Objective To study the application value of 5S management for the instrument management in ENT department.Methods Totally 20 instrument nurses in ENT department implementing 5S management were enrolled into an observation group,and another 20 nurses using conventional management method were involved in a control group.The two groups were compared on instrument management quality and instrument nursing management satisfaction.Results The observation group had the qualification rate of sampled sterile items,qualification rate of instrument packaging,qualification rate of instrument cleaning,efficiency of instrument application,instrument preparedness,standardized instrument allocation,intact rate of prepared instrument as well as the familiarity with instrument management and operation significantly better than those in the control group (P＜0.05).The time consumed for adding instrument,finding instrument,environment arrangement and finding expired goods in the observation group was statistically shorter than that in the control group (P＜0.05).The times of instrument set repeated disinfection in the observation group was obviously less than those in the control group (P＜0.05),and the satisfaction over nursing management in the observation group was also significantly better than that in the control group (P＜0.05).Conclusion 5S management gains high application values for instrument management in ENT department,and thus is worthy promoting clinically.

Objective To investigate the effects of preoperative mental care on patients undergoing local anesthesia cataract extirpation .Methods One hundred cataract patients were randomly divided into the control group (n=50) and the experimental group (n=50).The control group was in conventional nursing care, while the experimental group was with preoperative mental care .The state of anxiety , discomfort during operation and the satisfaction rate of the operation were compared between groups .Results Before intervention , the blood pressure ( BP ) , heart rate ( HR ) , body temperature , oxygen saturation and SAS score had no significant differences (P>0.05).After implement the mental care, the score of SAS in the experimental group was (46.3 ±5.32), which was lower than that of the control group (57.6 ±6.18), the difference was statistically significant (t =9.798, P <0.01).During the operation, in the control group, 14 patients (28.0%) had a palpitation or chest distress , 8 patients(16.0%) had nausea, which was much more frequent than those in the experimental group (6.0%,4.0%),the difference was statistically significant (χ2 =8.575, 4.002, respectively;P<0.05).The score of satisfaction in the control group was (74.5 ±7.25) significantly lower than (82.6 ±8.32) in the experimental group (t=5.192, P<0.01).Conclusions Mental care can decrease the fluctuation of patients ’ BP and HR, furthermore it is benefit in achieving the operation and improving patients’ satisfaction.

Objective:To analyze clinical features of aortoesphageal fistula (AEF) patients with massive upper gastrointestinal hemorrhage.Methods:Five AEF patients with massive upper gastrointestinal hemorrhage admitted in Peking Union Medical College Hospital from 2016 January 1st to 2019 December 31st. The clinical data, endoscopic findings, radiological manifestations, treatment and clinical outcomes were retrospectively analyzed.Results:Among 5 patients, 4 were males, 1 was female with an average age of (58±8) years old. The underlying conditions were atherosclerosis ( n=4), hypertension ( n=3), hyperlipidemia ( n=1); 2 cases had aortic aneurysm stent implantation and 1 case of rheumatic heart disease had valve replacement. All 5 patients were complicated with hematemesis and hypovolemic shock, and 4 cases had sentinel hemorrhage. Contrast-enhanced CT or CT angiography of the aorta showed thicken esophageal wall, local esophageal discontinuity, aortic aneurysm, gas around the aortic stent and contrast agent spilling over. The gastroscopy showed esophageal depression lesions, deep ulcers, mucosal erosion with bleeding. Conservative therapy and endoscopic hemostasis failed, 2 patients died without surgical intervention; 3 patients underwent emergency surgeries, 2 survived and 1 died perioperatively. Conclusions:Aortoesophageal fistula is in lack of specific clinical manifestations but is highly in mortality. Therefore CT and gastrocopic examination should be performed for suspected patients, early diagnosis and surgical treatment are the key to save patients′ lives.

Background::Breast cancer (BC) risk-stratification tools for Asian women that are highly accurate and can provide improved interpretation ability are lacking. We aimed to develop risk-stratification models to predict long- and short-term BC risk among Chinese women and to simultaneously rank potential non-experimental risk factors.Methods::The Breast Cancer Cohort Study in Chinese Women, a large ongoing prospective dynamic cohort study, includes 122,058 women aged 25-70 years old from the eastern part of China. We developed multiple machine-learning risk prediction models using parametric models (penalized logistic regression, bootstrap, and ensemble learning), which were the short-term ensemble penalized logistic regression (EPLR) risk prediction model and the ensemble penalized long-term (EPLT) risk prediction model to estimate BC risk. The models were assessed based on calibration and discrimination, and following this assessment, they were externally validated in new study participants from 2017 to 2020.Results::The AUC values of the short-term EPLR risk prediction model were 0.800 for the internal validation and 0.751 for the external validation set. For the long-term EPLT risk prediction model, the area under the receiver operating characteristic curve was 0.692 and 0.760 in internal and external validations, respectively. The net reclassification improvement index of the EPLT relative to the Gail and the Han Chinese Breast Cancer Prediction Model (HCBCP) models for external validation was 0.193 and 0.233, respectively, indicating that the EPLT model has higher classification accuracy.Conclusions::We developed the EPLR and EPLT models to screen populations with a high risk of developing BC. These can serve as useful tools to aid in risk-stratified screening and BC prevention.