“Integrated elderly care and medical services” is a new model of elderly care that relies on medical care as a guarantee， rehabilitation as a support， and combines ongoing medical treatment with nurturing， offering comprehensive therapy. This new type of elderly care model also poses new job requirements for elderly care workers. However， there is currently a large shortage of elderly care workers， along with prevalent issues such as low professional quality， low education level， and an older average age. The main reasons for this situation are low welfare benefits， low social status， and an incomplete promotion system in the industry， resulting in low social recognition of the industry， a shortage of employees， and a high number of resignations. Based on this， it is suggested to expand the number of the elderly care team and enhance the quality of the elderly care team by improving the career development system， increasing salary and welfare benefits， and expanding social recognition.

Objective:To establish an in vivo infection model of West Nile virus (WNV) pseudovirus and evaluate the neutralizing activity of antibody WNV-XH1.Methods:A stable cell line that can package the WNV pseudovirus was established in the early stage to prepare the pseudovirus supernatant. The supernatant was concentrated and infected BHK21 cells to detect the titer of the pseudovirus. After intraperitoneal injection of the pseudovirus into C57BL/J mice, bioluminescence imaging was performed to observe the infection status of the pseudovirus in the mice. After simultaneous infection, blood was collected and ELISA was used to detect NS1 levels in mouse serum. The in vivo functional activity of antibody WNV-XH1 was evaluated using the established mouse infection model.Results:Fluorescence was detected in C57BL/J mice infected with WNV pseudovirus, and the NS1 levels in the peripheral blood serum of mice infected with pseudovirus were significantly higher than those of non infected mice (1.453±0.09vs0.305±0.018). After intravenous administration of WNV-XH1 antibody before the attack, the fluorescence signal in the mice decreased and the serum NS1 level decreased (0.384±0.015).Conclusions:A successful in vivo infection model of WNV pseudovirus was established, and it was confirmed that the antibody WNV-XH1 had a protective effect against WNV pseudovirus infection in vivo.

Objective:To summarize the best evidence for the use of ankle pump exercises in preventing perioperative lower limb deep vein thrombosis (DVT) in patients undergoing joint replacement surgery and to evaluate its clinical application.Methods:This study utilized an evidence-based continuous quality improvement model. A systematic search was conducted for relevant clinical practice guidelines, expert consensus, systematic reviews, and randomized controlled trials (RCTs) from both domestic and international sources. The best evidence was evaluated and summarized, and audit indicators were developed for baseline assessments. Facilitating and hindering factors were analyzed based on the baseline results. From December 2022 to April 2023, the evidence was applied in the Department of Orthopedics at Henan Provincial People's Hospital. The pre-evidence group for baseline assessments included 36 joint replacement patients and 18 nurses from the orthopedic unit between December 2022 and January 2023, while the post-evidence group included 36 joint replacement patients and the same 18 nurses between March and April 2023. The knowledge level of nurses, the effectiveness of ankle pump exercises, the execution rate, and patient compliance were compared before and after evidence-based practice.Results:A total of 12 articles were included in the study, comprising one clinical practice guideline, five expert consensus papers, one systematic review, and five RCTs. Ten best practices were summarized in terms of applicable populations, exercise assessment, exercise positions, timing, methods, frequency, and patient education. After implementing evidence-based practice, the knowledge scores of nurses on ankle pump exercises significantly improved from (70.56±9.98) to (82.78±8.26) ( P<0.01). The compliance rates of audit items 2, 3, 4, 5, and 6 among nurses increased from 0, 22.2%, 0, 27.8%, and 11.1% respectively, to 94.4%, 94.4%, 83.3%, 100.0%, and 100.0% respectively ( P<0.01). On the patient side, the compliance rates for audit items 7 and 8 increased from 5.6% and 0 to 86.1% and 94.4%, respectively ( P<0.01) . Conclusions:Implementing evidence-based ankle pump exercises to prevent DVT in joint replacement patients can significantly improve nurses' knowledge of evidence-based practice, standardize the practice of ankle pump exercises, and explore balanced educational strategies that enhance patient compliance, ensuring clinical practices are evidence-based.

