OBJECTIVE To develop the evaluation system for the readability of drug instructions based on Chinese patient needs， and to provide scientific evidence for improving the readability of drug instructions in China. METHODS The literature review and expert consultation were adopted to establish the evaluation index system for the readability of drug instructions. Then， by the analytic hierarchy process， the index weight in the evaluation system was determined， and the evaluation system for the readability of drug instructions was established. Fuzzy comprehensive evaluation was used to test the evaluation system， taking drug instruction of Dexamethasone acetate cream as an example. RESULTS The evaluation system for the readability of drug instructions was established with 5 primary criteria such as text expression， numerical application， content design， behavioral suggestions， and layout design， as well as 17 sub-criteria such as easy-to-understand words and appropriately long sentences. The reliability and validity tests met the requirements. The result of 100 respondents evaluating the readability of the drug instructions of Dexamethasone acetate cream showed that the readability of drug instructions was scored as good as 4.24. CONCLUSIONS Established evaluation system for the readability of drug instructions in the study can be used to evaluate the quality and readability of drug instructions in China.

With rapid development of information technology,blended teaching model has gradually become mainstream teaching model in most colleges and universities.How to evaluate students'learning effect and analyze factors that affect students'per-formance is a key research direction of this teaching model.Taking blended teaching of Medical Immunology course in Xinxiang Medical University as an example,this paper introduces implementation process and evaluation system of blended teaching,analyzes main factors affecting students'performance and learning effect,and focuses on discussing influence of formative evaluation and"flipped classroom"on students'academic performance.

Objective: To integrate the best evidence of venous thromboembolism (VTE) prevention into practice, improve nurses′ compliance, and reduce the incidence of VTE in orthopaedic department. Methods: Guided by the standard procedure in the JBI-Paces program, collected the best evidence from online databases and set the standards. Collected data through field observation, interviews and review of nursing records. A total of 167 patients and 36 nurses we recruited in the study and audited twice. We judged the result by the knowledge level of nurses and patients, nurses′ compliance with the evidence and the incidence rate of VTE. Results: In baseline review, three criteria of poor compliance, "the correct situation of daily inspection of VTE risk assessment", "Wear gradient pressure stockings correctly for VTE high-risk patients", "Intermittent pneumatic compression device (IPCD) used twice a day for 30 minutes each time", were significantly improved after the application of evidence, increased from 47.22% (17/36) ,36.11% (13/36) ,36.11% (13/36) to 86.11% (31/36) , 86.11% (31/36) , 91.67 (33/36) respectively (χ²=12.25, 18.94, 24.08, all P < 0.05); The incidence of VTE decreased from 2.7% to 0 (P=0.195); the correct rate of VTE risk assessment, awareness rate of health education among patients, implementation rate of physical preventive measures and qualified rate of VTE-related knowledge and skills among nurses increased from 82.43% (61/74) ,74.32% (55/74) ,83.78% (62/74) ,77.03% (57/74) to 97.85% (91/93) ,91.40% (85/93) ,97.85% (91/93) ,96.77% (90/93) respectively (χ²= 8.86-15.24, all P < 0.01) . Conclusion The integration of best evidence standardize nurses′ behaviors, reduce the incidence rate of VTE, improve the quality of clinical care and promote the satisfaction of patients continuously.

