Objective To retrieve,analyse and integrate the best evidences in perioperative fluid management for elderly patients with hip fracture,therefore to provide references for patient care.Methods Following the 6S evidence model,databases and websites were searched to collect the evidences on perioperative fluid management of elderly patients with hip fracture.The searched databases including BMJ Best Practice,UpToDate,AAOS Clinical Practice Guidelines,ASBMR,ANZHFR,ESTES,NICE,SIGN,JBI,Cochrane Library,CINAHL,Embase,PubMed,Web of Science,CNKI,Wanfang Data,VIP database,CEBM Database,Medive,China Science and Technology Journal Database,SinoMed,and other websites about orthopaedics.The searched literatures included guidelines,clinical decision-making,best practices,expert consensus and systematic reviews.The time span for the published literatures was from the inception of the databases and websites to August 2022.Two researchers independently completed quality evaluations of the retrieved literatures,as well as extraction,assessment and integration of the abstracted evidences.Results A total of 15 articles were included,they were 2 guidelines,3 clinical decision-makings,1 best practice,7 expert consensus,and 2 systematic reviews.Thirty pieces of evidence were summarised from 7 aspects,covering multidisciplinary team collaboration,dynamic assessment and monitoring of fluid status,fluid resuscitation,fluid management before and after the surgery and health education.Conclusions This study summarised the best evidences in perioperative fluid management for elderly patients with hip fracture.The evidences provide an evidence-based solution which will enable the healthcare workers to fully combine the clinical scenarios,evaluate changes in fluid volume status dynamically,develope personalised fluid management strategies and improve patient outcomes.

Objective To explore the application effects of Donabedian's structure-process-outcome three-dimension quality assessment model on perioperative blood glucose management among elderly patients with hip fracture. Methods From September 2016 to April 2017, a total of 129 elderly patients with hip fracture of the Third Hospital of Hebei Medical University were numbered according to admission order. From September to December 2016, a total of 62 cases were in control group receiving routine blood glucose management. From January to April 2017, 67 cases were in observation group treated with blood glucose management based on Donabedian's three-dimension quality assessment model. And then, we compared the blood glucose on admission and before discharge, waiting time before surgery, healing time of wound and cases of hypoglycemia. At the same time, we investigated the demands of training content of medical staff (n=133). Results There was no statistical difference in the first blood glucose 24 hours after admission and 2 hours after meal of patients between two groups (P＞0.05). After intervention, the waiting time before surgery, healing time of wound and incidence rate of hypoglycemia in observation group [(3.34±0.88) d, (4.43±1.38) d and (3/67, 4.5%)]were less than those in control group [(4.63±1.41) d, (6.47±2.24) d and (10/62, 16.1%)];the fasting blood glucose and blood glucose 2 hours after meal in observation group [(5.96±1.21), (7.60±0.96) mmol/L] were lower than those in control group [(10.80±1.14), (9.94±1.98) mmol/L]one day before discharge all with significant differences (P＜ 0.05). There was also significant difference in blood glucose 2 hours after meal in observation group before and after intervention (P＜0.05). The demands of training content of medical staff (n=133) included diet management, correct usage of insulin, oral hypoglycemic agents instruction, blood glucose monitoring management;the influencing factors on implementing blood glucose management involved busy work, inconsistent dinner time, insufficient knowledge, and so forth. Conclusions Blood glucose management process based on Donabedian's three-dimension quality assessment model can effectively control perioperative blood glucose among elderly patients with hip fracture, shorten waiting time before surgery as well as healing time of wound and reduce cases of hypoglycemia which makes for overall rehabilitation of patients.