Objective:To construct a core muscle strength training plan for patients with lumbar degenerative diseases based on the concept of pre-rehabilitation, and provide a theoretical basis for core muscle strength training for patients with lumbar degenerative diseases.Methods:From January 2022 to June 2023 based on literature search and group discussion, develop a primary item pool for core muscle strength training plan for patients with lumbar degenerative diseases under the concept of pre-rehabilitation. Through two rounds of Delphi expert consultation, revise and establish the core muscle strength training plan for patients with lumbar degenerative diseases under the concept of pre-rehabilitation.Results:A total of 15 experts were consulted by letter, including 3 males and 12 females, aged 35-58 (41.38 ± 5.44) years old. The positive coefficients of two rounds of correspondence with experts were 1.00 and 0.93, the expert judgment coefficients were 0.78 and 0.90, the familiarity coefficients were 0.84 and 0.92, and the authority coefficients were 0.81 and 0.91. The Kendall coordination coefficients of two rounds of inquiry had statistical significance in terms of indicator rationality (0.378, 0.384), indicator importance (0.283, 0.291), and indicator operability (0.263, 0.375) (all P<0.05). The constructed perioperative nursing quality sensitive indicator system for minimally invasive spinal surgery patients included 3 primary indicators, 9 secondary indicators, and 17 tertiary indicators. Conclusions:The core muscle strength training plan for patients with lumbar degenerative diseases based on the concept of pre- rehabilitation is scientific, reliable, practical, and feasible, and can provide a theoretical basis for core muscle strength training for patients with lumbar degenerative diseases.

Objective:To explore the effect of feedback health education combined with positive psychological suggestion on the rehabilitation of patients undergoing artificial total knee arthroplasty.Methods:From August 2020 to July 2021, the convenient sampling method was used to select 126 patients with artificial total knee arthroplasty admitted to the Orthopedic Department of Henan Provincial People's Hospital. They were randomly divided into the control group and the observation group in a 1∶1 ratio using a random number table method. The control group received routine health education combined with positive psychological suggestion, while the observation group received feedback based health education combined with positive psychological suggestion intervention. The level of knowledge, attitude and practice, scores on the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Visual Analogue Scale (VAS), American Knee Society (AKS) score, knee swelling rate and nursing satisfaction were compared between two groups of patients.Results:The knowledge, attitude and practice scores of the two groups at discharge were higher than those at admission ( P<0.05), and the knowledge, attitude and practice scores of the observation group were higher than those of the control group at discharge ( P<0.05). The SAS and SDS scores of the observation group were lower than those of the control group before and on the third day after surgery ( P<0.05). The VAS of the observation group on the first day and 2 weeks after surgery were lower than those of the control group ( P<0.05), while AKS was higher than that of the control group ( P<0.05). The postoperative swelling rates in the observation group were lower than those in the control group at 1 week and 3 months after surgery ( P<0.05). The nursing satisfaction scores of the observation group in terms of health education, service attitude, department environment, psychological intervention, and nursing outcomes were higher than those of the control group ( P<0.05) . Conclusions:Feedback health education combined with positive psychological cues can improve the knowledge, attitude and practice levels of patients undergoing artificial total knee arthroplasty, reduce anxiety and depression, and improve rehabilitation effectiveness and nursing satisfaction.

Objective? To explore the effects of perioperative blood glucose management in orthopedic diabetic patients. Methods? Totally 75 diabetic patients receiving surgery and requiring blood glucose monitoring 7 times a day in the Department of Orthopedics, He'nan Provincial People's Hospital from October 2017 to February 2018 were included in the control group, who received blood glucose management using conventional methods. Another 79 patients of the same type hospitalized between March and June 2018 were selected into the observation group for whom a blood glucose team was built and an intervention protocol of perioperative blood glucose management was developed. Self-efficacy, blood glucose detection missing rate, patient's satisfaction and average length of hospital stay of the two groups were analyzed before and after intervention. Results? The self-efficacy score of the observation group was higher than that of the control group after intervention;the blood-glucose detection missing rate was lower in the observation group than in the control group; the average length of hospital stay was shorter in the observation group than in the control group; and patient's satisfaction was higher in the observation group than in the control group (P＜ 0.05). Conclusions? Blood glucose management in orthopedic diabetic patients helps to optimize the blood glucose management process, improve patients' self-management capability, reduce diabetic patients' operative risk, guarantee patients' safety, and improve the quality of medical service.

