Objective To analyze the level of satisfaction and its influencing factors in emergency patients, and to improve the satisfaction level of emergency patients. Methods The patients who visited the emergency department with the triage number ended with 1 from August 1 to August 15, 2015 in Second Affiliated Hospital of Zhejiang University School of Medicine were selected by the method of convenience and equidistant sampling, to take the Press Ganey′s Patient Satisfaction Questionnaires which were collected and analyzed at the end of the patient's emergency treatment. Results A total of 200 cases were investigated. Patient experience overall satisfaction was (91.64 ± 8.74) points. There were no significant differences in satisfaction between the gender, age, place of residence, the investigator, the clinic department, the time to wait, whether the first visit and the previous stay in hospital (P>0.05). The correlation between the satisfaction score and the patient's education, prognosis was less (r=-0.251,0.262, P =0.009,0.018) , but more higher correlated with the service attitude of ancillary hospital staff, nursing staff in the provision of nursing instructions, nursing staff can protect the privacy, the waiting time of the triage and the doctor′s explanation of the treatment of the disease (r=0.79-0.84, P<0.05). Conclusions The service attitude of the ancillary hospital staff, nursing staff in the provision of care instructions and privacy protection, and the waiting time of the triage and the doctor′s explanation of the treatment are the most important factors influencing the patients′ satisfaction in emergency department which also will be the key content for us to improve the patients′experience and satisfaction inemergency patients.

Objective To explore factors associated with emergency room(ER)length of stay and provide basis for the emergency managers about the development of relevant measures.Methods Data of critically ill patients from the emergency room in a tertiary teaching hospital from January 2010 to June 2011 were retrospectively studied.Binary Logistic regression analysis was used to determine possible factors and further compare the clinical characteristics of the patients.Results(1)From January 2010 to June 2011 a total of 11 468 patients were seen in the emergency department,the median ER length of stay was 11 h,a number of 6 525 patients(56.9％)stayed in ER more than 6 h.(2)Binary Logistic regression analysis showed that the main factors contributing to length of stay more than 6 hours were types of wards,green channel,treatment time,followed by admitted to ICU,traffic,sent by 120,the number of initial diagnosis,destinations of disposition,sex,holiday visit,visit month.While age,occupation,residence were not factors.Conclusions The patients in this hospital has a prolonged length of stay.The associated factors included types of wards,green channel,treatment time deserves a further study.

Based on the hospital information systems and the hospital network,a software for patients with peripherally inserted central catheter (PICC) was developed and applied in clinical practice,which achieved the share of PICC information within the hospital,saved nursing time effectively,made the clinical data more standardized,systematical and objective.

Objective To study a quick and effective assessing method used in the emergency trauma patients in order to prevent delaying treatment for patients from overlook or misdiagnosis during triage. Method From 1 January 2006 to 31 September 2006, there were 4023 patients evaluated with trauma assessment method, which was composed of CRAMS scale and trauma assessment program. Results Of 4023 patients, there were 2430 cases with CRAMS below 1( < 7) ,of whom 1979 cases assessed with trauma assessment program were found to be injuried severely to threaten their lives. And more noticeably,of 1593 patients with CRAMS ≥7 there were 46 patients found to have life-threatening injuries assessed with trauma assessment method. Conclutions CRAMS score can be used for triage, and trauma assessment program can be used to evaluate the injuries anatomically. Trauma assessment program and CRAMS employed conjointly can increase the sensitivity and specificity for the stratification of the severity in the injuried patients in order to get a successful triage and lo take advantage of the resources of e-mergency care appropriately.

The QCC campaign at the emergency center was themed as minimizing incidence of risky transport of critically ill patients,which aimed at continued quality improvement by means of conditions review,problem analysis,measures making,and procedure improvement.The incidence of risky transports dropped from 26％ to 0.9％ in six months.Another promising outcome was a sharp betterment of clinical nurse management. It has proved that QCC can effectively downsize risky transports of critically ill patients,making it a functional means to improve nursing quality.

Objective To explore the clinical characteristics of treatment?resistant depression ( TRD) and of its relevance with thyroid hormones. Methods 43 patients with TRD and 48 patients with non?TRD were as?sessed with 17?item Hamilton depression scale ( HAMD?17) and Hamilton anxiety scale ( HAMA) . The serum lev?el of thyroid?stimulating hormone ( TSH) ,total triodothgronine ( TT3) ,total thyroxine ( TT4) ,free triodothgronine ( FT3) and free thyroxine ( FT4) were determined by radioimmunoassay. χ2 test and t test were used for statistic a?nalysis. The quantitative relation of FT3 level with TRD was analyzed and the value of FT3 level in TRD diagnosis was evaluated by ROC curve.Results Compared with non?TRD patients,the TRD patients showed a younger dis?ease onset age ((16.98±2.25)years vs (23.50±3.38)years) and a longer disease course ((10.14±6.47)years vs (5.48±4.15)years) for total disease course;(60.35±23.64)months vs (5.00±3.40)months for current disease course),and had shorter education years ((8.53±1.72)years vs (11.04±2.07)years) and higher HAMD total scores (19.09±1.59 vs 15.69±2.38) and behavior retarding factor scores (8.72±0.98 vs 4.98±1.63). In addition, the FT3 level of TRD patients was lower than that of non?TRD patients ((3.92±0.15)pmol/L vs (4.16±0.20) pmol/L).All the above differences between two groups were statistically significant (P<0.05). The logistic regres?sion analysis showed that the risk of suffering TRD increased by 1. 006?fold when FT3 level reduced 0. 1 pmol/L (OR=2.006,95%CI=(1.501,2.681). The area under ROC curve was 0.821 (P<0.001) with its 95% confidence interval of (0.734,0.907). Conclusion Compared with non?TRD patients,TRD patients have a longer disease course,a younger disease onset age, a lower education level, higher HAMD total scores, more severe retardation symptoms,and a lower FT3 level. The serum FT3 level has a high reference value in diagnosis of TRD.

