Objective To construct quality evaluation indicators for perioperative nursing in heart transplantation,and to provide standard and professional quantitative bases for monitoring and management of perioperative nursing quality.Methods This study was conducted based on the frame work of the three-dimensional"structure-process-outcome"quality model,using literature review,Delphi method and analytic hierarchy to determine the content of the indicators,and the weight of each index.Results A total of 22 experts from 14 qualified heart transplantation hospitals were included,and a total of 2 rounds of consultations were conducted.The effective recovery rates of 2 rounds of expert consultation questionnaires were 100％.The authority coefficients were 0.817.The variation coefficients of each item ranged from 0.025～0.169 and 0.039～0.157.The Kendall harmony coefficients were 0.126 and 0.225(P＜0.001).The final evaluation indicators for perioperative nursing quality in heart transplantation included 3 first-level indicators,12 second-lever indicators and 59 third-level indicators.Conclusion The evaluation indicators of perioperative nursing quality in heart transplantation was scientific,comprehensive and specialized,which can provide references for the evaluation of perioperative nursing quality in heart transplantation.

ObjectiveTo explore the longitudinal measurement invariance of standardized Constitution in Chinese Medicine Questionnaire （CCMQ） among Chinese adult populations， and to provide evidence for the longitudinal effect analysis of this questionnaire. MethodsA total of 509 adults who voluntarily received 26 weeks of comprehensive traditional Chinese medicine （TCM） constitution fitness intervention were included （3 time points： before intervention， 13 weeks intervention， and 26 weeks intervention）， evaluated by CCMQ with 9 subscales. A single-group confirmatory factor analysis was performed to establish a single-group baseline model with a well-fitting model， and then nested models， that is multiple groups of confirmatory factors analysis， are used to analyze the longitudinal measurement invariance， followed by configural invariance， metric invariance， scalar invariance， and strict invariance. Comparative Fit Index （CFI）， Root Mean Square Error of Approximation （RMSEA）， and Standardized Root Mean Square Residual （SRMR） were used as model fit indicators for the analysis. ResultsThe single-group confirmatory factors analysis proved that the 9 subscales of CCMQ fit well at the three time points （CFI： 0.933~0.992， RMSEA： 0.027~0.080， SRMR： 0.022~0.045）. The multiple-group confirmatory factors analysis showed that the configural， metric， scalar， and strict invariance across time of qi-stagnation and special diathesis constitution were established （ΔCFI＜0.01， ΔRMSEA＜0.01）； the configural， metric， scalar， and partial strict invariance across time of phlegm-dampness constitution subscale were established （ΔCFI＜0.01， ΔRMSEA＜0.01）； the configural， metric， partial scalar and partial strict invariance of 6 subscales， including gentleness， qi-deficiency， yang-deficiency， yin-deficiency， dampness-heat， and blood-stasis constitutions， were all established （ΔCFI＜0.01， ΔRMSEA＜0.01）. ConclusionThe CCMQ met at least metric invariance at 3 time points， which can be applied to the study of whether different time points have the same unit or meaning. The measurement invariance of the 3 subscales of phlegm-dampness， qi-stagnation and special diathesis， special diathesis have longitudinal measurement invariance， so the mean comparison over time could be made； while the 6 subscales of gentleness， qi-deficiency， yang-deficiency， yin-deficiency， dampness-heat， and blood-stasis constitutions meet partial scalar and partial strict invariance， which could be explained partially for the difference in the comparison of the mean over time.

To summarize the nursing care of a patient with acute myocardial infarction complicated with cardiogenic shock before operation.The main nursing points are as follows:in the acute stage,the integrated rescue was implemented with rapid on-machine coordination of external cardiopulmonary resuscitation,multidisciplinary collaboration to ensure safe patient transport;during the bridging period,the combined operation care of extracorporeal membrane oxygenation,intra-aortic balloon counter pulsation and continuous kidney replacement therapy was carried out with goal-oriented anticoagulation care,prevention of catheter-related infection with the assistance of mechanical circulation,and neurological function monitoring.The patient successfully passed the waiting period for heart transplantation and underwent heart transplantation 21 days after admission.With the follow-up for 1 year,the patient recovered well.

Objective To construct a new model for the progressive training of nursing assistants using a"two-pronged approach,"providing references for management departments to formulate training strategies for nursing assistants.Methods Guided by the core competencies of nursing assistants,the Delphi expert consultation method was employed to solicit opinions from 18 experts across 7 provinces to develop the new training model.Results A total of two rounds of consultations were con-ducted,achieving a 100.00％response rate.The experts'authority coefficients were 0.935,and the Kendall harmony coeffi-cients for the two rounds were 0.240 and 0.256(P＜0.001),respectively.Ultimately,nursing assistants were categorized into five levels,which include stratified competency standards,training plans,and promotion requirements.Conclusion The new model for the progressive training of nursing assistants is scientifically rigorous and aligns with professional demands.It offers guiding sig-nificance for the training of nursing assistants and can be appropriately adjusted based on the actual situation of hospitals.

