Objective:To summarize the clinical nursing practice of mitral valvuloplasty combined with coronary artery bypass grafting in a patient with hemophilia A who suffered acute mitral valve tendon rupture and coronary heart disease.Methods:Individualized care plans were developed for patients with hemophilia A who need mitral valvuloplasty and coronary artery bypass grafting. Nursing measures were conducted from anticoagulatiaon care, bleeding care, hypoxemia care, multimodal analgesic care, psychological care, discharge guidance and discharge follow-up.Results:After multidisciplinary comprehensive treatment and standardized, individualized nursing, the patient recovered well and discharged after surgery on the 13th day.Conclusions:Implement personalized anticoagulation programs and care for this patient's individual situation to ensure the patient's smooth perioperative period Effective implementation of various postoperative care measures to promote early recovery of patients and reduce the pain caused by the disease during their hospitalization, also to improve the patient's quality of life.

ObjectiveTo discuss the effect of preoperative psychological communication on psychological state of elderly patients before destined operation.Methods136 cases of elderly patients underwent elective operation were divided into the observation group and the control group with 68 cases in each group,the control group was given routine nursing of general surgery,the observation group received targeted psychological communication based upon routine nursing for consecutive 3 days before surgery.The psychological state such as anxiety,depression and fear was compared between two groups.ResultsThe anxiety,depression and fear in the observation group was significantly improved compared with the control group.ConclusionsPreoperative appropriate and targeted psychological communication can alleviate the anxiety,depression and fear of the elderly patients with elective operation,and contribute to the smooth operation.

Objective:To construct an evaluation index system for the quality of hospice care services, so as to provide scientific basis for evaluating the clinical practice quality of hospice care in China.Methods:Based on theories related to medical quality, a primary item pool was constructed through literature analysis. From November to December 2023, the Delphi method was used to conduct two rounds of consultation with 18 hospice care experts from 10 provinces and municipalities directly under the central government, to establish the indicators at all levels of the evaluation index system. The weights and combination weights of indicators at all levels were calculated using the analytic hierarchy process. The expert's positive coefficient was expressed as the effective response rate of the questionnaire. The degree of expert authority was expressed as the expert authority coefficient. The degree of coordination of expert opinions was represented by Kendall's W and coefficient of variation. Results:In the two rounds of expert consultation, the effective response rates of the questionnaires were 88.89% (16/18) and 93.75% (15/16), the expert authority coefficients were 0.885 and 0.897, the kendall's W values of the overall indicators were 0.152 and 0.191 ( P<0.01), and the coefficients of variation of indicators at all levels were 0 to 0.31 and 0 to 0.21, respectively. The final constructed evaluation index system for the quality of hospice care services included seven first level indicators, 22 second level indicators, and 42 third level indicators. Conclusions:The evaluation index system for the quality of hospice care services constructed is scientific, comprehensive, and targeted, which can provide reference for the comprehensive evaluation of hospice care service quality in China.

Pain is one of the most common and unendurable symptoms in cancer patients and a major factor affecting their quality of life.Patient-controlled analgesia(PCA) is an important palliative measure in additional to conventional pharmacological control of pain.Nurses play the primary role in the management of PCA for cancer pain, and their knowledge, attitude and practice about PCA for cancer pain directly affect the effectiveness of cancer pain management.This article summarizes and analyzes the current status of nurses' knowledge, attitude and practice and associated influencing factors, aiming to improve nursing management of PCA, reinforce specialized nursing training, propose recommendations for an expert consensus on PCA for cancer pain and provide a reference for nursing practice in PCA for cancer pain.

Objective To test the reliability and validity of Meaningful Life Measure-Chinese Revised (MLM-CR) in Chinese college students. Methods A total of 1035 college students were evaluated with MLM-CR, Satisfaction with Life Scale (SWLS), Purpose in Life (PIL) and Patient Health Questionnaire-2 (PHQ-2), and 120 of the students were examined with PIL-SF twice. Result All the items in MLM-CR had good discrimination indexes (r=0.753-0.838, P<0.001). Confirmatory factor analysis confirmed the hypothesized five-factor model of MLM-CR (χ2/df=3.4, GFI=0.946, AGFI=0.924, RMR=0.069, NFI=0.953, CFI=0.966, RMSEA=0.048). The total internal consistency reliability of MLM-CR was 0.942, and the alpha coefficients of the 5 dimensions ranged from 0.782 to 0.877;the total split-half reliability was 0.920, and the split-half reliability of the 5 dimensions ranged from 0.752 to 0.830;the total test-retest reliability was 0.871, and the test-retest reliability of the 5 dimensions ranged from 0.783 to 0.805. The criterion validity of MLM-CR in correlation with SWLS, PIL and PHQ-2 was 0.66, 0.755 and-0.388, respectively (P<0.01). The Average score of MLM-CR of the college students was 5.20 ± 0.90, and the scores were significantly higher in female students than in the male students (P<0.001). Conclusion MLM-CR has good psychometric properties for application in comprehensive evaluation of personal meaning in life.

