Objective:To construct a training program to improve the psychological nursing ability of clinical nurses, so as to provide a strong guarantee for the clinical development of psychological nursing.Methods:By consulting the literature, related books and investigating the curriculum of nursing colleges, the first draft of the training program was drawn up. Four departments of Cardiovascular Medicine of the Second Xiangya Hospital of Central South University from May to August 2019 were recruited and 64 nurses were trained. After the training, the training program was revised again. After two rounds of training and modification, the second draft of the training program was formed, and then Delphi method was used to conduct two rounds of expert consultation on the second draft of the training program.Results:The positive coefficients of experts in the two rounds of consultation were 94.1% and 96.7% respectively, and the average authority coefficient of experts was 0.81. The final training contents included 5 first-class indexes, 18 second-class indexes and 45 third-class indexes. The coefficient of variation of each item of training contents was 0.06-0.23, and the coefficient of variation of training methods and training duration of each part was 0.06-0.17.Conclusions:The training program is scientific, reasonable, detailed and practical, which can provide guarantee for improving the psychological nursing ability of clinical nurses.

OBJECTIVE: To compare the clinical efficacy under local anesthesia and general anesthesia proximal femoral nail anti-rotation(PFNA) fixation for intertrochanteric fracture of femur in high risk patients. METHODS: From February 2018 to February 2019, 32 patients underwent PFNA operation due to intertrochanteric fracture of femur, including 16 patients undergoing PFNA operation under local anesthesia, 9 males and 7 females, aged 54 to 98 (82.43±9.30) years and hospitalized for (10.94±5.30) days;16 patients undergoing PFNA operation under general anesthesia, 6 males and 10 females, aged 51 to 83 (72.69±9.48) years and hospitalized for (12.88±4.12) days. The patients' gender, age, fracture AO classification, preoperative VAS (visual analogue score), preoperative ASA condition grade, postoperative 1st day resting state VAS, hospitalization cost and length of stay were recorded. RESULTS: All patients recovered well, the wound healed well, and the ability of lower limb activity was restored. The average follow-up time was 4.6 months. There was significant difference in age between two groups (< 0.05);there was no significant difference in sex ratio, AO classification of fracture and VAS before operation (>0.05). There was no significant difference on ASA between two groups (>0.05), but there was significant difference on ASA≥grade Ⅲ between two groups (<0.05). In local anesthesia group, VAS pain score was 4.19±1.50, which was tolerable. There was no significant difference in postoperative 1st day resting state VAS, average hospitalization cost and average length of stay between two groups(>0.05). CONCLUSION Under the multi-disciplinary diagnosisand treatment mode, the method of PFNA operation is safe and feasible, the patients with local anesthesia are older, and the proportion of patients with ASA≥grade Ⅲ is higher, which is better for some elderly high-risk patients than general anesthesia.
Aged ; Aged, 80 and over ; Anesthesia, Local ; Bone Nails ; Female ; Femoral Fractures ; surgery ; Fracture Fixation, Intramedullary ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To analyze the current status of diagnosis and management of acute appendicitis (AA) in China. METHODS: Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary. RESULTS: A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001). CONCLUSIONS The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.
Acute Disease ; Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Appendectomy ; Appendicitis ; diagnosis ; therapy ; China ; Female ; Health Care Surveys ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

Objective: To investigate the current situation of emotional and behavioral problems and analyze the influencing factors of middle school students. Methods: The general information questionnaire, the strengths and difficulties questionnaire (student version), and the illinois bullying scale were used to evaluate 680 students in two middle schools in Hunan province.Statistical analysis was performed using t test, analysis of variance, Pearson correlation analysis and stepwise multiple regression analysis. Results: (1) The detection rate of total difficulty (12.09±5.67), conduct problem (2.42±1.66), hyperactivity/attention defect (3.65±2.08), emotional (2.82±2.32), peer relationship problem (3.21±1.79) and pre-socialization behavior (7.02±2.39) were 11.2%, 11.2%, 7.7%, 6.9%, 11.0% and 14.5%.(2)The scores of total difficulties, conduct problem, hyperactivity/attention deficit and peer relationship problems of boys were higher than that of girls(t=2.79, 4.03, 2.44, 3.40, all P<0.05), while the score of pre-socialization behavior of boys was lower than that of girls (t=-5.29, P<0.05). (3) The scores of total difficulties, conduct and peer relations, pre-socialization of rural students were significantly different with those of urban students(t=-3.93, -2.55, -7.00, 5.26, all P<0.05). (4) The score of total difficulties, conduct problem, hyperactivity/attention deficit and emotional symptoms of left-behind students were higher than that of un-left-behind students (t=-3.18, -2.50, -2.67, -2.40, 2.19, all P<0.05). (5) Middle school students with different fathers' education levels showed different scores of total difficulties, peer relationship problem and pre-socialized behavior(F=3.84, 7.10, 6.20, all P<0.05), while middle school students with different mothers' education levels showed different scores of total difficulties and peer relationship problem(F=3.97, 7.38, both P<0.05). (6) The scores of total difficulties, emotional symptoms, conduct problems, and hyperactivity/attention deficit of the middle school students were significantly positively correlated with the total score of the bullying total scale, the bullish subscale, the bullying subscale, and the fighting subscale(r=0.165-0.430, P<0.05). (7) Gender, urban and rural areas, left-behind or not, maternal education level, bullying, being bullied, fighting were the influencing factors of middle school students' emotion and behavior problems(β=0.010-0.533, P<0.05). Conclusion Some middle school students in Hunan province have emotional and behavioral problems and more attention should bo paid to mental health education.

