Objective To explore the effect of JiTT teaching-mode based on the Moodle on the undergraduate teaching of surgical nursing,and to reform the traditional undergraduate nurse teaching mode.Methods Totally 84 nursing undergraduates of Grade 2008 were randomized into the control group and the experimental group.The control group was given traditional teaching-oriented method,while the experimental group was applied JiTT teaching-mode based on the Moodle.Results In the experimental group,83.6％ recognized the JiTT teaching-mode,and 76.4％ felt satisfactory with the new teaching method.They thought the integrated check-up evaluation method and records distribution was more appropiiate.The nursing examination suggested that the average grade of the experimental group was significantly higher than the control group.In the experimental group,71.5％ thought the examination were less hard,though more study time was spending.6.7％ refused the new method because the higher requirement on the online study.78.4％ thought the in and out classroom study was more appropriate,it helped to cultivate the ability of the team work cooperation and the communication.Conclusions The JiTT teaching-mode based on the Moodle platform applying in the surgical nursing can construct an effective,communicative online course,stimulate the learning interest,cultivate the ability of exploration and cooperation,and also promote the learning revolution and high quality nurses cultivation.

Objective To investigate infection rate and susceptibility to antimicrobial agents of Mycoplasma urealyticum and Mycoplasma hominis in the genitourinary tract, and to provide a reference for clinical diagnosis and therapy. Methods Genitourinary secretions were collected with swabs. They were cultured with the diagnostic kit of Mycoplasma (Biomerieux Company) to detect M. urealyticum and M. hominis. Meanwhile the susceptibility of Mycoplasma against 9 antimicrobial agents was tested with the same kit. According to the manual of the kit, the results were read. The data were statistically analyzed with WHONET5.1 and SPSS. Results A total of 1 008 samples were collected, and the positive rate was 77.5%. Among 781 positive cases of Mycoplasma, 572 were M. urealyticum(56.0%), 40 were M. hominis (4.0%), and 169 were M. urealyticum combined with M. hominis (16.7%). The susceptibility rate of M. urealyticum to Doxycycline, Josamycin, Ofloxacin, Erythromycin, Tetracycline, Ciprofloxacin, Azithromycin, Clamycin and Pristinamycin was 89.3%, 95.1%, 17.5%, 64.3%, 84.1%, 14.8%, 77.8%, 90.8% and 96.5%, respectively. The susceptibility rate of M. hominis to the above drugs was 86.0%, 78.9%, 23.2%, 0, 73.2%, 57.1%, 0, 7.7% and 83.9%, respectively. The resistant rate of Mycoplasma to Azithromycin and Clamycin in 2004 was higher than that during the period of 2000 to 2003(P

Objective To understand the results and characteristics of targeted monitoring of healthcare-associated infection (HAI)in an intensive care unit (ICU)of a tumor hospital,so as to provide scientific basis for formulating measures of prevention and control of HAI.Methods Patients who admitted to an ICU from January to December 2013 were performed targeted monitoring,incidence of HAI was adjusted with an average severity of illness score (ASIS),three types of invasive procedure-related infection,distribution of pathogens,and multidrug-resistant or-ganisms were monitored.Results A total of 455 patients were monitored,the total patient-days were 2 483 days, 52 cases of HAI occurred,incidence of HAI was 11 .43%,incidence of HAI per 1 000 patient-days was 20.94‰,af-ter the adjustment with ASIS,incidence of HAI per 1 000 patient-days was 6.29‰.The main infection site was re-spiratory system(63.46%),followed by urinary system(19.23%);Incidence of ventilator-associated pneumonia per 1 000 ventilation-days,catheter-related bloodstream infection per 1 000 catheter-days,and catheter-associated urinary tract infection per 1 000 urinary catheter days were 12.08‰,0.95‰,and 4.07‰ respectively.A total of 181 path-ogenic isolates were detected,74.59% (n=135)of which were gram-negative bacteria,18.23%(n=33)were gram-positive bacteria,and 7.18%(n=13)were fungi;18.23%(n=33)were multidrug-resistant strains.Conclusion ICU is the high risk department of the occurrence of HAI,the main infection is respiratory tract infection,the major pathogen is gram-negative bacteria.Targeted monitoring can timely reflect the deficiency in infection control practice,is helpful for formula-ting effective prevention and intervention measures,and reducing the occurrence of HAI.

