Objective To evaluate the effectiveness of discharge planning in patients after total laryngectomy. Methods One hundred and four patients were randomly divided into the intervention group and the control group, there were 52 cases in each group. The patients in the control group were received routine nursing, while the patients in the intervention group were received discharge planning based on routine nursing. The patients'days of hospitalization, scores of the Exercise of Self-care Agency Scale (ESCA) at discharge and 4 weeks after discharge, scores of University of Washington Quality of Life Questionnaire (UW-QOL) at 4 weeks after discharge and re-admission rate were compared between the two groups. Results The ESCA scores in the intervention group at discharge (108.62 ± 11.23) and 4 weeks after discharge (116.35 ± 12.08) were significantly higher than those of the control group at discharge (96.16±10.34) and 4 weeks after discharge (105.20±10.76) respectively (t=5.886, 4.970, P<0.05), and the UW-QOL score in the intervention group (810.56±98.25) was significantly higher than that of the control group (687.32±96.74) at 4 weeks after discharge (t=6.445, P<0.05). No significant difference in the days of hospitalization was found between the intervention group (15.27 ± 3.33) and the control group (16.60 ± 3.97) (P>0.05). The re-admission rate in the intervention group (2/52,3.85%) was significantly lower than that of the control group (8/52,15.38%) (χ2=3.983, P<0.05). Conclusions Discharge planning can improve the ability of self-care and quality of life in patients after total laryngectomy, and reduce the re-admission to hospital.

Objective To explore the effect and mechanism of intrathecal injecting κ-opioid receptor agonist U50, 488H on the rats with myocardial ischemia/reperfusion injury.Methods 50 Sprague–Dawley rats were randomly divided into five groups (n=10): sham group (Sham), ischemia/reperfusion group (IR), high-dose intravenous injection group (IV1), low-dose intravenous injection group (IV2), and intrathecal injection group (IT).In sham group the rats were followed by the modeling step without ligation of the left coronary and no drug injection by intravenous or intrathecal; in IR group the rats were underwent 30 minutes of myocardial ischemia followed by 120 minutes of reperfusion, and were not treated with any drug.All the rats in IV1, IV2 and IT groups were intravenous injected with U50, 488H at 1 hour before they were underwent myocardial ischemia/reperfusion as in IR group.IV1 and IV2 groups were intravenous injected with U50, 488H respectively at the dose of 0.1 mg/kg and 0.01 mg/kg, while the IT group was intrathecal injected with U50, 488H at the dose of 0.01mg/kg.All the rats from 5 groups were observed with cardiac ultrasound, myocardial sirius staining, serum CGRP and ET level.Results Compared to IR group(EF%=35.4 ±1.1,FS% =21.1 ±1.1), the rats in IT group (EF%=49.1 ±1.2,FS%=27.1 ±1.0) and IV1 group (EF%=46.3 ±2.2,FS%=26.6 ±0.6) showed better myocardial contraction (P<0.05) and reduced myocardial fibrosis (P<0.05).IT group and IV1 group also showed reduced ET but increased CGRP in the serum (P<0.05).There were no difference between IV2 group and IR group in both observation.Conclusion Pretreatment with intrathecal injection of opium κ-receptor stimulant U50, 488H not only protected the myocardial function from myocardial ischemia/reperfusion injury, but also repressed myocardial fibrosis.The protection may result from modulation of CGRP and ET.

Objective To investigate Hospital-acquired infections in patients with liver cirrhosis caused by relevant factors.Methods From Jul.2006 to Jan.2011 the clinical data of 476 cases of hospital-acquired infections in patients with decompensate cirrhosis were retrospectively analyzed by case-control study for the effective factors.Results By logistic regression analysis,17 factors are found to affect Hospital-acquired infections ; 16 risk factors:Occupation in manual labor ( OR =4.119,95 ％ CI:2.631-6.325 ) ; Age ( OR =3.014,95 ％ CI:1.163-7.136) ; The cirrhosis disease history ( OR =1.761,95 ％ CI:1.439-2.130) ; Length of stay in hospital (OR =17.354,95 ％ CI:2.539-101.304) ; Interventional procedures ( OR =5.379,95％ CI:2.354-17.594) ;Peotein intake ( OR =3.201,95％ CI:1.539-4.528) ; Alcohol drinking history ( OR =3.158,95％CI:2.274-7.153 ) ; Development of complication ( OR =8.367,95 ％ CI:2.023-11.736 ) ; ALB ( OR =4.613,95％ CI:2.157-9.936 ) ; PCR-HBV DNA quantitative ( OR =3.628,95％ CI:2.245-7.129 ) ; WBC ( OR =3.758,95％ CI:2.276-7.018 ) ; CHE ( OR =3.148,95％ CI:2.202-6.038 ) ; TC ( OR =3.210,95％ CI:2.102-5.107) ;TBIL(OR =2.748,95％ CI:1.283-3.153) ; Antiviral agents (OR =0.257,95％ CI:0.145-0.382 ) ; Preventive application of antibiotics ( OR =3.147,95％ CI:2.236-7.182 ) ; PTA ( OR =2.798,95％CI:1.293-4.182) ;Liver function of Child B and C (OR =4.164,95％ CI:2.236-6.761 ).Conclusion Age,length of stay in hospital,interventional procedures,alcohol drinking history,development of complication,ALB,PCR-HBVDNA quantitative,WBC,TC,Preventive application of antibiotics,liver function of Child are risk factors.Use of anti-virus drug are protective factors.

