Objective To understand the humanistic care ability of undergraduate nursing students,and to explore the mediating effect of emotional intelligence between their self-compassion and humanistic care ability.Methods A total of 1 567 nursing undergraduates were investigated with the general information questionnaire,Caring Ability Inventory,Self-Compassion Scale and Emotional Intelligence Scale. Results The score of humanistic care ability of nursing undergraduates was（184.65±23.65）. The mediating effect test showed that emotional intelligence had a mediating effect（β=0.149,P＜0.001） between self-compassion and humanistic care ability,accounting for 24.27% of the total effect. Conclusion The humanistic care ability of nursing undergraduates is at a medium level. Selfcompassion of them directly affects their humanistic care ability,and can also indirectly affect the humanistic care ability through emotional intelligence.

目的:探讨老年脑卒中患者中营养风险发生率及营养筛查意义.方法:选取2019年7月至2020年6月上海市徐汇区中心医院康复科收治的490例老年(>60岁)脑卒中患者,患者病程均在在6个月内,入院后24 h内用营养风险筛查2002(nutrition risk screening 2002,NRS 2002)评估表进行营养风险评估,调查该群患者营养风险发生率,并将患者分为营养风险组与正常组.所有患者出院前24 h内用Barthel指数评估其出院时日常生活活动能力(activities of daily living,ADL),并分析所有患者入院时的营养风险、血红蛋白、白蛋白、前白蛋白、肌酐水平与出院时ADL间的关系;同时比较营养风险组与正常组间出院时ADL的差异.结果:490例老年脑卒中患者的营养风险发生率为69.18％,所有患者营养风险评分、前白蛋白、肌酐水平与出院时ADL呈显著负相关,即使在医院经过对症治疗,入院营养风险组ADL在出院时依然显著低于正常组[(47.45±22.35)分比(54.10±22.14)分](P<0.05).结论:老年卒中患者中,营养风险发生率高达69.18％,在院康复老年脑卒中患者存在营养风险评分高者,其出院时ADL较低,提示对于入院时筛查有营养风险的老年患者需采取更积极的措施.

目的:探讨居家腹膜透析患者跌倒发生的危险因素,为制定居家透析患者安全管理策略提供依据.方法:选择2019年1月—12月期间在我院腹膜透析门诊长期随访符合条件的147例腹膜透析患者,每3个月常规评估时回顾性调查3个月内和1年内跌倒发生情况,并使用Logistic多元回归分析发生跌倒的危险因素.结果:1年内共有32例患者发生跌倒,共计51例次,跌倒发生率为21.8％.将所有患者根据有无发生跌倒分为未跌倒组与跌倒组,比较糖尿病(7.8％比21.9％,P=0.048)、透析龄[26.0(11.0,49.3)个月比44.4(24.1,76.8)个月,P=0.002]、内生肌酐清除率(endogenous creatinine clearance rate,CCR)[58.61(50.85,79.16)L/周比51.53(45.39,59.50)L/周,P=0.001]、血浆白蛋白[(36.6±4.1)g/L比(34.9±4.3)g/L,P=0.047]、血磷[1.6(1.4,1.9)mmol/L比1.7(1.5,2.2)mmol/L,P=0.05]、24 h尿量[700(60,1100)mL/24 h比75(0,488)mL/24 h,P=0.002]、透析液超滤量[600(300,900)mL/24 h比800(472,1160)mL/24 h,P=0.002]、降压药物种类数量(≤3种80.9％比56.3％,≥4种19.1％比43.8％,P=0.0042)、移动能力(无需帮忙98.3％比87.5％,搀扶或拐杖0比12.5％,轮椅1.7％比0,P=0.021)均为跌倒发生的危险因素.Logistic多元回归分析显示合并糖尿病[优势比(odds ratio,OR)=6.569,P=0.007]、透析龄长(OR=1.022,P=0.011)、血磷高(OR=3.372,P=0.024)、使用降压药物种类多(OR=3.601,P=0.015)、24 h尿量减少(OR=1.001,P=0.039)是跌倒发生的危险因素.结论:腹膜透析患者发生跌倒是多种因素综合作用的结果,应及早采取针对措施预防跌倒发生.

