Professor Liu Shenlin is one of the famous traditional Chinese medicine (TCM) oncologists. Through his own experience in clinical practice , Prof . Liu has put forward the theory that the onset of gastric cancer is based on spleen deficiency , and presented with cancerous toxin , namely the theory of spleen-deficiency and toxin-accumulation. In addition , he had conducted clinical as well as basic research on this theory , which had received great progress. This article was aimed to conclude and explore the theory postulated by Prof. Liu in order to improve the clinical effects of TCM treatment in gastric cancer .

Currently,three predominant subtypes of influenza virus are prevalent in pig populations worldwide:H1N1,H3N2,and H1N2.European avian-like H1N1 viruses,which were initially detected in European pig populations in 1979,have been circulating in pigs in eastern China since 2007.In this study,six influenza A viruses were isolated from 60 swine lung samples collected from January to April 2011 in eastern China.Based on whole genome sequencing,molecular characteristics of two isolates were determined.Phylogenetic analysis showed the eight genes of the two isolates were closely related to those of the avian-like H1N1 viruses circulating in pig populations,especially similar to those found in China.Four potential glycosylation sites were observed at positions 13,26,198,277 in the HA1 proteins of the two isolates.Due to the presence of a stop codon at codon 12,the isolates contained truncated PB1-F2 proteins.In this study,the isolates contained 591Q,627E and 701N in the polymerase subunit PB2,which had been shown to be determinants of virulence and host adaptation.The isolates also had a D rather than E at position 92 of the NS1,a marker of mammalian adaptation.Both isolates contained the GPKV motif at the PDZ ligand domain of the 3' end of the NS1,a characteristic marker of the European avian-like swine viruses since about 1999,which is distinct from those of avian,human and classical swine viruses.The M2 proteins of the isolates have the mutation (S31N),a characteristic marker of the European avian-like swine viruses since about 1987,which may confer resistance to amantadine and rimantadine antivirals.Our findings further emphasize the importance of surveillance on the genetic diversity of influenza A viruses in pigs,and raise more concerns about the occurrence of cross-species transmission events.

Objective:To understand the current situation and demand of intracavity electrocardiographic positioning technique training for PICC specialist nurses in Shandong Province, and provide a reference for further improving and improving the training of PICC specialist nurses.Methods:From July 7-23, 2019, a total of 903 PICC specialist nurses in Shandong Province were selected by the convenience sampling method. The nurses were investigated by the self-made general information questionnaire of PICC specialist nurses in Shandong Province and the training demand questionnaire of intracavity electrocardiographic positioning technique.Results:40.75% (368/903) PICC specialist nurses had participated in intracavity electrocardiographic positioning technique training; 84.27% (761/903) PICC specialist nurses thought it necessary to conduct intracavity electrocardiographic positioning technique training. PICC specialist nurses had various training on intracavity electrocardiographic positioning technique, the average content requirements were all above 4.67 points. The highest score of theoretical training content was the judgment of the relationship between catheter tip position and electrocardiogram P wave (4.80 ± 0.47), and the highest score of operation training content was the intracavitary electrocardiography guided PICC catheterization (4.74 ± 0.55). 94.24%(851/903) PICC specialist nurses hoped to achieve the goal of improving clinical nursing practice ability through intracavity electrocardiographic positioning technique training. Intravenous therapy specialist academic conference was the main hoped training form(76.85%, 694/903). Multiple regression analysis showed that the number of years of catheterization, job position and understanding of the technology were the influencing factors of PICC specialist nurses′ training needs for intracavity electrocardiographic positioning technique ( t = -3.73,3.12, -3.63, all P<0.05). Conclusions:The training rate of intracavity electrocardiographic positioning technique was low, but PICC specialist nurses had higher training requirements for intracavity electrocardiographic positioning technique. Managers should pay attention to the training of intracavity electrocardiographic positioning technique, and develop targeted training programs to further improve the clinical practice capabilities of the PICC specialist nursing team.

Objective To explore the real user experiences of patients with PICC catheter for PICC maintenance network in Shandong province.Methods Descriptive phenomenological methodology was adopted in this study.A semi-structured interview was conducted with 18 patients of PICC-line maintained in different hospitals from PICC maintenance network in Shandong province.We analysed the data by Colaizzi's phenomenological research method.Results The experiences of patients with PICC catheter for PICC maintenance network in Shandong province contain positive and negative aspects.The positive aspects were convenient medical treatment,cooperation in various level hospitals,progress of basic hospitals,and enthusiastic services;the negative aspects were personnel shortage,different levels of nurses and imperfect supporting system.Conclusions Patients with PICC maintenance network possessed positive experience,but the accessibility of PICC maintenance network should be further enhanced,specialized development should be promoted.Meanwhile,for the questions proposed by patients,some measures should be taken to improve the overall PICC maintenance service from various level hospitals in Shandong province and make the experience of patients better.These measures include strengthening the standardized training and quality control of PICC,improving the supporting system,and promoting the implementation of continuous nursing mode in the primary hospitals.