Objective To investigate Zunyi C Class infectious diseases ,and provide basis for formulating prevention and control measures .Methods A network report of class C infectious diseasesfrom in Zunyi city from 2009 to 2012 was statistically analyzed by Excel software ,and data analysis was conducted by descriptive epidemiological method for .Results In Zunyi city from 2009 to 2013 reported a total of 8 kinds of class C infectious diseases (68 915 cases) ,annual report incidence rate was 213 .23/10 million;the top three are hand foot and mouth disease ,mumps and other infectious diarrhea ,accounted for 62 .22% of the total reported ca‐ses ,19 .68% and 13 .44% .There was slightly higher incidence rate of the disease from March to August and the main risks were in scattered children ,kindergarten children and students ;the age of onset lie in the population under 14 years old ,the male to female ratio was 1 .67∶1 .00 (χ2 =3 445 .64 ,P<0 .01) .Conclusion Hand foot and mouth disease ,mumps ,other infectious diarrhea and other infectious disease has become an important public health problem in Zunyi city .Therefore ,the kindergarten ,school infectious disease epidemic monitoring should be strengthened ,the infectious disease outbreaks should be reduced ,and communicable disease diagnosis and reporting standards ,which is helpful to improve the epidemic situation of infectious diseases research and prevention and control level should be improved to maintain the protection of public health .

Objective To study the predictive validity of fidgety general movement assessment in pre-term twins and multiplets for motor development outcomes.Methods A total of 53 pre-term twins or multiplets delivered between July 2011 and February 2016 participated in this study.They were assessed using a general movements (GM) assessment and participated in the follow-up program until one year old.The motor development outcomes of the infants at one year old were determined according to clinical diagnoses and the Peabody developmental motor scale number two (PDMS-2) evaluation.The predictive validity of fidgety general movement assessment for motor development outcomes was calculated against the standard motor development of infants at one year old.Results There were 53 twins or multiplets who accepted the GM assessment of fidgety movement period.Of these,43 were assessed as normal (NF) and ten (19％) as lacking a normal level of fidgety movement (F-).All 53 cases were followed-up for the motor development outcome.Forty-three cases (81.1％) were assessed as normal at one year old,while ten (18.9％) were assessed as abnormal.All ten had cerebral palsy,and no motor development retardation was found.The predictive value of F-for cerebral palsy was 90.0％ in terms of sensitivity,97.7％ in terms of specificity,90.0％ in positive predictive value,and 97.7％ in terms of negative predictive value.Conclusions Among pre-term twins or multiplets,the fidgety general movement assessment can be a useful early indicator of motor development difficulties.

Objective:To explore the relation of new-type drug using intention,self-efficacy,and perceived stress in secondary vocational school students.Methods:A total of 2692 secondary vocational school students in Zhaoqing,Guangdong Province were selected.The questionnaire of new-type drugs using intention,General Self-Efficacy Scale (GSES),and Perceived Stress Scale (PSS) were respectively used to assess the secondary vocational school students'new-type drugs using intention,self-efficacy,and perceived stress.Path analysis model was used to analyze the relationship of new-type drugs using intention,self-efficacy,and perceived stress among secondary vocational school students.Results:There were 13.6％ (295/2165) of the secondary vocational school students reported an intention to use new-type drugs.The total scores of GSES and PSS were (2.4 ±0.5) and (18.8 ±5.0),respectively.The results of path analysis showed that,after controlling for age,gender,and residence,the scores of GSES were negatively correlated with the scores of PSS (γ =-0.21,P ＜0.001),and the scores of PSS were positively correlated with the scores of questionnaire of new-type drugs using intention (γ =0.05,P ＜ 0.05).However,the scores of GSES showed no significant direct correlation with the scores of questionnaire of new-type drugs using intention (γ =0.04,P ＞ 0.05).Conclusion:The secondary vocational school students' level of perceived stress are positively correlated with their intention to use new-type drugs.Self-efficacy might moderate the individual's level of perceived stress,thus to show indirect correlation to the secondary vocational school students' intention.