Objective? To explore the establishment and effects of preventive nursing sensitivity indicators for venous thromboembolism (VTE) in orthopedic patients. Methods? Preventive nursing sensitivity indicators for VTE in orthopedic patients were established using Delphi expert consultation method. Totally 160 patients before the preventive nursing sensitivity indicators for VTE were carried out (May 2017) were selected as the control group, while another 201 patients after the indicators were carried out (November 2017) were selected as the study group. Patients in the control group received conventional preventive nursing care for VTE, whereas patients in the study group received monitoring and management using the self-developed preventive nursing sensitivity indicators for VTE. Patients' incidence rate of VTE, satisfaction with VTE prevention, accuracy of VTE risk assessment, awareness rate of health education knowledge, implementation rate of physical prevention measures, achievement rate of nurses' VTE-associated knowledge and skills before and after the indicators were carried out. Results? Patients' incidence rate of VTE was 25‰ before the indicators were carried out, while that after the indicators were carried out was 5‰ (P=0.175); patients' satisfaction before the indicators were carried out was 78.12%, while that after the indicators were carried out was 93.53% (χ2=18.344, P＜0.001); and there were statistically significant differences in accuracy of VTE risk assessment, awareness rate of health education knowledge, implementation rate of physical prevention measures and achievement rate of nurses' VTE-associated knowledge and skills before and after the indicators were carried out (P＜ 0.01). Conclusions? The establishment and application of preventive nursing sensitivity indicators for VTE can effectively improve the nursing quality of VTE prevention as well as patient's satisfaction.

Objective To investigate the microbiological trends and antibiotic susceptibility of peritoneal dialysis(PD)-related peritonitis (PDAP).Methods All patients who developed PDAP between 2004 and 2015 in Renji Hospital,Shanghai Jiao Tong University School of Medicine were enrolled.Demographic data,results of dialysate pathogen culture and drug susceptibility test were recorded.The trend of peritonitis incidence was measured by Poisson regression and the chi-square test or Fisher exact test method was used to compare the composition of causative organisms and their antimicrobial susceptibilities over time.Results During the study period,a total of 711 episodes of PDAP were occurred in 386 patients.The culture positive rate of pathogens rose from 52.0％ in 2004 to 77.0％ in 2015 (P ＜ 0.001).The distribution of causative organisms of the culture positive peritonitis was gram-positive bacteria (270,59.5％),followed by gram-negative bacteria (129,28.4％),polymicrobial(39,8.6％),fungi (15,3.3％) and mycobacteria (1,0.2％).From 2004 to 2015,the incidence of peritonitis decreased from 0.214 to 0.160 episodes/patient·year (P=0.034).The incidence of coagulase-negative staphylococcus peritonitis decreased from 0.049 to 0.027 episodes/patient · year (P=0.025),while others had no significant change;A significant decline was observed in the sensitivity of Gram-positive strains to the first generation cephalosporin and ampicillin/sulbactam in 2010-2015 group compared with those in 2001-2009 group (61.3％ vs 88.2％,P ＜ 0.001;61.7％ vs 85.5％,P=0,001),whereas the sensitivity to vancomycin remained the same.The sensitivity of Gram-negative strains to ceftazidime and amikacin showed no significant change.As for the gram-positive peritonitis treated with cefradine as empirical treatment,compared with those in 2004-2009 group,in 2010-2015group the proportion of patients requiring to change their treatment regime was significantly higher,and the treatment course was longer.Conclusions A gradual decline is observed in the incidence of PDAP and the culture positive rate of pathogens improves.Peritonitis caused by coagulase-negative staphylococcus decreases overtime.The present empirical treatment protocols may need re-evaluation considering the decreased rate of the first generation cephalosporin sensitivity in recent years.

Objective To evaluate the efficacy of minimally invasive percutaneous intervertebral disc approach for treatment of sympathetic cervical spondylosis. Methods Fifty?six patients diagnosed as having sympathetic cervical spondylosis from January 2009 to August 2014, aged 22-64 yr, with the dis?ease course ranged from 6 months to 15 yr and a follow?up period of 6 months, were enrolled in the study. The related minimally invasive approach was selected according to the height of the diseased intervertebral space. When the ratio of the height of diseased intervertebral space∕normal intervertebral space≤1∕3, per?cutaneous radiofrequency ablation was used ( groupⅠ, n=19); when the ratio within the range of 1∕3-2∕3, percutaneous laser disk decompression was used ( groupⅡ, n=12); when the ratio≥2∕3, low?tem?perature plasma radiofrequency ablation was used ( group Ⅲ, n=25) . Before operation, at 2 weeks after operation, and at 1, 3 and 6 months after operation, the sympathetic symptoms were evaluated using the 20?point score. At 2 weeks and 6 months after operation, the patients′ subjective satisfaction was assessed and graded ( excellent, good, medium and poor ) . Results All the patients were followed up for 6 months. The sympathetic symptom scores were significantly lower at each time point after operation in Ⅰand Ⅲ groups and at 2 weeks and 3 and 6 months after operation in group Ⅱ than those before operation
( P<0.05) . The excellent and good rate of patients′subjective satisfaction was 67.9% at 2 weeks after op?eration, and 76.8% in the last follow?up period at 6 months after operation. Conclusion The minimally invasive percutaneous intervertebral disc approach has a marked short?term effect on sympathetic cervical spondylosis.

