OBJECTIVE To investigate the risk factors for nosocomial pneumonia(NP) caused by imipenem-resistant Acinetobacter baumannii(IRAB) and its antimicrobial susceptibility in vitro. METHODS The data of 34 cases of IRAB-NP were analyzed and 68 cases of NP caused by imipenem-susceptible A.baumannii(ISAB) were randomized as control.Antimicrobial susceptibility(MIC) was determined with the method of agar dilution. RESULTS The two independent factors associated with the development of IRAB-NP: previous fluoroquinolone(OR=5.738) and imipenem/meropenem(OR=7.129) use.The drug sensitivity test in vitro showed that these strains were multiresistant to commonly used antibiotics,and only ampicillin/sulbactam and cefoperazone/sulbactam whose resistance rate was less than 30%. CONCLUSIONS Previous imipenem/meropenem and fluoroquinolone use is independent risk factors for IRAB-NP.These strains are high drug resistant.

Objective To explore the relativity between clinical learning organization culture and core competency among registered nurses,to offer theoretic basis and practical advices for improving core competency among registered nurses.Methods 680 registered nurses in three tertiary hospitals in Ji'nan city were investigated with the general information questionnaire,Competency Inventory for Registered Nurses and the Dimensions of The Learning Organization Questionnaire.Results The total score and all the four subscales of learning organization were positively correlated with the core competency among registered nurses(P＜0.01),the dimension of overall situation senses and strategic leadership were the main influencing factors.Conclusions The cultivation of nurses' overall situation senses should be strengthened,providing strategic leadership for learning,strengthening cooperation and innovation,and promoting inquiry and communication.These will help increase core competency among registered nurses and improve their general competence.

Aim To investigate the effect of hypercholesterolemia on L-type Ca2+(ICa-L) current and intracellular calcium concentration ([Ca2+]i) in single ventricular myocytes of hypercholesterolemic rats.Methods 12 male wistar rats were randomly divided into two dietary groups:a group fed a normal diet(n=6)and a group fed high-cholesterol diet(n=6) for 4 weeks,respectively. The level of serum lipid was examined.Zymolytic method was used to isolate single ventricular myocytes from hypercholesterolemic and normal rats,which were loaded with Ca2+-sensitive fluorescent indicator Fluo-3/AM.[Ca2+]i represented by fluorescent intensity(FI)was measured by laser scanning confocal microscope.Whole cell patch clamp technique was used to record ICa-L.Results There was no significant influence exhibited on TG level.However, the serum total cholesterol(TC)level of hypercholesterolemic rats was much higher than that of model control group; at the test potential of 0 mV, ICa-L decreased from(-8.56?1.29)pA/pF(Control)to(-5.24?0.90) pA/pF(HC)(n=6 in each group,P

Objective To study the level of serum lipids and body-fat content of high-fat diet induced pbesity rats(DIO).explore the relationship between intracellular caleium and ventrieufar arrhythmia.Methods Sixty male Sprague-Dawley(SD)rats were divided into control group(15)and experiment group(45),high-fat diet was administrated for 12 weeks to established obesity model,15 rats were selected into obesity group according to their body weight gain.The standard 2-lead electrocardiograph was used to detect the incidence and scores of arrhythmia induced by barium chloride(BaCl2,0.1 mg/kg)for 1 hour on every 8 rats from different groups respectively.Body-fat content.the level of serum total cholesterol(TC),triglyceride(TG),low density lipopmtein cholesterol (LDL-C) and high density lipopmtein cholesterol (HDL-C)were measured.The epididymal(EP),retroperitoneal (RE) and mesenteric(ME)white adipose pads was measured to obtain the body fat content.Single ventricular myrocytes of rats were isolated by enzymatic dissociation.The confocal laser scanning microscope was used to record basic intraceUular calcium level([Ca2+]i).Results The body-fat content in obesity group[(7.71±0.74)%] was significantly higher than control group[(4.69±0.37)%](t＝3.650,P＜0.05).The level of serum TC,TGand LDL-C were significantly higher(t＝3.801,2.778,3.536.P＜0.05) in obesity group[(1.26±0.04),(0.58±0.10),(0.51±0.04)mmol/L]than those in control group[(0.92±0.08),(0.29+0.03),(0.31±0.04) mmol/L].The level of serum HDL-C wa8 decreased gradually from control group[(0.53±0.05)mmol/L] toobesity group[(0.52±0.02)mmol/L],but there waft no significant difference between them(t＝0.186,P＞0.05).The incidence of arrhythmia induced by BaCl2(0.1 mg/kg)in obesity group was significantly higher than controlgroup(X2＝5.333,P＜0.05),and the scores of arrhythmla was increased in obesity group(2.5±0.6)too.The fluorescence intensity standing for[Ca2+]i was increased significantly(t＝2.409,P＜0.05)from obesity group(247.96±20.03)to control group (174.25±23.13).Conclusion As the free cytosolic calcium begin to accumulate,the arrhythmia morbidity is increased in obesity rats.

