Objective:To investigate the status quo of preoperative decisional conflict in patients with traumatic amputation, analyze its influencing factors, and provide a reference for the development of targeted decision-making support programs.Methods:Totally 189 patients with traumatic amputation hospitalized in the Emergency Department of the First Affiliated Hospital of Zhengzhou University from January 2022 to October 2023 were selected by convenience sampling. Data were collected using a sociodemographic questionnaire, the Chinese version of the Decision Conflict Scale (DCS), the Control Preference Scale (CPS), and the Perceived Social Support Scale (PSSS). Data analysis was performed using SPSS 25.0.Results:A total of 196 questionnaires were distributed, with 189 valid responses, yielding an effective response rate of 96.4%. The average preoperative decisional conflict score among the 189 patients was (44.32 ± 9.27). During the decision-making process, 69 patients (36.5%) preferred a shared decision-making model, but 100 patients (52.9%) experienced a passive role. Multiple stepwise regression analysis indicated that the primary factors influencing decisional conflict were age, educational level, occupation, family income, actual participation role, family support (adjusted R2=0.799, P<0.01) . Conclusions:There is a discrepancy between the expected and actual participation roles in the decision-making process among patients with traumatic amputation, leading to a high level of preoperative decisional conflict. Several factors contribute to this conflict. Healthcare providers should pay particular attention to peasants, older patients, those with lower education and family income, respect patients' control preferences, and provide appropriate decision-making support.

Objective:To investigate the status quo of preoperative decisional conflict in patients with traumatic amputation, analyze its influencing factors, and provide a reference for the development of targeted decision-making support programs.Methods:Totally 189 patients with traumatic amputation hospitalized in the Emergency Department of the First Affiliated Hospital of Zhengzhou University from January 2022 to October 2023 were selected by convenience sampling. Data were collected using a sociodemographic questionnaire, the Chinese version of the Decision Conflict Scale (DCS), the Control Preference Scale (CPS), and the Perceived Social Support Scale (PSSS). Data analysis was performed using SPSS 25.0.Results:A total of 196 questionnaires were distributed, with 189 valid responses, yielding an effective response rate of 96.4%. The average preoperative decisional conflict score among the 189 patients was (44.32 ± 9.27). During the decision-making process, 69 patients (36.5%) preferred a shared decision-making model, but 100 patients (52.9%) experienced a passive role. Multiple stepwise regression analysis indicated that the primary factors influencing decisional conflict were age, educational level, occupation, family income, actual participation role, family support (adjusted R2=0.799, P<0.01) . Conclusions:There is a discrepancy between the expected and actual participation roles in the decision-making process among patients with traumatic amputation, leading to a high level of preoperative decisional conflict. Several factors contribute to this conflict. Healthcare providers should pay particular attention to peasants, older patients, those with lower education and family income, respect patients' control preferences, and provide appropriate decision-making support.

Objective:To analyze the effects of different anesthesia depths on serum S100β protein level and postoperative cognitive function in patients undergoing minimally invasive McKeown esophagectomy with bispectral index (BIS) monitoring.Methods:A total of 120 patients who received minimally invasive McKeown esophagectomy in the Second Hospital of Shanxi Medical University from April 2018 to April 2019 were selected, and they were divided into light anesthesia group (L group, 40 cases, BIS 46-60), deep anesthesia group (D group, 40 cases, BIS 35-45) and control group (C group, 40 cases, no BIS monitoring) by using the random number table method. Elbow venous blood was taken from each group to detect serum S100β protein levels before induction (T 0), 10 minutes after extubation (T 3), the first day after surgery (T 4), and the third day after surgery (T 5). The mini-mental state examination scale (MMSE) score and the monterey cognitive assessment scale (MoCA) score were performed before surgery and on day 1, 3, and 7 after surgery to count the incidence of postoperative cognitive dysfunction(POCD). Results:There was no statistical difference in serum S100β protein levels between the three groups at T 0 (F = 0.083, P = 0.920). The level of serum S100β protein in D group [(1.08±0.05) μg/L] was significantly higher than that in C group and L group [(0.98±0.10) μg/L and (0.84±0.09) μg/L] at T 3, and the level of serum S100β protein in L group was lower than that in C group, the differences between the three groups were statistically significant (P < 0.05). There was no statistical difference in the incidence of POCD among the three groups on day 7 after surgery (χ 2 = 2.914, P = 0.233). The incidence rates of POCD in D group on day 1 and 3 after surgery (57.1% and 37.1%) were significantly higher than those in C group (41.7% and 38.9%) and L group (20.0% and 14.3%), and the incidence of POCD in L group were lower than those in C group, the differences among the three groups were statistically significant (χ 2 = 10.187, P = 0.006; χ 2 = 6.296, P = 0.043). Conclusions:For patients undergoing minimally invasive McKeown esophagectomy, intraoperative BIS monitoring maintains a light anesthetic state, which can effectively reduce serum S100β protein level and POCD. The mechanism may be related to reducing serum S100β protein level and improving brain damage.