目的 了解首发急性缺血性脑卒中(acute ischemic stroke,AIS)患者的就医决策延迟现状,并探讨希望水平、社会支持和应对方式与首发AIS患者就医决策延迟的关系.方法 采用一般资料调查问卷、社会支持量表、Herth希望量表、简易应对方式问卷对首发AIS患者进行问卷调查,构建中介效应模型对四者间的关系进行分析.结果 共纳入243例患者,就医决策时间为(125.09±6.78)min.社会支持及各维度和希望水平及各维度及应对方式中积极应对与就医决策延迟时间呈负相关,消极应对与就医决策延迟时间正相关.社会支持和积极应对在希望水平和就医决策延迟时间上发挥部分中介效应,中介效应占总效应的91％.结论 临床护士及社区卫生保健人员应多关注脑卒中高危人群,积极为其争取来自家庭、社会的支持,指导其主动采取就医行为,切实缩短就医决策延迟时间.

目的 探索以甲基丙烯酸酐化明胶(Gelatin methacrylate,GelMA)水凝胶加载骨髓间充质干细胞(Bone marrow-derived mesenchymal stem cells,BMSCs)的细胞治疗方法增强肩袖损伤后愈合的研究.方法 分离培养并鉴定近交系Wistar大鼠BMSCs,以GelMA包裹细胞构建BMSCs/GelMA水凝胶,体外培养后以CCK-8法检测BMSCs/GelMA的细胞增殖情况,细胞骨架染色观察GelMA中的细胞形态.选用36只近交系Wistar大鼠,建立肩袖损伤模型,切断冈上肌肌腱止点,破坏纤维软骨层,并予腱-骨修复.实验分为3组(n=12):①BMSCs/GelMA组,修复术中加入BMSCs/GelMA水凝胶;②GelMA组,修复术中加入GelMA水凝胶;③对照组,仅行修复手术.术后2周和4周取材,以实时定量PCR检测腱-骨界面相关基因的表达情况.术后4周取材标本另行组织学检测和生物力学检测,以判断腱-骨愈合情况.结果 本研究提取的BMSCs表现出多向分化潜能,BMSCs/GelMA水凝胶体外培养显示出良好的细胞增殖性和细胞形态.基因检测提示术后2周BMSCs/GelMA组中腱-骨相关基因的表达均上调,术后4周时BMSCs/GelMA组Ⅱ型胶原的表达明显高于术后2周(P<0.01)和其他组(P<0.05).术后4周组织学染色均显示BMSCs/GelMA组的腱-骨界面有较多的纤维软骨形成和胶原沉积.术后4周三组的腱-骨生物力学检测结果无显著差异.结论 GelMA水凝胶为BMSCs提供了合适的生长微环境;以GelMA加载BMSCs的方式修复肩袖损伤,显示出良好的软骨再生能力,表现出较好的腱-骨愈合效果.

目的:基于现代化安全管理理论构建不良事件管理系统及在膀胱癌手术患者围术期中的应用.方法:采用半结构访谈方式确定手术部门及管理部门的需求,建立网络化不良事件管理系统,利用美国健康促进研究所开发的全面触发工具,实现对膀胱癌手术患者围术期不良事件管理系统的监控.选取医院收治的53例膀胱癌手术患者,按照构建的不良事件管理系统应用前后,将其分为对照组(25例)和观察组(28例),对照组给予常规的围术期管理,观察组在对照组基础上采用不良事件管理系统进行围手术期管理,对比两组患者围术期管理期间稽查质量评分、不良事件发生率和患者对管理方法的满意度评分.结果:观察组围术期的不良事件上报、不良事件分析、整改措施和持续性改进评分均高于对照组,其差异有统计学意义(t=5.254,t=6.335,t=10.387,t=7.527;P<0.05);观察组的非计划性拔管、用药错误、坠床、皮肤损伤以及其他意外事件等类型的不良事件合计低于对照组,其差异有统计学意义(x2=6.347,P<0.05);观察组患者对管理方法中的技术操作、工作态度、疾病宣教和总满意度评分均高于对照组,其差异有统计学意义(t=5.247,t=6.368,t=4.874,t=9.114;P<0.05).结论:将基于现代化安全管理理论构建的不良事件管理系统应用于膀胱癌手术患者的围术期管理中,能够提高稽查评分,降低不良事件发生率,提高患者对围术期管理方法的满意度.