Objective To explore the implementation methods and effects of precise quality control model mediated by nursing quality indexes in quality management.Methods Fifty-seven care units with complete quality control data were collected. From January to December 2015, the 57 using the traditional quality control mode were selected as control group, whilst from January to December 201657 units were chosen for the intervention group using precision quality control mode, that was, to select the number of indicators and target values, screening quality control points, unified the acquisition path of indicators, lock the key departments and monitoring points affecting the quality to carry out quality management performance. We observed the changes of the two groups of quality indicators.Results The nine process quality indicators including wards 6S management, first aid techniques, health education, primary care, first class and critical care nursing, safe treatment, operating nursing documents,drug and sterile product quality and pass rate of identity verification were significant difference between the two groups(P<0.05). The five outcome quality indicators including hospitalized patients fall, dosing defects, hospital pressure sores, burns and urinary uncontrolled extubation rates were significant difference between the two groups(P<0.05) as well.Conclusions The quality control model, which is mediated by the nursing quality index, is helpful to improve the nursing quality. It is an effective quality control mode to achieve continuous improvement of nursing quality.

Objective To evaluate the clinical effects of ultrasonography for structural examination in the diagnosis of fetal brain malformation and neural tube defects ( NTDs ) in early pregnancy . Methods A retrospective study was conducted to analyse 6 630 cases taking obstetric examination in Dongguan Maternal and Child Health Hospital from February 2014 to June 2015. The examination included a standardized ultrasound structural examination at 11-13 plus 6 weeks of pregnancy. The autopsied results of the induced fetus in early pregnancy from craniocerebral and neural tube structure malformation were investigated. All the cases were followed up concerning the outcomes and the malformation detection rate was calculated for analysis. Results The detection rates of exencephalus and anencephalus, holoprosencephaly, aphylly-holoprosencephaly, rachischisis, open spina bifida, and meningocele were 100%, 80%, 100%, 42.9%, 50% and 100%, respectively. The malformations which was missed in the early pregnancy but detected in the later gestational ages included:Dandy-Walker Syndrome, most of the non-open spina bifida, hypoplasia of the corpus callosum, foliaceous-holoprosencephaly and ventriculomegaly. Conclusions The structural examination using ultrasonography at early pregnancy is effective in the detection of severe open-neural tube defects. It′s worth generalizing in the cliical diagnosis but part of fetal malformations still need a further ultrasound examination in the mid-gestation or the later gestation.

Objective To explore clinical practice value of Disease Severity Evaluation Scale (DSAS), and divide patient's nursing level according to the results of DSAS. Methods The assessment group was set up for evaluation of the scale, DSAS was used to determine the nursing level of 3 713 hospitalized patients (age > 18 years old) from 17 clinical departments, from April to May 2014. Results Nursing level determined by DSAS was compared with the standard nursing level, kappa coefficient was 0.72, P < 0.05, suggesting that the consistency was better. According to the kappa coefficient, 17 clinical departments could be divided into three categories, namely the applicability of DSAS were different in different departments. Conclusions DSAS can be used as a objective basis for division of nursing level and has a certain clinical significance. But in order to make it guide clinical work better, scoring system with department characteristic should be developed on the basis of DSAS.

Objective To investigate feasibility and effectiveness of combined level-one quality control and management mode. Methods Contents of combined level-one quality control and management mode were introduced, including determining departments combination, establishment and work procedure of the combined quality control group, frequency of combined quality control, and approaches of continuous quality improvement. Quality control data of the Nursing Department from January 2013 to December 2014 were taken to statistically analyze compliance rate of 6 nursing quality standards, satisfaction of hospitalized patients, and incidence of nursing defects, before and after implement of combined quality control&management mode. Results Compared with before, after implementation of combined level-one quality control and management mode, compliance rates of nursing documentation, basic nursing, treatment safety, head nurse management, and ward management, as well as satisfaction of hospitalized patients, and incidence of nursing defects were statistically significant (χ2 =4. 182, 8. 177, 6. 157, 5. 148, 5. 135, 7. 875, 7. 754; P <0. 05). Compliance rates of health education quality before and after the implementation were not statisticallysignificant (χ2 = 4. 182, P > 0. 05 ). Conclusions Implementation of combined level-one quality control and management mode can improve compliance rate of nursing quality standards and satisfaction of hospitalized patients, and decrease incidence of nursing defects, which is a new feasible and effective management mode in clinical work.