Objective:To investigate the effects of propofol combined with sevoflurane intravenous-inhalational anesthesia and propofol intravenous anesthesia on implicit memory, explicit memory and stress response in patients undergoing gynecological cancer surgery.Methods:A total of 48 patients undergoing gynecologic cancer surgery in the Second Hospital of Shanxi Medical University from August 2018 to May 2019 were selected. Random number table was used to divide patients into propofol intravenous anesthesia group (group A) and propofol combined with sevoflurane intravenous-inhalational anesthesia group (group B), 24 cases in each group. During the operation, the patients in group A were given continuous intravenous anesthesia with propofol and the patients in group B were given continuous intravenous anesthesia with propofol combined with sevoflurane. Minimal alveolar concentration (MAC) of sevoflurane was 0.5, and midazolam was not utilized throughout the whole anesthesia for both groups. The bispectral index (BIS) value of the two groups ranged from 45 to 55 during the operation. The concentration of cortisol, adrenocorticotropic hormone (ACTH) and prolactin(PRL) in elbow venous blood was measured before anesthesia induction (T 1) and 10 minutes after intraoperative auditory recording (T 2). Implicit and explicit memory scores were measured 12-24 h after operation. Results:Neither group produced explicit memory compared with 0 (group A: 0.012±0.007, t = 1.554, P > 0.05; group B: 0.016±0.002, t = 1.942, P > 0.05), and there was no significant difference in explicit memory score between the two groups ( t = -0.417, P > 0.05). Both groups produced implicit memory (group A: 0.089±0.050, t = 8.726, P < 0.05; group B: 0.189±0.060, t = 15.415, P < 0.05), and implicit memory score was higher in group B ( t = -6.215, P < 0.05). The level of cortisol, ACTH and PRL at time T 1 was not significantly different between the two groups (all P > 0.05), and the level of cortisol, ACTH and PRL in group B was higher than that in group A at time T 2 [(276±35) μg/L vs. (96±33) μg/L; (228±42.3) pg/ml vs. (14.1±1.7) pg/ml; (4 208±213) mU/ml vs. (3 805±196) mU/ml; t value was 18.634, 34.879, 12.605, all P < 0.05]. Conclusion:Propofol intravenous anesthesia can better inhibit the production of implicit memory and intraoperative stress response compared with propofol combined with sevoflurane intravenous-inhalational anesthesia.

