Objective To investigate the main symptoms and the health care consciousness of the menopausal women.Methods From Jul.2013 to Oct.2014,a one-on-one,face-to-face questionnaire was conducted in selected menopausal women in Gynecology Clinic of the Second Affiliated Hospital of Chongqing Medical University.Results There were 583 valid questionnaires overall.349 women had natural menopause,and the average age was(48.7±3.4) years.66.72％ women appeared menstrual disorders in premenopausal stage,presenting longer cycle and fewer menstrual quantity.82.50％ (481/583) women had menopausal symptoms,with hot flashes (57.46％,335/583) as the most,followed by insomnia (50.60％,295/583).Kupperman score showed 7.03％ (41/583)patients were the severe degree.Among the patients with menopausal symptoms,234 cases went to menopause clinics on their own initiative and 36 cases visited other department first and then transferred to menopause clinics.Among patients with college or above degree,51.27％ (101/197)received menopausal hormone therapy (MHT),significantly higher than those with poor educational background.Conclusion Vasomotor symptoms such as hot flashes were still the main symptoms of menopausal syndrome.Although some menopausal patients had intentions to seek medical care by themselves,there sre still some patients lacking health care consciousness,which is more commonly seen in patients with lower level of education.Menopausal education promotion is needed.

Objective To study the relationship between the medial artery calcification and expression of core-binding factor alpha 1 (Cbf α-1) and collagen Ⅱ (Col Ⅱ) in chronic kidney disease (CKD) stage 5 patients.Methods Pieces of radial arteries were taken from 40 patients with CKD stage 5 during internal arteriovenous fistula operation.Ten patients with subtotal gastrectomy and normal renal function were chosen as control.The vessels were examined for calcification by von Kossa stain and for the presence of Cbfα-1 and Col Ⅱ by immunohistochemistry.According to von Kossa stain,CKD stage 5 patients were divided into no calcification group,mild-moderate calcification group and severe calcification group.Other related factors including serum calcium,phosphate,intact parathyroid hormone (iPTH),C-reactive protein (CRP),triglyceride(TG),cholesterol(TC) and lowdensity lipoproteins(LDL) were also detected.Results Seventeen (42.5％) of CKD Stage 5 patients showed vascular calcification,while calcification was not found in controls.Most calcification occurred in medial layer.Positive immunohistochemical staining of core-binding factor and Col Ⅱ was found in the smooth muscular cell plasma of medial layer in the vessels with calcification.However,above positive staining was also observed in 78.3％ of no calcification group.But there was little staining in control group.Positive staining score of Cbfα-1 and Col Ⅱ in severe calcification group was significantly higher than that in no calcification group.Same findings were obtained in mild-moderate calcification group,but the difference between them was not statistically significant.CRP and Ca × P were positively correlated with staining score of Cbfα-1 and Col Ⅱ.Serum phosphate was positively correlated with Cbfα-1 (r=0.786,P＜0.01) and Col Ⅱ (r=0.785,P＜0.01) respectively.Conclusions 42.5％ of CKD stage 5 patients in our group shows vascular calcification,which occurrs mainly in medial layer.High expression of Cbfα-1 and Col Ⅱ can be observed in vascular calcification of radial arteries,which is earlier than vascular histological changes.Cbfα-1 and Col Ⅱ may be involved in the development of vascular calcification.

BACKGROUNDTo investigate the clinical characteristics and diagnosis of lung cancer with paraneoplastic syndrome as initial symptom.

METHODSThe clinical data of 168 cases of lung cancer with paraneoplastic syndrome as initial symptom were analysed from Jan. 1990, to Nov. 2002, in the hospital.

