Objectives To investigate antimicrobial resistance and beta-lactamase production of Moraxella catarrhalis isolates from respiratory tract in children and to understand the characteristics of BRO beta-lactamase gene. Methods From June 2011 to Sep-tember 2012, 401 Moraxella catarrhalis isolates were obtained from respiratory tract in children. Minimum inhibitory concentrations (MIC) of commonly-used antibiotics were determined by microbroth dilution assay, and beta-lactamase production was detected by Nitroceifn disk test. PCR combining restriction endonuclease analysis was employed to do the BRO genotyping. Results 96.5%iso-lates were beta-lactamase positive (387/401), MIC (MIC50/MIC90) values and resistant rates of beta-lactamase producing isolates were higher than those of non beta-lactamase producing isolates for ampicillin, cefaclor and cefuroxime (P<0.05). The positive rate of BRO gene was 99.2%in beta-lactamase producing isolates (384/387), consisting of 93.0%BRO-1 isolates and 7.0%BRO-2 isolates. MIC50 and MIC90 values of BRO-1+isolates were higher than those of BRO-2+isolates for ampicillin, cefaclor, cefuroxime and azithromycin. Conclusions The beta-lactamase production rate is high in Moraxella catarrhalis isolates from respiratory tract in children. BRO-1 type was the dominant genotype of beta-lactamase producing isolates, having more inlfuence than BRO-2 type in the inlfuence on some beta-lactams and macrolides.

The aging of population and the increasingly morbidity rate of chronic disease had brought great influence on public health and economy.And community whose scientific management model could improve effectivity was a main prevention place for chronic disease.Thus on the basis of domestic and foreign literatures,several types of chronic disease community management models were introduced,and aimed at providing a reference for community chronic disease management.

Objective: To explore the related factors of subependymal hemorrhage (SEH) and cerebral hemodynamic changes. Methods: From October 2012 to October 2017, 200 cases of children with subependymal hemorrhage diagnosed by ultrasound in our department of pediatrics were selected as the observation group , and a total of 150 children who were admitted to the Department of Pediatrics in the same period due to craniocerebral diseases and other serious diseases were selected as control group. The independent risk factors of the children in the observation group were analyzed, and the difference of the maximum systolic blood flow velocity (SV), the diastolic maximum flow velocity (DV), the systolic and diastolic velocity ratio (S/D), the resistance index (RI), and the pulsatile index (PI) were compared between the two groups. Results: Neonatal asphyxia, preterm birth, acidosis, neonatal respiratory distress syndrome (NRDS), patent ductus arteriosus and coagulation dysfunction were independent risk factors for subependymal hemorrhage. The bleeding side SV and DV of the observation group were higher than those of the control group, with statistically significant difference (P<0.001). In the observation group, the bleeding side SV and DV were higher than those of the healthy side, with statistically significant difference (P<0.001). There was no significant difference in bleeding side SV, DV, S/D, RI and PI in 110 cases of single side ependymal hemorrhage (P>0.05). Conclusions Children with ependymal hemorrhage can observe the hemodynamic indexes of anterior cerebral artery (ACA) dynamically by craniocerebral ultrasound, and judge the therapeutic effect by evaluating the systolic and diastolic blood flow velocity, so as to prevent the further aggravation of subependymal hemorrhage

Objective:To observe the application effect of outcome-based education (OBE) concept on the teaching of otorhinolaryngology nursing.Methods:A total of 97 nursing interns from the Department of Otorhinolaryngology in The Second Affiliated Hospital of Army Medical University were selected as the research objects. Among them, 46 ones from March 2017 to February 2019 were collected as the control group, and 51 ones from March 2019 to February 2021 as the observation group. The control group adopted traditional nursing clinical teaching, and the observation group adopted the nursing clinical teaching based on the OBE concept. All the nursing students had an internship for 3 weeks, and had an evaluation in terms of the clinical communication ability of the two groups of nursing students when they leave the department (the nursing students' clinical communication ability assessment scale), the daily life problem solving ability (simplified Chinese version of the daily life problem solving questionnaire), theoretical and operational assessment results, and the internship satisfaction (nursing student internship satisfaction scale). SPSS 19.0 was used for independent-sample t test. Results:When leaving the department, the observation group's clinical communication ability scores were significantly higher than those of the control group in such dimensions as establishing a harmonious relationship, keen listening, confirming patient problems, participating together, transmitting effective information, and verifying feelings ( P<0.05). The scores of simplified Chinese version of the daily life problem solving questionnaire of rational problem solving and positive problem orientation of the observation group were significantly higher than those of the control group ( P<0.05), while the scores of negative problem orientation, avoidance style and impulsivity/carelessness style were significantly lower than those of the control group ( P<0.05). The scores of theoretical and operational evaluations of the observation group were significantly higher than those of the control group ( P<0.05). The practice satisfaction scores on each dimension of the observation group, including clinical teaching, classroom teaching, and internship plan, support and resources were significantly higher than those of the control group ( P<0.05). Conclusion:The OBE concept applied in the teaching of otorhinolaryngology nursing can enhance the clinical communication ability and daily life problem-solving ability of nursing students, increase the theoretical and operational assessment results, and improve the satisfaction of internship.