Objective To evaluate the protective effect and mechanism of luomaishutong(LMST)on acute myocardial ischemia-reperfusion injury in rabbits.Method Twenty-four New Zealand white rabbits were randomly divided into 3 groups:the LMST group,the control group and the sham-operated group.The AMI reperfusion model was established by removing the blockade after the occlusion of coronary artery for 2 hours.The changes of hemodynamics,oxygen free radical and clearance system were measured in all rabbits.Results (1)Compared with the control group,left ventricular systolic pressure(LVSP)and maximal changing rate of left ventricular innner pressure(?dp/dt_(max))increased remarkably in the LMST group after reperfusion,meanwhile, LVEDP decreased significantly.(2)In the control group,MDA level of cardiocyte was noticeably higher,while SOD and NOS levels were lower than in the sham-operated group.Compared with the control group,MDA level in the LMST group was significantly lower.Furthermore,SOD and NOS levels were higher in LMST group,and the infarcted area was smaller in the LMST group as well.Conclusions LMSF can protect myocardium after ischemia-repcrfusioninjury and improve cardiac function through inhibiting induced by oxygen free radicals.

Objective To evaluate the in vitro activity of cefazolin penta-hydrate and other common used antimicrobial agents against clinical pathogens isolated within last 3 years. Method MIC values were deter-mined by standard twofold agar dilution method. Time kill curves were il-lustrated by colony form unit (cfu) count method. Totally , MICs of 604 isolates within last 3 years from 19 hospitals were tested. Result The results indicated that for Gram - positive aerobic pathogens, cafazolin pentahydrate showed satisfied in vitro activity against methicillin suscepti-ble Staphylococcus aureus ( MSSA), methicillin susceptibel Staphylococcus epidemidis (MSSE), penicillin susceptible Streptococcus pneumonies (PSSP) and Streptococcus spp. β-hemolytic group. MIC90 was ≤ 4 mg · L-1 For Gram- negative bacilli, cefazolin pentahydrate also showed antibacterial activity. MIC values was ≤ 8 mg · L-1 for non- ESBLs Enterobacteriaceae bacteria. Time- kill curves test results indicated that cefazolin pentahydrate typically is of time dependent profile against staph-ylococci, but for E. coli, the bactericidal activity slight increased with drug concentration increased. Conclution Compared with contrast drugs, the activities of cefazolin pentahydrate against G+ bacteria were better than cephalexin, clindamycin, clarithromycin, and silght better than cefotiam, and similar with amoxicillin/clavulanic acid, cefuroxime and levofloxacin. For non - ESBLs Enterobacteriaceae, the activies of cefazolin pentahydrate were better than cephalexin, and similar with amoxicillin/clavulanic acid and cefuroxime.

Objective To explore the nursing process of robot-assisted radical cystectomy and ileum neobladder so as to improve the quality of nursing matching.Methods Preoperative preparation,intra-operative positioning and cooperation,and peri-operative management of devices were managed by cooperating with six cases of robot-assisted radical cystectomy and ileum neobladder.Results All six operative procedures were successfully performed with no conversion to open surgery and high satisfaction of cooperation.Conclusions Preoperative preparation,reasonable layouts in the operation room,practiced operative procedures and close cooperation are the keys of the success of robot-assisted operations.