Objective To test the reliability and validity of Meaningful Life Measure-Chinese Revised (MLM-CR) in Chinese college students. Methods A total of 1035 college students were evaluated with MLM-CR, Satisfaction with Life Scale (SWLS), Purpose in Life (PIL) and Patient Health Questionnaire-2 (PHQ-2), and 120 of the students were examined with PIL-SF twice. Result All the items in MLM-CR had good discrimination indexes (r=0.753-0.838, P<0.001). Confirmatory factor analysis confirmed the hypothesized five-factor model of MLM-CR (χ2/df=3.4, GFI=0.946, AGFI=0.924, RMR=0.069, NFI=0.953, CFI=0.966, RMSEA=0.048). The total internal consistency reliability of MLM-CR was 0.942, and the alpha coefficients of the 5 dimensions ranged from 0.782 to 0.877;the total split-half reliability was 0.920, and the split-half reliability of the 5 dimensions ranged from 0.752 to 0.830;the total test-retest reliability was 0.871, and the test-retest reliability of the 5 dimensions ranged from 0.783 to 0.805. The criterion validity of MLM-CR in correlation with SWLS, PIL and PHQ-2 was 0.66, 0.755 and-0.388, respectively (P<0.01). The Average score of MLM-CR of the college students was 5.20 ± 0.90, and the scores were significantly higher in female students than in the male students (P<0.001). Conclusion MLM-CR has good psychometric properties for application in comprehensive evaluation of personal meaning in life.

Background Air pollutants PM_2.5 and its adsorbed metal elements are important factors affecting public health. Objective To explore the distribution characteristics and sources of metal elements in atmospheric PM_2.5 in Lanzhou from 2019 to 2020, and to assess the health risks of metal elements to different groups of residents through inhalation. Methods From January 2019 to December 2020 in two districts of Lanzhou City (Chengguan District and Xigu District), regular PM_2.5 and metal elements [antimony (Sb), aluminum (Al), arsenic (As), beryllium (Be), cadmium (Cd), chromium (Cr), mercury (Hg), lead (Pb), manganese (Mn), nickel (Ni), selenium (Se), and thallium (Tl)] were regularly monitored, and their concentrations were described by the median (M) and 25^th and 75^th percentiles (P₂₅, P₇₅) as not following a normal distribution (because the detection rates of the five elements Be, Cr, Hg, Ni, and Se were less than 70%, the five elements were not included in subsequent analysis), and then compared with the secondary concentration limits in the Ambient Air Quality Standards (GB 3095-2012). The differences between the medians of the two groups were compared by the Mann-Whitney U rank sum test, and the differences among the medians of multiple groups were compared by the Kruskal-Wallis H rank sum test; the enrichment factor (EF) method and principal component analysis were used to evaluate the pollution degree of the metals and their sources; the health risks of five non-carcinogenic metals (Sb, Al, Pb, Mn, and Tl) and two carcinogenic metals (As and Cd) in PM_2.5 were evaluated by hazard index (HI) and hazard quotient (HQ) using the incremental lifetime cancer risk (LCR) model and the non-carcinogenic risk assessment model, respectively. Results The PM_2.5 concentrations [M (P₂₅, P₇₅)] in Lanzhou City were 38.50 (26.00, 65.00) and 41.00 (29.00, 63.10) μg·m⁻³ in 2019 and 2020, respectively, and the difference was not statistically significant (Z=−0.989, P > 0.05). The average levels of the metal elements from high to low were: Al > Pb > Mn > As > Cd > Sb > Tl, and the annual average concentration of each metal element in 2019 was higher than that in 2020 (P<0.05). The M ( P₂₅, P₇₅) of PM_2.5 concentrations in Chengguan and Xigu districts were 52.98 (17.00, 61.00) and 55.40 (17.00, 67.00) μg·m⁻³, respectively, with no statistically significant differences (P<0.05); the concentrations of Sb and Al in Chengguan District were lower than those in Xigu District (P<0.05), and the concentrations of other metal elements were not different between the two areas (P>0.05). There were seasonal differences in the concentrations of PM_2.5 and seven metal elements in Lanzhou City (except P_Al=0.007, the other P_s < 0.001). The results of the enrichment factor method showed that the EF values of the six metals (Sb, Al, As, Cd, Pb and Tl) were all greater than 1. Among them, except As, the EF values of other metal elements were all greater than 10, and the EF values of Al and Cd were both greater than 100. The results of principal component analysis showed that the variance contributions of the three principal components were 45.61%, 24.22%, and 14.42%, and the cumulative contribution reached 84.25%. The principal component 1 included Pb, As, Cd, and Sb, the principal component 2 included Al and Mn, and the principal component 3 contained Tl. The non-carcinogenic risks of the five metals were, in descending order, Al > Mn > Pb > Tl > Sb, among which the HQ values of the remaining four metals were less than 1 for adults and children, except the HQ value of Al for adults, which was greater than 1. The ILC values of carcinogenic metal As for adult males, adult females, and children were 2.68×10⁻⁵, 2.51×10⁻⁵, and 1.45×10⁻⁵, respectively; the ILC values of carcinogenic metal Cd for adult males, adult females, and children were 1.53×10⁻⁶, 1.43×10⁻⁶, and 8.26×10⁻⁷, respectively. Conclusion There is pollution of atmospheric PM_2.5 and its adsorbed metal elements in Lanzhou. As and Cd elements may pose potential carcinogenic risks to the residents.

