixty-three patients were found to have bilateral varicocele, and in most of them, the clinical grades of the left-sided varicose veins were higher than those of the right-sided ones. The mean volume of the left testis of the patients was 10.99∓3.71 ml, significantly smaller than that of the right one (11.86∓4.05 ml, P<0.01). The physiochemical indices of the patients, including the voiding volume, semen pH, liquefaction time and sperm concentration, were normal or similar with those of the healthy volunteers (P>0.05). Almost all the patients sperm motility and viability were significantly lower than those of the healthy volunteers (P<0.05). In addition, no significant difference was found in the sperm density, motility or viability between the patients with unilateral and bilateral varicocele (P>0.05).

CONCLUSIONVaricocele may decrease the testicular volume. Both unilateral and bilateral varicocele may have an effect on the bilateral testes to cause possible functional impairment of the testes manifested by decreased sperm motility and viability.

Adolescent ; Adult ; Child ; Humans ; Infertility, Male ; etiology ; Male ; Middle Aged ; Retrospective Studies ; Semen ; Sperm Count ; Sperm Motility ; Testis ; physiopathology ; Varicocele ; complications ; physiopathology ; Young Adult

Objective To explore the clinical efficacy of early combined application of parenteral nutrition and enteral nutrition among patients in neurosurgical intensive care unit(NICU).Methods Two hundred fifty-five patients with severe neurological diseases were admitted to NICU of Shanghai Tenth People's Hospital from January 1 to August 31 in 2018.The patients were divided into two groups:traditional enteral nutrition group (control group,n=170),who were treated with enteral nutrition management at the early stage,and early combined application of parenteral and enteral nutrition group (experimental group,n=85),who were at first treated with parenteral nutrition since admission and then enteral nutrition management 72 hours later.The differences of Glasgow outcome scale (GOS),incidence of individual adverse reactions,daily average enteral nutrition,human albumin supplement,daily average fluid supplement,pulmonary infection rate,infection time and albumin level during hospitalization between the two groups were compared.The relationship among the course of enteral nutrition,nutrient content,pulmonary infection and serum albumin level in the experimental group were also discussed.The GOS was predicted by decision tree,random forests,nearest neighbor algorithm,adaboost and bagging.Results There was no significant difference between baseline scores after 1∶2 propensity score matching.The dominance ratio of GOS between the two groups was 1.853 (95％CI:1.018-3.385) (P=0.043).The change of albumin level was not related to the choice of nutritional regimen,but was related to the level of consciousness after admission and the level of basic albumin before admission.The level of consciousness in the experimental group was higher than that of the control group,and the fluid infusion volume was decreased while the daily average enteral nutrition and albumin supplementation were increased,the types of adverse reactions occurred more and earlier (P＜0.05).The misjudgment rate of GOS prediction models ranged from 0.482 to 0.606.Conclusions Compared with traditional early enteral nutrition therapy,early combined parenteral nutrition and enteral nutition can improve the prognosis of patients with severe neurological diseases.

Objective To explore the influence of intensive glycemic control by insulin pump on prognosis of critically ill patients with lung infection and respiratory failure.Methods In the emergency intensive care unit (EICU),200 critically ill patients with hyperglycemia (A-PACHE II score >15 ,random blood glucose > 11.1 mmol /L)were collected and randomly di-vided into the intensive insulin therapy (IIT)group and the convention insulin therapy(CIT) group(use insulin pump to control blood glucose).IIT group and CIT group included 31 cases and 33 cases of pulmonary infection and respiratory failure.Ventilator and antibiotic use days,short-term mortality (within 28 days),rate of hypoglycemia,nosocomial infection,hospital stay and hospital costs were observed and compared between two groups.Results There was no significant differences between two groups in aspects of age,sex ratio,oxygen saturation,pressure of oxygen, pressure of Carbon dioxide,pH,blood pressure,respiratory failure type,blood glucose,elec-trolytes,inflammation,heart function,liver and kidney function,fasting C peptide,HbAlc and APACHE Ⅱ score(P >0.05).APACHE II score at the time of 3 days and 7 days after admission, nosocomial infection,short-term mortality hospital day and hospital costs (P <0.05)in the IIT group were significantly lower and shorter than the CIT group.The hypoglycemia incidence rate of the IIT group was significantly higher than that of the CIT group (P <0.01).Result of serious hypoglycemia showed no significant difference between the two groups .Conclusion Strict intensive glucose control on pulmonary infection and respiratory failure may bring more benefits for acute and critically ill patients,and it can reduce the short-term mortality rate.

