ObjectiveTo investigate a suspected outbreak of healthcare-associated infection with carbapenem-resistant Klebsiella pneumoniae (CRKP) in a geriatric emergency ward, and to provide references for the prevention and control of multidrug-resistant bacteria in a hospital in Shanghai. MethodsOn-site epidemiological investigation, combined with environmental hygiene monitoring and pulsed field gel electrophoresis (PFGE) molecular typing method, were adopted to investigate a suspected outbreak of CRKP infection in the geriatric emergency ward of a hospital from October to November 2022, aiming at finding out factors caused the outbreak before taking corresponding control measures. ResultsA total of 3 cases of healthcare-associated CRKP infection were identified, of which 2 cases were homologous to a previous case of community-associated CRKP infection. What’s more, the 2 cases lived in the same ward with the latter and with adjacent beds, but the third case was non-homologous to the community-associated infection case. A total of 46 samples were collected from the environmental surfaces and the hands of healthcare workers, of which 7 samples tested positive for CRKP and were identical to the strains from the 2 healthcare-associated infection cases and the 1 community-associated infection case, originating from the bedrails, bedside tables, surface of non-invasive ventilator, bed curtains and panels of monitoring equipment, with a detection rate of 15.22%. But none of the 11 samples from the hands of healthcare workers tested positive for CRKP. The outbreak was effectively controlled after taking specific prevention and control measures such as strengthening personnel management, intensifying environmental cleaning and disinfection and strictly enforcing hand hygiene among healthcare workers. Subsequently, no similar new cases were reported during the 14-day follow-up period. ConclusionIncomplete environmental cleaning and disinfection, as well as inadequate enforcement of hand hygiene among heatheare workers may have contributed to the suspected outbreak of CRKP in the geriatric emergency ward. Early warning and timely investigation of suspected outbreaks of multidrug-resistant bacteria are crucial for preventing and controlling such outbreaks in hospitals.

Objective: To investigate the knowledge, attitude and practice of hepatitis B prevention and control among junior high school students in Linping District, Hangzhou City, so as to provide insights into management of hepatitis B among adolescents. Methods: Two classes were sampled using a cluster sampling method from grades 2 in 12 public junior high schools in Linping District, and all students in these two classes were enrolled. Students' knowledge, attitude and practice of hepatitis B prevention and control were collected using questionnaire surveys, and factors affecting knowledge, attitude and practice of hepatitis B prevention and control were identified using a multivariable logistic regression model. Results: A total of 1 102 questionnaires were allocated and 1 094 valid questionnaires were recovered, with an effective recovery rate of 99.27%. The respondents included 540 males (49.36%) and 554 females (50.64%), and 542 rural students (49.54%) and 552 urban students (50.46%). The awareness of hepatitis B prevention and control knowledge was 43.60%, and a low awareness rate was seen for the item “use of condom may prevent hepatitis B” (21.12%). The percentage of correct attitudes towards hepatitis B prevention and control was 57.77%, and a low percentage was found for the item “individuals living with hepatitis B will tell others” (38.67%). The percentage of positive practices towards hepatitis B prevention and control was 80.07%, and a low percentage was seen for the item “hepatitis B vaccines have been inoculated in recent five years” (16.54%). Multivariable logistic regression analysis identified gender (females, OR=1.483, 95%CI: 1.159-1.898), household registration (urban, OR=1.300, 95%CI: 1.011-1.670), and parental highest educational level (high school or technical secondary school, OR=0.703, 95%CI: 0.532-0.929) as factors affecting the awareness of hepatitis B prevention and control knowledge among junior high students, and parental highest educational level (high school or technical secondary school, OR=0.705, 95%CI: 0.533-0.934) and serving as class cadres (OR=1.449, 95%CI: 1.128-1.860) were factors affecting the attitudes hepatitis B prevention and control, while household registration (urban, OR=1.566, 95%CI: 1.144-2.143) and route of acquiring hepatitis B control knowledge (internet or magazine, OR=0.473, 95%CI: 0.288-0.776) were factors affecting the formation of practices towards hepatitis B prevention and control. Conclusions The overall awareness of and percentage of attitudes towards hepatitis B prevention and control, and the percentage of hepatitis B vaccination are low among junior high school students in Linping District. Targeted health education pertaining to hepatitis B prevention and control is required to be reinforced and promotion of hepatitis B vaccination is recommended.

Objective:To construct nursing quality evaluation indicator system for comprehensive stroke center, so as to provide reference for standardized nursing quality evaluation of comprehensive stroke center.Methods:From September 2018 to December 2019, based on the theory of Donabedian′s structure-process-outcome quality model, literature review, semi-structured interview, Delphi method and analytic hierarchy process were used to determine nursing quality evaluation index system and index weight for comprehensive stroke center.Results:A total of 16 experts from comprehensive stroke center were consulted for two rounds. The clinical working time was 24.63±10.08 years, and the effective recovery rates of two rounds were 100%. The authority coefficient of experts was 0.888, and the coordination coefficients W of two rounds were 0.229 and 0.283 respectively.Finally, a nursing quality evaluation indicator system for comprehensive stroke center was constructed, including 3 first-level indicators, 13 second-level indicators and 46 third-level indicators. Conclusions:The established nursing quality evaluation indicator system for comprehensive stroke center covers the whole process of stroke emergency, stroke unit, and follow-up, which is scientific and reliable, and provides an evaluation tool for daily nursing quality monitoring and continuous quality improvement in comprehensive stroke centers.

