Caregivers for chronic disease patients of caregiver activation emphasizes the subjective initiative and preparedness of caregivers in managing patients' health conditions and medical needs.Caregivers with high activation levels can participate more effectively in disease management,significantly improve the quality of care,and have a positive impact on their own mental health and quality of life.This article reviews the concept,assessment tools,current situation,influencing factors,and intervention strategies of caregiver activation,and proposes future research directions,aiming to provide references for conducting research and practical exploration related to caregiver activation.

Caregivers for chronic disease patients of caregiver activation emphasizes the subjective initiative and preparedness of caregivers in managing patients' health conditions and medical needs.Caregivers with high activation levels can participate more effectively in disease management,significantly improve the quality of care,and have a positive impact on their own mental health and quality of life.This article reviews the concept,assessment tools,current situation,influencing factors,and intervention strategies of caregiver activation,and proposes future research directions,aiming to provide references for conducting research and practical exploration related to caregiver activation.

Objective:To investigate the effect of vitamin D supplementation on weight loss efficacy and insulin resistance (IR) in obese patients.Methods:It was a randomized controlled trial. A total of 190 obese patients with vitamin D deficiency were selected from the obesity clinic of Tianjin Union Medical Center from March to December in 2023. The patients were divided into control group (95 cases) and vitamin D group (95 cases) according to random number table. The control group was given energy-limited high-protein diet combined with moderate intensity exercise, and the vitamin D group was supplemented with vitamin D on the basis of the control group, 14 000 U/week for 24 weeks. A total of 25 dropped out of the study from the two groups for various reasons. Finally, 79 cases in the control group and 86 cases in the vitamin D group were included in the analysis. Independent sample t test and rank sum test were used to compare serum 25 hydroxyvitamin D [25 (OH) D] level, body weight, body mass index, fat mass, visceral fat area, fasting blood glucose, fasting insulin and glycated hemoglobin (HbA 1c) between the two groups at baseline and after intervention. Homeostasis model insulin resistance index (HOMA-IR) was used to evaluate the degree of insulin resistance (IR), and the effects of vitamin D supplementation on weight loss efficiency and IR in those patients were analyzed. Results:There was no significant differences in serum 25(OH)D level between the two groups before intervention ( P>0.05); the serum 25(OH)D level in the vitamin D group was significantly higher than that in the control group after intervention [(30.90±7.55) vs (16.00±4.34) μg/L] ( t=-15.35, P<0.001). The body weight, body mass index, fat mass, visceral fat area, fasting blood glucose, fasting insulin, HbA 1c, and HOMA-IR were all significantly lower after the intervention than those before the intervention in both groups [control group: (93.32±13.47) vs (98.95±14.31) kg, (33.74±5.09) vs (35.80±5.52) kg/m 2, (39.77±11.87) vs (44.12±12.79) kg, (183.76±40.95) vs (204.01±32.18) m 2, 5.00 (4.55, 5.67) vs 5.24 (4.68, 6.42) mmol/L, 16.78 (13.94, 24.30) vs 22.56 (15.95, 31.2) mU/L, 5.55%±0.53% vs 6.05%±0.99%, 4.11 (3.14, 5.57) vs 5.51 (3.61, 8.49); vitamin D group: (88.14±17.66) vs (104.43±22.02) kg, (31.02±5.10) vs (36.66±5.98) kg/m 2, (35.51±12.87) vs (46.67±13.33) kg, (166.50±49.50) vs (213.64±40.14) m 2, 4.70 (4.35, 5.07) vs 5.17 (4.77, 6.30) mmol/L, 13.18 (9.87, 18.84) vs 21.67 (15.78. 32.74) mU/L, 5.43%±0.48% vs 6.21%±1.22%, 2.88 (1.99, 4.21) vs 5.19 (3.82, 9.27)], and the body weight, body mass index, adiposity, visceral fat area, fasting blood glucose, fasting insulin, and HOMA-IR were all significantly lower in vitamin D group than those in the control group [(88.14±17.66) vs (93.32±13.47) kg, (31.02±5.10) vs (33.74±5.09) kg/m 2, (35.51±12.87) vs (39.77±11.87) kg, (166.50±49.50) vs (183.76±40.95) m 2, 4.70 (4.35, 5.07) vs 5.00 (4.55, 5.67) mmol/L, 13.18 (9.87, 18.84) vs 16.78 (13.94, 24.30) mU/L, and 2.88 (1.99, 4.21) vs 4.11 (3.14, 5.57), respectivley] (all P<0.05). The IR remission rate was significantly higher in the vitamin D group than that in the control group after the intervention (37.3% vs 15.3%) ( χ2=8.071, P=0.002). Conclusion:Supplementation of vitamin D on the basis of energy-limited high-protein diet combined with moderate intensity exercise can significantly improve the efficacy of weight loss and IR in obese patients with vitamin D deficiency.

