Objective: To investigate the efficacy and incidence of adverse reactions of therapeutic erythrocytapheresis in high altitude polycythemia (HAPC) population. Methods: A retrospective study was conducted on 243 HAPC patients who were either native residents or long-term workers in Xizang and underwent therapeutic erythrocytapheresis in the Chengdu Office Hospital of the People's Government of Xizang Autonomous Region from 2021 to 2023. A comparative study was carried out on the changes in blood routine, vital signs, skin color, serum iron metabolism data, and the incidence of adverse reactions before and after the procedure. Results: After erythrocytapheresis, significant decreases were observed in red blood cell (RBC) count (7.06±0.89×10 vs 6.08±0.93×10 /L, P<0.001], hemoglobin (HGB, 211.59±17.99 vs 182.76±19.83 g/L, P<0.001), hematocrit (Hct) [(65.30±6.45)% vs (55.56±8.12)%, P<0.001], serum iron (14.46±4.38 vs 11.77±3.78 μmol/L, P=0.003), total iron-binding capacity (126.62±4.47 vs 123.73±3.77 μmol/L, P=0.002), transferrin (1.88±0.41 vs 1.77±0.12 g/L, P=0.023), transferrin saturation [(11.32±3.11)% vs (9.43±2.78)%, P=0.004], serum ferritin (832.4±295.6 vs 665.3±249.2 ng/mL, P<0.001), systolic blood pressure (123.86±14.43 vs 118.51±13.68 mmHg, P<0.001) and diastolic blood pressure (81.68±9.54 vs 74.28±7.61 mmHg, P<0.001). In contrast, platelet count (Plt, 137.21±46.21 ×10 vs 147.94±50.66 ×10 /L, P<0.001) and oxygen saturation [(93.97±3.29)% vs (95.84±2.27)%, P<0.001] increased. No significant differences were found in white blood cell (WBC) count [5.35 (4.59, 6.44)×10 /L vs 5.43 (4.54, 6.53) ×10 /L, P=0.690], unsaturated iron-binding capacity (112.15±0.50 vs 111.96±0.25 μmol/L, P=0.074) and pulse rate (73.42±11.28 vs 73.19±7.18 beats/min, P=0.750). Furthermore, skin color of the face (conjunctiva, lips) and palms mitigated after therapeutic erythrocytapheresis, changing from purplish-red to red. The total incidence of adverse reactions during erythrocytapheresis was 13.98% (34/243), including citrate toxicity 12.75% (31/243), puncture site hematoma 0.82% (2/243) and blood volume imbalance 0.41% (1/243). Conclusion: Therapeutic erythrocytapheresis could rapidly decrease HCT, Hb, serum iron, transferrin and transferrin saturation levels in HAPC patients, with a low incidence of adverse reactions. Therefore, therapeutic erythrocytapheresis has broad clinical application prospects in Xizang Autonomous Region.

Objective:To evaluate the effects of the defect situational objective structured clinical examination (OSCE) in the training of specialized nurses in the operating room, and provide a new idea for the training of specialized nurses in the operating room.Methods:A quasi experimental study was used in this study. A total of 78 nurses who participated in the training of the operating room specialized nurses in Henan Province in 2022 and 2023 which were organized by the First Affiliated Hospital of Zhengzhou University were selected by cluster sampling method. The nurses who participated in the training in 2022 and 2023 were assigned to the control group (38 participants) and the experimental group (40 participants), respectively. Nurses in the experimental group received defect situational OSCE, while nurses in the control group received conventional teaching. After the training, the effect of the two teaching methods was evaluated by skill operation assessment results and Clinical Thinking Ability Assessment Scale.Results:There were 4 males and 34 females in the control group, aged (30.03 ± 4.33) years old, and 3 males and 37 females in the experimental group, aged (29.93 ± 3.95) years old. The scores of the verification and handover of surgical patients, surgical position placement and the occupational exposure protection were (91.80 ± 2.95), (90.38 ± 3.66), (91.10 ± 3.26) points in the experimental group and were (89.08 ± 3.21), (87.84 ± 3.49), (88.39 ± 4.21) points in the control group, the differences between the two groups were statistically significant ( t = 3.91, 3.13, 3.18, all P<0.05). The total score of clinical thinking ability in the experimental group was (80.66 ± 1.85) points, which was higher than (77.77 ± 1.62) points in the control group, the difference between the two groups was statistically significant ( t = 7.31, P<0.05). The evaluation of the teaching effect in the experimental group was better, and the satisfaction rate was 92.5%(37/40)-100.0%(40/40). Conclusions:The application of defect situational OSCE teaching method in the training of operating room nurses could better improve the operational ability and help to improve the clinical thinking ability of nurses. The training effect is superior to the conventional teaching method, and it is worthy of clinical application.