This paper reports an improved McAb-ELISA test in detecting blood stage P.vivax antigen in which the plates were coated with rabbit anti-P.cynomolgi poly-antibody and two monoclonal antibodies were used together for reaction. The coincidence rate with microscopically conformed P.vivax blood samples was 94.3% and the coincidence rate with microscopically negative blood samples was 96.1%. The sensitivity was over 1 parasite/106 erythrocytes.

Objective:To investigate the clinical application of cognitive behavioral therapy (CBT) and the reasons of the choosing CBT.Method:Totally 14 psychotherapists accepted a semi-structured interview,including their backgrounds of CBT training,the application of CBT in psychotherapy,their attitude toward consultative relations,their opinion on comparing other schools with CBT,and their reasons for choosing CBT.Results:The main reasons for choosing CBT included the influence of important others,the characters of CBT and personal factors.In clinical practice,the most commonly used behavioral techniques included exposure therapy,roll play,relaxation Waining and so on.The most commonly used cognitive techniques included Socratic questioning,cognitive restructuring and challenge unreasonable cognition.Conclusion:Cognitive behavioral therapy (CBT) is suitable for those who are sensible and preferring structural therapy.Nevertheless,the trend in therapy is the integration of different psychotherapy schools.

Objective:To investigate the serotype distribution and drug resistance of Streptococcus pneumoniae ( S. pneumoniae) isolated in Urumqi Children′s Hospital and to evaluate the significances of 13-valent pneumococcal conjugate vaccine (PCV13) in preventing infection and controlling drug resistance. Methods:The S. pneumoniae isolates stored in clinical laboratory of Urumqi Children′s Hospital from January to December in 2018 were re-cultured.The serotypes were detected by capsule swelling experiment to assess the coverage rate of PCV13.The minimum inhibitory concentration (MIC) of Penicillin, Amoxicillin, Cefotaxime and Ceftriaxone were detected by E-test method, and the susceptibility of the isolates to Meropenem and other 9 antibiotics was detected by VITEC 2 Compact system. Results:A total of 225 S. pneumoniae strains were identified.The common serotypes were 19F (32.9%), 23F (12.0%), 19A (10.7%), 6B (10.2%) and 6A (8.0%). PCV13 coverage rate was 80.4%.There was no significant difference in serotype distribution and PCV13 coverage between children < 2 years old and ≥ 2 years old, as well as between Han and minority people.The 57.8% and 31.7% strains showed intermediate susceptibility and resistance against oral Penicillin, respectively.Based on the breakpoints for meningitis, 89.4% strains were resistant against pare-nteral Penicillin, and 47.5% and 64.6% strains were non-susceptible (mainly intermediately susceptible) to Ceftria-xone and Cefotaxime, respectively.The resistance rates of strains against Erythromycin, Sulfamethoxazole-trimethoprim and Tetracycline were as high as 98.1%, 67.6% and 89.6%, respectively.More than 90% tested isolates were susceptible to Amoxicillin, Meropenem, Levofloxacin or Moxifloxacin.PCV13 strains were more resistant to Penicillin than non-PCV13 strains. Conclusions:The serotypes 19F, 23F, 19A, 6B and 6A are common among the S. pneumoniae isolated in Urumqi.The coverage rate of PCV13 is about 80%.There was no significant difference in serotype distribution between Han and minority nationality children. S. pneumoniae were frequently resistant against Erythromycin.The high resistance to Penicillin and other beta-lactams should be taken into account when treatment is decided for suspected pneumococcal meningitis.Universal administration of PCV13 would be effective strategy to prevent pneumococcal infection in children and to control the drug resistance of S. pneumoniae.

