Objective:To explore the effectiveness of applying the ADDIE (analysis, design, develop, implement, evaluate) Model in clinical teaching for nursing interns in spine surgery department.Methods:Using a convenience sampling method, 44 nursing interns in the Department of Orthopedics at Peking Union Medical College Hospital were selected as the control group from July 2021 to May 2022, and were taught using traditional methods. From July 2022 to May 2023, 45 nursing interns were selected as the observation group, and a teaching team was formed to design a training program based on the five stages of the ADDIE instructional design model. This program was tailored to improve the overall clinical competence of the spinal surgery nursing interns. After training, the teaching effects were evaluated based on knowledge test scores, skills test scores, overall clinical competence, and teaching satisfaction.Results:After the training, the skills test scores in specialized nursing for the observation group were (94.87±1.10) points, higher than the control group's (93.98±1.41) points, with a statistically significant difference ( P<0.01). The observation group also scored higher than the control group in clinical judgment, organizational effectiveness, overall performance, and total score in the Mini-Clinical Evaluation Exercise, with statistically significant differences ( P<0.01). Additionally, the observation group reported higher satisfaction with the teaching plan and methods compared to the control group ( P<0.05) . Conclusions:Clinical teaching for spinal surgery nursing interns based on the ADDIE instructional design model can improve their specialized practical skills and overall clinical competence. The interns also expressed a high level of acceptance for this teaching design model.

Objective:To investigate the clinical efficacy of anterior approach combined with blocking plates and screws in the management of acetabular fracture involving the quadrilateral area.Methods:A retrospective case series analysis was performed for 16 patients with acetabular fracture involving the quadrilateral area admitted to First and Second Affiliated Hospital of Guangxi Medical University from January 2017 to January 2019. There were 12 males and 4 females，with the age of 21-66 years［（45.3±10.6）years］. According to Letournel-Judet classification，there were 9 patients with bi-column fracture，6 with anterior and posterior traverse fracture and 1 with anterior column fracture. A total of 9 patients were operated via the ilioinguinal approach and 7 via the lateral-rectus approach. Reduction and fixation of the pelvis and acetabulum were performed，using 3.5 mm cortical bone screws or plates to block the internal displacement of fracture in the quadrilateral body. The incision length，operation time and intraoperative blood loss were recorded. The quality of fracture reduction was assessed according to the Matta reduction criteria at postoperative 2 days and hip function by the modified Merle D'Aubigne-Postel score at postoperative 3 months and 12 months. Postoperative complications were observed.Results:All patients were followed up for 13-24 months［（16.1±2.9）months］. The ilioinguinal approach and lateral-rectus approach showed surgical incision of 12-26 cm［（18.6±4.0）cm］and 8-15 cm［（10.7±2.3）cm］，respectively. The operation time was 107-215 minutes［（159.2±27.8）minutes］and the intraoperative blood loss was 200-2，300 ml［（853.1±489.7）ml］. According to Matta reduction criteria，the results were excellent in 9 patients and good in 7. Three months after operation，the modified Merle D'Aubigne-Postel score was 11-18 points［（15.2±2.2）points］，which showed the results were excellent in 4 patients，good in 7，fair in 4 and poor in 1，with the excellent and good rate of 69%. Twelve months after operation，the modified Merle D'Aubigne-Postel score was 13-18 points［（16.9±1.4）points］，which showed the results were excellent in 7 patients，good in 8 and fair in 1，with the excellent and good rate of 94%. The liquefaction of post-surgical incision was seen in a patient，bladder injury in a patient，lateral femoral cutaneous nerve injury in a patient，and heterotopic ossification in a patient. There was no loosening or breakage of the internal fixation.Conclusion:For acetabular fracture involving the quadrilateral area，anterior approach combined with blocking plates and screws can prevent the displacement of quadrilateral fracture and attain satisfactory reductiongood hip function recovery and few complications.