Objective To explore the application effects of the clinical nursing muscle strength assessment record for patients with spinal cord injury based on the color separation Symbol Marking Method. Methods According to the neural classification standard of spinal cord injury formulated by the American Spinal Cord Injury Association, the main 10 groups of key muscles innervated by the motor function of spinal cord were sequentially set from top to bottom and from left to right. Different colors were used to distinguish the base plates of left and right limbs, and a special muscle strength evaluation record sheet was designed and made for patients with spinal cord injury. A total of 40 nurses for the Spinal Surgery Department of He'nan People's Hospital were recruited as the research subjects, and divided into study group and control group with 20 cases in each. 60 patients with spinal cord injury who were admitted to the spinal ward from June 2016 to December 2016 in this department were selected as the objects of assessment. The self-made muscle strength assessment record was applied in the study group, while the conventional writing method were applied in the control group. The rate of error evaluation, the rate of missing evaluation, the time of evaluation record were compared between the two groups,evaluate the satisfaction of study group nurses. Results In the study group, the rate of missing evaluation was lower than that in the control group (P＜ 0.05), and the time of recording in the observation group was shorter than that in the control group (P＜0.05), but there was no significant difference between the two groups on error evaluation (P ＞ 0.05). 95% of nursing staff in the study group were willing to use muscular strength assessment record, with a high satisfaction. Conclusions Muscle strength assessment records based on the color separation area symbol method can reduce the error rate, save the recording time, and improve the satisfaction of nurses. It also standardizes the working process and recording standards of nurses.

Objective To explore the effects of application of self-made assessment card for spinal nerve motor function in clinical nursing.Methods An assessment card for spinal nerve motor function was designed and produced according to "spinal cord injury grading standards" by American Spinal Injury Association(ASIA).A total of 40 nurses working in orthopedic ward of our hospital were selected as study subjects,and divided into the experimental group and the control group with 20 nurses in each group.Theoretical and practical training regarding spinal nerve motor function was provided to nurses in both groups.Then totally 398 patieuts with spine or spinal cord diseases hospitalized in our orthopedic ward were recruited from June to September 2016 as subjects for assessment.The experimental group used self-made assessment card for spinal nerve motor function as guidance;the control group performed routine assessment for spinal nerve motor function.Results There were no significant differences between the experimental group and the control group in scores of theoretical and practical examinations (P＞0.05);compared with the control group,the error of assessment in the experimental group was reduced by 9.5％,missed assessment rate decreased by 16.2％;and the time for assessnent in the experimental group was significantly shorter than that in the control group(P＜0.05).Conclusion The assessment card for spinal nerve motor function can reduce the error of assessment,save the time for assessment,enhance the capacity of specialist nurses and improve work efficiency.

The ecological balance of intestinal microbiota plays an important role in digestion,absorp-tion,metabolism,immunity and protection against pathogens.Intestinal microbiota can not only regulate the innate immunity of the body,but also can stimulate the immune response by the bacteria itself and its metabo-lites.The imbalance intestinal microbiota may lead to abnormal immune mechanism,and then participate in the occurrence and development of the tumor,especially colorectal cancer.

The tumor microenvironment is closely related to the occurrence and development of tumor. Hypoxia is considered to be one of the most important factors in tumor microenvironment.Formation of hypoxic microenvironment can be found in most of malignant tumors,which can inhibit the anti-tumor immune response. Recent studies have indicated that immunosuppressive cells,tumor stem cells and circulating tumor cells in hypoxic tumor microenvironment can mediate immune suppression and immune tolerance,and then promote development of tumor.The new immune therapy will focus on normalizing tumor vasculature,reconstructing the tumor microenvironment,avoiding immune suppression and averting tumor immune tolerance.