RESULTS(1) Among the patients with lung cancer in the hospital, 11.8% (168/1 426) had paraneoplastic syndrome as initial symptom. The ratio of male to female was 4.25:1. There were 138 cases aged above 45 (82.1%) and 116 with smoking history (69.0%). (2)There were 62 cases of small cell lung cancer (36.9%) and 102 non small cell lung cancer (60.7%) and 4 carcinoid (2.4%). Thirty-three cases (37.5%) were central type and 82 (48.8%) peripheral type and 23 (13.7%) diffuse type. (3) The patients with paraneoplastic syndrome included: 48 cases of osteoarthopathy (28.6%), 27 cachexia (16.1%), 23 cancerous fever (13.7%), 14 myasthenia (8.3%), 12 vegetative nerve hyperfunction (7.1%), 11 cerebellar cortex degeneration (6.5%), 9 acanthosis nigricans (5.4%), 8 cutaneous pigmentation (4.8%), 7 dermatomyositis (4.2%), 5 encephalopathy (3.0%), and 4 gynecomastia (2.4%). (4)The misdiagnosis rate of the first consultation was 44.6% (75/168). (5)Initial chest X-ray positive rate was 61.9% (104/168); initial CT positive rate was 78.6% (132/168). (6)One hundred and thirty-two cases accepted the treatment of lung cancer: 32 cases accepted pure operation, 8 cases accepted pure chemotherapy, 35 cases accepted operation and chemotherapy, 39 cases accepted chemotherapy and radiotherapy, 18 cases accepted operation and chemotherapy and radiotherapy. Totally 8 cases were dead and 17 cases had abandoned treatment. One hundred and seven cases had improvement after complex treatment of lung cancer, including 83 cases with improvement or disappearance of paraneoplastic syndrome, 18 cases with no change, and 6 cases exacerbated.

CONCLUSIONSThe lung cancer with paraneoplastic syndrome as initial symptom is difficult to diagnose because of its latent onset. The knowledge of paraneoplastic syndrome should be improved, chst X-ray or CT examination should be done for the high risk group of lung cancer with paraneoplastic syndrome, and these strategies could decrease misdiagnosis rate and increase diagnosis rate of lung cancer in early stage.

Objective:To establish the content of training courses for infusion therapy specialist nurses, and evaluate the implementation effect of the course, so as to provide a theoretical reference for the training of infusion therapy specialist nurses.Methods:Based on the preliminary investigation research on the needs of nurses for the training of intravenous therapy knowledge, the Delphi method was used to determine the training content of 6 modules and 62 projects. From March to May and from September to November 2019, two training sessions were carried out at the vascular access technology training base in Hunan Province. A total of 97 nurses from 84 hospitals participated in and completed the theoretical and practical courses, and the number of students in the two training sessions were 46 and 51 respectively. The learning effect of the students was understood with the pass rate of the staged assessment, the pass rate of the graduation assessment and the self-evaluation questionnaire.Results:The 97 students' self-evaluation of the mastery of learning content was 3.30 to 5.00. In the staged assessment, the theoretical score was (87.50±4.48) , the peripherally inserted central catheter (PICC) maintenance operation score was (86.25±5.62) , the infusion port maintenance score was (89.50±6.25) , and the PICC catheterization operation score was (84.42±4.13) . The qualification rate of theoretical and operational assessment was both 100.0%. In the graduation assessment, 97 students all completed the graduation assessment requirements, a total of 4 941 indwelling needles were successfully placed, 509 PICCs were successfully placed, and 97 small lectures were completed. The graduation assessment pass rate was 100.0%.Conclusions:This course has a high degree of expert positivity, expert authority and coordination of expert opinions, and the curriculum setting is scientific. The training course promotes the students' mastery of the specialized knowledge theory and practical skills of intravenous therapy, and can provide a theoretical basis for the training of intravenous therapy specialist nurses in my country.

Objective? To investigate the current situation of intravenous therapy in 38 ClassⅡ and above hospitals in Hu'nan Province and analyze the existing problems. Methods? A questionnaire survey was conducted in 38 hospitals in Hu'nan Province in November 2018 using the Nursing Situation of Intravenous Therapy in Hospitals at All Levels designed by the Professional Committee of Intravenous Therapy and Chinese Nursing Association. To understand the status quo of intravenous therapy, quality management of intravenous therapy, and the status of specialist nurses in intravenous therapy. Results? In 38 hospitals, totally 36 hospitals provided continuous intravenous therapy services through intravenous therapy/peripherally inserted central catheter (PICC) clinics and a designated hospital department; 21 hospitals had established intravenous therapy/PICC clinics; the outpatient service was flexible in form, but the qualification certification of outpatient nurses needed further regulation. The proportion of hospitals carrying out medium and long-term catheter infusion and hospitals carrying out PICC transfusion with Modified Sedinger Technique (MST) puncture guided by ultrasound was 100.00% and 72.22%, respectively. In vascular visualization technology, hospitals using infrared, ultrasound and X-ray technology were 2.63%, 63.16% and 34.21% respectively. There were some gaps in the skin disinfectant and disinfection scope, concentration of flushing and sealing fluid and maintenance frequency between the hospitals and the national standards in peripheral and central venipuncture and catheter maintenance. In terms of quality management of intravenous therapy, 34 hospitals had established intravenous therapy teams, whose quality evaluation criteria are different. In terms of specialist nurses team construction, there were 505 specialist nurses in venous therapy/PICC in 38 hospitals. The structure of specialist nurses had been continuously optimized in terms of education, title and length of service. However, hospitals needed to pay more attention to the development of specialist nurses. Conclusions? The contents of continuous nursing of intravenous therapy need to be further expanded, the management of PICC clinic needs to be strengthened, the standardized use of infusion devices and connectors needs to be improved, the knowledge and practice gap between puncture nursing and catheter maintenance of intravenous therapy exists, and the quality control standards of hospitals need to be standardized and regulated, more attention should be paid to the development of specialist nurses.

