Objective To explore the clinical efficacy and safety of low dose fentanyl combined to ropivacaine in subarachnoid block for cesarean section.Methods Eighty patients with ASA physical status Ⅰ and Ⅱscheduled to undergo cesarean section for delivery were randomly allocated to receiving spinally mixture none fentanyl ( group R),5 μg fentanyl ( group F5 ), 10 μg fentanyl ( group F10 ), and 15μg fentanyl ( group F15 ), combined with 1%ropivacaine 1 ml and 10% glucose 1 ml respectively,after combined spinal-epidural anesthesia puncture was applied at the L2～3 interspace.Heart rate, blood pressure, the onset and recovery time of the sensory and motor block,time to the highest level and the highest level of sensory block, time to the maximal extent and the maximal extent of the motor block were recorded at regular intervals.The adverse effects were sought during and after surgery.Neonatal outcome was assessed using Apgar score.Results The recovery of sensory block was prolonged significantly in group F10 and group F15 than in group R and group F5.Conclusion Ropivacaine with 10μg fentanyl is safe and effective in subarachnoid block for cesarean section.

Objective To study the clinical significance of dexamethasone (DT) in the combined spinal and epidural anesthesia for delivery of elderly parturient women. Methods 134 elderly parturient women were selected as the research object, and randomly divided into two groups. 69 cases in DT group received intramuscular injection of dexamethasone and combined anesthesia, while 65 cases in INN group received intramuscular injection of tramadol (INN) and combined spinal and epidural anesthesia. The anesthetic effect of the two groups were observed. Results After treatment, the interleukin (IL-6), myeloperoxidase (MPO), tumor necrosis factor-α (TNF-α) and methane dicarboxylic aldehyde (MDA) in DT group were significantly higher than INN group (P<0.05). The five kinds of immunoglobulins levels (IgA, IgD, IgE, IgG and IgM) in DT group were higher than those in INN group (P<0.05). The heart rate (HR) in DT group was lower and mean arterial pressure (MAP) was higher than that in INN group(P<0.05). There was 1 cases of macrosomia, 2 cases of premature delivery in DT group, the adverse pregnancy outcomes was 4.35%(3/69). there was 1 cases of macrosomia, 1 cases of congenital deformity, 1 cases of premature delivery and 1 case of postterm delivery in DT group, the adverse pregnancy outcomes was 5.80%(4/69), with no significant difference between two groups. Conclusion Dexamethasone combined with anesthesia is very effective for delivery of elderly parturient women which shows very good anti-inflammatory and immunoregulation.

To explain the relation between diabetic vasculopathy and'Blood blocking collaterals and phlegm turbidness not being removed'proposed by Mr.ZHU Kan-yu.It is believed that the turbidness is the basic pathological product during the development of diabetes.Blood glucose remains high,which reflects the disorders of transportation and distribution of turbid yin and qi in the body.That is to say that the thick coreal nutrients in the vessels are unable to be distributed and absorbed but stay in the vessels as turbid pathologic factors.Blood stasis and phlegm is the further result of turbid pathologic factors.The TCM explanation of diabetic vasculopathy is that phlegm,turbidness,blood stasis block the meridians and collaterals.Those visible pathological factors deposit in vessels and cause narrow vessels and thick walls.Meanwhile the deposit stimulates,spreads,erodes and burns the walls and finally ruins the walls.