Objective To observe the effects of homemade head and neck fixation pillow in patients with oral and maxillofacial free flap transplantation. Methods Totally 114 patients who needed head and neck fixation after oral and maxillofacial free flap transplantation were divided into the observation group (58 cases) and the control group (56 cases) based on the admitted consequence. Besides the routine treatment and nursing measures, the observation group received head and neck fixation with homemade head and neck fixation pillow, while the control group received traditional fixation with sandbags. The patients′ comfortable degree, compliance, occipital skin condition and the nurses′evaluation of clinical application were investigated. Results The degree of comfort were (2.93 ± 1.28) points in the observation group and (4.96±1.25) points in the control group, respectively. The comfortable degree was higher in the observation group than that in the control group, the difference was statistically significant (t=-8.569,P<0.05). There were 43 patients with complete compliance, 15 with partial compliance, and 0 with no compliance in the observation group respectively, while 18 with complete compliance, 35 with partial compliance, and 3 with no compliance in the control group respectively. The compliance was better in the observation group than that in the control group, the difference was statistically significant (P<0.05). None of the patients in the observation group had pressure ulcer, while 3 patients in the control group had stageⅠpressure ulcer. 96.9％of the nurses considered the homemade head and neck fixation pillow was easy to operate. 100.0％of the nurses considered the homemade headand neck fixation pillow could immobilize the patient′s head and neck effectively. Conclusion The homemade head and neck fixation pillow is easy to operate and can effectively immobilize the patient′s head and neck, protect the patient′s occipital skin, as well as improve patient′s comfort and compliance.

Objective To investigate the benefits and risks of stress ulcer prevention (SUP) using proton pump inhibitors (PPI) for critical patients. Methods The clinical data of adult critically ill patients admitted to the intensive care unit (ICU) of Northern Jiangsu People's Hospital from January 2016 to December 2018 were retrospectively analyzed. All patients who were treated with PPI for SUP within the first 48 hours after ICU admission were enrolled in the SUP group. Those who not received PPI were enrolled in the control group. A one-to-one propensity score matching (PSM) was performed to control for potential biases. The gender, age, underlying diseases, main diagnosis of ICU, drug use before ICU admission, sequential organ failure score (SOFA) at ICU admission, risk factors of stress ulcer (SU) and PPI usage were recorded. The end point was the incidence of gastrointestinal bleeding, hospital acquired pneumonia, Clostridium difficile infection and 30-day mortality. Kaplan-Meier survival curves were plotted, and survival analysis was performed using the log-rank test. Results 1 972 critical patients (788 in the SUP group and 1 184 in the control group) were enrolled, and each group enrolled 358 patients after PSM. Prior to PSM, compared with the control group, the SUP group had older patients, more underlying diseases, higher proportion of acute coronary syndrome (ACS), acute cerebrovascular disease, acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and poisoning in main diagnosis of ICU, more serious illness, and more risk factors of SU, indicating that ICU physicians were more likely to prescribe SUP for these patients. The incidence of gastrointestinal bleeding in the SUP group was significantly lower than that in the control group [1.8% (14/788) vs. 3.7% (44/1 184), P < 0.05], while the incidence of hospital acquired pneumonia and 30-day mortality were significantly higher than those in the control group [6.6% (52/788) vs. 3.5% (42/1 184), 17.9% (141/788) vs. 13.1% (155/1 184), both P < 0.01]. There was no significant difference in the incidence of Clostridium difficile infection between the SUP group and the control group [2.9% (23/788) vs. 1.8% (21/1 184), P >0.05]. After the propensity scores for age, underlying diseases, severity of illness and SU risk factors were matched, there was no significant difference in the incidence of gastrointestinal bleeding or 30-day mortality between the SUP group and the control group [2.2% (8/358) vs. 3.4% (12/358), 15.9% (57/358) vs. 13.7% (49/358), both P > 0.05], but the incidence of hospital acquired pneumonia in the SUP group was still significantly higher than that in the control group [6.7% (24/358) vs. 3.1% (11/358), P < 0.05]. Kaplan-Meier survival curve analysis showed that the 30-day cumulative survival rate of the SUP group was significantly lower than that of the control group before the PSM (log-rank test: χ2 = 9.224, P = 0.002). There was no significant difference in the 30-day cumulative survival rate between the two groups after PSM (log-rank test: χ2 = 0.773, P = 0.379). Conclusion For critical patients, the use of PPI for SUP could not significantly reduce the incidence of gastrointestinal bleeding and mortality, but increase the risk of hospital acquired pneumonia.