Objective: To explore the status of care quality evaluation in the built-in type institution that integrating pension and health care service and analyze the focus on nursing service and management,it aims to provide theoretical basis for nurse managers to implement scientific nursing management. Methods: Descriptive phenomenological methodology was adopted in this study,a semi-structured interview was conducted with 8 nurse managers from 7 built-in type institutions that integrating pension and health care service.Data were analyzed based on Colaizzi′ s phenomenological research method. Results: Two themes were extracted, including the status of care quality evaluation in the built-in type institution that integrating pension and health care service; key indicators of nursing quality in the built-in type institution that integrating pension and health care service. Conclusions Through in-depth interviews with 8 nurse managers, we suggest that state should attach importance to the quality inspection of nursing care in the built-in type institution that integrating pension and health care service, and explore the evaluation criteria for nursing quality,in order to ensure the safety of elderly care, and it also can provide a basis for the comparison between inter-agency nursing quality and promote healthy competition among institutions.

Objective:To investigate the status quo of a mobile nursing application acceptance of nurses, and analyze the influencing factors, so as to promote the application of a mobile nursing APP in clinic.Methods:On the principle of convenience sampling, 1207 participants from Shandong province were recruited to complete the self-designed questionnaire, including demographic data, smartphone use behavior and acceptance evaluation of the mobile nursing APP.Results:Average score of nurses' acceptance of a mobile nursing APP was 4.16±0.69. Multiple regression results showed that duty, use experience, recognition, smartphone self-efficacy and daily use time were the main factors affecting the acceptance of a mobile nursing APP for nurses ( t value was -7.132-22.678, P<0.05 or 0.01) and explained 39.1% of the total variation of the acceptance of mobile nursing app ( P<0.01). Conclusions:The acceptability of mobile nursing APP of clinical nurses is at a medium and high level, and it is influenced by the use experience, smartphone self-efficacy and other aspects, suggesting that nursing managers attach importance to the behavioral differences of nurses in using a mobile nursing APP.

Objective? To understand the work experience of PICC nurse specialists in using intracavitary electrocardiogram for PICC placement, so as to provide a reference for further promoting and standardizing of the intracavitary electrocardiogram method. Methods? From October 2018 to February 2019, the PICC nurse specialists from 5 Class Two and 16 Class Three hospitals which developed intracavitary electrocardiogram guided PICC in Shandong Province were selected by purposive sampling method as interveiwees. A qualitative phenomenological study was used to conduct semi-structured interviews with 21 PICC specialist nurses. Colaizzi's seven-step analysis method was used to analyze the data. Results? Three themes were identified:a method that "makes your mind at rest", difficulties met in work, growth and learn. The intracavitary electrocardiogram method effectively promoted PICC placement and released pressure of nurse specialists. Nurse practitioners will experience hardship at the beginning of using the intracavitary electrocardiogram method. As they gradually became skilled and came across difficulties, they would experience development personally and professionally. Conclusions? The intracavitary electrocardiogram method can benefit PICC nurse specialists both in their profession and career identity. However, the PICC nurse will face difficulties from different aspects while using this method. It is necessary to support better training courses and standardized management for the extension of intracavitary electrocardiogram method, promoting the promotion and application of new technologies.

Objective:To understand the practice status of intracavitary electrocardiography (ECG) -guided peripherally inserted central catheter (PICC) placement in Shandong Province, so as to provide a reference for promoting the application of intracavitary ECG positioning technology, carrying out systematic training and formulating standardized intracavitary ECG-guided PICC placement procedures.Methods:From July to August 2019, convenience sampling was used to select 1 034 PICC specialist nurses from 258 hospitals in Shandong Province as the research object. The self-designed questionnaire Survey Questionnaire on the Practice Status Quo of Intracavitary ECG-guided PICC Placement in Shandong Province was used to investigate the practice status of the intracavitary ECG-guided PICC placement by PICC specialist nurses in Shandong Province. A total of 1 034 questionnaires were returned, and 903 valid questionnaires were collected, with a valid rate of 87.33%.Results:Among the 903 PICC specialist nurses, 835 (92.47%) of the nurses had learned about the intracavitary ECG-guided PICC placement, 368 (40.75%) had participated in the training of intracavitary ECG-guided PICC placement, and only 363 (40.20%) had used intracavitary ECG-guided PICC placement. Among 363 nurses who had used intracavitary ECG-guided PICC placement, 93.66% (340/363) evaluated the patient's body surface electrocardiogram before puncture, and 49.31% (179/363) believed that PICC was delivered when P wave was the highest, and the catheter was retreated when P wave appeared negative until the negative wave just disappear; 91.18% (331/363) thought that chest radiographs must be taken to locate the catheter tip after the application of intracavitary ECG-guided PICC placement.Conclusions:At present, the training, promotion and application of intracavitary ECG-guided PICC placement needs to be strengthened. There is an urgent need to develop a unified and standardized operation process for intracavitary ECG-guided PICC placement to improve the scientific and standardization of this application.

Objective: To explore the real experience of functional exercise after PICC operation. Methods: Phenomenological methods were used to conduct semi-structured interviews with 15 patients who had different functional exercises after PICC. Colaizzi phenomenological analysis was used to analyze the data. Results: Through interviews, four themes were drawn: the exercise characteristics of different postoperative functional exercise, the benefits of postoperative functional exercise, the obstacles to postoperative functional exercise and the suggestions for education related to postoperative functional exercise. Conclusion The patients with PICC think that the postoperative functional exercise is safe and practical, but the recognition and compliance of the postoperative functional exercise are still limited. It is suggested that appropriate training should be carried out among medical staff, so as to rationally select the way of postoperative functional exercise, further promote the application of postoperative functional exercise, and improve the compliance and experience of patients.