Objective To investigate the fatigue experience of the community-dwelling frail elderly to establish the conceptual model.Methods Grounded theory was adopted.With MAXQDA v10.4.15.1for 3 levels coding,the conceptual model of fatigue experience of community-dwelling frail elderly people was structured through constant comparison and in-depth analysis.Results Multi-response,selfmanagement,safe and belonging,hitting rock bottom,accepting and transferring formed the conceptual model.Conclusions Based on the conceptual model,nurses should pay more attention to concern about the fatigue experience of community-dwelling frail elderly people,and probe different assessment methods to enrich comprehensive geriatric assessment (CGA),then improve the community health service level and the quality of elderly people's life.

With the public hospitals expanding,the nurses at age of marriage or bearing are enrolled and account for large part of all health care workers in China.A significant percentage of nurses in the period of pregnancy or lactation,especially abortion and sterility,deteriorate the shortage of nursing human resources and the nurses' health.It is essential to cope with the matter in order to maintain the nurses and contribute to the professional development.In this paper,we review the human resource management of the nurses during the periods at home and abroad from the human resources,occupational protection and management approaches,which is contributed to supplement the human resource.

As one of the important factors that impact the life of quality to the elderly,visual impairment has become a research highlight in developed countries.And some related results have been found out.It is in the primary stage of establishing the elderly community extending service system in China.Based on this background,literature about the impact of visual impairment on quality of life of the residential setting elderly and related interventions were reviewed.By drawing the experience from developed countries,we aim to innovate perfect interventions,improve the quality of life,avoid unexpected events such as fall and medication mistakes.

A comprehensive analysis was carried out about the influencing factors of medication safety in the elderly with multiple chronic diseases,who lived in the community and stayed at their own homes.Applicable and simple preventive countermeasures should be established to ensure the medication safety outside medical agency.We should promote extending service of hospitals,cooperate with community and nursing facility in order to increase life quality of the elderly,and supply reference for professional continuous service model including rapid aging,empty nest with advanced age,disability and dementia and elderly people with chronic diseases.

Objective To explore the opportunities and challenges which COC (continuity of care) has been facing,some strategies were proposed and improved continuously during the process of deepening medical reform in public hospital,and at the same time to supply reference for government to make relative policy.Methods By SWOT-analysis,the strengths,weaknesses,opportunities as well as threats of COC in medical reform were analyzed comprehensively.Results Depending on national relevant policies,supportive measures,the cooperation from multidisciplinary team was improved.Along with strategies of strengthening advantages,weakening disadvantages,meeting challenges and facing up to threat.COC had be approved and consented initially.Conclusions Public hospitals should demonstrate their various resources and make full use of their advantages,then guide and solid grass-roots in the new healthcare system which integrate medical,rehabilitation and elderly nursing out of the hospital.It must benefit the hospital,specialized subject,family and society.

The therapeutic effects of intensive insulin therapy in treatment of traumatic shock combined with multiple organ dysfunction syndrome (MODS) were investigated. A total of 114 patients with traumatic shock combined with MODS were randomly divided into two groups: control group (n=56) treated with conventional therapy, and intensive insulin therapy group (n=58) treated with conventional therapy plus continuous insulin pumping to control the blood glucose level at range of 4.4-6.1 mmol/L. White blood cells (WBC) counts, prothrombin time (PT), serum creatinine (SCr), alanine aminotransferase (ALT), serum albumin and PaO(2) were measured before and at the day 1, 3, 5, 7 and 14 after treatment. The incidence of gastrointestinal dysfunction, the incidence of MODS, hospital stay and the mortality were also observed and compared. After intensive insulin therapy, the WBC counts, SCr, ALT and PT were significantly reduced (P<0.05), but the level of serum albumin was significantly increased (P<0.05) at the day 3, 5, 7 and 14. In the meantime, the PaO2 was significantly elevated at the day 3, 5 and 7 (P<0.01) after intensive insulin therapy. The incidence of gastrointestinal dysfunction, the incidence of MODS, the length of hospital stay and the mortality were markedly decreased (P<0.01). The results suggest early treatment with intensive insulin therapy is effective for traumatic shock combined with MODS and can decrease the length of hospital stay and the mortality.