Objective: To explore the relationship between internalized stigma and insight, self-esteem in patients with schizophrenia. Methods: A total of 144 schizophrenic patients were investigated by the general information questionnaire, insight and treatment attitude questionnaire (ITAQ), internalized stigma of mental illness scale-Chinese version (ISMI-C) and the self-esteem scale (SES). Pearson correlative analysis and Bootstrap program mediation effect test were used to data analysis. Results: There was a significantly positively correlation between insight score(11.24±4.08) and internalized stigma score(2.18±0.65) of 144 schizophrenic patients(r=0.236, P<0.05). The Self-esteem score(27.57±3.76) was negatively correlated with insight score(r=-0.177, P<0.05) and internalized stigma score(r=-0.661, P<0.05). The mediation effect test analysis showed that the internalized stigma played a full mediating role in the relationship between insight and self-esteem, and the effect size was -0.143. Conclusion Insight can indirectly affect self-esteem via internalized stigma in patients with schizophrenia.Taking measures to decrease inpatients' internalized stigma level and improve their illness awareness should be paid attention in clinical practice.

OBJECTIVETo investigate the drug resistance of imipenem-resistant (IR) Gram-negative bacilli (GNB) in coal workers' pneumoconiosis (CWP)-chronic obstructive pulmonary disease (COPD) patients with lower respiratory tract infection (LRTI) and to provide a basis for clinical treatment.

METHODSSixty-six strains of IR-GNB were isolated from the sputum of CWP-COPD patients with LRTI, and the bacterial spectrum was investigated. The drug resistance of bacterial strains was studied by KB disk diffusion method.

RESULTSAmong the 66 strains of IR-GNB, 29 (43.9%) were Pseudomonas aeruginosa, 17 (25.8%) were Acinetobacter baumannii, and 11 (16.7%) were Stenotrophomonas maltophilia. The drug sensitivity test showed that all bacteria had high drug resistance; Pseudomonas aeruginosa had a susceptibility rate higher than 50% to ciprofloxacin, polymyxin B, fosfomycin, and amikacin, Acinetobacter baumannii had a susceptibility rate higher than 55% to fosfomycin, polymyxin B, and cefoperazone/sulbactam, Stenotrophomonas maltophilia had a susceptibility rate higher than 50% to cotrimoxazole, ciprofloxacin, piperacillin/tazobactam, levofloxacin, polymyxin B, and cefoperazone/sulbactam, and Pseudomonas cepacia had a susceptibility rate higher than 50% to piperacillin/tazobactam, ciprofloxacin, cefoperazone/sulbactam, and polymyxin B.

CONCLUSIONThe main species of IR-GNB are such non-fermentative bacteria as Pseudomonas aeruginosa, Acinetobacter baumannii, and Stenotrophomonas maltophilia in CWP-COPD patients with LRTI. These bacteria have high drug resistance and are sensitive to only a limited range of antibiotics.

Aged ; Aged, 80 and over ; Anthracosis ; complications ; microbiology ; Drug Resistance, Multiple, Bacterial ; Gram-Negative Bacteria ; drug effects ; Humans ; Imipenem ; pharmacology ; Microbial Sensitivity Tests ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; complications ; microbiology

Objective To investigate the pain level and its influential factors in patients after operation of hepatobiliary surgery. Methods 120 patients were evaluated with the demographic data, State Trait Anxiety Inventory Form (STAI) , Visual Analogue Scale (VAS) , Perceived Social Support Scale (PSSS) and Eysenck Personality Questionnaire (EPQ). Results The highest pain level was within 2h in patients after the operation,then decreased gradually,but its still in the moderate level until 72h after the operation;the pain scores of the PCIA group were lower than the control group ( 2h, 12h after the operation) (P ＜ 0.05, (P ＜ 0. 01 ). The preoperative state anxiety (S-AI) scores were higher than the norm (P＜0. 01 ). The psychoticism Personality characteristics influents the postoperative pain ( 12h,24h after the operation); there were positively correlations between P and VAS (12h, 1week after the operation). The analgesia methods influent the postoperative pain(2h,48h after the operation). The S-AI influents the postoperative pain (2h-48h after the operation) ,there were positively correlations between S-AI and VAS (2 ～ 72h after the operation). The social support influents the postoperative pain (48h after the operation); there were negatively correlations between PSSS score and VAS (48h ,72h and 1 week after the operation). The age and occupation of the patients influent the postoperative pain. Conclusion There was serious pain in patients after operation of hepatobiliary. The preoperative S-AI ,the psychoticism personality characteristics, analgesic modalities, social support, age, occupation of patients are influential factors of pain in patients after abdominal operation.

