Objective To establish a scientific, systemic objective and practical competency model for head nurses. Methods Based on the PPEB model, the competency model for head nurses was formulated through literature review, theoretical analysis, specialists interview and Delphi method. Results The head nurses′competency model consisted of professional competency, psychology competency, ethic competency and behavior competency, which included 10 second- level indicators and 33 third- level items. A total of 16 questionnaires were sent out in each round of consultation, and 15 and 16 questionnaires were retrieved separately. the experts′authority coefficient was 0.88 and the coordination coefficient was 0.131. Conclusions The enthusiam, authority and harmony of the specialists were good, which meant the competency model for head nurses were scientific and reliable. And it could provide references for head nurses′selection, training and performance appraisal.

The reduction of peripheral blood cells is a common and serious complication in hepatic cirrhosis portal hypertension patients with splenomegaly, and severely affects the prognosis.Its reasons include hypersplenism and non-hypersplenism factors.We should correctly understand these two factors.Hypersplenism factors is common, and non-hypersplenism factors, including the toxic effects of virus on the bone marrow, liver cirrhosis, hepatosis, immunodeficiency, the toxic effects of drugs, dystrophia, the destruction of platelets in blood circulation and hemorrhage.Etiological treatment and liver transplantation is the main treatment.Now, treatment of the reduction of peripheral blood cells has become an important topic.In this paper, the causes and treatments of peripheral blood cytopenias, which were caused by non-hypersplenism factors in the patients of liver cirrhosis and portal hypertension, were reviewed.

Objective To explore the relationship between the neighborhood environment and the residents' suicidal risk and provide evidence for suicide prevention.Methods The study sample consisted of 392young suicides (aged 15-34 years) and 416 community living controls from the same areas of China (randomly selected from 16 rural counties in three provinces).Social factors in the village neighborhoods were measured by the WHO SUPRE-MISS scale of Community Stress and Problems.Psychological autopsy methods and multivariable Logistic regression were employed.Two informants were interviewed to collect the information of each subject.Results It was found that there was positive correlation between the community surrounding score and suicide.The community stress and problems was the main risk factor for suicide(Wald x2 =10.036,P＜0.05,OR=1.323).Family disputes,inconvenience transportation,lack of health care and job security,alcohol abuse,and superstition can increase the suicidal risks among rural young Chinese.It was still indicated that relative poverty,suffering from a mental illness(OR=32.346) were the risk factors; but good education,married and good health were the protective factors for suicide.Conclusion Further improving the social assistance system,solving the existing community stress and problems,building better community environment are needed to reduce the stress of community residents.Psychological screening and the community mental health intervention for high-risk groups should be strengthened to improve residents' response capacity to stress.Those measures can reduce the suicide rate of China rural community residents effectively.

Objective To investigate the expression of CD55 and its implication on prognosis for patients with gastric stromal tumors.Methods Expression of CD55 was detected by immunohistochemistry staining and the correlation between CD55 and clinicopathological features and prognosis were analyzed on 60 cases of primary gastric stromal tumors from January 2010 to October 2012.Results Of the 60 patients with gastric stromal tumors there were 33 males and 27 females.CD55 was mainly located in the cytoplasm of gastric stromal tumors.There was no statistical difference between CD55 expression and patients' gender and age (P ＞ 0.05).Moreover,the expression of CD55 was closely related to tumor size,mitotic counts,2008 NIH classifications,and distant metastasis at the first visit to the hospital (P ＜ 0.05).During a median follow-up of 58.5 (range 23-78) months,14 patients had tumor progression.Log-rank univariate survival analysis showed tumor size,mitotic counts,2008 NIH classifications,radical resection,distant metastasis at the first clinical visit and CD55 expression were related to progression-free survival (P ＜ 0.001).COX multivariate survival analysis showed that tumor size (HR 11.504,95％ CI:1.085-122.011,P =0.043) and CD55 expression (HR 11.819,95％ CI:1.827-76.477,P =0.01) were independent prognostic factors.Conclusions Up-regulated CD55 might play an important role in the development and metastasis of gastric stromal tumors.