目的 探索PLGA基形状记忆支架材料的制备方法及其生物相容性.方法 采用粒子浸出法,制备疏松多孔的PLGA/PCL交联网状结构,通过傅里叶变换红外光谱(FTIR)检测并确定合成物的化学结构.通过调控交联密度和PCL-diol相对分子质量,设置控制组,最终实现调控支架的形变温度为37℃.体外测试材料的形变及复形功能,体视显微镜下检测材料三种状态的孔隙变化,扫描电镜下观察并测定支架材料非压缩状态下孔隙率.通过CCK8法检测三组材料(A组:形变前;B组:充分压缩后;C组:压缩并复形后)的细胞黏附率及细胞毒性.利用体内试验检测支架材料在大鼠皮下的降解情况及细胞侵入性生长情况.结果 通过调控得到PLGA交联率60％,PCL-diol相对分子质量3496时,材料复形温度为37℃,采用这种配方制作支架.支架形变后形态稳定,复形响应速度快.非压缩状态下孔径平均直径为269μm.三组材料细胞毒性无显著差异,A组与C组的细胞黏附率无显著差异,A组与B组细胞黏附率差异显著,B组细胞可以继续良好增殖.材料植入体内1个月后可见周围的细胞浸润性生长于材料上,6个月后材料基本降解.结论 PLGA基的形状记忆支架材料适合细胞的贴附与生长,压缩过程对细胞的贴附与存活产生了一定的影响,但是细胞仍能保持继续增殖.支架的降解速度适合骨组织生长.该支架有望应用于骨缺损的修复.

Objective To discuss the clinical application and coordination of ERAS in perioperative period of children laparoscopic surgery.Methods One hundred and forty-six children who underwent laparoscopic surgery in the Department of Pediatric Surgery of the Second Affiliated Hospital of Harbin Medical University from January 2016 to May 2017 were collected.Children in the ERAS group (n =76) received the coordination based on ERAS during the perioperative period,while those in the control group (n =70) received traditional routine intervention.Results There was no difference in curative effect between two groups (P ＞ 0.05).No postoperative complications occurred in the 146 children.The incidence of dysphoria,nausea and vomiting in the ERAS group was significantly lower than those in the control group (P ＜ 0.05),but the incidence of fever was not different in two groups (P ＞ 0.05).Feeding time of (4.18 ± 0.38)h after surgery in the ERAS group was earlier than that of (6.11 ± 0.34) h in the control group (P ＜ 0.05).The length of stay in hospital of (1.05 ±0.36) d in the ERAS group was significantly shorter than that of (1.54 ± 0.94) d in the control group (P ＜ 0.05).Conclusion Intervention based on ERAS during the perioperative period for children laparoscopic surgery can effectively reduce surgical stress and adverse reactions,accelerate children's postoperative rehabilitation,shorten hospital stay,and increase patients' satisfaction.

Objective: To report the successful experience of the laparoscopic radical nephrectomy after neoadjuvant targeted therapy implemented to patients with the renal carcinoma complicated with vena cava tumor thrombus, followed by an exploration of the efifcacy of neoadjuvant targeted therapy and the therapeutic schedule.Methods: A 52 year old woman who was examined of right renal lesion for one month through the physical examination was hospitalized in our hospital in September 2012. ThePET-CT showed an 11.9 cm×8.1 cm tumor in the middle and lower part of the right kidney. It was veriifed as the renal carcinoma complicated with the vena cava tumor thrombus (Mayo II).Percutaneous biopsy conifrmed it clear cell carcinoma of kidney. Sunitinib 4/2 with 50 mg a day was used for patients for eleven weeks. 2 weeks after suspending, laparoscopic radical nephrectomy was implemented to the patient.Imaging evaluation was performed again before the operation.The follow-up survey was carried out.Results:After neoadjuvant treatment, CT scan revealed 27.73% size reduction of renal tumor, with only 8.6 cm×5.4 cm. Intravenous tumor embolus was obviously reduced (Mayo I).According to RECIST criteria, the objective response was partial remission of disease(PR).Nephrectomy was successfully performed under general anesthesia.Pathology report revealed that renal clear cell carcinoma was with major necrosis in primary tumor. During one year of post-operative follow-up, there was no recurrence and metastasis.Conclusion:Neoadjuvant Sunitinib treatment could result in the shrinking of primary tumor and tumor thrombi of vena, reducing the risk of surgery and improving the success rate of surgery, thus eventually improving patients overall survival rate.

