Thyroid dysfunction refers to the abnormality of thyroid hormone in the blood circulation .Hyper-thyroidism and hypothyroidism are the main clinical factors .Thyroid hormone can accelerate degradation of insulin , and can reduce the sensitivity of the organism (including the liver and peripheral tissues ) to insulin,moreover,thyroid hormone still can adjust the function of islet beta cells .Some studies have pointed out that the disorder of thyroid hormone has a certain influence on the incidence of insulin resistance .The purpose of this paper is to review the relationship between thyroid dysfunction and insulin resistance .

Objective:To explore the current status and training needs of clinical nursing teachers in Class Ⅲ Grade A hospitals in China, and provide a reference for further construction of clinical nursing teachers.Methods:From October 2017 to February 2019, by purposive sampling with a ratio of 1︰10, the clinical nursing teachers from 141 ClassⅢ Grade A hospitals in 30 provinces, autonomous regions and municipalities in China received a cross-sectional study with the Basic Information Questionnaire of Clinical Nursing Teachers in China's Class Ⅲ Grade A hospitals. A total of 11 594 questionnaires were collected, and 10 266 were valid questionnaires, with an effective rate of 88.55%.Results:Among the 10 266 clinical nursing teachers, 49.64% (5 096/10 266) were senior nurses; 51.27% (5 263/10 266) were between 30 and 39 years old; 78.42% (8 051/10 266) were those with a bachelor degree or below; 41.33% (4 243/10 266) had taught for less than 5 years; 41.84% (4 295/10 266) were selected and designated by managers; 38.78% (3 981/10 266) often or always felt the pressure of teaching; 56.31% (5 781/10 266) thought that they were competent for clinical teaching; 50.54% (5 188/10 266) occasionally participated in teaching training, and had a strong demand for training. The top three demands were teaching methods and skills, frontier knowledge of specialties, and nursing research. Clinical teachers with different teaching years, academic qualifications and professional titles are in basic theories of education, teaching methods and skills, nursing management, and nursing research. There was statistically significant difference in the training needs for the frontier knowledge of specialist subjects between clinical nursing teachers with different teaching years, educational background and job titles ( P<0.05) . Conclusions:The clinical nursing teachers in China's ClassⅢ Grade A hospitals are mainly senior nurses, and the overall initial academic qualifications are low. There are problems in the selection of clinical nursing teachers in teaching management, and the lack of teachers' participation in teaching training. It is recommended that the relevant departments establish a competency-oriented and demand-oriented selection and management system for clinical nursing teachers, thereby promoting the construction of the teaching staff.

Objective:To establish a clustered management plan for pulmonary care of massive burn casualties (hereinafter referred to as the clustered management plan for pulmonary care), and to explore its application effects.Methods:(1) A clustered care intervention group was established, including the medical and nursing staff from the Department of Burns and Plastic Surgery, Department of Respiratory Medicine, and Department of Infection Control at the Fourth Medical Center of PLA General Hospital (hereinafter referred to as our hospital). Four major links, including pulmonary care assessment, chest and lung physical therapy, artificial airway management, and specialized infection control were sorted out according to the key points and difficulties in pulmonary care for massive burn casualties. Evidence-based nursing methods were employed to retrieve articles related to the above-mentioned four links from PubMed, Chinese Journal Full- Text Database, VIP Database and Wanfang Data using terms of " mass burn, respiratory management and airway management" and terms of "成批烧伤,肺部护理,集束化管理" , and the clustered management plan for pulmonary care was established based on reading and discussion in combination with clinical practice and experience. (2) In this non-randomized controlled study, the clustered management plan for pulmonary care was applied to 73 massive burn patients (48 males and 25 females, aged 32 (25, 38) years) who were admitted to our hospital from January 2016 to December 2019 and met the inclusion criteria, and they were included into the clustered care group; 43 massive burn patients (25 males and 18 females, aged 35 (17, 45) years) who were admitted to our hospital from January 2013 to December 2015, received routine care and met the inclusion criteria were retrospectively included into routine care group. The pulmonary infection rate and mortality of patients in the two groups were recorded during the hospital stay. Data were statistically analyzed with chi-square test, Mann-Whitney U test, and independent sample t test. Results:(1) The clustered management plan for pulmonary care included a total of 12 specific measures covering four aspects of pulmonary care. The contents in pulmonary care assessment clearly stated to include the previous medical history, history of injury, respiratory status, hoarseness, pulmonary auscultation, etc. Chest and lung physical therapy included how to guide patients to effectively cough and do pursed lip breathing and abdominal breathing exercise, etc. Artificial airway management specified the preparation for the establishment of artificial airway at clinical reception, the observation index and frequency after tracheotomy, the method of humidification, the method and frequency of sputum suction, and the management of mechanical ventilation, etc. Specialized infection control required to strengthen hand hygiene and ventilator management. (2) The pulmonary infection rate and mortality of patients in the clustered care group were 2.74% (2/73) and 4.11% (3/73), respectively, significantly lower than 25.58% (11/43) and 18.60% (8/43) in routine care group ( χ2=11.986, 5.043, P<0.05 or P<0.01). Conclusions:The clustered management plan for pulmonary care developed for massive burn casualties focuses on the major links and key points. The measures are systemic and comprehensive, simple but precise, and highly operable, covering the entire process of massive burn care, hereby reducing the pulmonary infection rate significantly and improving the success rate of treatment.

Objective:To explore the application effect of timed, step-by-step and segmented sputum suction in airway management of patients with inhalation injury.Methods:From January 2017 to December 2019, 104 patients with inhalation injury admitted to the Department of Burns and Plastic Surgery, the Fourth Medical Center of the PLA General Hospital were selected as research objects. A non-randomized controlled study was adopted, and the patients were divided into control group ( n=49) and experimental group ( n=55) according to the single and even day of admission. The control group received the routine sputum suction, and the experimental group received the method of timed, step-by-step and segmented sputum suction. We compared the general information, incidence of lung infection and the number of daily sputum suction of patients between the two groups. Results:There was no statistically significant difference in the general information of patients between the two groups ( P>0.05) . The incidence of lung infection in the experimental group was 29.09% (16/55) , which was lower than 51.02% (25/49) in the control group with a statistically significant difference ( P<0.05) . In the experimental group, the number of daily sputum suction for patients with tracheotomy was 6 (3, 6) times, the number of daily sputum suctions for patients without tracheotomy was 1 (1, 2) times, and the number of daily sputum suctions for patients with severe inhalation injury was (6.56±2.96) times, which were less than 14 (11, 19) , 3 (3, 7) , (15.40±3.75) times respectively in the control group, and the differences were statistically significant ( P<0.01) . Conclusions:The timed, step-by-step and segmented sputum suction can reduce the number of sputum suctions for patients with inhalation injury and the workload of nursing, and effectively decrease the rate of lung infection, which is worthy of clinical promotion.