Objective We aimed to study the status of nurse-physician collaboration in tertiary general hospitals and analyze the influencing factors,and provide references for improving the status and the service of medical-nursing quality.Methods Totally 280 nurses and 186 doctors working in medicine,surgery,emergency room,operating room and ICU in tertiary general hospitals were recruited in the study.The participants were investigated with the questionnaire of Nurse-Physician Collaboration Scale,Jefferson Scale of Attitudes towards Physician-Nurse Collaboration and the Tool for Organizational Culture.Results The status of nurse-physician collaboration was in a good condition,doctors scored (82.98±12.97),which was significantly higher than those of nurses (76.71±14.25),and there was sighificant difference.For doctors,the influencing factors included organizational culture,cooperative attitudes,gender,the type of contract; for nurses,the influencing factors included organizational culture,the department and marital status.Conclusions It is suggested to improve the condition of nurse-physician collaboration from the hospital managers and medical staff's point of view in tertiary general hospitals and construct the harmonious relationship between health care to provide high quality service for patients.

Objective To summarize the clinical experiences and efficacy of laparoscopic total extraperitoneal repair(TEP) for inguinal hernia.Methods From April 2004 to August 2006,294 TEP operations was performed on 269 patients with inguinal hernia by using laparoscopy under epidural or general anesthesia.Among the patients,175 had indirect hernia,40 direct hernias,25 bilateral hernias,and 29 recurrent hernias.Results The operation was completed without converting to open surgeries in all the cases.The mean operation time was(63.1?37.5) min,blood loss(12.3 ?8.2) ml,and hospital stay(3.7 ?1.4) d.Of the patients,24 had peritoneal tearing(8.2%,24/269),4 had groin hematoma(2.4%,4/269),and 2 had foreign body sensation(0.7%,2/269).The patients were followed up for 6-12 months(median,9 months),the recurrence rate was 1.0%(3/294). Conclusion Laparoscopic TEP is safe and effective for patients with inguinal hernia.

Objective To provide basis for clinical teaching methods and course system,this article analyzed practice nursing students self-directed learning readiness status and its influencing factors.Methods The report surveyed a total of 240 nursing students in Zhengzhou University,the Peking Union Medical College by using the general information questionnaire,the Chinese version of Nursing SelfDirected Learning Readiness Scale and The Questionnaire of Clinical Teaching.The total score of the practice nursing students' self-directed learning readiness was obtained on the basis of quantitative analysis,and in this paper,the development and research status had been summarized through document analysis.Results The total score of the practice nursing students' self-directed learning readiness was (116.59±21.79) scores.The influencing factors of practice nursing students' self-directed learning readiness included:whether the students like nursing major,whether perception learning difficulties,whether having the experience of group learning,and the satisfaction to clinical teachers,curriculum system optimization.Conclusions Currently practice nursing students self-learning readiness is relatively low and have many influencing factors.A targeted training should be taken during the clinical teaching and the course system should be optimized to improve the practice nursing students' self-directed learning readiness.

Objective:To explore the real return-to-work experiences and expectations of young and middle-aged stroke patients in community, in order to provide reference for the formulation of the support plan for returning to work from the perspective of patients, and further promote their return to work.Methods:Using the phenomenological method of qualitative research, 11 young and middle-aged stroke patients in Zhengzhou community from April to May, 2019 were interviewed in a semi-structured way, then the interview data were analyzed and the theme was extracted.Results:The community young and middle-aged stroke patients return-to-work experiences and expectations included the following five themes: uncertain return-to-work belief, limited work-related ability, complex inner feelings in the process of returning to work, insufficient external support and expectation of returning to work after stroke (The desire to return-to-work, expectation to get support and help related to returning to work).Conclusions:In order to promote young and middle-aged stroke patients in community to return to work, the three-way interaction mode of community-society-workplace should be considered from the aspects of patients' personal and external support to help patients recover actively, establish beliefs, reduce negative emotions, and further promote patients to return to work.

Objective To explore the clinical effects of injection rhinoplasty with non-absorpted material and prevention of the complications.Methods A total of 578 patinets with rhinoplasty in Interpretation Medical Cosmetic Center of Wuhan City and Southwest Hospital from March 2010 to January 2016 were selected,who included 239 cases injected by absorbed material,213 cases injected by non-absorbed material and 126 cases implanted by silicone prosthesis.Then the clinical effects,curative keeping time and complications of three groups in 0,1,3,6 and 12 months after injected or implanted were observed.Results 578 patients of nasal shape and outline were significantly improved immediately after surgery and injection,but the adverse reaction and complication of silicone prosthesis increased more than those of other two groups,the differences were significant(P<0.01).While,the nose shape and outline and cosmetic effects of patients by silicone prosthesis or absorbed material postoperated became worse from 6 months to 1 year(P<0.05),and the non-absorbed groups had kept much better in the nose shape and outline and the satisfactory effects than the other two groups,the differences were significant(P<0.01).Conclusion Injection of rhinoplasty is safe and effective,meanwile the injection rhinoplasty with non-absorbed material is more suitable for Asian with less adverse reaction.