Based on the field questionnaire survey in different grade undergraduates in some medical colleges , this paper summarized the main performance of network moral abnormality in medical college students , and further analyzed the internal and external causes , thus put forward the countermeasures of strengthening medical college students′network moral education: innovate moral education methods and improve the moral quality of college students;strengthen the network legal system propaganda education , enhance the students′self -discipline con-sciousness;play a role of main channel and enhance the actual effect of network moral education ;meet the require-ments for the internet age and the construct a new administrative team; strengthen the position consciousness , es-tablish network moral education platform;strengthen the guidance function , carry out various kinds of network mor-al education.

Objective To discuss the effect of rehabilitation nursing for total knee arthroplasty by discussing hospitalization expenses and its factors of rehabilitation nursing.Methods 305 patients who were underwent total knee arthroplasty from 2011 to 2013 were recruited and recovered according to rehabilitation nursing and training requirements established by our hospital.Patients admitted in 2011 were designated as control group.The comparison of American knee society knee score and knee rang of motion of patients were made and analyzed.Results The annual comparison of sores of pre-and post-operative KSS (t=5.30,7.99,11.20),and knee ROM of patients (t=8.21,4.57,7.86) showed that the difference was statistically significant (P＜0.05).The total costs and rehabilitation nursing expenses inreased year by year (P＜0.05).The proportion of rehabilitation and rehabilitation nursing expenses each year were 5.77％ (3 157/54 679),4.60％ (2 847/61 831),5.15％ (3 341/64 930) and 0.51％ (280/54 679),0.64％ (393/61 831),0.52 ％(338/64 930),respectively.Conclusions Pre-and post-operative correct rehabilitation exercises are one of the most important guarantee of curative effect.There is a lower percentage of rehabilitation nursing expenses in total costs,and the value of the nursing staff has not been fully reflected.

Objective To explore the fixed-effects of the treatment using transarticular screw joint lateral mass screw unilateral bi-direction fixation through posterior midline approach.Methods 16 patients,12 patients with traumatic fracture-dislocation and 4 patients with cervical disc herniation with spinal stenosis,were treated with transarticular screw(caudad) joint lateral mass screw (cephalad)unilateral bi-direction fixation in the posterior cervical.Results 32 transarticular screws were implanted,including C4-5 8 pieces,C5-6 12 pieces,C6-7 12 pieces;36 lateral mass screws were implanted,including C2 13 pieces,C3 14 pieces,C4 9 pieces.All screws were successfully implanted in operation,without injuries and other complications in vertebral artery,nerve root and spinal cord.16patients were followed up for averaged 18 months ( 10 - 30 months).Surgical incisions reduced by half than traditional ,fusion time were 2.0 to 4.5 months for an average of 3.1 months.Conclusions When through theposterior fixed cervical spine,used transarticular screw joint lateral mass screw unilateral bi-direction fixation,fixed simply and reliably,reduced internal fixation materials for implantation,reduced operative time,increased bone bed area,the bone fusion rate was high,reduced the length of surgical incision,reduced the blood vessels,nerve root injury risk ,reduced complications such as axial symptoms ,saved medical expenses,achieved good results.