Objective To explore the prevalence of sialorrhea and its clinical correlation with dysphagia in Chinese patients with Parkinson′s disease ( PD ).Methods One hundred and sixteen consecutive patients with a clinical diagnosis of PD were selected.Demographic data included sex , age, years of education, age at onset of PD, clinical genotype, disease duration, treatment, Hoehn and Yahr (H&Y) stage.Sialorrhea was assessed using the Unified Parkinson′s Disease Rating Scale (UPDRS) Ⅱitem number 6.All patients were studied with videofluoroscopic study of swallowing ( VFSS).Results The prevalence rate of sialorrhea in PD was 59.5% (69/116, 95% CI 50.6%-68.4%).Males were more likely to develop sialorrhea than females (47/70 vs 22/46,χ2 =4.298, P=0.038).PD patients′sialorrhea correlated with oral dysphagia:with food leaking from the mouth ( liquid r=0.229, P=0.014; juice r=0.197, P=0.034;pudding viscosities r=0.231, P=0.013;solid food r=0.255, P=0.006), with more than 1 ml of oral food residues (liquid r=0.319, P<0.01;solid food r=0.185, P=0.047), with delay in food transfer to the root of the tongue (liquid r=0.279, P=0.002; juice r=0.209, P=0.024), and delayed swallow transfer ( pudding viscosities r=0.257, P=0.005).Sialorrhea score was not related to H&Y stage, clinical course and levodopa equivalent doses (LED).The prevalence rate of dysphagia in PD was 87.1%(95% CI 81.0% -93.2%).Liquid was more likely to cause pharyngeal dysphagia ( P=0.03).With the increase in H&Y stage , so did the oral and pharyngeal stages of dysphagia.Late and mid-course was more likely to develop oral and pharyngeal dysphagia than those with early clinical course .Conclusions Sialorrhea and dysphagia are common non-motor symptoms in PD patients.Sialorrhea is more prevalent in males and correlates with oral phase of dysphagia.Liquid is more likely to cause pharyngeal dysphagia.With increase in H&Y stage , so did oral and pharyngeal dysphagia.Even though late clinical course is more likely to develop oral and pharyngeal dysphagia than early clinical course , the comparison between late and intermediate clinical courses does not reach statistical significance .

Objective To observe the clinical effect of western medicine combined with traditional reatme medicine in the treatment of ear herpes zoster.Methods 60 herpes zoster oticus patients were selected,randomly divided into observation group and control group,30 cases in each group.The control group received conventional western medicine treatment,while the observation group treated with integrated traditional Chinese and western medicine treatment.Two groups of clinical curative effects,and the average healing time of clinical symptoms were observed.Results The total effective rate in observation group was 93.3 %,which was 73.3 % in the control group,the difference was statistically significant(x2 =4.32,P ＜0.05),the clinical symptoms of two groups of cure time average of the differences were statistically significant (t =5.24,7.72,7.70,6.21,all P ＜ 0.05).Conclusion The western medicine combined with traditional reatme medicine in the treatment of ear herpes zoster has better effect than that of western medicine.

Objective To explore the pathway of continuous rehabilitation intervention in community stroke patients and to evaluate its effect. Methods Stroke patients (64 cases) were selected from Yuetan community as the rehabilitation group by objective sampling based on inclusive and exclusive standard and 64 stroke patients wre selected from other community in Xicheng district as the control group. At the same time, 16 doctors and nurses from 10 clinics of Yuetan community health service center were trained and they gave reha-bilitative intervention to the rehabilitation group. After intervention for 6 months, the effect of rehabilitative in-tervention was evaluated compared with the control group who did not receive rehabilitative intervention. Re-suits The Fugl-Meyer score of the rehabilitation group was (76.14±12.48), the score of the control group was (19.36±14.32),which had significant difference compared with the rehabilitation group, P < 0.05. The Batthel index of the rehabilitation group was (72.25±10.22), the index of the control group was (22.62±9.71),which was significantly different from that of the rehabilitation group, P < 0.05.Besidcs, the rate of knowing health knowledge and healthy exercise in the rehabilitation group was higher than that of the control group, P < 0.05. Condusions The rehabilitation information net and systemic community rehabilitation intervention can im-prove the motor ability and the ability of daily activity for patients with stroke.

Objective:To summarize the research progress of domestic nurses′ turnover intentions in the past ten years, and to provide references for related research on improving nurses′ turnover intentions.Methods:In May 2021, the documents related to nurses′ resignation intentions were retrieved in China National Knowledge Infrastructure (CNKI), Wanfang and VIP database and Citespace5.7.R5 software was used to perform keyword visualization analysis to form keyword clustering graphs and tables, emergent words, and corresponding time zones figure, the current research status and hot trends of nurses′ turnover intentions were analyzed.Results:A total of 2 029 valid documents were retrieved, the number of publications reached the highest peak in 2019. Among them, "nurse", "willingness to leave", "job satisfaction", "turnover intention" and "influencing factors" were the top 5 hot keywords and 23 emergent words were generated; research directions mainly included influencing factors and research objects and workplace related topics.Conclusions:Managers should actively play a leadership role to reduce nurses′ turnover intention through various effective intervention studies.

