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Objective To investigate the nurse self-directed learning readiness in some 3A hospital in Shandong province and discuss the strategies how to improve it. Methods Self-designed questionnaire and The Nurses Self-Directed Learning Readiness Scale were used to investigate 210 nurses from 23 departments in Shandong provincial hospital. Results Before and after the implementation of the video training, a total of 230 and 210 self-directed learning readiness scales were distributed, 210 and 210 questionnaires were returned, the effective recovery rate was 91.30%and 100%respectively. The data of questionnaires were statistically analyzed by the method of paired t test. The results showed that after the implementation of the project, the total score of the after test (156.63±19.48) was higher than the before (137.91 ± 13.71). The difference was statistically significant (t=-9.54, P<0.05). The score in the three dimensions of self-management, self-control, and desire for study (48.03 ± 7.25), (48.71 ± 6.44), (59.89 ± 7.61) points, were higher than (40.11±5.48), (43.40±5.34), (54.40±6.26) pointsbefore implementation. The difference was statistically significant (t=-10.22,-7.67,-6.83,P<0.05). Conclusions The video training would provide the convenient and quick way and could inspire the nurses′ learning motivation even more which is of great significance to improve the nurses ability of autonomic learning.
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Objective To evaluate the efficacy and safety of autologous peripheral blood stem cell transplantation (APBSCT) in treatment of patients with decompensated hepatitis B cirrhosis.Methods Sixty two patients with decompensated hepatitis B cirrhosis admitted in Ningbo Second Hospital during January 2010 and December 2013 were enrolled in the study.Patients were randomly assigned in two groups: 50 patients in control group received comprehensive medical treatment only, and 12 patients in combination group received APBSCT on the basis of medical treatment.The levels of serum total bilirubin (TBil), albumin (Alb), alanine aminotransferase (ALT) and prothrombin time (PT) in two groups were mearsured at the 4th,12th,24th week.Overall survival (OS),progression-free survival (PFS) and complications were compared between two groups after 3 years follow-up.SPSS17.0 software was used to analyze the data.Results After APBSCT treatment, the level of Alb and PT at week 4,12 and 24 in combination group improved significantly(tAlb=-4.437,-5.210 and-6.915,tPT=12.083,11.251 and 10.640,all P<0.01),there were also significant differences between combination group and control group (tAlb=4.985, 5.565 and 6.260,tPT =-3.013、-3.727 and-3.983,all P<0.01).The 3-year OS and 3-year PFS of patients in combination group were higher than those of control group [(90.9±8.7)%vs.(60.7±7.4)%, (75.8±12.5)% vs.(47.9±7.3)%](χ2=6.887 and 5.565,P<0.05).Besides,APBSCT had more advantages than control group in reducing ascitic fluid and hepatic encephalopathy(χ2=7.992 and 4.681,P<0.05 or <0.01).Conclusion APBSCT combined with medical treatment can improve liver function and 3-year survival rate with mild adverse reaction in patients with decompensated hepatitis B cirrhosis.
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Objective To construct and implement the nursing quality information feedback system based on QUACERS model and control theory, and discuss its application effect and the problems that should be paid attention to and to provide operational cases and practical basis for nursing quality management. Methods Through literature review and expert consultation, the framework and content of nursing quality information feedback system were set up and implemented. The changes of the nursing quality and the repeated occurrence of nursing problems were evaluated before (2013) and after (2015) the implementation of this project. And in December 2015, a self-made questionnaire was conducted among the nurses in the hospital to evaluate the importance of the feedback and it′s effect of improving the nursing quality. And evaluate the timeliness and effectiveness of different feedback forms. Results 1 120 and 1 136 nurses were followed-up in 2013 and 2015 respectively. The scores of human resource management, clinical nursing service and nursing safety management were higher than before, and the repeated occurrence of nursing problems was lower than before. A total of 450 questionnaires were distributed, 438 copies were collected, the effective recovery rate was 97.33%. Ratings for the importance of each item was from 3.37 to 4.57. Ratings for the effect of improving the quality of care was 3.79 to 4.39. The percentage of quality information received by nurses was more than 95%, and the average score of feedback timeliness was 4.29 to 4.53. Conclusions Quality information feedback system based on QUACERS model can cover multiple dimensions of quality management, and it was conducive to obtaining comprehensive information;Combined with multiple feedback forms can improve the effect of information feedback.
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Objective To construct and implement theSTARnurse training model, and discuss its application effect and the problems that should be paid attention to, and to provide operational cases and practical basis for nursing clinical education. Methods Through literature review and expert consultation, the framework and content of STAR nurse training model were set up and implemented. The questionnaire survey and semi structured in-depth interviews were conducted among the nurses in the hospital to evaluate the effect of improving the nurses′self-directed learning ability. Results After the implementation of the project, the scores of the three dimensions of self-management, desire for study and self-control were (3.67±0.57), (4.05±0.54), (3.99±0.50) points, which were higher than (3.55±0.49), (3.71± 0.52), (3.53±0.42) points before implementation. The difference was statistically significant (P<0.05 or 0.01). The semi structured in-depth interviews showed that all the nurses believed that STAR nurse training model could promote independent learning and stimulate interest in learning. 14 nurses thought it was beneficial for the nurses to find the problems. Conclusions STAR nurse training model can create a favorable learning environment for nurses, and stimulate the learning motivation. It plays a positive role in improving nurses′ability of self-directed learning.