Objective: To investigate the current status of malaria rapid diagnostic test (RDT) strips application and malaria laboratory technicians' evaluation about them at primary healthcare provider level in Jiangsu Province. Methods: From November to December 2016, 878 medical institutions and 118 CDCs of city, county and township/community level in Jiangsu Province were selected as study samples using stratified random sampling method. Self-designed questionnaire was distributed to investigate the institution's malaria work task, RDT strips application and evaluation status in 2015. We also investigated the socio-demographic information and collected the RDT strips evaluation score from the malaria laboratory technicians selected from the institutions investigated (one technician from each institution). Rank sum test was performed to compare the RDT strips evaluation scores between medical institutions and CDCs, and among different medical institutions and CDCs. Results: In 2015, 405 cases of malaria were reported, 362 200 person-time of malaria blood testing task was conducted, and 100 000 RDT strips were procured and provided for healthcare providers in Jiangsu province for free. Of the 996 healthcare institutions investigated, 628 used RDT strips in the year 2015 and the median (P₂₅, P₇₅) of RDT strips volume used in these institutions was 10 (2, 25). The volume of RDT strips used in CDCs (15 (5, 52)) was significantly higher than that in medical institutions (10 (2, 25), (Z=3.42, P=0.001)). The investigated CDCs gave higher score on RDT strips' testing time per operation (10 (8.5, 10)) than medical institutions (9(8, 10), (Z=-2.20, P=0.028)). The employers of 614 investigated malaria laboratory technicians used RDT strips in 2015. The median of the scores given by CDC malaria laboratory technicians for RDT strips in terms of testing time per operation, testing operation and results judgement difficulties were 10 (9, 10), 10 (9, 10) and 10 (9, 10), respectively, which were significantly higher than those from technicians of medical institutions (9 (8, 10), 9 (8, 10), 9 (8, 10), (Z values were -2.55, -2.97 and -2.96, respectively; P values were all less than 0.05)). Conclusion RDT strips had been widely performed in health institutions in Jiangsu Province. The amount of RDT strips used in CDCs was significantly higher than that in medical institutions. Primary-level institutions and malaria laboratory technicians generally recognized RDT strips' advantage for application in terms of testing time and operational procedure. CDCs and malaria laboratory technicians from them gave higher regards on RDT strips in terms of testing time per operation, testing operation and results judgement difficulties compared with that of medical institutions.

Objective:To develop the screening checklist of brief interview for autism disorder suitable for Chinese children and evaluate its reliability and validity.Methods:Based on existed research results and diagnostic criteria for autism spectrum disorder of DSM-5, the screening checklist of brief interview for autism spectrum disorder(SCAD) was developed. A sample of 238 children were selected for investigation and 28 of them were retested for test-retest reliability with 2-4 weeks interval. Cronbach's α coefficient, split-half correlation coefficient, test-retest reliability, and evaluator consistency were used to test the reliability of the scale. Content validity, construct validity and empirical validity were used to test the validity of the scale.All statistical analysis were conducted by SPSS 22.0 and AMOS 17.0.Results:The SCAD contains two components and six dimensions, with a total of 25 items. The Cronbach's α coefficient was 0.936 for the total scale and were 0.938, 0.771 for the two components. The split-half coefficient for the total scale and the two components were 0.962, 0.938 and 0.794. The test-retest reliability for the total scale and the two components were 0.806, 0.795 and 0.766. The Kendall coefficient for the total scale and the two components were 0.968, 0.982 and 0.950. The SCAD item-level content validity index (I-CVI) ranged from 0.66 to 0.98 and the Kappa value ranged from 0.66 to 0.98. The scale-level content validity S-CVI/UA and S-CVI/Ave were 0.89 and 0.94. The correlations between SCAD and calibration tests such as ABC, CARS and M-CHAT were 0.54, 0.53 and 0.87, and the correlation coefficients with the M-CHAT-R/F between the two components were 0.87 and 0.76 respectively (both P<0.01). The result of CFA demonstrated that the model fitted the data with well construct validity(χ 2/ df=0.910, RMR=0.049, AGFI=0.974, RMSEA=0.010, PNFI=0.530, PCFI=0.533, NFI=0.994, RFI=0.988, CFI=1.000). The correlation coefficient of the two components was 0.88 and that with the total scale were 0.97 and 0.90, each dimensions with the total scale ranged from 0.72 to 0.93. Conclusion:The SCAD has a good reliability and validity, and it can be used as a clinical screening tool for children with autism spectrum disorder.