Objective:To construct a competency evaluation indicator system for infection prevention and control nurses in Operating Rooms (hereinafter referred to as "IPC") and provide an objective basis for the management of IPC nurses.Methods:From June to November 2022, an initial competency evaluation indicator system for IPC nurses was developed through literature review and semi-structured interviews. The Delphi method was employed to consult 20 experts from 11 provinces and municipalities across the country. Analytical Hierarchy Process (AHP) and mean distribution method were applied to quantify and determine the weight of each level of indicators within the system.Results:Nineteen experts were finally included, with two rounds of questionnaire recovery rates of 95.00% (19/20) and 100.00% (19/19), respectively. The authority coefficients of the experts were 0.858 and 0.861, familiarity coefficients were 0.850 and 0.853, and coefficients of judgment basis were 0.865 and 0.868, respectively. The Kendall's W coefficient of concordance for the two rounds of inquiries were 0.139 and 0.202 ( P<0.05), respectively. The final IPC nurse competency evaluation indicator system included six primary indicators, 22 secondary indicators, and 66 tertiary indicators. Conclusions:The constructed IPC nurse competency evaluation indicator system is scientific, reasonable, objective, and comprehensive, providing a valuable reference for the capability training, assessment, entry standards, and qualification certification of IPC nurses.

Objective:To investigate the level of self-management and daily physical activity in patients with type 2 diabetes mellitus (T2DM) of Zang and Han nationalities in Tibetan, China, and to compare the difference in daily management between T2DM patients of Zang and Han nationalities, to develop reasonable and effective chronic disease management strategies for long-term out-of-hospital management of T2DM patients of Zang nationalities.Methods:A total of 265 T2DM patients with glycosylated hemoglobin (HbA1c) ≥ 7% who were admitted to the Endocrinology Ward of the Hospital of Chengdu Office of People's Government of Tibet Autonomous Region from November 2020 to April 2021 and who were from different regions of Tibet were included in this study according to inclusion and exclusion criteria. The general data of all included patients were collected. Glucose and lipid metabolism-related indicators were determined. The Generalized Diabetes Self-Management Efficacy Scale and International Physical Activity Questionnaires (IPAQ) were used to evaluate patients' levels of self-management and daily physical activity.Results:The hemoglobin level in T2DM patients of Zang nationality was (154.09 ± 24.11) g/L, which was significantly higher than that in T2DM patients of Han nationality ( P < 0.05). The total cholesterol, fasting blood glucose, and low-density lipoprotein in T2DM patients of Zang nationality were (4.63 ± 1.41) mmol/L, (7.94 ± 2.19) mmol/L, and (2.75 ± 1.11) mmol/L, respectively, which significantly higher compared with T2DM patients of Han nationality (all P < 0.05). Compared with T2DM patients of Han nationality, T2DM patients of Zang nationality had lower self-management scores (81.40 ± 15.44) points, diet control scores (17.26 ± 4.97) points, physical exercise scores (11.67 ± 4.42) points, prevention and treatment of high and low blood sugar score (12.21 ± 5.72) points. The differences were statistically significant (all P < 0.05). Moderate-intensity physical activity was a significant difference between T2DM patients of Zang and Han nationalities ( P < 0.05). Conclusion:Compared with T2DM patients of Han nationality, T2DM patients of Zang nationality have lower overall self-management levels, including diet control, physical exercise, prevention and management of high and low blood glucose, and moderate-intensity physical activity. Targeted individualized education should be carried out according to the Tibetan cultural characteristics, to further develop an intervention method and an out-of-hospital management strategy for chronic disease, which are suitable for T2DM patients of Zang nationality.