Objective The aim of this case-control study is to explore clinical objective variables for diagnosing delirium of intensive care unit (ICU) patients.Methods According to the method of prospective case-control study, critical adult postoperative patients who were transferred to ICU of Peking University People's Hospital from October 2015 to May 2016 and needed mechanical ventilation were included. After evaluating the Richmond agitation sedation scale score (RASS), the patients whose score were -2 or greater were sorted into two groups, delirium and non-delirium, according to the confusion assessment method for the ICU (CAM-ICU). Then these patients were observed by domestic multifunctional detector for electroencephalographic (EEG) variables such as brain lateralization, brain introvert, brain activity, brain energy consumption, focus inward, focus outward, cerebral inhibition, fatigue, sleep severity, sedation index, pain index, anxiety index, fidgety index, stress index and the cerebral blood flow (CBF) index which was named of perfusion index. Other variables including indexes of ICU blood gas analysis, which was consisted of variables of blood gas analysis, routine blood test and biochemistry, previous history and prognostic outcome was recorded. Binary logistic regression was used for multivariate analysis.Results Forty-three postoperative patients, who needed intensive care, were included. Eighteen were in delirium group and twenty-five in control group. Excluding the trauma, variables like gender, age, temperature, heart rate, respiratory rate, mean arterial pressure, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, organ failure, dementia and emergency surgery didn't show any statistical significance between two groups. The trauma in delirious patients increased obviously compared with the control group (33.3% vs. 4.0%,P = 0.031). Except for the brain activity [122.47 (88.62, 154.21) vs. 89.40 (86.27, 115.97),P = 0.034], there were no statistical differences in any other EEG and CBF variables. In ICU blood gas analysis, only pH value (7.43±0.42 vs. 7.47±0.31,P =0.003), chloride concentration [Cl- (mmol/L): 114.66±4.32 vs. 111.90±3.08,P = 0.019], magnesium concentration [Mg2+ (mmol/L): 0.60±0.10 vs. 0.54±0.06,P = 0.035] and blood osmolality [mmol/L: 290.10 (284.15, 306.35) vs. 282.70 (280.20, 286.75),P = 0.014] were statistically significant. Compared with control group, the prognostic variables in delirium group such as duration of mechanical ventilation [days: 125.0 (49.0, 293.0) vs. 149.5 (32.0, 251.3)], length of stay in ICU [days: 216.5 (50.5, 360.8) vs. 190.0 (72.0, 330.5)] and mortality rate (22.2% vs. 24.0%) didn't appear to be statistically significant either (allP > 0.05). It was shown by multivariate logistic regression analysis that pH [odds ratio (OR) = 1.446, 95% confidence interval (95%CI) = 1.116-1.875,P = 0.005] and Cl- (OR= 0.708, 95%CI =0.531-0.945,P = 0.019) were potential risk factors of delirium.Conclusions The brain activity of HXD_Ⅰ may contribute to the clinical diagnose of delirium, but it still remained to be proved further. The pH and Cl- are potential risk factors of delirium.

OBJECTIVE:To improve the work quality in Pharmacy intravenous admixture service(PIVAS). METHODS:The major working links of PIVAS(labeling and drug admixture)were optimized,the work efficiency and error before and after optimi-zation were compared. RESULTS:The work efficiency was improved and error was decreased by adding logo and adjusting work range of personnel when labeling and improving distribution principles of drugs to be allocated in horizontal laminar flow table when drug admixture;compared with before,the labeling time for each bag decreased from(2.69±0.17)s to(2.19±0.08)s,to-tal time for admixture decreased from (104 ± 2) min to (83 ± 2) min,error rate of drug admixture decreased from 0.34% to 0.16%. CONCLUSIONS:The optimized work flow had improved the work quality of PIVAS.

The incidence and its growth rate of hypertension are both very high. Its pathology and pathogenesis are complex and unclear,and it does serious harm to human health. Hypertension remains incurable. Chemical medicine has good effect on hypertension,but life-long application and multi-drug combination are required,with significant adverse reactions. Also,complications can′t be effectively alleviated. Traditional Chinese medicine (TCM)guided by traditional theories,can lower blood pressure,improve metabolic abnormalities and reduce complications. Its advantages or potentials have not been fully exploited and clinical application is inadequate. Metabolic hypertension has become the main form of hypertension,and its formation mechanism is mainly related to metabolic abnormalities and insulin resistance,metabolic inflammation and other pathology and pathogenesis. A better understanding of the current status of antihypertensive pharmacology of TCM,especially devel?opment and application of metabolic hypertension models is of great significance for TCM treatment of hypertension,and for exploration of new approaches to hypertension.

