Objective To investigate the guidance value of procalcitonin(PCT) dynamic measurement on antibiotics usage of patients with stroke associated pneumonia(SAP).Methods One hundred and thirty-two cases with SAP were randomly divided into control group(64 cases with regular treatment) and observation group (68 cases with procalcitonin dynamic monitoring treatment).The treatment course of antibiotics in control group was according to antibiotics guidelines in China.Patients in observation group were given antibiotics for 5 days,stopped if the level of PCT was less than 0.25 μg/L,and continued to take if the level of PCT was more than 0.25 μg/L.The information were recorded including periods and cost of antibiotics usage,the periods and costs of hospitalization,clinical efficacy,mortality on the 30th day.The score of Institutes of National Institutes of Health Stroke Scale (NIHSS) and Barthel index (BI) were measured.Results (1) There were no significant differences in terms of age,gender,hypertension rate,coronary heart disease rate,diabetes rate,systolic blood pressure,the score of NIHSS in admission,pathogen and antibiotics between two groups (P ＞ 0.05).(2) After 30 days treatment,there were no significant differences in terms of clinical efficacy(86.8％ (59/68) vs.87.5％(56/64)),mortality (7.4％ (5/68) vs.7.8％ (5/64)),the score of NIHSS ((12.3 ±5.8) vs.(11.7 ± 4.5)) and BI (60.9 ± 22.3 vs 58.7 ± 21.6) between observation group and control group (P ＞ 0.05).The periods of hospitalization in observation group was (20.1 ± 5.1) d,less than that of control group ((25.4± 6.0) d,t =5.479,P ＜ 0.01).The costs of hospitalization in observation group was (8 ± 6) thousand yuan,significant lower than that of control group ((12 ± 8) thousand yuan,t =3.262,P ＜ 0.01).The periods of antibiotics usage in observation group was (11.3 ± 2.6) d,less than that of control group ((14.4 ± 3.1) d,t =6.238,P ＜ 0.01).The costs of antibiotics in observation group was (3 ± 1) thousand yuan,significant lower than that of control group ((5 ± 2) thousand yuan,t =7.331,P ＜ 0.01).Conclusion PCT dynamic monitoring can guide the safe usage of antibiotics in SAP in terms of shortening the length of hospitalization,duration of antibiotics,and reducing the costs.

Objective To evaluate the effect of acupuncture point stimulation on the urodynamics of spinal cord injury patients.Methods Sixty spinal cord injury cases were divided into a research group and a comparison group.Both groups were given bladder training, but the research group also received acupuncture point stimulation.The subjects' maximum cystometric capacity, maximum detrusor pressure and residual urine were measured, along with renal function and any urinary tract infections.The scale of activity of their daily lives was compared before and 3 months and 6 months after the treatment.Results There were no statistically significant differences between the groups before the treatment.There were statistically significant differences in maximum cystometric capacity, maximum detrusor pressure, residual urine and Barthel index (BI) after 3 and 6 months of treatment.In the research group, maximum detrusor pressure, residual urine and BI scores had all improved after 6 months compared with the 3 month values.In the comparison group only the BI score had improved significantly between 3 and 6 months, and this was not reflected in a significant change in the scale of activity in daily life.After 3 months, only the average BI differed significantly between the two groups.After 6 months all indexes except the BI and maximum cystometric capacity differed significantly.There were also significant differences between the groups in reflex voiding, percussion voiding, and abdominal pressure voiding.Conclusions Acupuncture point stimulation can improve the bladder function of spinal cord injury patients.It can also decrease the incidence of urinary tract infection and the possibility of renal dysfunction.

Through random sampling,a total of 300 residents of Beijing Changping Ming Tombs Town were selected for home-based questionnaires.The smoking rate of interviewed residents was 21.4％ (53/248).The rate in men (42/125,33.6％ ) was bigber than that in women ( 11/123,8.9％ ).The rate in those with higher education was lower than that in those with lower educational level ( x2 =27.12,P ＜ 0.05 ).The population awareness of tobacco hazards was 80.6％ (200/248).Awareness in smokers was lower than the average awareness of ex-smokers and nonsmokers ( x2 =5.07,P ＜ 0.05 ).The higher the education level,the higher the awareness of tobacco health hazards ( x2 ≈ 19.72,P ＜ 0.05 ).There were differences in awareness among different age groups (x2 =13.37,P ＜ 0.05 ).

Objective: To find out the current situation of the reproductive health about countrywomen in west of China,and explore the factor of the reproductive health under social medicine theory framework.Methods: Summarize literature about women reproductive which have been done recently,and do 608 samples survey in Xi'an of Shaanxi,which is about the current situations of social economic,reproductive health,gynecological diseases and mental health.Results: The research clarified the primary connotation about the reproductive health of countrywomen,and identified the current situation of countrywomen reproductive health in Shaanxi province of China.Conclusion: The situation of countrywomen reproductive health is far away from the demand of strategic target of "Everyone enjoys the reproductive care since 2015",and the countrywomen are on the hip in birth control,bearing culture,acquirement of health knowledge and primary diathesis.

