Objective To explore the application of the PRECEDE -PROCEED model on the improvement of junior guide nurses'behavior in service .Methods On the basis of the PRECEDE -PROCEED model, 23 junior guide nurses were accepted standardized training on behavior in service .The condition of junior guide nurses'service principle and behavior in service was investigated by using questionnaires and participant observation ; then we ana-lyzed the trends that influence behavior in service , promoted and strengthened these trends , carried out a complete training plan to provide standardized intensive training and used methods , including self-assessment , continuous su-pervision and timely feedback , to compare patients'and doctors'satisfaction, nurses'knowledge about service princi-ple, self-assessment of behavior in service and the observation of onsite service .Results After the training , the scores, in terms of patients'and doctors'satisfaction, nurses'knowledge about service principle , self-assessment of behavior in service and the observation of onsite service rose obviously .Compared with those before the training , these changes had statistical significance (p<0.01).Conclusion The PRECEDE-PROCEED model can improve junior guide nurses'behavior in service , and improve patients'satisfaction.

Objective to investigate therapeutic methods and effect of X-knife for on intracranial diseases. Method Recent effect of 44pqtients with cranial diseases by X-knife was observed. Radiological follow-up was performed on 40 cases with mean 5.65 months of followup time. Result 92.5% of tumors were controlled locally, stability and recovery rate was 90.0%. The local control of metastatic tumors of brain was higher, but most patients with metastatic tumors died of primary lesion. New metastatic lesions appeared in patients without panencephalic radiotherapy in 1～5months. Tumors of pineal region were sensitive to X-knife. Conclusion X-knife has a definite effect on intracranial diseases. For patients with tumors of pineal region complicated by serious hydrocephalus, shunting should be conducted before X-knife treatment. For patients with mild or morderate hydrocephalus, X-knife chould be utilized only under correct interventions such as dehydration. The local control rate of intracranial metastatic tumors was high, but survival time postoperation depended on panencephalic radiotherapy or control of primafry lision. For tumors with diameter＞ 3cm, pituitary tumors, brains stem tumors and tumors in cerebellopontine angle region repeated X-knife were suggested, which could improve cure rate and decrease complications.

OBJECTIVEStudy on the diagnostic accuracy and value of cell block and tissue fragment preparations collected from lung fine needle aspiration (FNA).

METHODSA total of 187 FNA (22G) samples from the lungs with matched histological diagnosis were studied. Among them, the diagnosis made by depending on 124 cell block and fragment preparations were analyzed in comparing retrospectively with the diagnosis of 187 cases by smear preparations.

RESULTS(1) Of the 124 cell blocks cases, 89 cases were true positives, 22 cases were true negatives, 13 cases were false negatives and no false positives. Of the 187 smears cases, the figure were 136, 30, 19 and 2 cases respectively. The diagnostic accuracy of cell blocks was 87.3% in sensitivity, 100% in specificity, 89.5% in overall accuracy. The figures for smears were 87.7%, 93.8% and 88.8% respectively. (2) For malignant tumours, the histological typing accuracy of cell blocks was 93.3% (83/89), and to be 67.9% (91/134) by diagnosis depending on the smears (P < 0.01). For the benign lesions, the figures were 86.4% (19/22) and 60% (18/30) respectively (P < 0.05). (3) It was possible to obtain many minisections for further studies from cell blocks. Immunoperoxidase staining on minisections was reliable and agreed with those on the surgical specimens.

CONCLUSIONSThe diagnostic accuracy of cell block is high, particularly in histological typing which approaches to that of the diagnosis made depending on the postoperative specimens. A combined use of smears and cell block is recommended which may raise further the diagnostic accuracy.

Adolescent ; Adult ; Aged ; Biopsy, Needle ; Female ; Histocytological Preparation Techniques ; Humans ; Lung Neoplasms ; classification ; pathology ; Male ; Middle Aged

Objective:To evaluate the prevalence of euthyroid sick syndrome(ESS)in sepsis patients and to explore its influencing factors.Methods:In the study,365 patients diagnosed with sepsis in the emergency critical care department of Shanghai First People's Hospital from January 2017 to January 2023 were retrospectively enrolled.The patients were divided into ESS and non-ESS groups based on whether the patients were complicated with ESS.Baseline variables and relevant clinical data of the enrolled pa-tients were collected.The prevalence of ESS in sepsis patients and its influencing factors were evaluated by multivariate Logistic regression analysis,and the 30-day survival rates were compared between the two groups.The optimal cutoff value for free triiodothyronine(FT3)was explored to predict death in the pa-tients with sepsis.Results:There were 103 sepsis patients with ESS,accounting for 28.2％of the total cases.The severity of sepsis in ESS group was significantly higher than that in non-ESS group(P＜0.05).The acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score and sequential organ failure assessment(SOFA)score of ESS group were significantly higher than those of non-ESS group(P＜0.05).C-reactive protein(CRP),procalcitonin(PCT),serum amyloid A(SAA)and interleu-kin-6(IL-6)in ESS group were higher than those in non-ESS group.total cholesterol(TC)and high-den-sity liptein cholesterol(HDL-C)in ESS group were lower than those in non-ESS group,and the differences were statistically significant(P＜0.05).Multivariate Logistic regression analysis showed that PCT,IL-6,CRP,SAA and activated partial thromboplatin time(APTT)were independent risk factors for ESS in the sepsis patients(OR values were 1.105,1.006,1.005,1.009 and 1.033,respectively;95％CI were 1.044-1.170,1.001-1.012,1.001-1.009,1.005-1.014,1.004-1.062,respec-tively,P＜0.05).The 30-day survival rate in ESS group was significantly lower than that in non-ESS group,the Long-rank chi-square test value was 16.611,and the difference was statistically significant(P＜0.05).The receiver operation characteristic area under the curve(AUCROC)of FT3 predicted death in the patients with sepsis was 0.924(95％CI 0.894-0.954).The serum FT3 cutoff point was 3.705 pmol/L,the specificity was 0.868,and the sensitivity was 0.950.Conclusion:In this study,the inci-dence of ESS in sepsis patients was determined to be 28.2％with poor prognosis.The results showed that PCT,IL-6,CRP,SAA and APTT were independent risk factors for ESS in sepsis patients,while HDL-C was a protective factor(P＜0.05).FT3 is a novel potential biomarker for predicting death in patients with sepsis.