Objective:To investigate the related factors that affect the timing and prognosis of early tracheostomy in patients with multiple rib fractures.Methods:A retrospective case series study was conducted on medical data of 222 patients with multiple rib fractures who underwent tracheostomy in Affiliated Hospital of Yangzhou University from February 2013 to October 2019，including 160 males and 66 females，with the age of 18 to 85 years ［（49.5 ± 16.3）years］. According to the practice management guidelines for tracheostomy timing and the use of propensity score matching technology，there were 118 patients with tracheostomy within 7 days of tracheal intubation （early group） and 104 patients with tracheostomy after 7 days of tracheal intubation （late group） before matching，and there were 87 patients in early group and 87 patients in late group after matching. Data were compared between groups including the gender，age，underlying disease，injury severity score （ISS），Glasgow coma score （GCS），number of fractured ribs，total number of rib fractures （NTRF），first rib fracture，flail chest，traumatic brain injury，combined injuries （spine，maxillofacial，sternum），acute respiratory distress syndrome （ARDS），volume fraction of pulmonary contusion（VPC），blood lactic acid （within 24 hours of admission），hemothorax，pneumothorax，mechanical ventilation time，duration of tracheostomy，time from tracheal intubation to incision，length of hospital stay，length of stay in ICU，closed thoracic drainage，number of fiberoptic bronchoscopy，multi-drug resistant bacteria infection，ventilator-associated pneumonia，antibiotic use time，duration of sedative and analgesic drugs used and 28-day mortality. The multivariate Logistic regression analysis was used to predict independent risk factors for early tracheostomy. The Pearson method was used to compare the relationship between multiple factors. The receiver operating characteristic （ROC） curve was used to predict indicators that affect the prognosis of patients with early tracheostomy，and calculate the best cut-off value. The Kaplan-Meier single factor and COX multivariate survival were used to analyze the relevant factors affecting the 28-day mortality of patients.Results:（1） In early group，the NTRF，ARDS and VPC were higher than those in late group，and the time from tracheal intubation to incision and 28-day mortality rate were lower than those in late group （ P < 0.05），while the two groups showed no significant differences in the gender，age，underlying diseases and ISS （ P > 0.05）. （2） The multivariate Logistic regression analysis showed that there was statistical significance in NTRF （ OR = 1.775，95% CI 1.439-2.188），ARDS（ OR = 3.740，95% CI 1.441-9.711），VPC （ OR = 1.087，95% CI 1.052-1.124） （ P < 0.05）； the Pearson method analysis showed a significant correlation between VPC and NTRF （ r = 0.369， P < 0.05） and a low degree of correlation between ARDS and VPC （ r = 0.179， P < 0.05），but there was no significant correlation between ARDS and NTRF （ r = 0.132， P > 0.05）. （3） The ROC curve analysis showed that the area under the curve （AUC） of the VPC and NTRF ［AUC = 0.832 （95% CI 0.770-0.893），AUC = 0.804 （95% CI 0.740-0.868）］ were significantly higher than those of the number of rib fractures ［AUC = 0.437（95% CI 0.352-0.523），GCS ［AUC = 0.519 （95% CI 0.432-0.605）］ and ISS ［AUC = 0.484 （95% CI 0.398-0.571）］ （ P < 0.05）. After calculating the Yorden index，the best cut-off value for VPC was 23.9，and the best cut-off value for NTRF was 8.5. （4） The Kaplan-Meier single factor and multivariate COX model survival analysis showed that the 28-day survival ratio of patients with early tracheostomy was significantly better than that of late tracheostomy （ P < 0.05）. Conclusions:The NTRF，ADRS and VPC are independent risk factors for the timing and prognosis of early tracheostomy. There is a significant correlation between VPC and NTRF. The VPC ≥ 23.9% and or NTRF ≥ 8.5 can be used to predict early tracheostomy in patients with multiple rib fractures. Early tracheostomy may benefit the 28-day survival of patients with multiple rib fractures.