Objective To investigate the effect of hyperbaric oxygen intervention time on Glasgow Coma Score (GCS) and functional independent measure (FIM) scores in patients following traumatic brain injury,so as to provide clinical evidence for optimal intervention time in the comprehensive rehabilitation of those patients.Methods There were 130 patients with moderate or severe traumatic brain injury (TBI),who were divided according to different injury time into 4 groups:the control group (n =25),the HBO group 1 (TBI ＜ 15 d) (n =40),the HBO group 2 (TBI time of 15 to 30 d) (n =40) and the HBO group 3 (TBI ＞ 30 d) (n =25).The patients in all the groups received drug therapy and rehabilitation treatment measures.On the basis of the above routine treatment,the patients in all the HBO groups were treated with HBO for a total of 40 sessions.Therapeutic efficacy was assessed by using GCS and FIM scores performed respectively at day one,day 30 and day 60.Results Statistical significance could be noticed in all the TBI groups in GCS and FIM scores performed at day 30 and day 60(P ＜0.01).For HBO group 1 and group 2,statistical differences could be seen in GCS scores detected at day 60 (13.36 ± 3.06,13.66 ± 1.42,11.83 ± 3.57),as compared with those of the control group(P ＜ 0.05).For HBO group 1 and group 2,statistical differences could also be seen in FIM scores detected respectively at day 30 and day 60,as compared with those of the control group (P ＜ 0.05).Variance in the scores of GCS and FIM was:group 1 was greater than group 2,group 2 was greater than group 3 and group 3 was greater than the control group.Conclusions Different HBO intervention time seemed to have some effect on the improvement of GCS and FIM scores in patients with traumatic brain injury.On the whole,treatment results indicated that the therapeutic effects for the HBO group 1 were superior to those for the HBO group 2,and the therapeutic effects for the HBO group 2 were superior to those for the HBO group 3.

Objective To investigate the effect of hyperbaric oxygen intervention time on Glasgow Coma Score (GCS) and functional independent measure (FIM) scores in patients following traumatic brain injury,so as to provide clinical evidence for optimal intervention time in the comprehensive rehabilitation of those patients.Methods There were 130 patients with moderate or severe traumatic brain injury (TBI),who were divided according to different injury time into 4 groups:the control group (n =25),the HBO group 1 (TBI ＜ 15 d) (n =40),the HBO group 2 (TBI time of 15 to 30 d) (n =40) and the HBO group 3 (TBI ＞ 30 d) (n =25).The patients in all the groups received drug therapy and rehabilitation treatment measures.On the basis of the above routine treatment,the patients in all the HBO groups were treated with HBO for a total of 40 sessions.Therapeutic efficacy was assessed by using GCS and FIM scores performed respectively at day one,day 30 and day 60.Results Statistical significance could be noticed in all the TBI groups in GCS and FIM scores performed at day 30 and day 60(P ＜0.01).For HBO group 1 and group 2,statistical differences could be seen in GCS scores detected at day 60 (13.36 ± 3.06,13.66 ± 1.42,11.83 ± 3.57),as compared with those of the control group(P ＜ 0.05).For HBO group 1 and group 2,statistical differences could also be seen in FIM scores detected respectively at day 30 and day 60,as compared with those of the control group (P ＜ 0.05).Variance in the scores of GCS and FIM was:group 1 was greater than group 2,group 2 was greater than group 3 and group 3 was greater than the control group.Conclusions Different HBO intervention time seemed to have some effect on the improvement of GCS and FIM scores in patients with traumatic brain injury.On the whole,treatment results indicated that the therapeutic effects for the HBO group 1 were superior to those for the HBO group 2,and the therapeutic effects for the HBO group 2 were superior to those for the HBO group 3.