Background: Intestinal mucosal barrier function is closely related to the prognosis of patients with severe acute pancreatitis (SAP). Protecting intestinal mucosal barrier function has become the key of treatment of SAP. Aims: To explore the relationship between autophagy and intestinal mucosal barrier function in SAP and the effect of autophagy inhibitor 3-MA. Methods: SD rats were randomly divided into sham operation (SO) group, acute necrotizing pancreatitis (ANP) group and 3-MA group. Each group was further divided into 3 subgroups: 3, 6 and 12 hours after surgery. HE staining was used to observe the pathological changes of pancreatic and intestinal tissue. Blood amylase was detected; serum endotoxin and intestinal fatty acid-binding protein (I-FABP) were determined by ELISA; protein expression of Beclin-1 was examined by Western blotting. Results: Compared with SO group, pathological score of pancreatic and intestinal tissue, blood amylase, endotoxin and I-FABP were significantly increased at each time points in ANP group (P<0.05), while protein expression of Beclin-1 was significantly decreased (P<0.05), and all above-mentioned indices were time-dependent (P<0.05). After treatment with 3-MA, above-mentioned indices were significantly ameliorated (P<0.05). Conclusions: In SAP, intestinal autophagy gradually increases with the progress of disease. After intervention with 3-MA, intestinal autophagy decreases and damage of intestinal mucosal barrier function is alleviated, suggesting that intestinal autophagy is related to the damage of intestinal mucosal barrier function of SAP, and 3-MA has an inhibitory effect.

Objective To understand the nutrition status in elderly patients with hip fracture, and clarify its effects on postoperative functional recovery,complications and mortality based on literature analysis of the past 10 years. Methods PubMed,Medline,Embase Database,Wanfang Database,Chinese National Knowledge Infrastructure(CNKI)and China Biology Medicine disc(CBMdisc)were searched,and relevant researches published from 1st January,2010 to 31th May,2019 were collected. Single rate Meta-analysis was used to integrate the prevalence and mortality of malnutrition. A qualitative systematic review was used to analyze the relationship between nutritional status and prognosis after surgery. Results A total of 11 articles was included,including 21791 patients. Meta-analysis showed that the mean prevalence of malnutrition during hospitalization in elderly patients with hip fracture was 46％(95％CI:45％-47％)using serum albumin(ALB),and was 17％(95％CI:12％-22％)assessing by the Mini Nutritional Assessment (MNA),and the risk of malnutrition prevalence was 42％(95％CI:45％-47％). The results of qualitative evaluation showed that compared with the well-nutrition group(Short-form MNA 12-14 points),the malnutrition risk group(Short-form MNA 8-11 points)had lower activity ability 4 months after the operation (OR=2.03,95％CI:1.24-3.31),and the MNA score decreased by 1 point,the risk of death increased by 15％(HR=0.869,95％CI:0.757-0.998). The malnutrition group(ALB<3.5 g/dl)had a higher incidence of sepsis (P< 0.001)and pulmonary infection(P=0.019),with every 1 g/dl reduction in ALB and 0.59-fold increased risk of death(RR=0.59,95％CI:0.53-0.65). Conclusions The incidence of hip fracture malnutrition or malnutrition risk is very high in the elderly patients with hip fracture. Both malnutrition and malnutrition risk have negative effects on postoperative functional recovery,complications and death rates,and the worse the nutritional status,the worse the prognosis. So,both ALB and MNA are recommended to be included in the care plan of elderly patients with hip fracture. When ALB is failed to diagnose malnutrition,the MNA evaluation method should be adopted to find the problems of nutrition and offer nutritional intervention in advance.

Objective:To construct the nutritional intervention regimen for elderly patients with hip fractures during the perioperative period and rehabilitation period.Methods:Based on Stetler evidence-based practice model, 151 elderly patients with hip fractures surgery who were admitted to Jiading District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences from January to May 2019 were investigated, and nutritional problems were found in the perioperative period and 3 months after surgery. Through systematic literature search, the best evidence was extracted to construct a nutritional intervention regimen for elderly hip fractures patients with oral nutrition supplements (ONS) . The expert meeting method was adopted to demonstrate the scheme and determine the final intervention scheme and process.Results:A total of 7 guidelines were included, and 25 recommendations were formed based on evidence, including 24 strong recommendations and 1 weak recommendation. Nutritional intervention scheme and process for elderly patients with hip fractures, mainly ONS, were determined. The expert authority coefficient was 0.89.Conclusions:In this study, the nutritional intervention regimen for elderly patients with hip fractures, mainly ONS, was constructed with a high degree of expert authority and reliable results, providing a theoretical basis for clinical nutrition intervention for elderly patients with hip fractures in the perioperative period.