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ObjectiveTo identify the differences in clinicopathological features between HBeAg-positive and HBeAg-negative chronic hepatitis B (CHB). MethodsA total of 665 CHB patients who were admitted to Ningbo No. 2 Hospital during June 2002 and January 2010 were enrolled, in which 428 were HBeAg-positive and 237 were HBeAg-negative. HBV DNA loads, live histological inflammation grades and fibrosis stages were compared between two groups. SPSS 1 1. 5 was used for statistical analysis.For measurement data, t (for normal distribution) or Mann-Whitney U (for skew distribution) was performed; for enumeration data, Chi-square test was performed; and Pearson correlation analysis was conducted. ResultsLiver inflammatory grade and fibrosis staging in HBeAg-negative CHB patients were more severe than those in HBeAg-positive patients (x2 = 7.92 and 10.35, P ＜ 0. 01 ). The ratio of serum HBV DNA levels ＜ 3, ≥3- ＜ 5 log10 copies/mL in HBeAg-negative CHB patients were significant higher than those in HBeAg-positive patients (x2 = 105.16 and 36.92 ,P ＜0.01 ) ; and the ratio of HBV DNA ≥7 log10 copies/mL in HBeAg-negative group was lower than that in HBeAg-positive group (x2 = 110. 18, P ＜0. 01 ). With the rising of serum HBV DNA levels, liver inflammatory grade and fibrosis staging in HBeAg-positive patients had a descending tendency (r =-0. 287 and-0. 224, P ＜0.01 ), while those in the HBeAg-negative group were ascending (r = 0. 360 and 0. 303, P ＜ 0. 01 ). ConclusionCompared with HBeAg-positive CHB patients, liver inflammation and tissue damage in HBeAg-negative patients are more severe, which need close monitoring.
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Objective To study the clinical practical use of the model for end-stage liver disease(MELD) and assess its validity in predicting the prognosis of the.chronic severe hepatitis patients.Methods The clinical data of 391 patients with chronic severe hepatitis among 2003～2005 in our hospital were analyzed,and they were graded with MELD formula.These patients were divided into plasma exchange group and none plasma exchange group according to plasma exchange treatment or not.The death rate was observed within three months.The validity of the model in predicting the prognosis of the patients with severe hepatitis was determined by the concordance(c)-statistic.Results 236 patients died within three-months and the mortality was 60.6%.The mortality of patients in PE group whose MELD score were less than 30 and 30～40 was 25% and 75% respectively,but in non-PE group they were 42.0%,90.7% respectively,there were significant difference between PE group and non-PE group(P0.05).The optimal cut-off values of MELD to predict the prognosis of patients were 30 in PE group whose sensitivity and specificity were 66.7% and 86.4%,and its c-statistic was 0.823(95% CI 0.734～0.912);and in non-PE group they were 27,76.4%,79.1% and 0.832(95% CI 0.787～0.877) respectively.Conclusions The mortality of the patient with chronic severe hepatitis increases with the increase in the MELD score.The MELD can accurately predict the short-term prognosis of patients with chronic severe hepatitis.
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Objective To investigate the etiological factors of hepatic dysfunction during late gestational period,and explore its effect on the mothers and babies.Methods The causes and prognosis of 347 cases with hepatic dysfunction during gestational period were retrospectively analyzed.Result Of the 347 cases of pregnancy,viral hepatitis was present in 216 cases(62.2%),and intrahepatic cholestasis of pregnancy(ICP) present in 80 cases(23.1%);Postpartum hemorrhage rate increased significantly in viral hepatitis,and the rates of premature birth,fetal distress in uterus and cesarean increased obviously in ICP.Conclusion Viral hepatitis and ICP were the main causes of hepatic dysfunction,different complicated diseases may increase the danger of the mother and baby during pregnancy and childbirth.
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Objective To investigate the clinical significance of HBV pre-core and basal core promoter mutations in chronic hepatitis B using Gene-chip technique.Methods Four spot mutations of 1896,1814 dots in pre-core region and 1762,1764 dots in basal core promoter region were detected in 95 patients with chronic hepatitis B using gene chips.Serum HBV DNA level was measured using fluorescent quantitation polymerase chain reaction(FQ-PCR).Results In the 95 patients with chronic hepatitis B, HBV pre-core or basal core promoter mutations were detected in 91 patients,and the positive rate was 95.8%.The mutation rate of G1896A,A1762T associated with G1764A,and G1896A plus A1762T plus G1764A were 36.3%,70.3% and 24.2% respectively.No A1814C mutant was detected in these patients.Compared with no mutation group,the serum HBV DNA quantity was lower in G1896A plus A1762T and G1764A mutation group,and no significant changes was found in other groups.Conclusion Several different variant sites of HBV can be detected at one time using gene chip technique.HBV pre-core and basal core promoter mutations have effect on the serum HBV DNA level in chronic hepatitis B patients to a certain extent.
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Objective:To study the expression of EG-1 in thyroid cancer tissue and analyze its correlation with clinical prognosis. Methods:EG-1 mRNA levels in malignant thyroid tissues were evaluated by RT-PCR. All patients were followed up. The survival rates were analyze in EG-1 positive group and EG-1 negative group. Benign thyroid tissues were used as control. Results:EG-1 was expressed in thyroid cancer. The differences between expression of malignant thyroid tissues and benign thyroid tissues were statistically significant (P
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50 years showed no significat difference;there was significant difference of p53 expression between ER negative and ER positive groups,but p16,CDK4 and cyclin D expression showed no difference;p53 expression was ~significantly different in ER negative and PR positive groups,but the levels of the other proteins were not ~significantly different.(2)There were significant differences between the expression of p16 and p53(P