Objective To investigate the clinical value and adverse reactions of indwelling ureteral stentsinthepreventionofureteralinjurybeforecomplexpelvictumorsurgery.Methods 145casesofpatients with rectal cancer ,cervical cancer ,ovarian cancer and pelvic sarcomas were retrospectively analyzed ,and 53 pa-tients with complex pelvic tumor surgery ,preoperative were under cystoscope unilateral or bilateral ureteral stent tube,pulled out according to the intraoperative situation after surgery or lien ,92 patients as control group .Results Ureteral injury was found in 10 of the 145 patients,2 cases in ureteral catheter group and 8 cases in control group .3 cases of postoperative ureteral fistula occurred in the control group .Indwelling ureteral stents could cause adverse reactions such as hematuria ,osphyalgia and urinary irritation ,and the adverse reactions of catheter group was obviously higher than that of control group (P<0.05).Conclusion Cystoscopic ureteral stent placement has important clinical significance for prevention of ureteral injury despite certain adverse reactions ,which can be used in operation of complex pelvic tumor .

客观结构化临床考试(OSCE)是一种客观评价医学生临床能力的考核框架.自2007年起,我院将OSCE应用于护生的出科考试和毕业考试中,经过多年探索,建立并完善了具有护理学科特点的OSCE模式,并在应用中取得了预期效果.文章针对该模式的设计、护理标准化病例编制、OSCE的实施及考试效度检测等方面经验作以介绍,以期为教学改革提供参考与借鉴.

Objective:A genome-wide study of adults identified a variant of PNPLA3(rs738409 C>G) associated with metabolism disorders,nonalcoholic fatty liver disease and hepatitis.Hence this study tested the association of rs738409 in PNPLA3 with type 2 diabetes in Chinese population for the first time.Methods:The samples were genotyped using Sequenom MassARRAY Assay Design 3.0 Software to design Multiplexed SNP Mass EXTEND assay.381 cases of diabetic patients and 380 controls of healthy patients' blood was used to extract genomic DNA.SNP genotyping using the standard protocol recommended by the manufacturer was performed by Sequenom MassARRAY RS1000.Microsoft Excel and SPSS 16.0 were used to analyze the association of genotyping data with metabolic syndrome.Results:The results indicate that there was no significant correlation between T2DM and variant of rs738409,but the mutation of rs738409 in PNPLA3 was associated with ALT,CHO,TG,HDL(P<0.05),which may be a diabetes-causing mutation by calculated prediction.Conclusions:The results suggest that rs738409 variant have an effect on metabolic syndrome.

Objective To enhance self-efficacy level and to improve self-management capacity for patients with chronic kidney disease by sending health education messages about self-management skills regularly via SMS platform.Methods Totally 108 patients with chronic kidney disease(CKD1-4) who were able to view SMS independently were recruited and randomly divided into two groups.The control group received routine health education,while the intervention group received routine self-management and health education from hospital SMS platform for three months after discharge.Self-management behavior and self-efficacy level were compared between the two groups three months after discharge.Results No significant difference about self-management behavior and self-efficacy were detected between the two groups before discharge(P>0.05).The intervention group in all aspects of the self-management(exercise,diet control,cognitive symptom management,communication with doctors) and self-efficacy were significantly better than those in the control group three months after discharge(P<0.05).Conclusion Chronic kidney disease patients can improve self-management skills and enhance self-efficacy via SMS platform for education effectively.

Objective To explore the status and influencing factors of self efficacy in patients with blood dialysis,and provide the basis for the implementation of targeted nursing intervention.Methods Eighty-nine patients with blood dialysis were surveyed by the United States Stanford University chronic centers for Disease Education Research self-efficacy scale.Results The score of self-efficacy in hemodialysis patients was (38.51 ± 10.91),and its influencing factors were family support,occupation,cultural degree and economic burden.Conclusions Clinical workers should arouse the patient' s potential,pay attention to improve patients'self-efficacy,so as to effectively improve their levels of physical and mental health.