Objective:To explore the application effect of multi-mode teaching guided by objective management in the standardized training of nursing students.Methods:A total of 39 standardized training nursing students from April 2019 to April 2020 in the department of oncology of a tertiary hospital were selected as the control group by cluster sampling method and they received traditional teaching; 40 standardized nursing students in the department of oncology from June 2020 to June 2021 were selected as the experimental group and the group adopted multi-mode teaching guided by objective management. The differences of theoretical and operational assessment scores, teaching satisfaction, critical thinking ability and nurse-patient communication ability between the two groups were studied. SPSS 20.0 was used for t-test and Chi-square test. Results:The scores of theoretical assessment [(86.17±3.74) vs. (83.92±4.93)] and operational assessment [(92.83±2.19) vs. (90.74±3.52)] in the experimental group were higher than those in the control group, and the differences were statistically significant ( P<0.05). The teaching satisfaction of the experimental group was higher than that of the control group [(46.10±2.96) vs. (42.67±2.45)], and the difference was statistically significant ( P<0.05). There were statistically significant differences in critical thinking, intellectual curiosity and analytical skills ( P<0.05). In terms of nurse-patient communication ability, except that there was no difference in collecting information, the rest were statistically significant( P<0.05). Conclusion:Multi-mode teaching guided by objective management can improve the theoretical and operational ability of nurses, nurse-patient communication ability, and teaching satisfaction.

BackgroundThe occurrence rate of dangerous behaviors in patients with severe mental disorders is higher than that of the general population. In China， there is limited research on the prediction of dangerous behaviors in community-dwelling patients with severe mental disorders， particularly in terms of predicting models using data mining techniques other than traditional methods. ObjectiveTo explore the influencing factors of dangerous behaviors in community-dwelling patients with severe mental disorders and testing whether the classification decision tree model is superior to the Logistic regression model. MethodsA total of 11 484 community-dwelling patients with severe mental disorders who had complete follow-up records from 2013 to 2022 were selected on December 2023. The data were divided into a training set （n=9 186） and a testing set （n=2 298） in an 8∶2 ratio. Logistic regression and classification decision trees were separately used to establish predictive models in the training set. Model discrimination and calibration were evaluated in the testing set. ResultsDuring the follow-up period， 1 115 cases （9.71%） exhibited dangerous behaviors. Logistic regression results showed that urban residence， poverty， guardianship， intellectual disability， history of dangerous behaviors， impaired insight and positive symptoms were risk factors for dangerous behaviors （OR=1.778， 1.459， 2.719， 1.483， 3.890， 1.423， 2.528， 2.124， P<0.01）. Being aged ≥60 years， educated， not requiring prescribed medication and having normal social functioning were protective factors for dangerous behaviors （OR=0.594， 0.824， 0.422， 0.719， P<0.05 or 0.01）. The predictive effect in the testing set showed an area under curve （AUC） of 0.729 （95% CI： 0.692~0.766）， accuracy of 70.97%， sensitivity of 59.71%， and specificity of 72.05%. The classification decision tree results showed that past dangerous situations， positive symptoms， overall social functioning score， economic status， insight， household registration， disability status and age were the influencing factors for dangerous behaviors. The predictive effect in the testing set showed an AUC of 0.721 （95% CI： 0.705~0.737）， accuracy of 68.28%， sensitivity of 64.46%， and specificity of 68.60%. ConclusionThe classification decision tree does not have a greater advantage over the logistic regression model in predicting the risk of dangerous behaviors in patients with severe mental disorders in the community. ［Funded by Chengdu Medical Research Project （number， 2020052）］