Objective To improve the quality of outpatient prescriptions, to guarantee the rational use of antibi-otics and clinical use of drugs and to enhance the quality of pharmacy services through medication management system. Methods The results from rational medication management system applied in our hospital were analyzed retrospectively and evaluated comprehensively. Results The rational medication management system applied in our hospital could make a full prescription review, and the warning percentage number at all levels for each quarter over the past year reduced gradually, compared with that of the previous quarter (P<0.05). The usage rate of an-tibiotics and injection rate in internal medicine, pediatric, breast and gynecological clinic were significantly lower than those before the application of the system (P<0.05) and the usage rate of antibiotics and injection rate in department of gynecology care, child care clinic and medical examination center did not show any significant re-duction compared with those before the application of the system(P>0.05). The system played a monitoring role in the medication of antibiotics in all the departments. Conclusion The application of rational medication manage-ment system can promote the rational use of drugs in hospital and can help to improve pharmacy services.

Objective:To analyze the application value of the mechanical thrombectomy system in the treatment of acute limb ischemia.Methods:The clinical data of 50 patients with lower limb ischemia who were treated with the Rotarex mechanical thrombectomy system from Jun 2017 to Sep 2019 were retrospectively analyzed.Results:In 4 cases of popliteal artery rupture occurred during the operation. The success rate of the operation was 92%. Catheter-directed thrombolysis was used in 7 cases, percutaneous transluminal angioplasty was used in 4 cases and percutaneous transluminal angioplasty combined with stent implantation was used in 39 cases. The ankle-brachial index of these 50 patients before and after operation was 0.18±0.24 and 0.64±0.28 respectively ( t=12.87, P<0.001). Treatment was successful in 43 cases. Follow-up ranged from 1 to 24 months, 5 cases were amputated, 2 cases had no improvement of toe ulcer gangrene, 9 cases had thrombus recurrence, and no complications such as bleeding were observed. The primary patency rates at 3, 6 and 12 months were 92%, 84% and 74%, respectively. Conclusion:The mechanical thrombectomy system is safe and effective in the treatment of acute lower limb ischemia with ideal short-term patency.

Objective To build an evaluation index system of medical practitioners'competency for county-level public hospitals. Methods By means of the Iceberg Model based on competence and professionalism, and following two rounds of consultations of 47 experts, the evaluation indexes and weights of medical practitioners' competency were determined using SPSS frequency, mean, Kendall harmony coefficient and factor analysis. Three county-level public hospitals in Shaanxi province were selected for example verification of service competency. Results The evaluation index system of county-level public hospitals included 4 level-1 indexes and 16 level-2 indexes. The 4 level-1 indexes were diagnosis competency, treatment competency, communication competency and self-development competency. The weights of these indexes were 0.3,0.3,0.2 and 0.2 respectively. Conclusions Such hospitals should start with these competencies to strengthen the cultivation of medical practitioners' competency and constantly improve their comprehensive service level.

Objective:To survey the working status of outpatient nurses in general practice departments of general hospitals.Methods:From March to April 2021, personal in-depth interviews were conducted with outpatient nurses from general practice residency training bases in Beijing. The thematic framework analysis method was used to analyze the interview data and refine the themes.Results:Fourteen nurses working in general practice outpatient clinics were interviewed in this study. Four themes were extracted from the interview data: (1) inadequate staffing of full-time outpatient nurses in general practice departments of comprehensive hospitals; (2) unclear job functions for outpatient nurses in general practice departments; (3) no standardized patient health education in the department; (4) no relevant training received systematically.Conclusion:General practice departments in general hospitals should setup full-time general practice nurse positions, clarify the job responsibilities, strengthen the relevant training and enhance core competency for nurses working in general practice department.

Objective To investigate current research in nursing interventions for shoulder-hand syndrome after stroke in Class Ⅲ Grade A hospitals in China.Methods Totally 215 nurses from the departments of neurology and rehabilitation of 6 Class Ⅲ Grade A hospitals from a municipality or provincial capital from 6 provinces,which scattered across the northern,northeastern,eastern,central and southern,southwestern and northwestern parts of China,were selected by convenient sampling between January and June 2016.The nurses were investigated with the self-designed Shoulder-hand Syndrome After Stroke Questionnaire.Totally 215 questionnaires were sent out,with 184 valid questionnaires collected.SPSS 21.0 software was used in data statistics.Results The 184 nurses' average scores in the dimension of attention to shoulder-hand syndrome after stroke was(4.38±0.59);and the score in reasonableness of nursing interventions for shoulder-hand syndrome after stroke was(3.98±0.88).Their scores in nursing knowledge related to patients with shoulder-hand syndrome was(48.50±16.67),and their scores in the dimensions in clinical manifestation,risk factors and interventions were(4.59±3.24),(2.67±3.90)and(4.06±1.21),respectively.The knowledge scores were sorted in descending order,and the top 3 scores were found in"nursing principles for shoulder-hand syndrome" "best period of rehabilitation training for shoulder-hand syndrome" and "observation points of affected extremities".Conclusions The nurses' attention to and knowledge about shoulder-hand syndrome after stroke is not enough.There is a lack of standards or guidelines for shoulder-hand syndrome.The process of nursing interventions for shoulder-hand syndrome is not reasonableenough and the nursing processes are not fully implemented.Therefore,nursing processes need to be further standardized.

Nurse is one of the most common occupations in shift work. Due to the particularity of nursing work, shift work often causes nurses to suffer from shift work sleep disorders. It will not only lead to an increase in the risk of accidents in work, but also increase the incidence of nursing errors, and even seriously harm the physical and mental health of individual nurses. This paper reviews the prevalence, serious harm, related influencing factors and intervention measures of shift work sleep disorders among nurses at home and abroad, in order to expect nursing managers and nurses to raise their awareness and pay attention to shift work sleep disorders, thereby improving professional identity and happiness of nurses.