Objective To construct a diagnosis models for differential diagnosis of bloodstream infection(BSI)using nomogram model,random forest model,and decision tree model,respectively.Methods A retrospective analysis was performed on 225 BSI patients diagnosed and treated in Pujiang County People's Hospital from January 2022 to January 2024,and the patients were divided into a training set and a validation set according to a ratio of 7:3.The differential diagnostic models for Gram negative BSI(GN-BSI)and Gram positive BSI(GP-BSI)were established by nomogram model,random forest model,and decision tree model,and the differential diagnostic efficacy of different models were analyzed.Results Binary Logistic regression analysis showed that neutrophil to lymphocyte ratio(NLR),C-reactive protein(CRP),interleukin-6(IL-6),red cell volume distribution width to platelet ratio(RPR),procalcitonin(PCT)were diagnostic variable between GN-BSI and GP-BSI(P＜0.05).In training set,area under the curve(AUC)of nomogram model,random forest model and decision tree model to identify GN-BSI and GP-BSI were 0.900,0.911 and 0.884,respectively,and AUC of random forest model was significantly higher than that of decision tree model(Z=3.521,P=0.038).In verification set,AUC of nomogram model,random forest model and decision tree model for identifying GN-BSI and GP-BSI were 0.908,0.916 and 0.893,respectively,and AUC of random forest model was significantly higher than that of decision tree model(Z=3.412,P=0.042).Conclusion The three models have good identification value for GN-BSI and GP-BSI,among which the random forest model and nomogram model have better identification performance.

Objective:To explore the causes and feelings of delayed experience of seeking medical treatment in patients with advanced lung cancer, and to provide new insights for more targeted health education and medical care services.Methods:A semi-structured in depth interview based on the theory of planned behavior was conducted among 30 patients with advanced lung cancer who experienced medical delay from November to December in 2021 admitted to First Affiliated Hospital of Guangxi Medical University. The interview content was analyzed and abstracted by using Colaizzi phenomenological analysis method and Nvivo11.0 software.Results:The delay duration of 30 patients with advanced lung cancer ranged from 90 to 213 days. Four subject groups were extracted by generic analysis: the cause of delay, the cause to seek medical help, the worry about the disease, and solutions.Conclusions:The delay behavior of patients with advanced lung cancer is affected by external situational factors such as symptom severity, family economic capacity, social support, accessibility of health services, prevalence of novel coronavirus, and subjective psychological factors such as sense of stigma and burden of disease, it is necessary to reduce the occurrence of medical delay in patients with advanced lung cancer through the comprehensive management strategy of multiple channels.

Objective:To investigate the current sedation level of patients with mechanical ventilation in ICU, and to explore the influence of early different sedation levels on clinical outcomes, so as to provide theoretical basis for better guidance of clinical sedation evaluation and implementation of sedation strategy management.Methods:This study was a retrospective longitudinal study. The 201 patients with invasive mechanical ventilation who underwent sedation in the Department of Intensive Care Medicine of the First Affiliated Hospital of Guangxi Medical University from January to December 2021 were selected by convenience sampling method. According to the results of Richmond Agitation-Sedation Scale(RASS), the patients were divided into deep sedation group (98 cases) and shallow sedation group (103 cases). The influencing factors of endotracheal intubation retention time and outcome were investigated by Cox multifactor analysis.Results:In the early sedation ≤48 h after the start of mechanical ventilation, 63.2%(2 143/3 389) of patients with invasive mechanical ventilation had a RASS score of shallow sedation, 35.2%(1 194/3 389) of patients with deep sedation, and 1.5%(52/3 389) of patients with insufficient sedation. Cox multivariate regression analysis showed that age, sedation level, duration of invasive mechanical ventilation and continuous renal replacement therapy were the factors influencing the indentation time of tracheal insertion ( χ2 values were 4.73 to 74.31, all P<0.05); early deep sedation was a risk factor for delayed extubation ( HR=0.499, 95% CI 0.276-0.903, P<0.05); gender, sedation level, invasive mechanical ventilation duration, acute physiology and chronic health evaluation Ⅱ scores, admission mode, continuous renal replacement therapywere the influencing factors of patient outcomes ( χ2 values were 4.41 to 26.20, all P<0.05). The deeper the sedation, the worse the patient outcomes ( HR=0.568, 95% CI 0.335-0.963 all P<0.05) . Conclusions:The early sedation level is related to the retention time and outcome of tracheal intubation in ICU patients with mechanical ventilation, and different sedation levels affect the clinical outcome of patients. The retention time of tracheal intubation in patients with shallow sedation was shortened, which was beneficial to the outcome of patients.Therefore, sedation evaluation should be strengthened in clinical work, and sedation methods should be selected according to the needs of patients. In the absence of contraindications, the shallow sedation strategy should be implemented as soon as possible. This study provides some reference and theoretical basis for the formulation and management of clinical sedation strategies.

