Objective To investigate the influence of transitional care intervention on the outcome of patients with chronic heart failure.Methods The randomized controlled trials (RCT) on transitional care intervention were researched by the database of Pubmed,Medline and CBM.Data were analyzed using Stata 12.0 software.Results 17 RCTS were enrolled in this study.The results of Meta-analysis showed that transitional care intervention could reduce the total incidence of hospital readmission and readmission to hospital with heart failure.However,there was no significant difference in mortality among the two groups.Conclusions Transitional care intervention can reduce the total incidence of hospital readmission and readmission to hospital with heart failure for patients with heart failure.

Objective We aimed to evaluate the effect of transitional care intervention on the quality of life for patients with chronic heart failure.Methods The randomized controlled trials (RCT) on transitional care intervention were researched by the database of Pubmed,Medline and CBM.The influencing factors of transitional care intervention of quality of life of patients with heart failure were analyzed using Stata 12.0 software.Results 12 articles were enrolled in this study.The quality of life in the experimental group was significantly enhanced when comparing with the control group in the total level,physical and emotional aspects,SMD values were-0.62,-0.72 and-0.50,the difference had statistical significance.Conclusions Transitional care intervention can improve the quality of life for patients with chronic heart failure and the best effect can be obtained on the 3rd to 6th months.

Objective To evaluate the influence of international normlized ratio(INR) self-management intervention on the complication of patients after mechanical heart valve replacement (MHVR).Methods The randomized controlled trials (RCT) about comparing the INR self-management with conventional management in patients after MHVR were researched by the database of PubMed, Medline, China Biomedical Literature Database, Wanfang data, Chinese National Knowledge Infrastructure, and the data were analyzed by Stata 12.0 software.Results Nine RCTs were enrolled in this study, 4 265 cases in total.The results of Meta-analysis showed that INR self-management could reduce the incidence of thrombosis, relative risk(RR) was 0.68, 95％ confidence interval (95％CI) was 0.50-0.94, P＜0.05.However, there was no significant difference in hemorrhage between the two groups, yet could not evaluate the effect on INR values within the target range, RR(95％CI) was 1.29(1.20-1.38), P＜0.05.But due to the high heterogeneity in literature, the results were for reference only, it remained to be further argumen.Conclusions INR self-management can reduce the incidence of thrombosis in patients after mechanical heart valve replacement, and does not increase the risk of bleeding complication at the same time.

Objective To reflect the main influencing factors of career development for Chinese nurses. Methods Databases including PubMed, Embase, Cochrane Library, CNKI, VIP, CBM and Wanfang Data were searched to collect literature on the main influencing factors of career development for Chinese nurses. The literatures were screened according to the inclusion and exclusion criteria. After extracting data and appraising the quality of the included studies,Meta-analysis was conducted by Revman 5.0 and Stata 12.0 software. Results Of the 494 identified studies, 8 studies were included. The summary effect size and 95％CI were found for psychological capital 0.44(0.16-0.73), self-efficacy0.35 (0.22- 0.48), positional titles 0.20(0.14- 0.27), hospital scale- 0.19(- 0.26-- 0.13), years of work experience 0.17(0.09-0.25), stress-0.17(-0.24--0.09) respectively. Conclusions Psychological capital, self-efficacy, positional titles, hospital scale, years of work experience and stress are the main influencing factors related to nurses′ career development. Nursing managers should pay attention to and actively develop nurses' psychological capital, use of different professional titles and seniority nurses reasonably, and reduce the work pressure to promote the nurse career development.

This study summarized the experiences of disease-specific performance appraisal at tertiary hospitals in Shanghai,which was launched since year 2013 by Shanghai Hospital Development Center (SHDC). 38 tertiary hospitals in Shanghai were included in the study. A disease-specific performance appraisal system centering on quality and performance, by means of case-mix model, classified surgery management and typical disease screening, and leveraging disease and surgery difficulties analysis, and inter-hospital performance appraisal of typical diseases. This reform has established appraisal criteria of disease difficulty management,coding criteria and data norms,guiding such hospitals to consolidate their functional positioning of focusing on difficult,urgent and complicated cases in the medical service delivery system.All these efforts have paved the way for the reforms to build a hierarchical medical service system, pricing per disease, payment per disease, and consolidate performance appraisal of medical workers.

