Objective To explore the professionalization model of nursing management team in an international medical center in a provincial public tertiary hospital.Methods Through literature research and Delphi method,a three-person nursing management team was established respectively in three nursing units:outpatient,first-ward,and second-ward of the center,and then trained professionally to define management boundaries and responsibilities.The training effect was verified by applying the professionalization management in the international medical center.The three nursing teams(nine nurses totally)were compared in terms of leadership,patient satisfaction,and nursing discipline construction before and after the training.Results Following the training,the three teams all exhibited a significant improvement in leadership as well as its dimensions(P＜0.05),and pa-tient satisfaction(P＜0.05).Additionally,care quality,scientific research capacity,and innovation ability were all elevated across the three groups.Conclusion The establishment of a nursing management team and performance of professional training can effectively promote the concept of professionalization management,improve the leadership of nurses,cultivate talent eche-lons,drive the overall development of disciplines and teams,and expand the connotation of nursing culture.For all these bene-fits,this model is suitable for promotion and application among clinical departments.

Objective:To investigate the prognosis and influencing factors in critically ill surgical patients of different feeding intolerance trajectories.Methods:The retrospective cohort study was conducted. The clinical data of 354 critically ill surgical patients who were admitted to 69 medical centers in the Chinese Critical Care Nutrition Trials Group -NEED database from March 2018 to July 2019 were selected. There were 247 males and 107 females, aged 58(46,68)years. According to the trajectory model of feeding intolerance change, 354 patients were divided into 3 categories as feeding intolerance, decreased feeding intolerance, continuous feeding intolerance, including 164, 49, 141 cases respectively. Observation indicators: (1) general situations of patients of different feeding intolerance trajectories; (2) treatment of patients of different feeding intolerance trajectories; (3) survival of patients of different feeding intolerance trajectories; (4) analysis of pro-gnostic factors in critically ill surgical patients. Measurement data of normal distribution were expressed as Mean± SD, and one-way analysis of variance was used for comparison between groups. Measurement data of skewed distribution were expressed as M( Q1, Q3), and Kruskal-Wallis rank sum test was used for comparison between groups. Count data were expressed as absolute numbers or percentages, and chi-square test was used for comparison between groups. Ordinal data were compared using the Kruskal-Wallis rank sum test. Bonferroni correction was used for pairwise comparison. Group-based trajectory model was constructed according to Traj plug-in in Stata17.0 statistical software, and the optimal trajectory model was evaluated by Bayesian information criterion and average posterior probability parameter. The Kaplan-Meier method was used to draw the survival curve and calculate the survival rate, and Log-Rank test was used for survival analyses. Univariate and multivariate analyses were conducted using the COX proportional hazard regression model. Results:(1) General situations of patients of different feeding intolerance trajectories. Of 354 critically ill surgical patients, 257 cases underwent enteral nutrition and 97 cases underwent enteral plus parenteral nutrition. The acute physiological and chronic health score (APACHEII) was 17(13,21), and the sequential organ failure score (SOFA) was 6(5,8). The modified Critical Illness Nutritional risk score (mNUTRIC) was 4 (2,5), the number of complications was 2(1,3). There were 293, 55 and 6 patients with grade Ⅰ, grade Ⅱ and grade Ⅲ acute gastrointestinal injury (AGI), and there were 224, 17 and 61 patients who were treated with mechanical ventilation, continuous renal replacement therapy and vasoactive drugs, respectively. The incidence of feeding intolerance in 354 patients increased first and then decreased, reaching a peak of 25.42%(90/354) on the third day and 53.67%(190/354) within 7 days. Of 354 critically ill surgical patients, cases with no feeding intolerance, decreased feeding intolerance, continuous feeding intolerance had the APACHE Ⅱ as 16(12,20), 17(14,25), 18(13,22), mNUTRIC as 3(2,5), 4(3,6), 4(3,5), the number of complications as 2(1,2), 2(2,3), 2(2,3). There were 152, 27, 114 cases with grade Ⅰ AGI, 12, 22, 27 cases with grade Ⅱ-Ⅲ AGI, 95, 39, 90 cases with mechanical ventilation. There were significant differences in the above indicators among the three groups ( H=6.14, 13.11, 28.05, χ2=37.96, 7.65, P< 0.05). Further analysis showed that compared with patients with no feeding intolerance, patients with decreased feeding intolerance and continuous feeding intolerance had the higher number of complications and grade of AGI ( Z=60.32, 54.69, χ2=39.72, 9.52, P<0.05), patients with decreased feeding intolerance had the higher mNUTRIC scores and ratio of mechanical ventilation ( Z=53.41, χ2=7.59, P<0.05). (2) Treatment of patients of different feeding intolerance trajectories. Cases with prokinetic drugs use and post-pyloric feeding were 36, 13 of patients with no feeding intolerance, 25 and 10 of patients with decreased feeding intolerance, 46 and 19 of patients with continuous feeding intolerance, respectively, showing significant differences in the above indicators among the three groups ( χ2=15.76, 6.20, P<0.05). Further analysis showed that compared with patients with no feeding intolerance, patients with decreased feeding intolerance had higher ratio of prokinetic drugs use and ratio of post-pyloric feeding ( χ2=15.60, 6.10, P<0.05). (3) Survival of patients of different feeding intolerance trajectories. The 28-day overall survival rates of patients with no feeding intolerance, decreased feeding intolerance, and continued feeding intolerance were 96.96%, 95.92%, and 87.94%, respectively, showing a significant difference ( χ2=10.39, P<0.05). Further analysis showed a significant difference between patents with no feeding intolerance and patients with continuous feeding intolerance ( χ2=9.19, P<0.05). (4) Analysis of prognostic factors in critically ill surgical patients. Multivariate analysis showed that continuous feeding intolerance was an independent risk factor for 28-day death in critically ill surgical patients ( hazard ratio=3.92, 95% confidence interval as 1.43-10.79, P<0.05). Conclusion:For surgical critically ill patients, patients with continuous feeding intolerance have a higher 28-day mortality than patients with no feeding intolerance, and the continuous feeding intolerance is an independent risk factor for 28-day death in critically ill surgical patients.