Training and improving the clinical skills of specialist nurses is an important part of nursing education in Operating Room. The objective structured clinical examination is currently recognized as an objective assessment method to evaluate the clinical practice skills of medical students. Its assessment model is still in its infancy in the field of clinical nursing education in China. This article reviews the connotation of clinical skills,the design of objective structured clinical examination and the application status of clinical skills training of specialist nurses in Operating Room.

Objective? To explore the medical staff's recognition of the nursing quality evaluation of a comprehensive stroke center,so as to provide reference for constructing the nursing quality evaluation index system in the comprehensive stroke center. Methods? By descriptive qualitative method, 11 doctors and nurses from comprehensive stroke center were enrolled to have semi-structured in-depth interviews from February to April of 2019. The data were analyzed using a directed content analysis method. Results? A total of 2 subjects related to structured nursing quality evaluation were extracted: nursing staff allocation,organizational structure configuration; 6 subjects related to process nursing quality evaluation:disease condition observation and assessment,specialist nursing practice,complications management,rehabilitation nursing,health education, effective communicationand coordination; 3 subjects related to outcome nursing quality evaluation: incidence of complications,physical and mental status,patient benefits. Conclusions? The relevant topics of comprehensive stroke center nursing quality evaluation extracted based on the perspective of medical staff, can provide a reference for constructing a comprehensive, scientific and applicable index system to improve the quality of care in the comprehensive stroke center.

Objective To compare the clinical efficacy of refined mirabilite vs.Chaishao Chengqi Decoc-tion in treating sever acute pancreatitis(SAP) complicated with abdominal compartment syndrome(ACS). Methods 60 cases of SAP complicated with ACS were divided into treatment group(n = 32) and control group (n=28) with random number table.The treatment group was given the nasal feeding and enema with refined mira-bilite base on routine western medicine treatment. The control group was given the nasal feeding and enema with Chaishao Chengqi Decoction. The 2 groups were compared with respect to the changes of the APACHEⅡ scores, intra-abdominal pressure,endotoxin,calcitonin(PCT),tumor necrosis factor alpha(TNF-α),recovery time of bowel sound,self-defecation recovery time,length of stay and hospitalization expenses. Results After 7 days of treatment,the intestinal permeability index(endotoxin) and the related indicators(PCT,TNF-α) were significantly lower than before treatment in both groups(P<0.05).The abdominal pressure of both groups at days 1,3 and 7 days after treatment was significantly lower than before treatment(P < 0.05) but the difference between the two groups had no statistical significance(P > 0.05). In the 3rd and 7th days of the treatment,APACHEⅡ scores were significantly lower than before treatment(P<0.05),but the difference between the two groups was not statis-tically significant in the score(P>0.05).The two groups showed no significant difference in the recovery time of bowel sound,self-defecation recovery time,length of stay and hospitalization expenses(P > 0.05). Conclusions Refined mirabilite as adjuvant therapy in SAP with ACS,can effectively reduce the internal pressure,promote the intestinal function recovery,protect the intestinal mucosal barrier function,reduce intestinal bacteria and endotox-in translocation and the complications of infection.It has a similar clinical effect as Chaishao Chengqi Decoction to the recovery of the disease.

Astract: Objective To explore the efifcacy and safety of endoscopic tissue adhesive injection in treatment of gastric variceal bleeding from liver cirrhosis.Methods Object of study are 92 cirrhotic patients (72 male/20 female) in hospital, who had been diagnosed with gastric varices bleeding from June 2014 to May 2016. Child-Pugh score at presentation for cirrhotic patients was A-28; B-36; C-28. According to endoscopic classiifcation of gastric varices, GEV1 were detected in 80 patients, GEV2 in 12. All patients were treated with endoscopic hypertonic glucose tissue adhesive ‘sandwich’ injection.Result Successful injection rate was 100.0% in 92 patients, among which 40 patients had accepted emergency endoscopic treatment and the immediate hemostasis rate was 100.0%. 65 patients were Having gastroscope review after the injection six months, 22 patients were significantly effective, accounting for 33.8%; 38 patients were effective, accounting for 58.4%; 5 patients were invalid, accounting for 7.7%. All the patients were followed up in 1 to 24 months. The late-rebleeding rate was 2.2%. None of them were having early-rebleeding or dead; Complications the incidence of rebleeding rate which caused by removing the needles which trapped in the varices was 2.2%. The incidence of chest pain rate was 4.3%, the bloating rate was 6.5% and the ulceration rate was 15.2%. There was no complications like fever, infection, stomachache, embolism and so on.Conclusion With low rebleeding rate and light side-effect, endoscopic tissue adhesive injection in the treatment of gastric variceal bleeding caused by cirrhosis portal hypertension has really good effect.