Objective:To develop a guiding manual of family doctor contracting service for the disabled with Delphi method.Methods:From November 2017 to July 2018, a research group was formed and a survey on the status of family doctor service for disables was conducted in Beijing and other places. After the preliminary outline was formulated, 15 experts from the fields of general practice and rehabilitation for the disabled were invited and 4 rounds of expert consultation were conducted, finally the Guiding Manual of Family Doctor Contracting Service for the Disabled was developed. Results:The authority coefficient of experts was 0.870, and 13, 13, 15 and 15 questionnaires were collected from 15 experts in 4 rounds of consultation, respectively. The W value of Kendall harmony coefficient of the fourth round of expert consultation was 0.394 (χ 2=319.501, P<0.01) and accuracy was 0.234 (χ 2=189.189, P<0.01). After adding and deleting terms by the suggestion and scores of experts, the final draft of the manual is formed, including 5 first-level terms, 15 second-level terms, 18 third-level terms and 17 fourth-level terms. Conclusion:The Guiding Manual of Family Doctor Contracting Service for the Disabled has been developed with Delphi method. Its reliability, validity and practicability need to been further studied.

Objective:To investigate the feasibility of contracted nursing services for disabled persons.Methods:A qualitative study on the feasibility of contracted nursing services for disabled persons was conducted from August 2020 to October 2020 with the phenomenological method. Community nurses were selected with the purpose of sampling method from Yuetan and Baizhifang Community Health Service Centers in Beijing Xicheng District for semi-constructed interviews, and 12 community nurses were finally interviewed according to the principle of information saturation. The research team took field notes, audio recordings and transcriptions of the interviews, coded to refine the themes, and fed back with the respondents to confirm the accuracy of the themes.Results:All the interviewed nurses thought that the contents of basic medical and public health required by the Guidance manual of contracted services of family doctors for disabled persons (the manual) including basic documentation, appointments, pre-diagnosis and post-diagnosis services, home care, rehabilitation nursing guidance, referral services and extended nursing services for the disabled and their families could be completed. All interviewees said that the manual had a guiding role in contracted services for disabled persons. Eight interviewed nurses believed that the manual involved referral services and rehabilitation care, but the technical guidance content did not meet the actual work needs and it should be supplemented and improved; 9 interviewees pointed out that there was a lack of communication with various types of disabled people in service practice, especially for those with vision, hearing, mental disabilities and disabled children; 7 interviewees said that it the free home care for the disabled was not sustainable. Conclusion:The contracted nursing services for disabled persons are feasible and the manual has a guiding role for the practice,and some contents need to be added in the manual to further improve service capacity for disabled people.

Objective:To investigate the status quo of communication between contracted family doctor team and the disabled.Methods:Using convenience sampling, family doctor team members of 80 community health centers (CHCs) in Beijing were selected to participate in a questionnaire survey from April to June 2022. The questionnaire included the basic information of team members, the choice of communication methods and targets, the acquisition of communication knowledge and skills and so on.Results:A total of 365 team members participated in the survey. The most common type of disability was physical disability (78.08%,285/365). All participants met communication obstacles with disabled people in contracted health service, and hearing and speech disabilities were the most common (70.14%, 256/365). Only 13.42% (49/365) chose to directly communicate with the disabled themselves; 84.93% (310/365) used "increase the volume and slow down" method when communicating with the disabled, and 38.63% (141/365) chose "write and convey multiple messages at the same time". Most of participants (84.38%, 308/365) indicated the need for professional training in communication with persons with disabilities.Conclusion:There are communication obstacles between family doctor team members and the disabled during contracted services. More relevant professional training are urgently needed for contracted family doctor team to improve the abilities to communicate with the disabled.