By analyzing the theoretical basis of safeguarding citizens’ personal information right during the normalization period of epidemic prevention and control, this paper concluded that there are some problems in personal information, such as solidified collection and utilization mode, low degree of management systematization, imperfect processing technology and narrow application scope, low degree of data value development and high risk coefficient. Further combined with China’s current epidemic prevention mode and social governance characteristics, this paper put forward the idea of innovating data hierarchical management and implementing the sharing mode in the industry to reduce the number of information circulation, trace the source, strengthen data desensitization technology and broaden its application scope, make rational use of personal information and appropriately develop its commercial use to increase its utilization efficiency.

OBJECTIVE： To promote the implementation of the pre-prescription review work， and to ensure the rational drug use of patients. METHODS： With the idea of PDCA （Plan， Do， Check， Action） cycle management， the phased improvement of three PDCA cycles was gradually implemented in the operation of the pre-prescription review system， aiming at the establishment of the working mode of the prescription review work， the improvement of the rules of knowledge base in the review system and the improvement of the ability of pharmacists to review prescriptions. The operation results of the system were evaluated by comparing the irrational prescription rate of outpatient pharmacies before and after the operation of pre-prescription review system. RESULTS： Through adopting the prescription review mode of “rigid” and “flexible” interception， regular revision of knowledge base rules， regular training and examination of prescription pharmacists， pre-prescription review system operated smoothly， and the pre-prescription review work was carried out in the process of continuous improvement. In the three PDCA cycles， the irrational rate of prescriptions decreased significantly， such as after the first PDCA cycle， the irrational rate of TCM outpatient prescriptions decreased from 22.0％ （1 393/6 332） in Jan. 2017 to 7.4％ （416/5 627） in Jun. 2017； after the second PDCA cycle， the irrational rate of outpatient prescriptions in hospital decreased from 4.87％ （5 244/107 691） in Mar. 2018 to 2.21％ （2 219/100 412） in Aug. 2018. After the third PDCA cycle， the percentage of over-treatment course prescriptions in total prescriptions decreased from 16.97％ （15 728/92 684） in Jun. 2018 to 5.55％ （5 394/97 275） in Sept. 2018. CONCLUSIONS： The pre-prescription review system can effectively intercept and interfere with irrational prescriptions， and PDCA cycle management can effectively promote the operation of the pre-prescription review work.