Objective:To investigate the prevalence and risk factors of diabetic retinopathy (DR) in patients in Tibet.Methods:A total of 239 patients with DR who received treatment in Department of Endocrinology and Metabolism, Hospital of Chengdu Office of People's Government of Tibet Autonomous Region from December 2017 to December 2018 were included in this study. They were divided into Han nationality and Zang nationality groups according to ethnicity. The condition of DR was evaluated with nonmydriatic ocular fundus photography according to the staging criteria of the severity of retinopathy.Results:The prevalence of DR in Tibet was 18.0％. The prevalence of DR in Tibetan and Han patients with diabetes was 17.5% and 19.2%, respectively. There was no significant difference in the prevalence of DR between Tibetan and Han patients with diabetes ( χ2 = 0.10, P = 0.754). Logistic regression analysis revealed that the risk factors of developing DR in Tibet included diabetes duration ( OR = 1.14, 95% CI: 1.05-1.24, P < 0.05), insulin therapy ( OR = 2.74, 95% CI: 1.09-6.89, P < 0.05), fasting plasma glucose ( OR = 1.37, 95% CI: 1.07-1.75, P < 0.05) and hypertension ( OR = 1.98, 95% CI: 1.02-3.86, P < 0.05). Diabetes duration and fasting plasma glucose are independent risk factors of DR. However, although elevated glycated hemoglobin levels were high in Tibet, they could not be used to predict the risk for developing DR ( OR = 1.01, 95% CI: 0.82-1.25, P > 0.05). Conclusion:Hyperglycemia is an important risk factor of developing DR in Tibet. However, elevated glycated hemoglobin levels cannot be used to predict the risk of developing DR in Tibet. Findings from this study fill the gap in the research on DR prevalence and ethic difference of DR prevalence, providing scientific evidence for prevention and treatment of DR in high-altitude areas.

Objective:To explore the effect of small private blended teaching combined with guided feedback in the training of specialist nurses in Operating Room.Methods:The cluster sampling was used to select 62 trainees who participated in the training of specialist nurses in Operating Room of the First Affiliated Hospital of Zhengzhou University in 2019 and 2020 as the research object. The trainees in 2019 and 2020 were divided into the control group ( n=32) and the experimental group ( n=30) . The experimental group adopted the small private online course (SPOC) teaching method combined with guided feedback, and the control group adopted the traditional teaching method. After the training, the two teaching methods were evaluated by theoretical assessment, operational assessment and self-designed questionnaires. Results:The theoretical knowledge, surgical safety verification, and surgical position placement scores of the specialist nurses in Operating Room of the experimental group were (89.90±3.92) , (91.37±3.57) , (92.03±2.98) , and the scores of the control group were (87.44±3.06) , (88.53±4.23) , (87.28±3.10) respectively, and the differences between the two groups were statistically significant ( P<0.05) . The students in the experimental group had a good evaluation of the effect of the SPOC teaching method combined with guided feedback, and their satisfaction was over 90%. Conclusions:The SPOC teaching method combined with guided feedback can improve the theoretical knowledge and operational ability of specialist nurses in Operating Room, and enhance the enthusiasm of students to learn, cultivate clinical thinking ability and humanistic care consciousness. The training effect is better than traditional teaching method, which is helpful to improve the teaching quality of specialized nursing in Operating Room.

Objective:To investigate the training status of robotic-assisted surgery nurses in hospitals with robotic-assisted surgery system in China, and to provide reference for the training and management of robotic-assisted surgery nurses.Methods:From August to December in 2021, hospitals with robotic-assisted surgery system in China were surveyed by a self-designed questionnaire distributed online.Results:The participants in the survey of 111 hospitals in 30 provinces, cities, autonomous regions and municipalities directly under the central government, nurses cooperated with robotic-assisted surgery exist the phenomenon of their own training was up to 96.40% (107/111) of hospital, 47.75% (53/111) of the hospital said the current training content also need to add other aspects of the course. Training duration of theoretical courses was 0-13 (2.86 ± 3.03) periods arranged by hospitals, and the training duration of practical courses was 1-60 (8.38 ± 9.91) d. 35.14% (39/111) of hospitals set up regular assessment after training, and the assessment cycle of them was 1-12 (4.08 ± 3.31) months. Many hospitals put forward suggestions on strengthening English training and attaching importance to team cooperation and so on.Conclusions:In our country, Robotic-assisted surgery nurses′ training has turned to that training themselves in operating rooms, the training time, form, content and other aspects have no uniform standard, strict admittance, standardization of specialist training , these are questions need to solve.

