OBJECTIVE To investigate current status of ventilator-associated pneumonia(VAP) and to provide prevention measures associated with nursing.METHODS Clinical data,such as incidence,categories of pathogenic bacteria and prevention measures associated with nursing,were retrospectively analyzed in 106 patients who received ventilator treatment in our hospital during 2004-2006.RESULTS The positive rate of microorganism culture in these patients was 95.3%.Totally 178 strains of microorganisms were cultured,including 63 strains of fungi,48 strains of nonfermanters,34 strains of Staphylococcus,33 strains of Enterobacteriaceae.There were many risk factors contributed to pathogenesis of VAP.Among these factors,underlying disease was one of the important internal causes and invasive medical procedure was one of the important external causes.The incidence of VAP was reducing yearly as improving of prevention measures associated with nursing.CONCLUSIONS Nurse acts an important role in prevention of VAP.Enhancing nursing management,improving nursing procedure and adopting appropriate intensive care measurement will reduce incidence of VAP.

Objective To evaluate the effect of late course accelerated hyperfractionated irradiation combined with intraluminal hyperthermia for esophageal carcinoma. Methods From March 2000 to October 2002, totally 91 such eligible patients were entered into the prospective randomized control trial of late course accelerated hyperfractionated irradiation (LCAH-, 44 patients) versus LCAH combined with intraluminal hyperthermia ( LCAH-HT-, 47 patients). Radiotherapy regimen consisted of conventional fractionation radiotherapy (1.8 ?Gy/f, 5f/w, totally 41.4 ?Gy/23fx) during the first two-thirds of the radiotherapy course, followed by accelerated hyperfractionation radiotherapy (1.5?Gy/f, 2f/d, with 6 h interval), using the cone-down fields, to a total dose of 68.4?Gy/41fx . Hyperthermia was given weekly during conventional fractionation irradiation, totally 4 times. Results The CR and PR rates were 47.7% and 72.3%, 52.3%and 27.8% in the LCAH arm and LCAH-HT group,respectively(P=0.016). The median survivals were 30.3 and 30.6 months,the 1-,2-,3-year survival rates were 77.3%,57.4% ,37.3% and 80.5%,68.6%, 46.3%(P= 0.526 ), the 1-,2-,3-year local control rates were 86.3%,70.5%,56.5% and 92.4%,72.5%,65.5% (P= 0.686 )in the LCAH group and LCAH-HT group,respectively. Grade III and severer of esophagitis were 18.2% and 27.6% in LCAH and LCAH-HT (P= 0.498 ), Grade III and severer tracheitis were 11.4% and 19.2% respectively (P=0.191). Conclusions The immediate effect of LCAH combined with hyperthermia is better than that of LCAH alone. Additional hyperthermia to LCAH does not increase the likelihood of radiation injury.

An introduction to the Basic service module featuring holistic,full flow and seamless connection built by the hospital.Authors described their experiences in achieving homogenous clinical nursing care,and pointed out that integrating medical humanistic care into the daily nursing process,can improve doctor-patient relationship and patients satisfaction,thus raising medical service quality and efficiency.

Objective? To explore the effects of Internet + home care platform on continued nursing care for peripherally inserted central catheterization (PICC) in cancer patients. Methods? Totally 173 cancer patients who were hospitalized and received PICC in Hu'nan People's Hospital between March and December 2017 were selected using convenient sampling and divided into the control group (n=92) and the home care group (n=81). Patients in the control group received conventional continued nursing care, while patients in the home care group received continued nursing care via the home care platform by following the WeChat account, including on-site catheter maintenance and personalized health education. The cases and frequency of catheter maintenance, patient's knowledge about daily PICC maintenance and the incidence of PICC-related complications from catheterization to catheter removal were compared between the two groups. Results? The incidence rate of complications was lower in the home care group than in the control group, the difference was statistically significant (χ2=5.210, P＜ 0.05); the number and frequency of missing catheter maintenance in the home care group were lower than that of the control group, while the knowledge levels about daily PICC maintenance at home in the home care group were higher than those of the control group, and the differences were all statistically significant (P＜ 0.05). Conclusions? Continued nursing care based on the Internet +home care platform for cancer patients receiving PICC is practical and feasible, and patients can enjoy safe, homogeneous and continued PICC nursing care at home. Therefore, it is worth promoting in clinical practice.

Objective To explore the effect of enhancing nursing quality by combining partitioned management mode and hierarchical use of nurses in the pediatric emergency room .Methods The pediatric emergency room was partitioned into rescue area , observation area , transfusion area and patient ’ s condition evaluation area .The nursing staff was analyzed and evaluated by capability , professional title , work years and classified into senior charge nurse , intermediate charge nurse and junior charge nurse .The rescue success rate and the nursing adverse event rate were compared before ( from July to December , 2009 ) and after ( from July to December , 2011 ) applying the partitioned management mode and hierarchical use of nurses .Results The nursing adverse event rate was 0.025 2%(15/59 452) in the control group and 0.005 8%(4/68 790) in the intervention group, and the difference was significant (χ2 =8.12, P<0.05).The rescue success rate was 97.57% (201/206) in the control group and 99.61%(256/257) in the intervention group, and the difference was significant (χ2 =7.32, P<0.05).Conclusions The combined application of partitioned management mode and hierarchical use of nurses in pediatric emergency room has obvious effects in enhancing the quality of pediatric emergency nursing .