Objective To investigate the therapy and influencing factors for prognosis of ventilator-associated pneumonia(VAP) caused by multidrug-resistant organisms(MDROs).Methods 169 patients with VAP who were admitted to a hospital between January 2012 and December 2013 were included in analysis, 125 were in MDRO infection group and 44 in non-MDRO infection group.MDRO infection group was subdivided into MDR-A group(n=78, resistant to selected antimicrobial agents) and MDR-B group (n=47, sensitive to at least one kind of selected antimicrobial agent).Antimicrobial choice and prognosis between each group were analyzed and compared.Results 242 strains of pathogenic bacteria were isolated from airway secretion of VAP patients, 173(71.49％) were MDROs.The major pathogens causing VAP were Klebsiella spp.(n=66), Pseudomonas aeruginosa(n=64), Acinetobacter spp.(n=60), Staphylococcus aureus(n=27), and Escherichia coli (n=17), the percentages of MDROs of above pathogens were 68.18％, 50.00％, 91.67％, 88.89％, and 76.47％ respectively.The prognosis of MDRO infection group was poorer than that of non-MDRO infection group, MDR-A group had the worst prognosis(P<0.001).Persistent fever, leukocytosis, and progress of pulmonary inflammation in VAP patients suggested poor prognosis(all P<0.001);antimicrobial use in patients with effective therapy was higher than those in a worsened condition before onset, at the beginning of onset, and after culture of specimens(all P<0.001), while coma, early-onset VAP and multiple bacterial infection had no prognostic significance in patients with VAP(all P>0.05).Conclusion There is high incidence of MDRO infection in patients with VAP, effective antimicrobial therapy can improve the prognosis.

AIM:Mitochondrial DNA (mtDNA) copy number variation (CNV), which reflects the oxidant-induced cell damage, has been observed in a wide range of human diseases .However, whether it correlates with heart failure , which is closely related to oxidative stress, has never been elucidated before .We aimed to systematically investigate the association between leukocyte mtDNA CNV and heart failure risk and prognosis .METHODS: A total of 1 700 hospitalized patients with heart failure and 1 700 age-and gender-matched community population were consecutively enrolled in this observational study , as well as 1 638 ( 96.4%) patients were fol-lowed prospectively for a median of 17 months (12~24 months).The relative mtDNA copy number in leukocyte of peripheral blood or cardiac tissue was measured in triplicate by quantitative real-time PCR method .RESULTS:Patients with heart failure possessed much lower relative mtDNA copy number compared with control subjects (P<0.01), especially for the patients with ischemic etiology (P<0.01).Patients with lower mtDNA copy number exhibited 1.7 times higher risk of heart failure ( P<0.01).Long-term follow-up (median 17 months) showed that decreased mtDNA copy number was significant associated with both increased cardiovascular deaths (P<0.01) and cardiovascular rehospitalization (P<0.01).After adjusted for the conventional risk factors and medications , lower mtDNA copy number were still significantly associated with 50% higher cardiovascular mortality (P <0.05).CONCLUSION:
mtDNA copy number depletion is an independent risk factor for heart failure and predicted higher risk of cardiovascular deaths in patients with heart failure .

Objective To investigate the current situation and related risk factors of healthcare-associated infection (HAI),so as to provide evidence for making prevention and control measures of HAI.Methods On November 26, 2014,a combination method of bedside visiting and medical record reviewing was adopted to survey HAI status, pathogen examination,and antimicrobial application in all hospitalized patients in a tertiary first class military hospi-tal.Results A total of 1 657 hospitalized patients were investigated,66 patients developed 71 times of HAI,HAI rate and HAI case rate were 3.98% and 4.28% respectively.The top 4 departments with HAI prevalence rates were departments of neurosurgery (24.49%),hematology(19.05%),cadre ward(13.73%),and burn surgery (10.91 %).The top 5 HAI sites were lower respiratory tract (40.85%),urinary tract(23.94%),upper respirato-ry tract(12.68%),surgical site(9.86%),and gastrointestinal tract(5.63%).Of 66 cases of HAI,39 (59.09%) patients sent specimens for culture,a total of 48 pathogens were cultured,the major isolated bacteria was Esche-richia coli (n = 10,20.84%),followed by Staphylococcus aureus ,Klebsiella pneumoniae ,and Pseudomonas aeruginosa ,each was 7 (14.58 %)respectively.The usage rate of antimicrobial agents was 34.40%,specimen de-tection rate in patients receiving therapeutic and therapeutic+prophylactic antimicrobial agents was 59.28%.Risk factors for HAI were age <2 years old or >60 years,with respirator,tracheotomy,urinary tract catheterization, arteriovenous catheterization,hemodialysis,and surgery,difference was significant(all P <0.05).Conclusion Mo-nitoring on key departments and key sites of HAI should be strengthened,antimicrobial agents should be used rationally based on pathogenic detection results,specimen pathogenic detection rate should be improved,and effective prevention and control measures needs to be taken according to the risk factors of HAI.

