Objective To investigate the clinical features of non-steroidal anti-inflammatory drugs (NSAIDs) caused gastrointestinal bleeding in the elderly.Methods We performed a retrospective analysis ofNSAIDs caused gastrointestinal bleeding with 308 cases admitted to Department of Gastroenterology,The Second Hospital of Tianjin Medical University.Patients were divided into elderly group(≥65 years,n =208) and young group (＜ 60 years,n =100) to make a comparative analysis of two group differences in clinical characteristics.Results The NSAIDs in the elderly taking were mainly Aspirin (55.8 ％ (116/208)),which was significantly more frequent than that of young group (37.0％ (37/100),x2 =9.517,P ＜ 0.05).There was no significant difference on the blood routine and coagulation between the two groups (P ＞ 0.05).The recent bleeding rate of the elderly group (21.2％ (44/208)) was lower than the young group (63.0％ (63/100))(x2 =52.161,P ＜0.05).The two groups had no significant difference on the history of uleer and Hp infection (P ＞ 0.05).Conclusion The clinical characteristics of NSAIDs caused gastrointestinal bleeding on the elderly were different with young or middle-aged.This infers that elderly patients need individualized treatment.

Objective To study the expression of Vascular Endothelial Growth Factor (VEGF),Malondialdehyde (MDA),Hypoxia Inducible Factor-1 α (HIF-1 α) in the Non-Steroidal Anti-Inflammatory Drug (NSAID)-associated gastric mucosa injury tissue,and to understand the mechanism of NSAID induced gastric mucosa injury.Methods We collected 114 biopsy specimen of gastric mucosa under endoscope from patients admitted to our hospital,including 70 cases with NSAID-associated chronic erosive gastritis or gastric ulcer (NSAID group) and 44 cases with chronic superficial gastritis who never take NSAID as controls (the control group).Immunohistochemistry technique was used to detect the positive expressions of VEGF,MDA,HIF-1α in patients.Results The positive rate of VEGF expression in the NSADI group was significantly lower than that in the normal control group (25.7％ (18/70) vs.54.5％ (24/44),x2 =9.70,P ＜ 0.05).The positive rates of MDA and HIF-1α in the NSADI group were significantly higher than these in the normal control group (MDA:62.9％ (44/70) vs.27.3％ (12/44),x2 =13.70,P ＜0.05; HIF-1α:45.7％ (32/70) vs.13.6％ (6/44),x2 =12.50,P ＜ 0.05).Conclusion NSAID drugs may induce gastric mucosa injury by decreasing the expression of VEGF and increase the levels of MDA and HIF1-α in gastric mucosa tissue.

This paper introduced the application and effects of mobile operating room nursing information management system (MORNIMS) in the operating room. The MORNIMS was designed by operating room and information center based on the Enterprises Digital Assistant (EDA) and was applied in the operating room for two years. Its application significantly improved work efficiency,optimized the work flow,reduced nursing mistakes,enhanced the retrospective quality monitoring of sterile materials,and realized information management in the operating room.

Objective To explore the impact of diagnosis related groups (DRGs) payment and drug zero plus on the management of intensive care medicine department. Methods The clinical data of patients in one year from 2016 to 2017 admitted into the Department of ICU in Liuzhou Worker's Hospital concerning their numbers of discharged patients, transferred patients, bed utilization rate, number of bed turnover, average length of stay of discharged patients, cure and improvement rates, admission and discharge diagnostic coincidence rate, 3-day definite diagnosis rate, clinicopathological diagnosis coincidence rate, rescue success rate, total income, drug proportion, consumable proportion, DRGs payment and settlement data, etc were retrospectively analyzed to explore the dual challenges, DRGs payment and drug zero plus, facing the department and how to respond and deal with them. Results In 2016 and 2017, the total incomes of the department of critical care medicine in our hospital were 42.107 0 million yuan and 41.371 3 million yuan respectively, and the medical insurance incomes were 15.03 million yuan and 16.69 million yuan respectively;in 2016 and 2017, 2 693 patients and 2 922 patients were admitted and treated respectively; 595 patients and 577 patients were discharged respectively, with 2 071 patients and 2 334 patients transferred respectively; the balances of the department were 15.48 million yuan and 29.11 million yuan, respectively. From July to December 2017, the medical insurance DRGs payment data suggested that the proportion of loss of the department be 7.02%. Accelerating the Grade 6 electronic medical records and informationization construction, adopting the severe disease information solution program and fine quality control management in the department of critical care medicine can reduce the cost of manpower. Conclusion Our future development direction in the Department of Intensive Care Medicine includes the following aspects: Open source and reduce expenditure, strictly control the proportions of drugs and consumables, improve the balance of the department, and actively respond and deal with the medical insurance DRGs payment.

Objective: A graded response system based on pediatric early warning score (PEWS) was constructed to provide a scientific basis for clinical intervention and management by clinical nurses. Methods: Domestic and foreign literature and the results of previous research were reviewed to build a preliminary framework of graded response strategies. Two rounds of expert consultation were conducted by Delphi method and the results were statistically analyzed. Meanwhile, the results were integrated into the electronic medical record system to form the PEWS grading response system. Results: The positive coefficient of experts in the first and second rounds of consultation both were 15/15, and the average of the expert authority coefficient was 0.87 and 0.89 respectively. The expert coordination degree Kendall′s W value was 0.292 and 0.301 respectively (P<0.05), indicating that the experts′ opinions tended to be consistent. Finally, four segmented response systems were formed, with PEWS scored on the scale of 0-1, 2, 3 and 4 or single 3 points. Conclusions The graded response system based on pediatric early warning score constructed by using Delphi expert consultation method can be used in clinic, which can promote the nurses′ participation in clinical intervention decision-making and improve the quality of nursing.