OBJECTIVE To probe current status on protection of occupational exposure for contract workers in supply center of military hospital,therefore to put forward rational suggestion and measure.METHODS Current status among contract workers in supply center of military hospital were investigated by questionnaire with conversation.RESULTS The investigation showed that contract workers in supply center of military hospital had poor recognition on protection of occupational exposure,with higher prevalence of occupational exposure(95%),and short of effective protection against occupational exposure,and without correct and efficient measures once occupational exposure occurred.CONCLUSIONS It is essential to enhance education on occupational exposure protection,establish strict,systemic and periodic training,thus to strengthen self-protection on occupational exposure,therefore to reduce the occurrence of inhospital infection.

The article summed up academic thinking of LOU Duo-feng professor in treating rheumatism.Professor LOU thought that deficiency,pathogen and stasis were the fundamental pathogenesis of rheumatism,and suggested that we should handle deficiency,pathogen and stagnation as a whole in treating rheumatism.There were four treatment principles should be obey in treating rheumatism:firstly,strengthening the genuine-qi to eliminate the evil-qi,simultaneous treatment of principal and subordinate symptoms;Secondly,application of diffusing and obstruction-removing,choosing different medicine according to different location of disease;Thirdly,treatment in accordance with three types of disease causes,treating combing similarities and differences;Lastly,changes of prescriptions and principals according to different courses of disease.In this article,the author list Tongbitang,the basic prescription of Professor LOU in treating rheumatism,and his clinical experience in treating deficiency heat type of obstinate arthralgia.

OBJECTIVE To seek for an effective,rapid,economic,safety and practical cleaning method,so as to ensure the high quality of sterilization in hospital supply center.METHODS Six hundred moderately contaminated recyclable instruments were divided into three groups randomly,conventional group,experimental group A and experimental group B(two hundred sorts each).The instruments in experimental group A were put into warmed water(40 ℃) for ten minutes first,and that in experimental group B were put into multi-enzyme solution for five minutes first,and then all the instruments in three groups were put into automatic sprinkling cleaning machine to accomplish the cleaning process automatically.After cleaning process,cleaning degree of the instruments and remained blood residues were compared in three groups.RESULTS The cleaning quality in the groups A and B was significantly higher than that of the conventional group,both P

Objective To investigate the correlation between acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) scores and delirium probability of senile severe pneumonia patients undergoing invasive mechanical ventilation (MV).Methods A retrospective study was conducted. Eighty-nine senile severe pneumonia patients undergoing invasive MV admitted to intensive care unit (ICU) of Hunan Provincial People's Hospital from January 2015 to March 2017 were enrolled. APACHE Ⅱ scores were collected 24 hours before invasive MV. Consciousness assessment method-ICU (CAM-ICU) was used to diagnose delirium, and the patients were divided into delirium group and non-delirium group. The first delirium occurrence time, duration of MV and the length of ICU stay were recorded. The patients were divided into ≤15, 16-20, 21-25, 26-30, 31-35, 36-40 groups according to APACHEⅡ score, and the incidence of delirium in all groups were observed. The linear regression and Pearson correlation were used to analyze the correlation between APACHE Ⅱ scores and delirium probability. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive effect of APACHEⅡ score on delirium.Results Eighty-nine patients were enrolled in the final analysis, of which 35 had delirium, and 54 had no delirium, with delirium incidence of 39.33%, and the first delirium occurrence time of (1.85±1.30) days. The duration of MV and the length of ICU stay of delirium group were significantly higher than those of non-delirium group [duration of MV (days): 9.43±4.77 vs. 6.08±3.30, length of ICU stay (days): 14.60±6.59 vs. 9.69±4.61, bothP < 0.01]. The APACHE Ⅱ score in delirium group was significantly higher than that in non-delirium group (29.89±5.45 vs. 21.48±4.76,P < 0.01). With the increase in APACHE Ⅱ scores, the delirium incidence was gradually increased. Correlation analysis showed that there was a negative correlation between APACHE Ⅱ scores and first delirium occurrence time (r = -0.411,P = 0.014), and a significant linear positive correlation between APACHE Ⅱ scores and delirium incidence in all patients was found (r = 0.982, P = 0.000), which indicated the higher APACHE Ⅱ scores, the higher delirium incidences and the earlier first delirium occurrence time was. ROC curve analysis showed that the area under ROC curve (AUC) of APACHE Ⅱ scores on predicting delirium occurrence was 0.877, when the cut-off value of APACHE Ⅱ score was over 27, the sensitivity was 92.59%, the specificity was 71.43%, the positive predictive value was 83.33%, and the negative predictive value was 86.21%.Conclusions With the increase in APACHE Ⅱ score, the incidence of delirium was increased gradually in senile severe pneumonia patients receiving invasive MV. APACHE Ⅱ score played an important clinical value in evaluating the delirium probability of these patients