Background Polycyclic aromatic hydrocarbons (PAHs) are one of the most widely distributed and harmful organic pollutants in the atmosphere. Objective To investigate the distribution characteristics and composition sources of PAHs in the atmosphere of two districts of Lanzhou from 2019 to 2020 and evaluate the health risks of PAHs via inhalation to different populations. Methods The PAHs concentrations in two urban areas (Chengguan District and Xigu District) of Lanzhou City from January 2019 to December 2020 were regularly monitored. Mann-Whitney U test was used to compare differences in target pollutant concentrations between the two areas. Diagnostic ratio method and principal component analysis were adopted for source identification. Incremental lifetime cancer risk (ILCR) model was applied to evaluate the health risks of PAHs. Results The M (P₂₅, P₇₅) PAHs concentrations in Chengguan District and Xigu District were 24.04 (14.59, 41.81) ng·m⁻³ and 25.97 (18.59, 42.56) ng·m⁻³, respectively, with no significant difference (Z=−0.970, P>0.05). As to seasonal distribution, most PAHs monomer concentrations in Chengguan District were higher than those in Xigu District in summer, and the concentrations of benzo[a]anthracene and benzo[g,h,i]perylene in Chengguan District were also higher than those in Xigu District in spring and autumn (P<0.05), but there were no significant differences in PAHs monomer concentrations between the two urban areas in winter (P>0.05). Ring number of PAHs exhibited seasonal fluctuations. In winter and spring, the highest proportions in Chengguan District and Xigu District were both 4-ring PAHs (37.32%-41.73%, 35.20%-39.66%), and in summer and autumn, the highest proportions were both 2- and 3-ring PAHs (39.38%-49.54%, 47.17%-51.23%). The results of diagnostic ratio method revealed mixed atmospheric PAHs sources in the two urban areas, including fossil fuel, coal, and biomass combustion. The results of principal component analysis showed that the cumulative contribution rate of the four principal component factors reached 79.54%. Principal component 1 included phenanthrene, anthracene, fluoranthene, pyrene, chrysene, benzo[a]anthracene, benzo[b]fluoranthene, benzo[k]fluoranthene, and benzo[a]pyrene; principal component 2 included acenaphthene and dibenzo[a,h]anthracene; principal component 3 was fluorene; principal component 4 was naphthalene. The results of health risk assessment showed that the ILCR values of adult males, adult females, and children in Chengguan District were 2.30×10⁻⁶, 2.16×10⁻⁶, and 1.73×10⁻⁶, respectively; and those in Xigu District were 1.58×10⁻⁶, 1.48×10⁻⁶, and 1.19×10⁻⁶, respectively; all were greater than 10⁻⁶. Conclusion PAHs pollution exists in the atmosphere of the two urban areas of Lanzhou City, mainly comes from mixed sources of fossil fuels, coal, and biomass burning, and may pose potential carcinogenic risks to the population.