Objective:To explore the effect of ICE regimen (ifosfamide, carboplatin, VP16) combined with methotrexate on the clinical efficacy and expression of miR-451a and miR-15a in patients with diffuse large B cell lymphoma (DLBCL).Methods:A total of 56 patients with DLBCL in the Third Hospital of Changsha from March 2013 to may 2018 were prospectively selected and randomly divided into observation group and control group, 28 cases in each group. The control group was treated with ICE regimen, and the observation group was treated with ICE regimen combined with methotrexate. The tumor control rate, toxic and side effects, the expression of miR-451a and miR-15a, immune function (CD3 +, CD4 +, CD8 +, CD4 +/CD8 +), serum tumor markers [β 2 microglobulin (β 2-MG), carbohydrate antigen 125 (CA125), and lactate dehydrogenase (LDH)] levels were compared before and after treatment between the two groups, follow-up for 6 to 12 months was used to calculate the survival rate of the two groups. Results:The tumor control rate in the observation group (92.86%) was higher than that in the control group (71.43%) ( P<0.05); After treatment, the miR-15a decreased and miR-451a increased in the two groups, and the miR-15a in the observation group was lower than that in the control group, while miR-451a was higher than that in the control group ( P<0.05); After treatment, the CD3 +, CD4 +, CD4 +/CD8 + of the two groups were lower than before treatment, and CD8 + was higher than before treatment ( P<0.05), but there was no significant difference between the two groups ( P>0.05); After treatment, the serum CA125, LDH, and β 2-MG in the two groups were lower than before treatment, and the above indexes in the observation group were lower than those in the control group ( P<0.05); There was no significant difference between the two groups in the incidence of side effects and the survival rates of 6, 9 and 12 months after treatment ( P>0.05). Conclusions:ICE regimen combined with methotrexate in the treatment of DLBCL can further improve the therapeutic effect and reduce the serum tumor marker levels by regulating the expression of miR-451a and miR-15a, with less toxic side effects and less immune damage, and high safety.

Objective:To explore the current status of clinical nurses' perception of authentic leadership, scientific research ability, and self-transcendence, and analyze the path relationship among them.Methods:This study was a cross-sectional study. In June 2020, convenience sampling was used to select clinical nurses from two Class Ⅲ Grade A hospitals in Zhengzhou as the research object. The survey was conducted using the General Information Questionnaire, Authentic Leadership Questionnaire (ALQ) , Nursing Research Capacity Self-evaluation Questionnaire, and Self-Transcendence Scale (STS) . This study collected 913 questionnaires, of which 897 were valid questionnaires, with a valid rate of 98.25%.Results:Among 897 clinical nurses, the ALQ total score, Nursing Research Capacity Self-evaluation Questionnaire total score and the STS total score were (58.72±6.72) , (47.42±18.23) and (37.94±7.86) respectively. The structural equation model showed that with self-transcendence as an intermediary, the indirect effect of authentic leadership on scientific research ability was 0.15.Conclusions:Self-transcendence plays a mediating role between nurses' perception of authentic leadership and scientific research ability. Nursing managers should take effective measures to cultivate authentic leadership behaviors, promote the improvement of nurses' self-transcendence level, and thereby enhance nurses' scientific research capabilities.

Objective:To formulate a safety check plan for intraoperative magnetic resonance imaging (IMRI) , and provide a reference for the management of the combined MRI operation room.Methods:Totally 207 intracranial mass lesion surgeries performed in the combined MRI operation room of the First Affiliated Hospital of Zhengzhou University in 2019 were selected. Based on the visual management theory, the "point-to-point" fixed homing method and the "four-party" safety checklist for IMRI were designed to adjust the surgical process. After optimization, the surgeons, anesthesiologists, itinerant nurses and magnetic resonance physicians who participated in the scan safety check were interviewed to evaluate the effect of process improvement. The interview data were collected and analyzed using Colaizzi's phenomenological seven-step analysis method.Results:The interviews with surgeons, anesthesiologists, itinerant nurses and magnetic resonance physicians could boil down to two themes: fixed-point placement of items could ensure the safety of IMRI; "four-party" safety check could ensure patients' safety.Conclusions:The optimized surgical process in the combined IMRI operation room and the scanning safety check plan can ensure the safe homing of non-compatible items, improve the efficiency of scanning safety check, and enhance the safety of IMRI.