Objective To explore the clinical meaning of early systematic nursing intervention on the prevention of low limbs venous thrombus in ICU patients.Methods Totals of 120 patients in ICU were randomly divided into two groups by entering order number,odd numbers were experimental group(60 cases)and double numbers were control group(60 cases).Experimental group received early systematic nursing intervention while control group received ICU conventional nursing.All patients were measured the lower limb diameter per day,and were received colour Doppler examination to tested their femoral venous blood velocity in first,seventh and fourteen day of ICU,and their femoral venous blood velocity and incidence of low limbs venous thrombus were compared.Results No difference of femoral venous blood velocity in two groups was founded before intervention (P ＞0.05).After intervention,femoral venous blood peak velocity and average velocity of seventh and fourteen day in experimental group was(52.8 ± 9.6),(52.6 ± 8.8)and(34.2 ± 6.9),(35.3 ± 7.2),respectively,and higher than(41.3 ±7.8),(42.5 ±7.6)and(22.5 ±7.1),(23.7±6.6)in control group,differences between two groups were statistically significant(t =2.724,3.125,2.722,3.114 ;P ＜ 0.05); the incidence of low limbs venous thrombus in experimental group was lower than that of control group,and the difference was statistically significant(x2 =4.904,P ＜ 0.05).Conclusions Adopting early systematic nursing intervention can improve the femoral venous blood velocity,and effectively prevent and reduce the incidence of low limbs venous thrombus of ICU patients.

Objective To discuss the clinical effect of two-dimensional oral care for patients with mechanical ventilation by orotracheal intubation,and improve the quality of oral care.Methods Seventy inpatients with mechanical ventilation by orotracheal intubation from Feb 2011 to Jul 2012 in ICU were selected and randomly divided into experimental group (n ＝ 35) and control group (n ＝ 35).Experimental group was given two-dimensional oral care (oral swab just one time before intubation,and brush teeth and suction three times a day after intubation).Control group was given traditional oral care three times a day.Throat swab specimens were gathered for bacterial colony counts before intubation,and in 4 h,12 h,24 h,48 h after intubation,respectively.Bacteria quantitative culture was performed in sputum specimens and in throat swab specimens (one time per three days) after intubation.Oropharyngeal bacteria change and the incidence rate of ventilator associated pneumonia (VAP) were observed.Results Among all 70 patients,61 cases were valid,15 cases had VAP,and 8 cases died.In the experimental group,31 were valid,4 had VAP and 3 died,while in the control group,30 were valid,11 had VAP and 5 died.The difference of the incidence rate of VAP was statistically significant (x2 ＝ 4.643,P ＝ 0.040) and the difference of the incidence rate of death was not statistically significant (x2 ＝ 0.654,P ＝ 0.473).The difference of oropharyngeal bacterial colony counts had no statistical significance between two groups before intubation (t ＝-0.563,P ＝ 0.589),while the difference of oropharyngeal bacterial colony counts had statistical significance between groups in 4 h,12 h,24 h,48 h after intubation (t＝1.957,-2.520,-3.560,-2.165,respectively; P＜0.05).Conclusions Two-dimensional oral care can effectively reduce oropharyngeal bacterial colony,and decrease the incidence rate of VAP for patients with mechanical ventilation by orotracheal intubation.Thus it is a better nursing method to improve oral care quality.

With the development of integration process, how to manage citizens' cross-border healthcare be-tween member countries in an organized way has become a major agenda for European Union (EU). Through great efforts over years,a well-functioning mechanism has been established by EU's social health insurance and has been of global interest. It's believed that China's trans-provincial healthcare management can learn a lot from this mechanism. This study aims to provide experiences and reference to China's trans-provincial healthcare management by overview EU's mechanism for cross-border healthcare and then analyzing the differences between China and European Union in terms of object of management,authorization,service institutions,types of healthcare services,and reimbursement of medical insurance in different places. This study suggests that it's necessary for each province to officially introduce relevant policies in order to speed up and facilitate the establishment of trans-provincial healthcare management mech-anism. Moreover,to achieve orderly seeking medical treatment, health insurance agencies should be endowed with approval power to authorize patient trans-provincial application. Meanwhile, the network of health institutions which are entitled to provide services to trans-provincial patients should be expanded. Along with such expansion,and given the lack of understanding on behaviors of health institutions in different provinces for a specific local health insurance agency,it's required that national trans-provincial healthcare management system should take an active role in putting such health institutions under supervision.