Objective:To explore the effect of healthcare failure mode and effect analysis (HFMEA) management mode on perioperative nursing quality of cancer patients at arm infusion port.Methods:Using the convenient sampling, 68 cancer patients with arm infusion port in Hunan Cancer Hospital from January to October 2020 were selected as the control group, and 84 cancer patients with arm infusion port from November 2020 to August 2021 were selected as the intervention group. The control group followed the hospital's original perioperative safety management of chest wall port and peripherally inserted central catheter (PICC) insertion, while the intervention group adopted the HFMEA management mode for the perioperative safety management of arm infusion port. The risk priority number (RPN) , the occurrence of high-risk failure modes and complications of the two groups were compared.Results:The RPN values of failure modes such as inadequate preoperative evaluation, loss of intraoperative accessories, low puncture position, too short catheter clipping, loose connection between catheter and injection base, catheter positioning after incision suture, and insufficient postoperative health education in the intervention group were lower than those in the control group, with statistical differences ( P<0.05) . The incidence of inadequate preoperative evaluation, inadequate postoperative health education and postoperative complications in the intervention group were statistically lower than those in the control group ( P<0.05) . Conclusions:The HFMEA management mode can reduce the risk of perioperative links of cancer patients at arm infusion port and decrease the incidence of postoperative complications, which is worthy of clinical promotion.

Objective To evaluate the effects of"PICC fixed standard operation flow chart"in PICC fixed quality management. Methods Patients with PICC were admitted to the control group from January to June in 2014, given the routine PICC fixed method. PICC patients in the observation group who were enrolled from July to December 2014 were given new PICC fixed method that obey the"PICC fixed standard operation flow chart", which was established from relevant norms and guidelines and related literature. The incidence rate of medical adhesive related skin injury and unplanned extubation of PICC were compared with those of the two groups. Results The incidence rate of medical adhesive related skin injury was decreased from 35.20％(70034/198962) to 18.03％(37862/209955) (Z=-3.363, P<0.01) and PICC unplanned extubation decreased from 1.31‰(20/15384) to 0.37‰(7/18919) , the difference was statistically significant (χ2=6.940, P<0.05). Conclusions The PICC fixed standard operating flow chart can be used as a guide to implement the PICC fixation. Based on this, the quantitative management index is applied to the PICC fixed quality management, which can standardize the fixation of the PICC , reduce the related complications caused by the fixation of the catheter, prevent the occurrence of unplanned extubation of PICC , provide effective protection to ensure safe PICC long-term use and improve the patient's comfort.

Objective: To explore the safety management of implantable venous infusion port, prevent and reduce the occurrence of catheter rupture and other related complications, and implement effective treatment measures after occurrence. Methods: A patient with an implantable venous transfusion port suffered from complete rupture of the catheter outside the hospital. Under multidisciplinary consultation, the condition of the catheter inside the port was clarified, and a safe treatment plan was worked out. The multidisciplinary venous transfusion treatment team cooperated with each other to correctly implement the capture, catching and nursing in vivo. Results: With the cooperation of multidisciplinary team, the broken port and catheter were successfully and safely removed without any discomfort. Conclusions Establishing a multi-disciplinary cooperation mechanism, standardizing the quality control of implantation in infusion port, popularizing the knowledge of post-implantation maintenance and implementing the safety management of infusion port can ensure the safe and long-term application of implanted intravenous infusion port.