临床教学是护理教学的必须而重要的教学组织形式,是培养护理专业学生分析和解决问题能力及护理操作技能的有效途径,是培养护生理论联系实际及培养综合能力的关键阶段[1].

Objective: To investigate the job satisfaction and its influencing factors among nurses worked in ward.Methods: Nurses worked in the terriary hospital of Harbin were recruited and completed the job satisfaction assessment sacle and a demographic form.Results: The total average socre of nurses' job satisfaction was(76.85±10.97),the influencing factors of job satisfaction including age,marital status,and professional title.Conclusion: The level of ward nurses' job satisfaction was moderate,the factors of sociodemographic which influencing the job satisfaction were age,maritual status,and professional title.The manager should pay more attention to improve the working conditions,and formulate the personality regulatory framework to increase the nurses' job satisfaction,in order to enhance the quality of work.

Objective: To investigate the effect of the thyroid and breast preoperative anxiety level and personality characteristics on postoperative recovery.Methods: 1500 cases of thyroid breast surgery patients were chosen,SAS was used for self-rating anxiety scale assessed anxiety,Cattell's16 PersonalityFactorTest(16PF)wasused forpersonalitycharacteristicsofpatientsdetermination.Results: Thyroid and breast preoperative anxiety and postoperative complications,bed time,hospital stay,psychological adjustment,the number of analgesic use five indicators of association,P 0.05;Thyroid,breast,and postoperative recovery of O(anxiety),Q4(tension),I(sensitivity),C(stability) and A(Lok Kwan) showed correlation,P0.05,but they were not correlated with other factors.Conclusion: Preoperative anxiety and postoperative recovery of personality characteristics have an impact on the nursing staff to keep abreast of the patient's psychological adjustment and timely treatment of patients with a positive attitude to survive the perioperative period to ensure the safety of hospitalized patients and promote patient rehabilitation and prognosis.

Objective: To investigate the expression of E-cadherin(E-cad) and VEGF and its relationship with the clinical pathological features in young women with breast carcinoma.Methods: The expressions of E-cadherin and VEGF proteins were detected using immunohistochemistry in breast cancer tissues of 80 young and 80 postmenopausal women with breast cancer for analysing their association with clinical and pathological characteristics.Results: The rates of axillary lymph node metastasis was higher in young women than in postmenopausal women.The expressions rates of E-cad and VEGF were significantly diferent in young and postmenopausal breast cancer tissues(P0.01).Patients with axillary lymph node metastasis had significantly higher positivity rate of VEGF expression than those without(P0.01),but the E-cadherin expression was reverse.VEGF expression was inversely correlated with E-cad expression in young patients(P0.01).Conclusion: Low expression of E-cad and over-expression of VEGF indicate the invasive activity in young women with breast cancer.

目的 探讨黄芪多糖在乳腺癌新辅助化疗中的疗效及患者不良反应.方法 将64例新辅助化疗的患者随机分成治疗组34例、对照组30例.治疗组在CEF化疗期间给予黄芪多糖250 mg,1次/d,7 d为1个疗程,对照组仅给予CEF常规化疗.2个疗程后比较两组近期的疗效及不良反应.结果 治疗组有效24例(70.5%),对照组15例(50%),两组比较差异无统计学意义(P＞0.05).两组的主要不良反应为骨髓抑制及消化道反应.治疗组的不良反应较轻,尤其在白细胞减少及消化道反应方面(P＜0.05).结论 注射用黄芪多糖能减轻乳腺癌新辅助化疗后的不良反应,改善患者的生活质量.

Objective: To investigate the clinical features and prognosis of renal cell carcinoma(RCC) in young adults. Methods: Data of 62 young adults with RCC with age under 40 years from 1993 to 2004 were analyzed retrospectively,and 70 patients older than 40 were as controsl. Results: The stage of the young group was significantly higher than that of the old group(P<0.05).There was no difference between the tow groups of pathological phases and tissue types.3- and 5- year survial rates were 70% and 58%,respectively.The survial rates of young group were lower than the old group. Conclusion: In young population,RCC is difficult to diagnose because of occult symptoms at early stage,characterized by higher malignancy,and with poor prognosis.