Objective: To study the effects of different anesthesia depths on stress response during single-lung ventilation in patients with thoracoscopic lobectomy. Methods: Sixty patients selected for elective thoracoscopic lobectomy in the Second Hospital of Shanxi Medical University from September 2018 to May 2019 were randomly divided into three groups according to the digital random table method, with 20 patients in each group. Group A maintained deep anesthesia with the bispectral index (BIS) 36-45, group B maintained moderate anesthesia with BIS 46-55, and group C did not undergo BIS monitoring. The changes of heart rate, mean arterial pressure (MAP), stress indexes cortisol and blood glucose before anesthesia induction (T₀), immediately after one-lung ventilation (T₁), 60 min after one-lung ventilation (T₂) and immediately after skin suture (T₃) in the three groups were compared. Results: The concentration of blood glucose in group A at T₁, T₂ and T₃ was (5.28±0.49) mmol/L, (5.34±0.49) mmol/L and (5.40±0.47) mmol/L, and the cortisol was (142.75±31.45) ng/ml, (181.36±19.62) ng/ml and (153.81±33.92) ng/ml; the blood glucose in group B was (5.63±0.35) mmol/L, (6.06±0.19) mmol/L and (5.79±0.44) mmol/L, and the cortisol was (168.45±31.16) ng/ml, (171.09±25.28) ng/ml and (159.39±18.77) ng/ml; the blood glucose in group C was (6.35±0.56) mmol/L, (7.04±0.26) mmol/L and (6.17±0.54) mmol/L, and the cortisol was (191.13±46.00) ng/ml, (283.25±30.07) ng/ml and (183.01±19.71) ng/ml, respectively. The blood glucose and cortisol levels in group C at T₁, T₂ and T₃ were higher than those in group A and group B (all P < 0.05). The MAP in group A at T₁, T₂ and T₃ were (69±5) mmHg (1 mmHg= 0.133 kPa), (67±6) mmHg and (75±7) mmHg, respectively, and group B was (80±8) mmHg, (79±4) mmHg and (84±9) mmHg, the differences between the two groups were statistically significant (all P < 0.05). There was significant difference in cortisol between group A and group B at T₁ (P < 0.05). The heart rate and MAP at T₁, T₂ and T₃ in group A and group C were significantly different from those at T₀ (all P < 0.05). The heart rate and MAP at T₁ and T₂ in groups B were significantly different from those at T₀ (all P < 0.05). Conclusion BIS anesthesia depth monitoring should be performed during single-lung ventilation in thoracic surgery, and BIS should be maintained at 46-55, which can not only inhibit the stress response but also have a slight effect on hemodynamics.

Objective To retrospectively analyze the implementation of the antimicrobial agents prescription monthly review at the emergency and outpatient departments for the past five years, for evaluation of its action in promoting rational application of antimicrobial drugs. Methods At the baseline investigation stage, 1780 prescriptions on antibiotics in emergency and outpatient department from June 2012 to November 2012 were randomly selected for centralized evaluation. The period of correction and observation falls into two stages. The first stage ranged from December 2012 to February 2015, when the prescription of antibiotics was sampled manually for monthly review. The second stage ranged from March 2015 to June 2017, when a prescription review software for prescription comment was introduced for the sample purpose. The data so acquired were subject to chi-square test and linear regression analysis using Excel 2010 and SPSS 16. 0. Results The rational rate of prescription for antibiotics at the emergency department increased from 80. 56％ of the baseline stage to 99. 47％ of the second stage (166506/167400), scoring a difference of statistical significance (P<0. 001). With intervention of the prescription review software, the percentage of irrational use of antimicrobial agents dropped by 5. 18％ compared to the baseline stage. Conclusions Monthly prescription review on antimicrobial agents at the outpatient and emergency departments could promote the rational use of antimicrobial agents and play an important role in clinical drug safety. Information system and performance assessment contributed to the effect of prescription review.

Objective To investigate the prevalence rate of healthcare-associated infection(HAI)in a hospital,so as to provide reference for making HAI control measures.Methods The cross-sectional survey on HAI was carried out among all hospitalized patients on May 26,2010,December 12,2012 and December 4,2013,respectively,sur-veyed data were analyzed.Results The prevalence rate was 6.66%(n =116),6.67%(n =113)and 6.33%(n =120)in 2010,2012 and 2013 respectively,and case rate was 7.29%(n=127),7.38%(n=125)and 6.97%(n=132) respectively,intensive care unit(ICU )had the highest infection rate,internal medicine ICU was up to 71 .43%. The main infection site was lower respiratory tract(44.53%),followed by surgical site infection (9.11 %)and uri-nary tract infection (9.11 %).The isolation rate of gram-negative bacteria,gram-positive bacteria and fungi was 60.81 %,20.38% and 18.81 % respectively.Usage rate of antimicrobial agents in three years was 32.95%, 29.87% and 25.59% respectively (χ2 = 13.16,P <0.01 ).Conclusion Prevalence rate of HAI in this hospital is high ,the main pathogen is gram-negative bacteria,the main infection site is lower respiratory tract ,antimicrobial use decreased year by year.Monitor on high risk departments,main sites and pathogens should be intensified.