Objective:To summarize the nursing points of emergency heart transplantation in an elderly patient with fulminant myocarditis and acute myocardial infarction.Methods:Hemorrhage early warning care, cyclic goal-oriented care, rejection and staged care, infection prevention and control care, difficult ventilator weaning care, and individualized rehabilitation care were provided to elderly patient with fulminant myocarditis and acute myocardial infarction after emergency heart transplantation in July 2020 in the First Hospital Affiliated to Zhejiang University and the effects were observed.Results:The patient's heart function recovered well after the transplantation, and no rejection reaction occurred. Before discharge, the patient was clear, active and optimistic, eating on his own, walking 300 meters in 6 minutes, and the vital signs were stable. One month after discharge, the patient was followed up to take care of himself and was in a stable mood.Conclusions:Carrying out bleeding prevention, circulatory care, rejection care, infection prevention and control care, ventilator difficulty weaning care and individualized rehabilitation care for elderly patients with fulminant myocarditis and acute myocardial infarction after emergency heart transplantation are effective means to ensure the success of the operation and the recovery of patients after the operation.

Objective To analyze the clinical features and risk factors of urinary tract infection in patients with gestational diabetes mellitus ( GDM).Methods A total of 1 068 patients with GDM were enrolled from Nanshan People's Hospital between January and December 2014.The incidence of urinary tract infection, pathogens distribution and drug resistance rate were retrospectively analyzed.Multivariate Logistic regression was performed to analyze the risk factors of urinary tract infection in GDM patients . Results Among 1 068 patients with GDM, 130 (12.17%) were compliacated with urinary tract infection One hundred of forty-two strains of pathogens were detected in the middle urine culture sample from urinary tract infection patients, Escherichia coli (67.61%,96/142) and Klebsiella pneumonia (11.97%,17/142) were the most frequent strains.Escherichia coli has high resistance to semi-synthetic penicillins, quinolones and sulfonamides, and relatively low resistance rate to carbapenems , aminoglycoside antibiotics and nitrofurantoin.Klebsiella pneumoniae was completely resistant to ampicillin , while was completely sensitive to carbapenems, aminoglycoside antibiotics , piperacillin/tazobactam, aztreonam.Logistic regression analysis showed that glycated hemoglobin ＞6.5%(OR＝8.631, 95%CI 2.969-25.090, P＜0.01), fasting blood glucose＞5.3 mmol/L(OR＝3.116, 95%CI 2.040-4.761,P＜0.01), low density lipoprotein ＞2.6 mmol/L (OR＝1.649, 95%CI 1.083-2.511, P＜0.05), triglyceride＞1.7 mmol/L(OR＝2.986, 95%CI 1.256-7.112, P＜0.05), history of urinary tract infection (OR＝5.561,95%CI 1.315-23.519, P＜0.05) and history of maternity(OR＝1.631, 95%CI 1.018-2.614, P＜0.05) were the independent risk factors for urinary tract infection in GDM.Conclusion The incidence of urinary tract infection in patients with GDM is high.The control of blood glucose and blood lipids , enhanced health education for pregnant women with history of urinary tract infection and history of childbirth may reduce the occurrence of urinary tract infection in GDM patients.

Objective To evaluate the effect of exercise on the relationship between body mass index (BMI) and health-related quality of life (HRQOL).Methods A total of 1 114 participants were recruited from the Physical Examination Center of two hospitals.SF-36 was used to measure HRQOL,and the classification of sports level was done according to the subjective evaluation of participants.Results The total score of HRQOL,physical component summary and mental component summary were 76.26± 16.10,75.97 ± 16.67 and 76.55± 18.33 respectively.The results of correlation analysis were as following:the positive correlation between BMI and general health (r=0.109),vitality (r=0.116),social functioning (r=0.092),role emotional (r=0.122),mental health (r =0.145) were significant (P＜ 0.01).The negative correlation between BMI and PF(r=-0.07,P=0.019)was significant.The mediation effects of exercise in was relationship between BMI and general health,vitality,mental health were significant,and the mediating effect were 5.84％,9.14％ and 6.58％.Conclusion This study demonstrates that mediation effects of the exercise are significant in some dimensions of HRQOL,but the direct influence of BMI on the HRQOL plays a leading role.And BMI is a protective factor under certain conditions.

Objective To study the application of transcatheter superselective arterial embolization for the spinal tumorectomy preopera-tive.Methods From January 2009 to September 2015,the data of 65 patients with spinal tumor were collected.Before operation,all the pa-tients had been performed the transcatheter superselective arterial embolization by Seldinger technology,the embolization effect and the blood loss volume were recorded.Results The pathological vertebral body of 62 patients were significantly dyed and the tumor-feeding artery were obvious.But no obvious tumor-feeding artery and the tumor dyeing was found in 3 cases.The tumor-feeding artery positive incidence of angi-ography was 95.3%(62/65).All cases intubation was successful but one.After embolization, the pathological vertebral body was removed completely.The blood loss volume was 500-3 000 mL,with an average (1 400.65 ±230.62) mL.Conclusion The transcatheter superse-lective arterial embolization could reduce the blood loss in spinal tumorectomy and the operation risks,and increase the possibilities of radical resection,which is an effective preoperative intervention.