Based on the general ward round and subsequent analysis of various problems during the process, experience-based optimization scheme and measures should be put forward to improve the efficiency of the hospital management, raise the logistic service awareness, appropriately dispose and manage human resources, strengthen skill training and quality education of logistic group and transform the logistic service to a professional, specialized, scientific and socialized one so as to establish a new management system of hospital logistics.

Objective To investigate the clinical features of hypotensive maintenance dialysis patients after total parathyroidectomy with autotransplantation (TPTX + AT).Methods The consecutive patients who received TPTX + AT were enrolled between January 1,2010 and May 1,2015 in the nephrology department at the central hospital of Jiangmen.According to level of the blood pressure after TPTX + AT,the patients can be divided into hypotensive-group and non-hypotensive-group.The clinical and laboratory examinations of them were compared.Results The probability of calcification of aortic valve (4.76％ vs 30％,P =0.045),bicuspid valve (9.52％ vs 40％,P =0.032) and pulmonary hypertension (14.29％ vs 45％,P =0.043) was lower in the hypotensive-group with statistical significance.Serum parathyroid hormone [(9.31 ± 5.41) pg/ml vs (60.12 ± 96.95) pg/ml,P =0.021] and angiotensinⅡ (Ang Ⅱ) [(34.26 ± 15.73) pg/ml vs (63.78 ±23.55) pg/ml,P =0.000] were lower in the hypotensive-group with statistical significance.Serum intact parathyroid hormone (iPTH) (P =0.036) and AngⅡ (P =0.002) were the affecting factors of hypotension after TPTX + AT.Conclusions Hypotension after TPTX + AT is associated with the lower level of serum iPTH and Ang Ⅱ.The probability of calcification of cardiac valve and pulmonary hypertension is lower in the patients with hypotension,indicate that they may have better cardiac prognosis.

Objective To explore the effects of ecoimmunonutrition support on the intestinal barrier function and pancreas in rats with severe acute pancreatitis (SAP). Methods Totally 64 SPF rats were randomly divided into sham operation group (control group) , SAP without enteral nutrition support group (SAP group), SAP with early enteral nutrition support group (EEN group), and SAP with early ecoimmunonutrition support group (EIN group). Bacteria translocation (BT), plasma endotoxin (ET) , gut permeability, pancreas pathology score,and distant ileum pathology were determined on the 4th and 7th post-modeling day. Results The BT rate was significantly higher in SAP group, EEN group, and EIN group than in control group (P ＜ 0.05), was significantly lower in EEN group and EIN group than in SAP group (P ＜ 0.05), and was significantly lower in EIN group than in EEN group (P ＜ 0.05). ET and FD-40 levels in blood were both significantly higher in SAP group, EEN group, and EIN group than in control group (P ＜0.01)and were significantly lower in EIN group and EEN group than in SAP group (P ＜0.01); ET was significantly lower in EIN group than in control group (P ＜0.05). Pathological scores were significantly higher in SAP group, EEN group, and EIN group than in control group (P ＜0.01)and were significantly lower in EEN group and EIN group than in SAP group (P ＜ 0.01). The individual pathological scores of EIN group were not significantly different from EEN group (P ＞ 0.05), while the total score was significantly lower in EIN group than in EEN group (P ＞ 0.05). Distant iliac mucosa was significantly thicker in EIN group than in other groups. Conclusions Early enteral nutrition support protects the intestinal barrier and pancreas in rats with SAP. Ecoimmunonutrition has better nutritional effectiveness than the normal enteral nutrition.

Objective:To explore whether the action research on the pre-service training evaluation system of "Internet + TCM Nursing" guided by CIPP (context, input, process and product) and Kirkpatrick Model can improve the training effect of nursing staff under the background of internet and TCM nursing service.Methods:Taking 211 nurses of "Internet + TCM Nursing" in Guangdong Provincial Hospital of TCM from 2019 to 2020 as the research objects, action teams were made, and the data were collected and analyzed by various methods. According to the collected data, the action teams constructed the training scheme of "Internet + TCM Nursing", the compilation requirements of "internet + TCM Nursing", the case optimization scheme of "internet + TCM Nursing" process, and the evaluation model of "internet + TCM Nursing". After the training, the nurses' knowledge, skills and related attitudes, the general reaction and feelings to the training programs, and the evaluation of nurses' work performance by the competent leaders, medical staff and clients were compared by comparing their scores and issuing self-made questionnaires. SPSS 20.0 software was used for statistical analysis.Results:The results showed that the theoretical scores of nurses after training were (85.16±6.22) points, and the case assessment scores after training [(81.22±7.03) points] were higher than the previous theoretical scores [(61.23±12.90) points] and the case assessment scores [(59.54±14.41) points], with statistical significance ( P<0.001). The results of self-made questionnaire showed that there were significant differences in theoretical knowledge, skills and related attitudes among nurses after training ( P<0.001). In the process of training, there were statistically significant differences in training content, teacher training, training implementation and training guarantee at the end of training ( P<0.001). After training, there were significant differences in the evaluation of nurses' job performance by leaders in charge, medical staff and clients improved in knowledge and skills, professional ethics, working process and learning ability, and the improvement rate ( P<0.001). Conclusion:Action research is an effective research method to continuously improve nursing training. The optimization scheme of "internet + TCM Nursing" nurses based on CIPP and Kirkpatrick Model through action research can effectively improve the training effect.