Objective:Based on the clinical indicators of severe community-acquired pneumonia in emergency department, the early warning indicators of critical condition were constructed.Methods:The general information, vital signs before entering ICU, laboratory indexes and the survival rate in 30 days of 118 patients with community-acquired pneumonia were retrospectively collected in the emergency care unit of Peking Union Medical College Hospital from January to December 2018. The indexes of death patients (24 cases) and alive patients (98 cases) underwent comparative analysis, using ROC curve to predict the clinical outcome and reliable parameters of emergency patients with community-acquired pneumonia. The best cutoff value was determined according to Youden index and then undergoing multiple factors Logistic stepwise regression analysis. Then early warning model of critical degree was finally built.Results:Eleven indicators were used to predict the criticality of patients with acute community-acquired pneumonia, including AVPU (alert, voice, pain, unresponsive) score, Glasgow Coma Scale(GCS), heart rate, pulse oxygen saturation (SpO 2), fraction of inspiration O 2, oxygenation index,potential of hydrogen, blood potassium (K +), bilirubin, urea nitrogen, and C reactive protein, the optimal cutoff values were 2 points, 8 points, 91 times per minute, 0.94, 41%, 81.20%, 7.38, 4.0 mmol/L, 10.90 μmol/L, 2.23 mmol/L, and 41.5 mg/L. Multiple Logistic stepwise regression showed that the independent factors for predicting death were GCS score, SpO 2 and urea nitrogen, and the predictive ability of the early-warning model was 83.7%. Conclusions:GCS score, SpO 2 and urea nitrogen are effective early warning indicators for the severity of severe community-acquired pneumonia in emergency department, which are conducive to the rapid and efficient early identification and treatment of critically ill patients. Therefore, they are worthy of promotion and application in clinical practice.

Objective? To systematically analyze the incidence and influencing factors of post-extubation dysphagia (PED) among patients with mechanical ventilation. Methods? Observational studies on PED were systematically retrieved in PubMed, CIHNAL, Cochrane Library, WanFang data, China National Knowledge Infrastructure (CNKI) and VIP. We screened literatures, extracted data and evaluated the literature quality. The Stata14.0 was used to meta-analysis. Results? A total of 1 356 literatures were retrieved and 8 of them were included, 5 literatures on cohort study and 3 on cross-sectional study. Totals of 2 384 research objects were included and 553 of them were with PED. Meta-analysis showed that the incidence of PED was 36% (95% CI: 23%-50%), the rates of PED patients with intubation time ≥48 h and ＜48 h were 46% (95%CI: 40%-53%) and 6% (95%CI: 5%-7%) respectively. The independent influencing factors of PED were the intubation time and ages. Subgroup analysis revealed that the ages(OR=2.18,95%CI:1.42～3.34) was the influencing factor among patients with intubation time ＜48 h, but intubation time could not be determined;the ages (OR=1.02, 95%CI: 1.00-1.05) and intubation time (OR=1.28, 95%CI: 1.08-1.52) were the influencing factors among patients with intubation time ≥48 h. Publication bias analysis showed that the included literatures were with no significant bias and with credible results. Conclusions? We should pay attention to problems existing in PED among patients with mechanical ventilation particularly in patients with intubation time ≥48 h and old ages, so as to promote early detection and early intervention of PED.

Objective To investigate the construction of outpatient quality care services and the needs of patient for outpatient service,and to explore the relevance of the two projects.Methods A total of 152 cases of outpatient department registered nurse of Beijing Union Hospital and 281 cases of hospitalized patients on May,2017 were selected,and then developed the Content Questionnaire on Quality Nursing Work of Outpatient Nurse and the Questionnaire on Outpatient Needs Status to carry out investigation.Results This kind of hospital patients with college or university in 216 cases(76.9%,216/281),personal monthly income of 5.0-10.0 thousand accounted for 44.8%(126/281);outpatient nurses aged ≥46 in 83 cases(54.6%,83/152),the working time≥20 years in 120 cases(78.9%,120/152),college degree or above in 137 cases(90.1%,137/152),97 nurses(63.8%,97/152)in charge.The clinic nursing work relates to the rate of above 85%for disease treatment and consultation,health education,guidance service,self-service system services,on-site inspection,consulting room environment,and the cost of nurses working hours and the most frequent content for the on-site inspection and diagnosis of diseases,counseling,health education,medical order service.The order of patients' needs from high to low was disease and consultation,health education,guidance service,order service,on-site inspection,self-service system,registration service,waiting environment and consulting room environment.There was no correlation between the patient's needs and the rate of nursing,the length of work,and the frequency of work(P＞0.05).There were significant differences in the demand for health education on each department(F =3.047,P ＜0.05),education level,medical order service and on-site inspections have significant difference on demand(F=3.809,3.409,P＜0.05),family income,sources of patients were not statistically significant in the comparison(P＞0.05).The outpatient quality care services had lower improved demand(≤26%),and the first six item that needed to improve are disease and medical consultation,self-service system,treatment order service,waiting environment,health education,guidance services.Conclusions In view of the characteristics of outpatient medical staff and patients in large general hospitals,we will improve the quality of outpatient service and meet the needs of patient outpatient service,which will help to deepen the medical reform and improve the quality of medical service.