Objective To explore the influence of intensive glycemic control by insulin pump on prognosis of critically ill patients with lung infection and respiratory failure.Methods In the emergency intensive care unit (EICU),200 critically ill patients with hyperglycemia (A-PACHE II score >15 ,random blood glucose > 11.1 mmol /L)were collected and randomly di-vided into the intensive insulin therapy (IIT)group and the convention insulin therapy(CIT) group(use insulin pump to control blood glucose).IIT group and CIT group included 31 cases and 33 cases of pulmonary infection and respiratory failure.Ventilator and antibiotic use days,short-term mortality (within 28 days),rate of hypoglycemia,nosocomial infection,hospital stay and hospital costs were observed and compared between two groups.Results There was no significant differences between two groups in aspects of age,sex ratio,oxygen saturation,pressure of oxygen, pressure of Carbon dioxide,pH,blood pressure,respiratory failure type,blood glucose,elec-trolytes,inflammation,heart function,liver and kidney function,fasting C peptide,HbAlc and APACHE Ⅱ score(P >0.05).APACHE II score at the time of 3 days and 7 days after admission, nosocomial infection,short-term mortality hospital day and hospital costs (P <0.05)in the IIT group were significantly lower and shorter than the CIT group.The hypoglycemia incidence rate of the IIT group was significantly higher than that of the CIT group (P <0.01).Result of serious hypoglycemia showed no significant difference between the two groups .Conclusion Strict intensive glucose control on pulmonary infection and respiratory failure may bring more benefits for acute and critically ill patients,and it can reduce the short-term mortality rate.

Objective:To explore the correlation between occupational stress and the current working environment of clinical nurses.Methods:The cluster sampling method was used to select clinical nurses from First Affiliated Hospital of Xi'an Jiaotong University from March to September 2019 as the research objects. The research tools included nurses' general condition questionnaire, Occupational Stress Inventory Revised edition (OSI-R) and Profession Practice Environment (PPE) Scale. A total of 560 questionnaires were distributed and 540 valid questionnaires were recovered.Results:The Occupational Role Questionnaire (ORQ) score of 540 clinical nurses was (152.09±20.65) , the score of Personal Strain Questionnaire (PSQ) was (104.04±17.04) , the score of Personal Resources PPE Scale Questionnaire (PQR) was (125.84±19.75) and the total average score of PPE Scale was (3.00±0.28) . Pearson correlation analysis showed that the ORQ and PSQ scores of nurses were negatively correlated with the scores of the PPE Scale, and the PQR scores of nurses were positively correlated with the scores of PPE Scale ( P<0.05) . Conclusions:The overall performance of nurses is moderate occupational stress, the sense of occupational stress of nurses is negatively correlated with the working environment, and the coping resources of occupational stress are positively correlated with their professional working environment. Managers should take targeted measures to intervene to improve the professional working environment of nurses, reduce the level of occupational stress and guide nurses to improve their professional coping skills.

Objective:To explore the status and influencing factors of positive feelings of caregivers of patients with enterostomy, so as to provide a reference for targeted interventions.Methods:From May to October 2021, convenience sampling was used to select 130 caregivers of patients with enterostomy who received follow-up visits in the Stoma Clinic of the First Affiliated Hospital of Xi'an Jiaotong University as the research subject. The survey was carried out using the General Information Questionnaire, the Positive Aspects of Caregiving (PAC) , and the Care Preparedness Scale (CPS) . A total of 130 questionnaires were distributed, and 127 valid questionnaires were recovered, with a valid recovery rate of 97.69%.Results:Among 127 caregivers of patients with enterostomy, the total score of PAC was (32.69±4.99) , and the self-affirmation dimension score was (18.39±2.84) , and the life outlook dimension score was (14.36±2.53) , and the total score of CPS was (17.76±4.36) . Multiple linear regression analysis showed that caregiver gender, education level, work status, and readiness were the influencing factors of positive feelings of caregivers of patients with enterostomy ( P<0.05) , which explained 43.7% of the total variance. Conclusions:The positive perception of caregivers of patients with enterostomy is at an upper-middle level. Nurses should formulate targeted humanistic care strategies according to the influencing factors, increase the positive feelings of caregivers, help patients adapt to the stoma as soon as possible, and then improve the quality of life of patients.