Objective To revise looming maladaptive style questionnaire(LMSQ-R) and examine its reliability and validity.Methods 284 undergraduates were measured preparedly with LMSQ-R,281 university students participated in a retest,using LMSQ-R,fear of negative evaluation scale (FNE),Beck anxiety inventory (BAI),Beck depression inventory (BDI).Results ①The item distinguish analysis was acceptable.②Reliability analysis confirmed that Cronbach α coefficient of LMSQ-R was 0.736,Cronbach α coefficient of the two subscales were 0.593 and 0.636.The test-retest reliability of LMSQ-R ranged from 0.564 to 0.700.③Confirmatory factor analysis suggested that the first order six factor-second order two factor model was perfect according to the evaluation criteria.The correlation coefficient between the two subscales was 0.527,the correlation coefficients among the two subscales and the total score ranged from 0.872 to 0.875.The correlation coefficients among the LMSQ-R and FNE,BAI,BDI ranged from 0.872 to 0.875,the results had statistical significance.Conclusion The revised LMSQ-R shows the satisfactory reliability and validity in university students.It can be used as a useful testing tool of LCS in psychological research.

Objective Toexplore the expressions of interleukin-16 (IL-16), interferon-γ (IFN-γ), CXC chemokine receptor 3 (CXCR3), and CRP and their clinical significance in acute exacerbation chronic obstructive pulmonary disease by observing the changes in these factors in patients with AECOPD. Methods 103 patients with AECOPD and 20 healthy controls were collected. According to the 2013 GOLD guideline, all the patients with AECOPD were divided into4 groups(group A of 21 patients, B of 30, C of 27, andD of 25). Results As compared withthe control group, plasma concentrations of IL-16, IFN-γ, CXCR3. and CRP were significantly increased in the patients with AECOPD (P < 0.01), and as the severity of the disease was elevating, these expression levels were significantly increased.While the expression levels of IL-16, IFN-γ, CXCR3, and CRP levels were significantly reduced after treatment, but they were still higherthan those in the control group (P < 0.05). The expression levels of serum IL-16, IFN-γ, CXCR3, and CRP were significantly correlated in patients with AECOPD. Conclusions Expressions of IL-16, IFN-γ and CXCR3 are significantly increased in AECOPD, which is correlated with disease severity and decreased after treatment, suggesting that these three factors may be associated with the occurrence and development of COPD.

OBJECTIVE Topreparealipidderivativeofgemcitabine(Gem)anditspolymericmi-celles to overcome the disadvantages of Gem.METHODS N-benzyl-3′-acetyl-gemcitabine(BAG)was synthesized.A BAG-loaded poloxamer polymeric micelle (BAG∶poloxamer 188 =10∶1 ,mol/mol)was prepared using an injection method.The micelles were characterized with a laser particle size and elec-tric charge instru ment and negatively-stained trans mission electron microscopy.Hu man breast cancer cells MCF-7 were cultured with Gem or BAG polymeric micelles of 5,10,20,30,50,70,90 μmol·L-1 for 24,48 and 72 h,respectively.The inhibitory rate of cells was measured with an MTT method.The MCF-7 cytotoxicity of BAG polymeric micelles was investigated.A pharmacodynamic study was per-formed on the mice bearing mouse hepatocellular cancer cells H22.Intravenous (iv)and oral (ig)ad-ministration was used at the dose of Ge m 40 mg·kg -1 or BAG polymeric micelles 62 mg·kg -1 .The mice were administered on the 1 st,4th and 7th day and sacrificed on the 8th day.Tumor inhibitory rates were measured.RESULTS TheBAGstructurewasidentifiedbythinlayerchromatograph,1Hand13C NMR,infrared ray chromatograph and mass spectrum.The appearance of BAG micelles was a slightly blue suspension.The micelles were spheres according to the electron microscopic observation.Their size was 62.82 nm and the zeta potential was -18.8 mV.The half inhibition concentration (IC50)of Gem and BAG polymeric micelles was 40.6 and 90.0 μmol·L-1 ,5.0 and 14.9 μmol·L-1 ,5.0 and 1 3.6 μmol·L-1 at 24,48 and 72 h,respectively according to the MTT results.According to the in vivo results,compared with the tumor model group,Gem (ig),Gem (iv)and BAG polymeric micelles (iv and ig)had significant effect on the tumor weight of H22 cell xenograft mice (P<0.01 ).As for anti-tumor efficiency,BAG polymeric micelles (ig)were better than Gem (ig)(P<0.05);BAG polymeric micelles (iv)were better than BAG polymeric micelles (ig)(P<0.05),and BAG polymeric micelles (iv)were almostequaltoGem(iv).CONCLUSION ThelipidderivativeofGemcanbeloadedinthepoloxamer 1 88 polymeric micelles.BAG polymeric micelles show in vitro MCF-7 cell inhibition and in vivo inhibition of mouse H22 xerografts;iv or ig.BAG polymeric micelles (ig)show better anti-tumor effect than Gem (ig),indicating that BAG polymeric micelles are a promising novel anti-tumor oral preparation.