Objective To establish and evaluate the satisfaction index system in accordance with high quality nursing standard for emergency patients.Methods Emergency patients′satisfaction scale which included 4 dimensions and 20 items was established by literature research and the Delphi method.The reliability and validity of scale were analyzed and evaluated by Cronbach′s αindex and exploratory factor.Results The Cronbach′s αindex of each dimension was above 0.80 in the scale.The accumulative contribution rate of 4 extracted common factors reached 77.963%.Conclusions Emergency patients′satisfaction scale combined with high quality nursing service is characterized with good reliability and construct validity.The scale can be used as evaluation tool for emergency patients′satisfaction to continuously improve high quality emergency nursing.

Objective To translate Moral Distress Scale(MDS-R), and to test the reliability and validity of the Chinese version of MDS-R. Methods The MDS-R was translated, back translation and adapted according to Chinese culture. The reliability and validity of Chinese version of MDS-R was tested in 750 nurses in Quzhou city by item correlation analysis, content validity, exploratory factor analysis, confirmatory factor analysis, Cronbach′s Alpha coefficient and test-retest reliability. Results The internal consistency coefficient of the Chinese version of MDS-R ranged from 0.119-0.756 (P<0.01). The content validity was 0.952. validity.Factor analysis extracted three common factors, which explained 64.537％ of variance of the total scale. Based on the exploratory factor analysis, a theoretical model was established for the scale and each factor, and the fitting degree of the theoretical model was verified by the data. After fitting the model, the fitness values of the first and the second order confirmatory factor analysis were all up to the standard level. The Cronbach's Alpha coefficient of the scale was 0.925, and the test-retest reliability was 0.900. Conclusions The Chinese version of MDS-R is reliable and valid, and can be used to measure the moral distress of nurses.

Objective:To explore the necessity of implementing narrative wills in the context of active aging,and to provide a reference for China's active response to aging strategies.Methods:Employing strengths,weaknesses,opportunities,and threats(SWOT)analysis,this paper analyzes the internal strengths and weaknesses,and external opportunities and threats of implementing narrative wills in the context of active aging in China.Results:The advantages of implementing narrative wills in the context of active aging in China include abundant narrative resources,diverse narrative methods,and a return to humanistic care.The disadvantages include unclear conceptual definitions of relevant concepts,non-standardized implementation procedures for narrative wills,and the absence of an established implementation team for narrative wills.Opportunities include demand support,strategic orientation,digital age.Threats include personal privacy protection,lack of medical resources,and insufficient narrative research.Conclusion:In the context of active aging,the implementation of narrative wills has both advantages and disadvantages.The humanistic care can be truly achieved,only by strengthening the education and publicity of narrative wills,increasing organizational guarantees and intensity of support,strengthening relevant research on narrative wills,and enhancing privacy protection mechanisms.

Objective To analyze the correlation between digital mammography features,lymphocyte to monocyte ratio(LMR)and prognosis in patient with invasive breast cancer,and to explore the prognostic value of digital mammography features and LMR in invasive breast cancer.Methods Ninety-six patients with invasive breast cancer were selected.The data of digital mammography features and serum LMR levels were analyzed.The patients were followed up after discharge.According to different prognosis,all patients were divided into good prognosis group(68 cases)and poor prognosis group(28 cases).Spearman was used to analyze the correlation of digital mammography features,LMR level and prognosis of patients.Receiver operating characteristic(ROC)curve was drawn to analyze the prognostic value of digital mammography features and LMR level.Results The spicule sign and proportion of calcifica-tion in the poor prognosis group was significantly higher than that in the good prognosis group,the maximum diameter of tumor was significantly larger than that in the good prognosis group,and the serum LMR level was significantly lower than that in the good prognosis group(P＜0.05).Spearman correlation analysis showed that spicule sign,proportion of calcification and maximum diame-ter of tumor were positively correlated with poor prognosis of invasive breast cancer(P＜0.05).Serum LMR level was negatively correlated with poor prognosis of invasive breast cancer(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of spicule sign,calcification and tumor maximum diameter combined with LMR level to evaluate the prognosis of invasive breast cancer was 0.927,the sensitivity was 89.71％,and the specificity was 82.14％,which were significantly higher than those of each index alone.Conclusion Digital mammography and serum LMR levels may be closely related to the prognosis of patients with invasive breast cancer,and spicule sign,calcification,tumor maximum diameter combined with serum LMR may be of significant prognostic value in invasive breast cancer.