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Objective To evaluate the effects of aerobic combined strength and balance exercise on cognitive function and satisfaction in patients with cognitive impairment no dementia. Methods Four hundred and twenty patients with cognitive impairment no dementia were divided into control group (200 cases) and experimental group (220 cases) by random digits table method. The control group received general health education and rehabilitation training. The experimental group received aerobic combined strength and balance exercise. The patients were assessed with Montreal Cognitive Assessment (MoCA) to evaluate their cognition before training, as well as after training. And the patients′satisfaction with the questionnaire was evaluated. Results The total scores of MoCA, scores of name, attention, language, memory and directionafter training were (23.47 ±2.38), (2.77 ±0.42), (5.09 ±0.86), (2.50 ±0.65), (3.42 ±0.68), (5.03 ± 0.10) points in the experimental group, and (21.20±2.55), (2.31±0.76), (4.71±1.10), (2.35±0.70), (2.23±0.81), (4.48±0.96) points in the control group, and there were significant differences, P<0.05. There were no significant differences in the space and abstract thinking between experimental group and control group:(3.61±0.91) points vs. (3.45±1.09) points, (1.83±0.76 ) points vs. (1.72±0.52) points, P>0.05. The scores of satisfaction in the experimental group was significantly higher than that in the control group:(49.33 ±1.57) points vs. ( 48.20 ±2.14) points, P<0.01. Conclusion The application of aerobic combined strength and balance exercise could improve the cognitive function and patients′satisfaction.

Objective To investigate the influences of Xuebijing injection on organs' ultra-microstructure in septic shock rats. Methods Fifteen male Sprague-Dawley (SD) rats of clean grade were selected. According to the method of random digits table, all of them were divided into three groups: sham operation group, model group and Xuebijing treated group, 5 rats being in each group. Cecal ligation and puncture (CLP) was adopted to reproduce abdominal cavity infection leading to sepsis model formation. While the rats in sham operation group just underwent abdominal median incision, abdominal exploration and closure of abdominal wall after flipping retrocecal region. In the Xuebijing treated group, within 1 hour after the operation, Xuebijing injection (4 mL/kg) was transfused through the catheter inserted in the femoral vein, and then normal saline (2 mL·kg-1·h-1) was continuously transfused until the rat being sacrificed. In the sham operation group and model group, equal volume of normal saline was given after operation. The blood pressure of all the rats was monitored continuously by a pressure device connected with a catheter inserted in the right carotid artery. The rats were observed for 12 hours, afterwards they were sacrificed, the samples of heart, lung, kidney and liver were taken, and their ultrastructural changes were observed under an electron microscope. Results The blood pressure of sham operation group was decreased a little with time extension, but within normal limits. The mean arterial pressure (MAP) of model group and Xuebijing treated group developed into a state of sepsis shock at 9 hours and 10 hours after operation respectively, and MAP were lower than 70 mmHg (1 mmHg=0.133 kPa). The MAP levels of model and Xuebijing groups at 11 hours after operation were lower significantly than those of sham operation group (mmHg:58.7±7.0, 58.7±8.3 vs. 91.0±8.2, both P<0.01), and they were persistently decreased at 12 hours after operation;the MAP in Xuebijing group was a little higher than that of model group at the same period (mmHg:55.4±4.0 vs. 48.8±12.9, P>0.05). The results of the observation with electron microscope:the structures of heart, lung, liver and kidney in sham operation group were basically normal;all the organs of model group appeared different degrees of structural damage. Compared with model group, the injury of heart and lung in Xuebijing treated group was milder, especially, the changes of cellular mitochondria were obvious;however, there was no significant difference in injury of kidney and liver between the model and Xuebijing treated groups. Conclusion Xuebijing injection can play a certain role in stabilizing the circulatory system in rats with septic shock, and can possibly ameliorate the heart and lung damage caused by infection and shock.