Objective: To improve the effectiveness of incontinence-associated dermatitis (IAD) prevention and management by establishment skin care quality indicators and controlling the implementation process of incontinence care. Methods: The implementation rate of nursing measures (the treatment rate of incontinence, the effective collection of fecal implementation rate, and the rate of skin protection implementation) were used as the process indicators, and the incidence of IAD was used as the outcome indicators. 2747 incontinence patients from July to December 2016 before the implementation of the process control were used as the control group, and 3, 069 incontinence patients from July to December 2017 after the implementation of the process control were used as observation groups. Comparing the difference between the two groups of process indicators and outcome indicators. Results: The control group's implementation rate of incontinence, effective collection of fecal implementation rate, and skin protection implementation rate were 54.2%, 63.8%, and 27.7%, respectively. The observation group was 91.8%, 94.8%, and 92.8%, respectively. The difference between the two groups was statistically significant. (χ²=5.032, P=0.025; χ²=6.574, P=0.010; χ²=20.038, P=0.000;). The incidence of IAD in the control group was 28.9%, and the incidence in the observation group was 11.2%. The difference between the two groups was statistically significant (χ²=288.402, P=0.000). Conclusion The establishment of incontinence nursing quality indicators and the implementation of process control will help improve the level of incontinence care and reduce the incidence of IAD.

Objective To compare the efficiency of National Early Warning Score (NEWS),Chronic Respiratory Early Warning Score(CREWS) and BAP-65(elevated Blood urea nitrogen,Altered mental status,Pulse＞109bpm,age＞65 years)among patients with AECOPD (acute exacerbations of chronic obstructive pulmonary disease).Methods Totally 181 patients with AECOPD were investigated by these three scales,and the efficiency of NEWS,CREWS and BAP-65 was compared.Results The scores of NEWS,CREWS and BAP-65 in the death group were higher than those in the survival group and the general ward group(P＜0.01).Regarding the predicted results of hospital death,the area under the ROC curve of NEWS,CREWS and BAP-65 was 0.878,0.836 and 0.774,respectively,and the differences were not statistically significant(P＞0.05);for predicted results of ICU admission,the area under the ROC curve of NEWS,CREWS and BAP-65 was 0.826,0.813 and 0.716,respectively,and the differences were not statistically significant (P＞0.05).Conclusion NEWS,CREWS and BAP-65 have satisfied predictive efficiency for prognosis,and NEWS and CREWS are much easier and faster to use.

Objective To investigate the recent curative effect and adverse reactions of radiotherapy combined with temozolomide in non-small cell lung cancer (NSCLC) patients with brain metastases.MethodsThe clinical date of 51 NSCLC patients with brain metastases were retrospective analyzed in Department of Radiation Oncology of Affiliated Hospital of Hebei University.Patients were divided into experimental group (n=26) and control group (n=25) according to the different treatment methods.The experimental group underwent whole brain and local tumor radiotherapy plus temozolomide.The control group only received whole brain and local tumor radiotherapy.The recent curative effect and adverse reactions of the two groups were analyzed.Results The Karnofsky performance status score of patients in the experimental group was obviously improved than that in the control group (76.2±6.4 vs.72.8±5.3), with a significant difference (t=2.06, P=0.04).The total effective rate in the experimental group was higher than that in the control group (80.8% vs.64.0%), but there was no statistically significant difference (χ2=1.80, P=0.18).Compared with the control group, the incidences of nausea and vomiting (80.8% vs.28.0%) and bone marrow suppression (84.6% vs.24.0%) in the experimental group were significantly higher, with significant differences (χ2=14.33, P=0.00;χ2=18.91, P=0.00).There were similar incidences of headache (69.2% vs.60.1%), liver and kidney damage (73.1% vs.64.0%) in the two groups, with no significant differences (χ2=0.47, P=0.49;χ2=0.47, P=0.49).Conclusion Radiotherapy combined with temozolomide can improve the quality of life in NSCLC patients with brain metastases, which has controllable and tolerable adverse reactions.

