OBJECTIVE To analyze the cause,clinical characteristic and preventive measures in nosocomial infection of multiple sites. METHODS A total of 123 cases of nosocomial infection in multiple sites in our hospital in 2004 were prospectively monitored and analyzed retrospectively. RESULTS Among 1645 cases of nosocomial infection,123 cases suffered from nosocomial infection in multiple sites.The main infection sites were lower respiratory tract and urinary tract.The main risk factors were over usage of broad-spectrum antibiotics and invasive operation.The serious result was prolongation of duration in hospital,increase in mortality and expensiveness. CONCLUSIONS The nosocomial infection in multiple sites is a main object to be monitored.To prevent,discover and control nosocomial infection in time is an effective measure to reduce the risk of nosocomial infection.

OBJECTIVE To analyze the condition of nosocomical systemic fungus infection and make preventive and control measures against nosocomial systemic fungus infection.METHODS The 496 fungus-cultured positive cases with average age of 61.04 years old among the discharged patients from Jan 2003 to Dec 2005 were reviewed and analyzed.RESULTS The rate of nosocomical systemic fungus infection was 0.53%,from which the over 60 age senile patients accounted for 63.1%.Lower respiratory tract and urinary tract were the most frequent infection sites.The Candida albicans was accounted for 70.71%.The death rate of patients with nosocomial systemic fungus infection was 27.82%.The major correlated factors of nosocomial systemic fungus infection were the widespread use of broad-spectrum antibiotics and not be standardized and the iatrojenic injury of respiratory and urological tracts.CONCLUSIONS The causes of nosocomial systemic fungus infection are closely related to medical treatment;the death rate of patients with nosocomial systemic fungus infection is obvious higher than that without it;to prevent and control nosocomial systemic fungus infection is the key point of nosocomial treatment.

Objective To explore the implementation methods and effects of precise quality control model mediated by nursing quality indexes in quality management.Methods Fifty-seven care units with complete quality control data were collected. From January to December 2015, the 57 using the traditional quality control mode were selected as control group, whilst from January to December 201657 units were chosen for the intervention group using precision quality control mode, that was, to select the number of indicators and target values, screening quality control points, unified the acquisition path of indicators, lock the key departments and monitoring points affecting the quality to carry out quality management performance. We observed the changes of the two groups of quality indicators.Results The nine process quality indicators including wards 6S management, first aid techniques, health education, primary care, first class and critical care nursing, safe treatment, operating nursing documents,drug and sterile product quality and pass rate of identity verification were significant difference between the two groups(P<0.05). The five outcome quality indicators including hospitalized patients fall, dosing defects, hospital pressure sores, burns and urinary uncontrolled extubation rates were significant difference between the two groups(P<0.05) as well.Conclusions The quality control model, which is mediated by the nursing quality index, is helpful to improve the nursing quality. It is an effective quality control mode to achieve continuous improvement of nursing quality.

Objective To retrieve,analyse and integrate the best evidences in perioperative fluid management for elderly patients with hip fracture,therefore to provide references for patient care.Methods Following the 6S evidence model,databases and websites were searched to collect the evidences on perioperative fluid management of elderly patients with hip fracture.The searched databases including BMJ Best Practice,UpToDate,AAOS Clinical Practice Guidelines,ASBMR,ANZHFR,ESTES,NICE,SIGN,JBI,Cochrane Library,CINAHL,Embase,PubMed,Web of Science,CNKI,Wanfang Data,VIP database,CEBM Database,Medive,China Science and Technology Journal Database,SinoMed,and other websites about orthopaedics.The searched literatures included guidelines,clinical decision-making,best practices,expert consensus and systematic reviews.The time span for the published literatures was from the inception of the databases and websites to August 2022.Two researchers independently completed quality evaluations of the retrieved literatures,as well as extraction,assessment and integration of the abstracted evidences.Results A total of 15 articles were included,they were 2 guidelines,3 clinical decision-makings,1 best practice,7 expert consensus,and 2 systematic reviews.Thirty pieces of evidence were summarised from 7 aspects,covering multidisciplinary team collaboration,dynamic assessment and monitoring of fluid status,fluid resuscitation,fluid management before and after the surgery and health education.Conclusions This study summarised the best evidences in perioperative fluid management for elderly patients with hip fracture.The evidences provide an evidence-based solution which will enable the healthcare workers to fully combine the clinical scenarios,evaluate changes in fluid volume status dynamically,develope personalised fluid management strategies and improve patient outcomes.