OBJECTIVE: To analyze the clinical significance of ocular vestibular evoked myogenic potentials (oVEMP) and cervical vestibular evoked myogenic potentials (cVEMP) in primary unilateral benign paroxysmal positional vertigo (BPPV). METHOD: Fifty-two patients with unilateral primary BPPV (BPPV group) and 38 normal subjects (control group) received ocular vestibular evoked myogenic potential (oVEMP) and cervical vestibular evoked myogenic potential (cVEMP) test using tone burst stimuli. The response rate, latency and amplitude were analyzed. RESULT: In BPPV group, the response rate of oVEMP was 46.15% in lesioned side and 48.08% in healthy side, respectively. The response rate of cVEMP was 67.31% in lesioned side and 65.38% in healthy side, respectively. In control group, the response rate on the left ear was 84.21% for oVEMP and 92.11% for cVEMP. On the right ear, was 81.58% for oVEMP and 94.74% for cVEMP in control group, there was no significant difference in cVEMP and oVEMP P1, N1 N1-P1 latency and amplitude between left and right ear. The interaural amplitude ratio and asymmetry of cVEMP and oVEMP was significantly different between BPPV group and control group (P<0.05). CONCLUSION Unilateral primary BPPV with bilateral impaired vestibular otolith pathways function can be objectively evaluated by oVEMP and cVEMP detection. Abnormal oVEMP responses were more frequently detected than cVEMP.
Adult ; Benign Paroxysmal Positional Vertigo ; physiopathology ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Vestibular Evoked Myogenic Potentials ; physiology ; Young Adult

Objective To investigate the roles of a variety of cytokines including transforming growth factor beta (TGF-β),interleukin-6 (IL-6) and interleukin-2 (IL-2) in the differentiation of CD+4 Tlymphocyte cells.Methods T lymphocyte cells either in human peripheral blood or routine spleen were cultured in vitro under different stimulation conditions.Flow cytometry was used to analyze the percentages of CD+4IL-17+ T-helper 17(Th17) cells,CD+8 IL-17+ T cells,CD+4 CD+25 FOXP+3 T regulatory (Treg) cells among activated T cells.Results Differentiation of Treg cells,Th17 cells and CD+8 IL-17+ T lymphocyte cells was enhanced when murine splenic T cells were cultured with TGF-β.The levels of expression were (7.8±2.2)%,(12.6±3.1)%,(10.1±2.6)% ,respectively.Experimental control group was severally same type of T cells without cytokine treatment.The levels of expression were (4.8±0.6) %,(1.7±0.5) %,(1.0±0.4) %,respectively.There were statistically significant differences among them (q=4.09,8.80,9.61.P<0.05 or P<0.01).Under combination treatment with IL-6 and TGF-β,(17.8±5.3) % Th17 cells and (15.0±4.2)% CDCD+8 IL-17CD+ T cells were induced,whereas the levels of Treg cells whose differentiation were restrained were (4.1±1.2) %.The differences were statistically significant compared with the level of same type of T cells in TGF-β group (q=5.03,5.17,5.04,P<0.01).Moreover,combination treatment with IL-2 and TGF-β decreased percentages of Th17 and CDCD+8 IL-17CD+ T cells and increased percentages of Treg cells in T cell population.There was an opposite effect when anti-IL-2 was apphed.The percentages of Th17 and CD+8 IL-17+ T cells were increased and the percentages of Treg cells were reduced The regulation trend of T lymphocyte cells in human peripheral blood was similar with those in routine spleen.Conclusion Various cytokines are of great importance in the regulation of the balance between Th17 and Treg cell.