Objective To discuss the prognoais after hyperglycemia and electrolyte imbalance caused by stress in moderate or severe hypoxic ischemic encephalopathy newborns. Methods Blood sugar and electrolyte of 73 HIE patients, who hospitalized in our hospitial, including 73 moderate or severe patients and 63 mild patients. Results There was significant difference with increase of serum glucose,decrease of serum sodium and calcium between mod- erate or severe and mild HIE. The rate of hyperglycemia, hyponatremia and hypocalcemia was higher in moderate or severe HIE with 2 or more organ dyafunction than I alone. Conclusion The moderate or severe HIE newborns early time presents the hyperglycemia and the low blood sodium, the low serum calcium often prompts organism existence serious stress response, and prompts electrolyte disorder.

Objective To study interaction proteins with secreted apoptosis-related protein 1 (SARP1) in fibroblasts of hypertrophic scar and to analyze its molecular mechanisms.Methods The recombinant adenovirus Ad-SARP1 was successfully constructed and transfected into the fibroblasts of hypertrophic scar in culture.The proteins were precipitated by immunoprecipitation and separated by SDS-PAGE,then it was stained with Coomassie blue and proteins from SDS-PAGE gel electrophoresis strip were analyzed with enzymolysis and mass spectrometric in turn.The peptide sequences were obtained according to mass spectrometry and the database were searched automatically.Results The results showed that in control cells,Ad-SARP1 and Ad-EGFP infected cells,were precipitated 7 protein bands,their molecular weights were about 93 × 103,43 × 103,40 × 103,37 × 103,31 × 103,26 × 103 and 12× 103,respectively; without SARP1 antibody the protein bands did not precipitate.Analysis of the 6 protein bands showed that proteins that might interact with SARP1 included periostin precursor (OSF-2),asporin precursor (PLAP1),phosphoglycerate kinase 1,rCG50690,apolipoprotein A-I precursor (Apo-AI),and thioredoxin 1 (TRX1).Conclusions The interaction proteins of SARP1 can be obtained by immunoprecipitation combined with liquid chromatography/mass spectrometry and ion trap detection technology.These results provide new clues for the mechanism of SARP1 regulates the apoptosis signal pathway of HSFb.

Objective To investigate the predictive value of plasma lipoprotein associated phospholipase A 2 (Lp-PLA2 ) in cere-bral infarction(CI) after transient cerebral ischemia attack (TIA).Methods Plasma Lp-PLA2 level was detected in 112 TIA pa-tients ,and the incidence rate of CI was observed on 7 ,30 ,90 d after TIA.Then the grouping was performed according to the Lp-PLA2 level ,and the predictive value of Lp-PLA2 in the risk of CI occurrence after TIA was evaluated.Results Among 112 patients with TIA ,27 cases (24.1% ) developed CI within 90 d;there were 17 cases(63.0% ) of CI after TIA in the Lp-PLA2 >207 μg/L group ,which were significantly higher than that in the 175-207 μg/L group and <175 μg/L group (P<0.05);moreover the CI occurrence in TIA patients was mainly concentrated within 7 d after onset ;the patients of Lp-PLA2 ≥175μg/L were mainly distrib-uted in the moderate and high risk groups of ABCD2 score system ;in ROC curve of Lp-PLA2 for predicting CI after TIA ,with Lp-PLA2 ≥194 μg/L as the diagnostic critical point ,the sensitivity was 0.730 and specificity was 0.680.Conclusion Lp-PLA2 may be an effective risk predictive indicator of CI occurrence after TIA ,and can improve the adverse outcome of TIA patients.

Objective To explore a new surgical method for the treatment of refractory fistula after breast augmentation and to improve patients healing efficiently.Methods This paper had collected two groups,a total of 178 cases of injected breast augmentation,who had shown the polyacrylamide hydrogel(PAAG)mixture shift,and caused abdominal fistula.Among them,89 cases further adopt new design in the treatment of fistula by using breast muscle membrane tissue flap and improve the effect of fistula treatment after the removal of fistula.And the other 89 cases were token the pure clean the cavity away caused by the abnormal material shift into the chest and abdominal wall.Results It was observed that PAAG widely distributed in the chest and abdominal wall and formatted the fistula connected mammary gland,axillary,chest abdominal wall.The area of lesions lacuna shrink by 80％ for the group used tissue flap after 2 weeks,but those not with tissue flap shrink by 45％(P＜0.01).At 4th week,all the patients of flap group achieved tissue healed,while the completely heal ratio of control group was only 73％.Compared two groups of healing rate,the group with tissue flap was obviously better than ones only with surgical method.Conclusion It suggests that main reasons for the liquidity bag and huge cavity are PAAG mixture shift into thoracic and abdominal wall and formed chronic fistula and connected the chest and abdominal wall.Local muscle membrane tissue flap can obviously promote the chest and abdominal wall fistula healing.

Objective To construct a home-care service package for the urban disabled elderly that satisfy their demands and improve the efficiency of service. Methods From August to October, 2014, a total of 285 disabled (mild, medium and severe) elderly from a cluster sampling were investigated with the self-designed questionnaire about home-care demands among them. An initiatory service package was drawn to meet the demands reported by 40% of them or above. The package was consulted by a group of 15 experts using Delphi method. Results The final service package included 11, 19, 20 items of care for the mild, medium and severe disabled elderly, respectively. Conclu-sion The disabled elderly home-care package in Zhengzhou has been created based on the demands among disabled elderly.