Objective:To explore the effect of pathway nursing under multidisciplinary collaboration on self-care ability and rehabilitation effect in patients with acute cerebral infarction.Methods:Using the convenient sampling method, a total of 294 patients with acute cerebral infarction who were admitted to the Department of Neurology in the Fengcheng Hospital, Fengxian District, Shanghai from January 2018 to December 2019 were selected as the research objects. A total of 147 patients with acute cerebral infarction admitted from January to December 2019 were included in the experimental group, while 147 patients with acute cerebral infarction admitted from January to December 2018 were included in the control group. The experimental group adopted pathway nursing under multidisciplinary collaboration, while the control group adopted neurology routine nursing. Scores of Exercise of Self-Care Agency (ESCA) , National Institutes of Health Stroke Scale (NIHSS) , Fugl-Meyer Assessment (FMA) , Barthel Index and nursing satisfaction of patients were compared between the two groups. Finally, 147 patients in the experimental group and 145 patients in the control group completed the experiment.Results:The scores of self-concept, self-responsibility, health knowledge level and self-care skills in ESCA of patients in the experimental group at discharge were respectively (25.36±4.86) , (20.43±3.21) , (53.37±5.89) and (40.02±3.78) and the nursing satisfaction score was (97.26±2.52) , which were higher than (21.48±4.33) , (16.24±3.25) , (46.44±5.47) , (30.08±3.81) and (90.65±3.16) in the control group, and the differences were statistically significant ( P<0.01) . The NIHSS score of the experimental group 60 days after discharge was (3.7±2.2) , lower than (6.9±2.3) of the control group. And FMA and Barthel Index scores were respectively (79.3±9.2) and (78.7±14.5) , higher than (65.6±8.4) and (60.3±16.6) of the control group, and the differences were statistically significant ( P<0.01) . Conclusions:The implementation of pathway nursing under multidisciplinary collaboration for patients with acute cerebral infarction can enhance the consciousness of self-management, contribute to the recovery of neurological function and limb motor function and improve the ability of self-care and nursing satisfaction of patients.

Objective To verify the effectiveness of the"10S"management method in improving the efficiency of the traditional Chinese medicine pharmacy.Methods A controlled experiment was conducted to compare the expenditure on daily supplies,the environment of the place,the pharmacists'competence in pharmacy services,the quality and efficiency of the dispensing work,the error rate of dispensing,and the patients'satisfaction to the traditional Chinese medicine pharmacy,using the period before the implementation of the"10S"management(January to July 2022)as the control group and the period after the implementation of the"10S"management(January to July 2023)as the experimental group.Results After the implementation of the"10S"management,the daily expenditure of the Chinese medicine pharmacy was reduced,the place was tidy and orderly,the pharmacists'competence in pharmacy services was significantly improved,the quality and efficiency of the dispensing work were significantly improved,the dispensing error rate was reduced,and the patients'satisfaction was further enhanced.The data showed that the dispensing time of the Chinese medicine pharmacy was reduced from(7.77±0.21)min to(6.64±0.27)min during the busy phase,and the average dispensing time was reduced from(32.44±1.32)min to(17.05±2.23)min during the busy phase.Conclusion The"10S"management method is recommended to be promoted in traditional Chinese medicine pharmacies to improve the efficiency and service quality of Chinese pharmacists.

OBJECTIVETo explore the effects of acrylonitrile on T lymphocyte subsets, expression of toll-like receptor 4 and related cytokines in rats.

METHODSSixty-four Sprague-Dawley rats were randomly divided into 4 female groups and 4 male groups, and there were 8 rats in each group. Rats in each group were respectively given a single dose of 0, 5, 10 and 20 mg/kg acrylonitrile by gavage, once a day, 5 days a week, for 13 weeks. Blood and spleen T lymphocyte subsets was detected by flow cytometry, the mRNA expression of TLR4, IL-1β and TNF-α was analyzed by real-time quantitative PCR, the protein expression of TLR4 was evaluated by Western blot.

RESULTSCompared with control group, the percentages of blood CD3, CD4 T cells in 20 mg/kg female group and CD4/CD8 ratio in 5, 10 and 20 mg/kg female groups was significantly decreased, CD8 T cells in 20 mg/kg group was significantly increased (P < 0.05 or P < 0.01), blood CD3 T cells in 5 mg/kg male group, CD4 T cells and CD4/CD8 ratio in 20 mg/kg male groups were lower than that of control group, CD8 T cells in 20 mg/kg make group was significantly in oreased (P < 0.05 or P < 0.01). Spleen CD4, CD8 T lymphocyte percentages and CD4/CD8 ratio in 20 mg/kg female group decreased significantly, CD8 T cells in 20 mg/kg male group was significantly increased (P < 0.05 or P < 0.01), spleen CD3, CD4, CD8 T cells in 20 mg/kg male group and CD4/CD8 ratio in 10, 20 mg/kg male groups was also significantly decreased, CD3 T cells in 20 mg/kg and CD8 T cells in 10, 20 mg/kg male groups were significantly increased (P < 0.05 or P < 0.01) (TLR4 mRNA was lower expressed in 5, 10 and 20 mg/kg male groups and 10 mg/kg female group (P < 0.05 or P < 0.01), and TLR4 protein in 5 mg/kg female group and 20 mg/kg male group was significantly lower than control group (P < 0.05). The expression level of IL-1β mRNA was significantly decreased in 5, 10 and 20 mg/kg female group and 5, 10 mg/kg male group (P < 0.05 or P < 0.01), TNF-α mRNA was lower expressed in 10, 20 mg/kg female groups and 5, 10 mg/kg male groups (P < 0.01).

CONCLUSIONAcrylonitrile may lead to the changes of CD3, CD4, CD8 T lymphocyte percentages and CD4/CD8 ratio in rat blood and spleen, and also significantly effected the expression level of TLR4 mRNA and protein together with the secretion of IL-1β, TNF-α. This may cause effects on the cellular immune function.

Acrylonitrile ; toxicity ; Animals ; Female ; Interleukin-1beta ; metabolism ; Male ; Rats ; Rats, Sprague-Dawley ; T-Lymphocyte Subsets ; drug effects ; immunology ; Toll-Like Receptor 4 ; metabolism ; Tumor Necrosis Factor-alpha ; metabolism