Objective To investigate the influencing factors for the short-term prognosis in elderly patients with posterior circulation infarction after intravenous thrombolysis.Methods We retrospectively analyzed the clinical data of 67 elderly patients with posterior circulation infarction treated with thrombolysis from March 2011 to December 2012.Clinical data of age,sex,hypertension,hyperlipidemia,glucose abnormalities,and thrombolysis,National Institute of Health stroke scale (NIHSS) score on admission,hyperhomocystinemia,the infarction area,anticoagulation and antiplatelet treatment were collected.All patients were followed up after discharge.The prognosis was assessed by the Rankin scale (mRS) after 3 months of thrombolysis.Patients were divided into good (MRS score ≤2) prognosis group and poor (mRS＞2) prognosis group.Results There were 43 cases (64.2％) in good prognosis group and 24 cases (35.8％) in poor prognosis group.Logistic regression analysis showed that NIHSS score＞12 (95％CI:1.087-1.569,P=0.005),thrombolysis time＞4.5 h (95％CI:1.362-2.258,P=0.004),high homocysteine levels (95％CI:0.612-0.956,P =0.000),platelet after 24 h (95％ CI:0.785 1.133,P=0.001) were the independent risk factors for the poor prognosis of posterior circulation infarction in elderly patients after intravenous thrombolysis.Conclusions Early thrombolysis and timely anticoagulant treatments have certain significances in improving the short-term prognosis in patients with posterior circulation infarction.

Objective:To investigate the acceptance of advance care planning and its influencing factors in heart failure patients.Methods:A total of 208 patients with heart failure were surveyed by general data questionnaires and advance care planning acceptance questionnaires.Results:The total score of advance care planning acceptance of heart failure patients was (44.26 ± 11.73), the score of feeling dimension was (13.67 ± 5.72), the score of attitude dimension was (30.59 ± 6.33). 53.4%(111/208) of patients were willing to accept the talking about advance care planning. Regression analysis results showed that education level, New York Heart Association (NYHA) classification, communication status with medical staff and whether they had received life-sustaining treatment were important factors influencing of the acceptance of advance care planning in patients with heart failure.Conclusion:Patients with heart failure had higher acceptance of advance care planning. In clinical work, it is necessary to strengthen the scientific popularization of advance care planning in patients with low education level, low NYHA grade and no exposure to life-sustaining treatment. And strengthen the daily communication with patients to prepare for the follow-up advance care planning related communication.

Objective:To explore the application of information management platform for Investigator Initiated clinical trials (IIT).Methods:Elaborate the design and application of Clinical Information Management Platform (CIMP). Discuss the obstacles in platform development.Results:Compared with regions where clinical research is more developed, there is still a lack of standardized and efficient information management methods in China. Through the construction of the IIT information management platform, the scientific management of the IIT and the SWOT analysis of the use of the platform have been conducted. Further exploration and improvement are needed in terms of the collaboration of the information platform, data standardization, and information sharing security.Conclusions:The management efficiency can be improved by applying CIMP, which will also promote the smooth implementation of IITs.

Atherosclerosis (AS) is one of the pathological bases of ischemic stroke. AS caused by elevated low-density lipoprotein cholesterol levels is the main causative factor. However, recent studies have found that the traditional blood lipid indicators can not fully reflect the risk of stroke in high-risk populations. Non-traditional blood lipid parameters are developed from traditional blood lipid parameters, including remnant cholesterol (RC), non-high density lipoprotein cholesterol and a variety of blood lipid ratios, which may play a role in the prevention and treatment of cerebrovascular diseases. Among them, RC is increasingly recognized as a biomarker driving the residual risk of AS. It has been confirmed that RC is closely associated with the risk of cerebrovascular disease in the primary and secondary prevention studies of stroke.

Post-stroke fatigue is one of the common symptoms of stroke patients. Continuous fatigue will affect the rehabilitation of patients' limb functions, lead to the decline of daily living ability, and at the same time, make patients lack energy, lose the initiative of rehabilitation exercise, and seriously affect the quality of life and social function. This article reviews the epidemiology, clinical characteristics, evaluation scales, influencing factors, pathophysiological mechanism and treatment of post-stroke fatigue.

Objective To investigate the therapeutic effects of intravenous thrombolysis,intral-arterial thrombolysis,basilar artery embolectomy combined with stent implantation on patients with posterior-circulation infarction.Methods Fifty-seven patients with acute posterior circulation infarction (onset time within 6 to 72 h),admitted to our hospital from March 2005 to February 2013,were chosen; All subjects were randomly divided into three groups:group A,accepted intravenous thrombolysis (within 6 h of onset),group B,accepted intral-arterial thrombolysis (within 6-24 h of onset),and group C,accepted basilar artery embolectomy and stent implantation (over 24 h of onset).US National Institutes of Health Stroke Scale (NIHSS) was used to observe the clinical symptom improvement,and evaluate the results before and 24 h and 7 d after treatment.Three months after treatment,modified Rankin Scale (mRS) was employed to evaluate the clinical prognosis.Results Significant differences were noted in the treatment efficacy 24 h and 7 d after treatment among the three approaches (P＜0.05):that in group B was obviously higher than that in group A; that in group C was obviously higher than that in group A and B.The mRS scores were significantly different among the three groups (P＜0.05):the clinical outcome improvement in group B was obviously higher than that in group A; that in group C was obviously higher than that in group A and B.Conclusion Different treatments should be adopted based on the specific circumstances of the patients; for those with long time window of thrombolysis,basilar artery embolectomy combined with stent implantation might be more effective in improving the prognosis of the patients.