Objective To evaluate the effect of electroacupuncture ( EA) preconditioning on hipp-ocampal I-kappa B-α ( IκB-α)∕nuclear factor κB ( NF-κB)∕intercellular adhesion molecule-1 ( ICAM-1) signaling pathway during cerebral ischemia-reperfusion ( I∕R) in mice. Methods A total of 120 healthy male C57BL∕6 mice, aged 10-12 weeks, weighing 20-25 g, were divided into 4 groups ( n=30 each) u-sing a random number table method: control group ( group C) , cerebral I∕R group ( group I∕R) , precondi-tioning with EA at non-acupoint+cerebral I∕R group ( group S+I∕R) and preconditioning with EA at Baihui acupoint + cerebral I∕R group ( group E+I∕R) . The cerebral I∕R injury model was established by occlusion of bilateral common carotid arteries followed by reperfusion for 72 h in mice anesthetized with halothane or chloral hydrate in group I∕R. Group S+I∕R received EA at the points 2 mm lateral to the acupoints of Baihui for 5 consecutive days, and then the cerebral I∕R injury model was established. Group E+I∕R received EA at Baihui acupoints with a sparse-dense wave at an intensity of 1 mA and a frequency of 2 Hz∕15 Hz for 30 min once a day for 5 consecutive days, and then the cerebral I∕R injury model was established. Neurobe-havioral score was assessed at 24 and 48 h of reperfusion. Then 5 mice in each group were sacrificed, and the hippocampal tissues were obtained and stained with haematoxylin and eosin for examination of the patho-logical changes in hippocampal CA1 region and for determination of the expression of IκB-α, NF-κB, ICAM-1, interleukin-6 ( IL-6) , IL-1β protein and mRNA by Western blot and real-time polymerase chain reaction, respectively. Results Compared with group C, neurobehavioral score was significantly in-creased, and the expression of hippocampal IκB-α, NF-κB, ICAM-1, IL-6 and IL-1βprotein and mRNA was up-regulated in I∕R, S+I∕R and E+I∕R groups ( P<0. 05) . Compared with group I∕R, neurobehavioral score was significantly decreased, and the expression of hippocampal IκB-α, NF-κB, ICAM-1, IL-6 and IL-1β protein and mRNA was down-regulated in group E+I∕R (P<0. 05), and no significant change was found in the parameters mentioned above in group S+I∕R (P>0. 05). Compared with group S+I∕R, neu-robehavioral score was significantly decreased, and the expression of hippocampal IκB-α, NF-κB, ICAM-1, IL-6 and IL-1β protein and mRNA was down-regulated in group E+I∕R ( P<0. 05) . Conclusion The mechanism by which EA preconditioning attenuates cerebral I∕R injury may be related to inhibiting activation of hippocampal IκB-α∕NF-κB∕ICAM-1 signaling pathway in mice.

Objective:To evaluate the role of heat shock transcription factor 1 (HSF1) in the endogenous protective mechanism underlying mechanical ventilator-induced lung injury (VILI) in mice and the relationship with high mobility group box 1 (HMGB1).Methods:Forty SPF healthy male C57BL/6 mice, aged 6-8 weeks, weighing 20-25 g, were divided into 4 groups ( n=10 each) by the random number table method: control group (group C), VILI group (group VILI), negative control siRNA + VILI group (group NV) and HSF1 siRNA + VILI group (group siRNA). At 48 h before mechanical ventilation, negative control siRNA 5 nmol and HSF1 siRNA 5 nmol were intratracheally injected in NV and siRNA groups respectively, and the solution was diluted to 50 &mu;l with the sterile phosphate buffer in both groups. Group C kept spontaneous breathing for 4 h, and the rest animals were mechanically ventilated (tidal volume 35 ml/kg, respiratory rate 75 breaths/min, inspiratory/expiratory ratio 1∶2, fraction of inspired oxygen 21%) for 4 h. Blood samples from the femoral artery were collected for arterial blood gas analysis immediately after endotracheal intubation and at 4 h of ventilation, and PaO 2 was recorded. Then the mice were sacrificed under deep anesthesia to collect lung tissues and bronchoalveolar lavage fluid (BALF). The concentrations of interleukin-1beta (IL-1β), tumor necrosis factor-alpha (TNF-α) and HMGB1 in BALF were determined by enzyme-linked immunosorbent assay. The pathological results were observed by hematoxylin-eosin staining, and lung injury was assessed and scored. The wet/dry (W/D) weight ratio of lung tissues was calculated. The expression of HMGB1 and HSF1 mRNA in lung tissues (by quantitative real-time polymerase chain reaction) and expression of HMGB1 and HSF1 protein in lung tissues (by Western blot) were determined. Results:Compared with group C, PaO 2 was significantly decreased at 4 h of ventilation, the concentrations of TNF-α, IL-1β and HMGB1 in BALF, W/D ratio and lung injury score were increased, and the expression of HMGB1 protein and mRNA in lung tissues was up-regulated in group VILI, group NV and group siRNA ( P<0.05 or 0.01). Compared with group VILI and group NV, PaO 2 was significantly decreased at 4 h of ventilation, the concentrations of TNF-α, IL-1β and HMGB1 in BALF, W/D ratio and lung injury score were increased, and the expression of HMGB1 protein and mRNA in lung tissues was up-regulated, and the expression of HSF1 protein and mRNA was down-regulated in group siRNA ( P<0.05 or 0.01). There was no significant difference in the parameters mentioned above between group VILI and group NV ( P>0.05). Conclusions:HSF1 is involved in the endogenous protective mechanism underlying VILI in mice, which may be related to the down-regulation of HMGB1 expression and attenuation of inflammatory responses in lung tissues.