Objective To explore the clinical efficacy of iressa combined with radiotherapy in treatment of patients with non-small cell lung cancer (NSCLC) and brain metastasis.Methods Totally 78 NSCLC patients with brain metastasis were selected and divided into combined group and conventional group.All the patients received whole brain radiotherapy and radiotherapy for local metastasis.The combined group was additionally treated with iressa 250 mg/d, one time per day, and this treatment lasted for more than 8 weeks.Effect and complications were compared between two groups.Results The PR rate, effective rate and disease control rate in the combined group were significantly higher than those in the conventional group, while the disease progression rate was significantly lower than the conventional group (P<0.05).In the combined group, the positive rate of EGFR mutation was 91.30%, which was significantly higher than 62.50% of the negative rate of EGFR mutation (P<0.05).The KPS score, mean survival time and survival rate after treatment in the combined group were significantly better than those in the conventional group (P<0.05).Conclusion Iressa combined with radiotherapy can effectively improve the clinical effect, the survival time and the quality of life in NSCLC patients with brain metastasis.

Objective To explore the clinical efficacy of iressa combined with radiotherapy in treatment of patients with non-small cell lung cancer (NSCLC) and brain metastasis.Methods Totally 78 NSCLC patients with brain metastasis were selected and divided into combined group and conventional group.All the patients received whole brain radiotherapy and radiotherapy for local metastasis.The combined group was additionally treated with iressa 250 mg/d, one time per day, and this treatment lasted for more than 8 weeks.Effect and complications were compared between two groups.Results The PR rate, effective rate and disease control rate in the combined group were significantly higher than those in the conventional group, while the disease progression rate was significantly lower than the conventional group (P<0.05).In the combined group, the positive rate of EGFR mutation was 91.30%, which was significantly higher than 62.50% of the negative rate of EGFR mutation (P<0.05).The KPS score, mean survival time and survival rate after treatment in the combined group were significantly better than those in the conventional group (P<0.05).Conclusion Iressa combined with radiotherapy can effectively improve the clinical effect, the survival time and the quality of life in NSCLC patients with brain metastasis.

Objective We aimed to investigate the nurses' ethics cognition status and its influencing factors after carrying out the High quality nursing service demonstration project in Guangxi Zhuang Autonomous Region.Methods From May to June 2014,379 clinical nurses from 59 hospitals of different grades in Guangxi Zhuang Autonomous Region were investigated with the self-designed questionnaire.Results After carrying out the High quality nursing service demonstration project,the total score of the nurses' ethics cognition were (51.29±3.46),which was higher than those in 2010.There was no statistical difference in cognition of medical confidentiality between 2014 and 2010,but it showed significant statistical differences in dimensions of medical optimization,informed consent,the value of life,t value was 11.389,7.448 and 2.126,P ＜0.05.The multiple linear regression analysis showed that nurse-job seniority and hospital hierarchy of clinical nurses were influencing factors of nurses' ethics cognition; educational levels,professional title and nurse-job seniority of clinical nurses were influencing factors of medical optimization; nurses' professional title was influencing factor of informed consent; nurse-job seniority,department and hospital hierarchy of clinical nurses were influencing factors of medical confidentiality; nurses' educational level was influencing factor of life value.Conclusions The High quality nursing service demonstration project contributes to improve the level of nurses' ethics cognition.We should strengthen the nursing ethics continuing education system,in order to improve the nurses' comprehensive ethics cognition.

Objective:To investigate the impact of humanistic spirit cultivation on nursing students' ethics cog-nition. Method:Total 364 internship nursing students in 2010 were taken as the control group with the routine clini-cal teaching method, 381 in 2014 as the experimental group, not only a routine clinical teaching method but also to increase of their humanistic spirit culture. Results:Humanity spirit cultivation before and after practice nursing students in medical security system cognition difference is not significant, but in medical optimization, the patients right of informed consent, the life value differences of cognitive and ethical cognitive dimension score was statisti-cally significant ( P<0 . 05 ) . Conclusions:Humanistic spirit culture promote the practice of nursing students to raise the level of moral cognition foundation for humanity quality education and nursing ethics education, should further strengthen the diversification of internship training nursing students humanistic spirit.