Objective To explore the application of compound sequential technology on sputum exclusion for patients with cervical spinal cord injury. Methods A total of 86 patients with cervical spinal cord injury ( CSCI) were divided into intervention group and control group from January 2011 to December 2013 in our hospital on average. The patients of intervention group adopted compound sequential technology on sputum exclusion, while the patients in the control group underwent conventional nursing measures. We evaluated the occurrence of pulmonary infection and atelectasis, and the usage of artificial airway. Results In the intervention group, the incidence of lung infection and atelectasis (9. 3%) was lower than that of the control group (37. 2%), and the difference was statistically significant (χ2 =9. 382,P< 0. 05). The cure time in the intervention group was shorter that of the control group (t = -6. 339,P <0. 05). Utilization rate of artificial airway in the intervention group was 7. 0% compared with 30. 2% in the control group (χ2 =7. 679,P<0. 05). The length of carrying tube in the intervention group was lower than that of the control group (t = -5. 490,P <0. 05). Conclusions The compound sequential technology can improve the effect of sputum exclusion in patients with CSCI, decrease pulmonary infection and atelectasis, shorten the time of carrying tube, and enhance cure rate.

[ ABSTRACT] AIM:To screen out a suitable lead for monitoring the ambulatory electrocardiogram ( ECG) in un-restrained toad, and to investigate its practicability.METHODS:After subcutaneously implanting the electrodes in toads under anaesthesia, the ambulatory ECG of 5 leads were monitored with BL-420S data acquisition and analysis system, and the leads which could well express the waveform in ECG were screened out.The recovery process of the toads from the arti-ficial hibernation within 6 h, the day-to-day stability of the heart rate ( HR) and the heart rate variability ( HRV) in 5 suc-cessive days of hibernation, and the HR and HRV after freeze-thawing process were monitored to determine its practicabili-ty.RESULTS:Two out of 5 leads showed better ECG waveforms.Compared with 6 h post hibernation, lowered HR at 0 h and 1 h was observed, and the standard deviation of normal R-R intervals ( SDNN) was significantly increased ( P<0.05 or P<0.01), but the HR and SDNN from 2 to 5 h showed no significant difference, suggesting that the cardiac function reached the steady state after 2 h recovery.The HR at 2 h and 4 h on day 4 and day 5 decreased significantly compared with that on day 1 (P<0.05 or P<0.01), followed with a significant increase in SDNN (P<0.05 or P<0.01), sugges-ting that the ECG remained stable within 3 d.The HR increased, while SDNN decreased significantly at 1 h and 12 h post-thawing compared with that at pre-freeze (P<0.05), indicating the damaged cardiac function after freeze-thawing process. CONCLUSION:The method of subcutaneously implanting electrodes is suitable for effectively monitoring the ambulatory ECG in toads.

Among the different x-ray features of breast carcinoma, mass and calcification are the most significant reference parameters in the screening and diagnosis of early carcinoma. Mammographic follow-up after conservation therapy is the other important value of mammography for breast carcinoma. Calcification is the most important sign to show residue or recurrence of conservation therapy.

HEV is a positive strand RNA virus containing 3 open reading frames(ORFs), while the function of its binding protein pORF3 is poorly understood. In our study, the interactive protein of the pORF3 from human liver cDNA library was screened by the SOS recruitment system, and the construction of the pSOS bait-ORF3 plasmid was identified. The expression of the pORF3 was analyzed by Western blotting, and the detection result of the self activation of bait protein was obtained as expected. Totally, 8 putative interacting proteins had been successively screened. Some of these cellular binding proteins of pORF3, especially the important immunological pathway kinase p110δ, may advance our understanding of the role in ORF3 protein of HEV, and the possible implications of these candidate proteins for the further research are discussed.