OBJECTIVETo investigate the surgical methods and clinical results of modified transforaminal lumbar interbody fusion and internal fixation for the treatment of upper lumbar disc herniation.

METHODSClinical data of 32 cases of upper lumbar disc herniation in our department from June 2005 to June 2009 were retrospectively analyzed. There were 21 males and 11 females, the age from 24 to 59 years with an average of 38.5 years. All the cases were treated by the use of nucleus pulposus removed, modified transforaminal lumbar interbody fusion (TLIF) and internal fixation with pedicle screw system. All patients were followed up with an average of 9 months (from 3 to 18 months), according to Japanese Orthopedic Association (JOA) scores and visual analogue scores (VAS) to evaluate clinical effects.

RESULTSAll the cases were followed up from 3 to 18 months with an average of 9 months and the fusion rate was 100%. The JOA sores before and after operation were 10.5 +/- 2.1, 26.2 +/- 2.4 respectively, and the improvement rate was 84.9%. The VAS before and after operation was 7.2 +/- 1.3 and 1.4 +/- 1.1 respectively, and the rate of catabatic pain was 80.6%. Lumbar rigidity and unwell had 4 cases, obviously leg pain had 2 cases after operation, but the systems vanished gradually at 1-8 weeks after non-operative treatment.

CONCLUSIONModified transforaminal lumbar interbody fusion has the advantages of simple, safe operation and thoroughly decompression, and it is a therapeutic method for upper lumbar disc herniation.

Adult ; Female ; Follow-Up Studies ; Humans ; Internal Fixators ; Intervertebral Disc Displacement ; physiopathology ; surgery ; therapy ; Lumbar Vertebrae ; pathology ; physiopathology ; surgery ; Male ; Middle Aged ; Spinal Fusion ; methods ; Treatment Outcome

OBJECTIVETo analyze clinical characteristics and therapeutic efficacy of acute traumatic central cervical spinal-cord syndrome without fracture and dislocation,and to investigate its treatment methods.

METHODSClinical data of 47 cases with acute traumatic central cervical spinal-cord syndrome without fracture and dislocation were retrospectively analyzed. There were 3 female and 44 male,with a mean age of 56.2 years (ranging from 46 to 73 years). According to Frankel classification, 30 cases were grade B, 14 cases were grade C and 3 cases were grade D. Forty-two cases were treated without operation, and 5 cases which had significant compression factors or segmental instability were treated with surgical treatment. Among them, 3 cases were treated through anterior approach and 2 cases were treated through posterior approach. Causes of injuries, mechanisms of injuries,findings of imaging, functional impairment of nerve,methods of treatment,and therapeutic efficacy were analyzed.

RESULTSThe average followed-up time was 12 months (ranging form 3 to 84 months), 2 cases of non-operation were dead and 6 were loss. Three months after treatment, some complications occurrenced on 7 patients of non-operation. The majority bequeathed different degree impairment of intrinsic muscles of hands.

CONCLUSIONReduction and fixation through the pedicle of fractured vertebra is an effective therapeutic options to treat the thoracolumbar burst fractures and desearved clinical study and expansion.

Acute Disease ; mortality ; therapy ; Aged ; Cervical Vertebrae ; injuries ; surgery ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Spinal Cord Injuries ; complications ; mortality ; surgery ; therapy

OBJECTIVETo explore the expression of NF-kappaB and ICAM-1 in the gas explosion wounded lung of rats and the relationship.

METHODSDigoxin labeled NF-kappaB was used as probe. In situ hybridization was performed to detect the NF-kappaB mRNA. Immunohistochemistry was used to detect the expression of NF-kappaB and ICAM-1.

RESULTSThe levels of NF-kappaB mRNA, the expression of NF-kappaB and ICAM-1 in the wounded rats were significantly increased and reached their peak two hours after injury. Pathology of lung tissue showed that some crachea epithelium mucosae were desquamated; congestion, edema of trachea wall and infiltration of neutrophilic granulocytes were found; hemorrhage, edema and infiltration of lots of inflammatory cells were present in alveolus cells. Electron microscope showed that type I, especially type II alveolus epithelia had degeneration and desquamation.

CONCLUSIONThe injury of gas explosion can activate NF-kappaB, which has close correlation with the acute injury to lung.

Animals ; Blast Injuries ; metabolism ; pathology ; Explosions ; Intercellular Adhesion Molecule-1 ; biosynthesis ; genetics ; Lung ; metabolism ; pathology ; NF-kappa B ; biosynthesis ; genetics ; RNA, Messenger ; genetics ; Rats ; Rats, Sprague-Dawley