Objective To explore the reasons of abnormal decannulation in patients with malignant tumor undergoing chemotherapy during peripherally inserted central catheter ( PICC ) period. Methods A prospective study was conducted among 291 cancer patients who used PICC for chemotherapy in Hunan Provincial People′s Hospital from January 2012 to June 2014. The occurrence of complications during PICC period and the reasons of abnormal decannulation in patients were investigated and collected. The time of follow-up was one year. Results Among 291 patients, there were 72 cases ( 24. 74%) of PICC complications and 44 cases (15.12%) of abnormal decannulation, among which, there were 12 cases (4.12%) of upper extremity deep venous thrombosis ( UEDVT ) , 5 cases ( 1. 72%) of central line associated bloodstream infections (CLABSI), with an infection rate of 0.95 per 1 000 catheter days, 9 cases (3.09%) of exit-site infection, with an infection rate of 1.46 per 1 000 catheter days, 11 cases (3.78%) of catheter prolapse and 7 cases (2.41%) of occlusion. Single factor analysis showed that, the history of deep venous thrombosis ( DVT) and the types of chemotherapeutics could influence the incidence rate of abnormal decannulation of patients with PICC. Conclusions The incidence rate of abnormal decannulation in patients with malignant tumor undergoing chemotherapy during PICC is 15%. UEDVT is the main reason of abnormal decannulation of PICC, and the chemotherapeutics infusion is independent risk factor of abnormal decannulation.

Objective? To explore the application value of individualized full-term management model in the management of patients with hermaphroditism. Methods? From January 2015 to June 2018, a total of five hermaphroditism patients were treated in Department of Urology Surgery at the First Affiliated Hospital of Hu'nan Normal University. The perioperative and post-discharge transitional care were performed by the individualized full-term management model. Results? Among five patients, the surgeries were smooth with primary healing wounds. After discharge, the treatment compliance and social adaptability were all good. Conclusions? The application of individualized full-term management model for perioperative and post-discharge transitional care among hermaphroditism patients helps to promote the postoperative rehabilitation of patients,helps patients transit to social smoothly and improve patients' experience to seek medical advice.

Objective To investigate the current situation of standardized training and its influencing factors in the introduction of massive open online course (MOOC) teaching methods to newly recruited nurses. Methods From July to October 2017, a questionnaire survey was conducted on 176 nurses in a ClassⅢGrade A hospital in Hu'nan Province. The survey contents included general information, status of new nurses' participation of the standardization training of MOOC and the satisfaction of it. Results The total score of the trainee nurses attending the standardized training of MOOC was (68.85±9.65), and score of satisfaction was (64.42±9.60). The result of multivariate analysis indicated that nurses' education degree, the length of work and the educator's professional title were the main influencing factors of new nurses' satisfaction with MOOC standardization training (P< 0.05). Conclusions The current status and satisfaction of the newly enrolled nurses in MOOC training are at a moderate level. It is suggested that based on the influencing factors, hospitals should perfect the MOOC platform, adjust new nurses scheduling system, strengthen the construction of teachers team, so that the new nurses can integrate more quickly into clinical practice.

Objective:To explore the perception and demand of children's parents on Internet children's hospital, and provide reference for improving the service model of Internet children's hospitals.Methods:This is a qualitative study. Totally 11 parents of children who visited the outpatient services of Guangzhou Women and Children's Medical Center from November to December 2021 were selected by convenience sampling, and a semi-structured interview was conducted with them based on a self-made outline. The Colaizzi phenomenological 7-step analysis method was used to analyze the data and refine the themes.Results:A total of four themes were extracted, namely, the high degree of parental recognition of the Internet children's hospital service model, the need for convenient, timely and safe information acquisition, the need for professional, reliable and friendly diagnosis and treatment services, and the need for reasonable and transparent fees.Conclusions:The online diagnosis and treatment services of Internet children's hospitals meet the needs of parents for medical treatment and have good prospects. At the same time, the service model of Internet children's hospitals should pay more attention to the convenience, professionalism, safety and economy of users, so as to promote its healthy development.

Objective To identify the key genes differentially expressed in Wilms tumor and analyze their potential impacts on prognosis and immune responses of the patients. Methods High-throughput RNA sequencing was used to identify the differentially expressed mRNAs in clinical samples of Wilms tumor and paired normal tissues, and their biological functions were analyzed using GO, KEGG and GSEA enrichment analyses. The hub genes were identified using STRING database, based on which a prognostic model was constructed using LASSO regression. The mutations of the key hub genes were analyzed and their impacts on immunotherapy efficacy was predicted using the cBioPortal platform. RT-qPCR was used to verify the differential expressions of the key hub genes in Wilms tumor. Results Of the 1612 differentially expressed genes identified in Wilms tumor, 1030 were up-regulated and 582 were down-regulated, involving mainly cell cycle processes and immune responses. Ten hub genes were identified, among which 4 genes (TP53, MED1, CCNB1 and EGF) were closely related to the survival of children with Wilms tumor. A 3-gene prognostic signature was constructed through LASSO regression analysis, and the patients stratified into with high- and low-risk groups based on this signature had significantly different survival outcomes (HR=1.814, log-rank P=0.002). The AUCs of the 3-, 5-and 7-year survival ROC curves of this model were all greater than 0.7. The overall mutations in the key hub genes or the individual mutations in TP53/CCNB1 were strongly correlated with a lower survival rates, and a high TP53 expression was correlated with a poor immunotherapy efficacy. RT-qPCR confirmed that the key hub genes had significant differential expressions in Wilms tumor tissues and cells. Conclusion TP53 gene plays an important role in the Wilms tumor and may potentially serve as a new immunotherapeutic biomarker as well as a therapeutic target.