The therapeutic effects of intensive insulin therapy in treatment of traumatic shock combined with multiple organ dysfunction syndrome (MODS) were investigated.A total of 114 patients with traumatic shock combined with MODS were randomly divided into two groups:control group (n=56) treated with conventional therapy,and intensive insulin therapy group (n=58) treated with conventional therapy plus continuous insulin pumping to control the blood glucose level at range of 4.4-6.1 mmol/L.White blood cells (WBC) counts,prothrombin time (PT),serum creatinine (SCr),alanine aminotransferase (ALT),serum albumin and PaO2 were measured before and at the day 1,3,5,7 and 14 after treatment.The incidence of gastrointestinal dysfunction,the incidence of MODS,hospital stay and the mortality were also observed and compared.After intensive insulin therapy,the WBC counts,SCr,ALT and PT were significantly reduced (P＜0.05),but the level of serum albumin was significantly increased (P＜0.05) at the day 3,5,7 and 14.In the meantime,the PaO2 was significantly elevated at the day 3,5 and 7 (P＜0.01) after intensive insulin therapy.The incidence of gastrointestinal dysfunction,the incidence of MODS,the length of hospital stay and the mortality were markedly decreased (P＜0.01).The results suggest early treatment with intensive insulin therapy is effective for traumatic shock combined with MODS and can decrease the length of hospital stay and the mortality.

Background Although transforming growth factor-β (TGF-β)/Smad signaling pathway is important in regulating the occurrence and development of pulmonary fibrosis, the pathogenesis of pulmonary fibrosis remains elusive. Objective To explore the functions of genes associated with TGF-β/Smad signaling pathway in the progression of pulmonary fibrosis. Methods A NIH-3T3 fibroblast model induced by TGF-β1 was established. The experiment samples were divided into a control group and a TGF-β1 treatment group. The control group was exposed to normal saline, while the TGF-β1 treatment group was exposed to 10 ng·mL⁻¹ TGF-β1 for 12 h. The RNAs of the two groups were extracted, sequenced, and analyzed by bioinformatics methods to identify seven key genes in TGF-β pathway, including Dcn, Smad3, Smad7, Fbn1, Thbs1, TGF-β1, and TGF-β3. The gene expression levels of five markers [Collagen1α1, Collagen1α2, α-smooth muscle actin (α-SMA), TGF-β1, and TGF-β3] and the seven key genes were detected by quantitative real-time PCR (qRT-PCR). The proteins of the two groups were extracted. The important marker protein expression levels of Smad3, the phosphorylation of Smad3 (P-Smad3), and α-SMA were detected by Western blotting. At the same time, 30 healthy SPF-grade C57BL/6 mice were randomly divided into three groups, with 10 mice in each group: a control group, a SiO₂ inhalation exposure group for 28 d (10 mice), and a SiO₂ inhalation exposure group for 56 d (10 mice). The mice in the two treatment groups were exposed to a natural SiO₂ environment for 4 h per day with a 10-min pause for breathing fresh air at 2 h intervals. The lung tissues of the mice were taken after execution. The changes of pulmonary fibrosis were detected by Masson staining, and mRNAs and proteins were extracted to detect the expression of the above key genes and proteins. Results The expression levels of the five marker genes Collagen1α1, Collagen1α2, α-SMA, TGF-β1, and TGF-β3 were significantly increased in the TGF-β1-induced NIH-3T3 fibroblasts than those in the control group (P < 0.01); the expression levels of P-Smad3 and α-SMA proteins increased significantly (P < 0.01); the expression results of the seven key genes screened in the TGF pathway were that Dcn and Smad3 were obviously down-regulated (P < 0.01), and Smad7, Fbn1, Thbs1, TGF-β1, and TGF-β3 were obviously up-regulated (P < 0.01). The changes in gene expression levels of the transcriptome sequencing showed the same trend. The results of Masson staining showed that the content of collagen fibers in the lung tissues also increased in the SiO₂ inhalation exposure groups over time. In the mouse experiment, five marker genes were obviously up-regulated compared with the control group (P < 0.01); no obvious change was found in the expression of Smad3 protein, and the expression levels of P-Smad3 and α-SMA were obviously higher in the SiO₂ exposure groups than those in the control group (P < 0.01); the expression levels of Dcn and Smad3 showed a down-regulated trend, while the expression levels of Smad7, Fbn1, Thbs1, TGF-β1, and TGF-β3 showed an up-regulated trend with the increase of SiO₂ inhalation exposure days (P < 0.01). The expression levels of the above five marker genes, three important marker proteins, and seven key genes were consistent with the expression trends of TGF-β1-induced NIH-3T3 fibroblasts. Conclusion The expression levels of pulmonary fibrosis-related marker genes and proteins change significantly in TGF-β1-induced fibroblast cells, and the lung tissues of mice under natural SiO₂ inhalation exposure has obvious fibrosis characteristics. Seven genes (Dcn, Smad3, Smad7, Fbn1, Thbs1, TGF-β1, and TGF-β3) may be involved in the regulation of pulmonary fibrosis by the TGF-β/Smad signaling pathway.