Objective To explore the feasibility of oxygen saturation related diffusion index for assessing oxygenation status,and to establish the critical value of the oxygen saturation related diffusion index,so as to provide more approaches to monitoring oxygenation status.Methods A total of 30 patients with acute respiratory distress syndrome (ARDS) receiving mechanical ventilation support were retrospectively reviewed.Totally 340 cases were collected at corresponding time points,and were divided into mild,moderate and severe groups according to ARDS Berlin criteria.Results There was a positive correlation between oxygen saturation related diffusion index and oxygenation index (r=0.698,P＜0.001);the critical value between the moderate and severe groups of oxygen saturation related diffusion index was 171(sensitivity 84.7％,specificity 68.2％),and the critical value between mild group and moderate group was 440 (sensitivity 56.9％,specificity 91.9％).Conclusion The oxygenation index was consistent with the oxygen saturation related diffusion index in judging the oxygenation status of ARDS patients.As a noninvasive and continuous index,the oxygen saturation related diffusion index provides a new method for nursing assessment.

Objective To explore whether oxygen saturation-related dispersion index can be used as a non-invasive index for nurses to monitor ARDS patients' oxygenation and conditions.Methods Totally 23 patients with mechanical ventilation-associated complication and ARDS admitted in Peking Union Medical College Hospital between April 2015 and April 2016 were reviewed. Their PaO2, SpO2, PEEP and FiO2 values were recorded, and oxygenation index (OI) and oxygen saturation-related dispersion index were calculated for 132 case-times, respectively.Results The patients in the death group showed lower OI and oxygen saturation-related dispersion index than the patients in the survival group (P<0.05). The difference in oxygen saturation-related dispersion index between the light, middle and heavy groups were statistically significant (P<0.05).Conclusions Oxygen saturation-related dispersion index can be used to determine the prognosis of ARDS patients and the severity of the disease, especially the conditions of severe ARDS patients. As a non-invasive and continuous indicator, it provides a new measure for the nursing assessment of patients with mechanical ventilation-associated complication and ARDS.

Objective To investigation the incidence of central venous catheter related bloodstream infection (CRBSI) and the distribution of pathogens in patients in the emergency intensive care unit (EICU),and analyze the risk factors of central venous catheter related bloodstream infection.Methods Clinical materials of the patients with central venous catheters in the emergency intensive care unit in Peking Union Medical College Hospital from April 2015 to March 2016 were collected. The indwelling of central venous catheters and the infection situation were investigated with the self-designed central venous catheter monitoring table. Results From April 2015 to March 2016,108 cases of catheters were indwelled in EICU. The total number of days of central venous catheter indwelling was 688 days. There were 9 cases of CRBSI. The incidence of CRBSI was 13.08‰. There were 66.67% of catheters inspected. The gram-negative bacterium infection was the main pathogen of hospital infection. The main CRBSI risk factors were whether contaminated dressings were changed in time and timely removing unnecessary catheters.Conclusions Long term continuous targeted monitoring, timely understanding of infection related factors,and taking timely appropriate preventive measures can effectively reduce the incidence of catheter related bloodstream infection.

ObjectiveTo analyze the problems in the catheter related bloodstream infection (CRBSI) control for critically ill patients to reduce the incidence of CRBSI in emergency nursing practice.Methods An action research was performed to identify the problems causing high occurrence rate of CRBSI in emergency intensive care unit (EICU). According to the process of "plan-action-observation-reflection",doctors and nurses were surveyed on the knowledge-attitude-action successively. The preventive measures were determined in accordance with advices of emergency medical care specialist to improve the clinical practice of CRBSI control and control the incidence of CRBSI.Results An action group containing 19 EICU medical workers was built up. After the first round from June to July 2015,the incidence rate of CRBSI was 12.12‰. After the second round from August to September 2015,the incidence rate of CRBSI decreased to 8.90‰. Logistic regression analysis showed that the ductal indwelling time and gender of patients affected the occurrence of CRBSI.Conclusions In the study of decreasing the incidence of CRBSI,action research can improve the clinical nursing practice of CRBSI in EICU and is worth trying in the field of intensive care.

Ventilator-associated pneumonia (VAP) has become one of the most common and severe complications in patients with mechanical ventilation due to its high morbidity and mortality rates, and is an important cause of death in critically ill patients. Pathogenic oropharyngeal colonization mostly accumulates in the subglottic secretion, which is easy to be ignored and difficult to be cleaned. The leakage of subglottic secretion can result in pathogenic oropharyngeal colonization in the lung, and in turn cause VAP. Flushing of the subglottic secretion can effectively prevent VAP. Selection and amount of rinses, flushing frequency and proper cuff pressure maintenance during flushing were reviewed in the current study.