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Objective:To explore the factors that affect the participation of elderly care nurses in home-based elderly care services, in order to provide reference for the targeted improvement of human problems in home-based elderly care services.Methods:The phenomenological research method of qualitative research was used to conduct semi-structured in-depth interviews, on-site recordings and transcripts with 14 nurses in the geriatrics department of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical College from September to October, 2021. The collected data were analyzed and the theme was refined by using the 7-step analysis method of Colaizzi phenomenology.Results:Through sorting and analysis, four themes and six sub themes were extracted as follows: language behavior factors including environmental discomfort and differences in living habits, freedom was limited; psychological and emotional factors including high psychological pressure and loneliness, not respected; career development factors; social security factors including the definition of work scope is unclear, the division of responsibility for the accident was unclear and the protection of relevant rights and interests was insufficient.Conclusions:The intention of elderly care nurses to participate in home-based elderly care services is affected by many factors. These factors need to be accurately identified and targeted support measures should be taken to improve their enthusiasm to participate in home-based elderly care services and improve the human problems in home-based elderly care services.
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Objective To expore multi-drug resistant Acinetobacter baumannii efflux pump phenotype and efflux pump gene expression in the resistant isolates. Methods Application of K-B method to detect 96 strains isolated from the First Hospital of Hebei Medical University multi-drug resistant Acinetobacter baumannii′ resistance to 15 kinds of antibacterial drugs, detecting multi-drug resistant Acinetobacter baumannii efflux pump phenotype with broth microdilution method by the addition of carbonyl cyanide chlorobenzene hydrazone ( CCCP) pump inhibitors,using PCR amplification and sequencing to study efflux pump protein gene sequence characteristics . Results The Acinetobacter baumannii resistance rate of 96 strains to quinolones, cephalosporins, aminoglycosides, tetracyclines were 70. 8%-94. 8%.There were 34 positive efflux pump phenotypes in 96 multi-drug resistant Acinetobacter baumannii strains, including 33 adeB strains, 32 adeR strains, 33 adeS strains, 33 adeJ strains,0 adeE strain,33 adeM strains, positive detection rate were 97. 06%, 94. 12%, 97. 06%, 97. 06%, 0, 97. 06%, respectively. By sequence comparison, adeB, adeR and adeS genes sequence homology was 100% in the GenBank. Conclusion Active efflux pump gene perturbation is one of the important factors in multi-drug resistant Acinetobacter baumannii.
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Objective To study the clinical distribution and detection of the efflux pump gene in multiple drug-re?sistant acinetobacter baumannii. Methods The clinical distribution of 96 strains of multiple drug-resistant acinetobacter baumannii was analyzed. K-B method was used to detect 96 strains of multi resistant bauman resisted to 15 kinds of antibiot?ics. PCR amplification was used to detect the efflux pump gene. Results Ninety-six strains of multiple drug-resistant aci?netobacter baumannii mainly distributed in intensive care unit (ICU, 54.2%) and respiratory department (18.8%). The drug resistance rates to quinolone, cephalosporins, amino glucoside, tetracycline were above 70%. The 52 strains of multiple drug-resistant acinetobacter baumannii detected in ICU included 18 strains of adeB (34.62%), 16 strains of adeR (30.77%), 18 strains of adeS (34.62%), 18 strains of adeJ (34.62%), 0 strain of adeE and18 strains of adeM (34.62%). The18 strains of multiple drug-resistant acinetobacter baumannii detected in respiratory department included 9 strains of adeB, 8 strains of adeR, 8 strains of adeS, 8 strains of adeJ, 0 strain of adeE and 8 strains of adeM. Conclusion Efflux pump genes are impor?tant factors for multiple drug-resistant acinetobacter baumannii distributed in ICU and respiratory department.
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Objective To investigate the prognostic value of decreased vasopressin (VP)modulation in the late-phase of septic shock. Methods A prospective study was conducted. Fifty-five septic shock patients hospitalized in intensive care unit (ICU)of the First Hospital of Hebei Medical University from January 2012 to February 2014 were enrolled. All patients received 3% hypertonic saline solution infusion. Serum concentrations of sodium and VP were measured before and after hypertonic saline solution infusion. Patients with ratio of difference in sodium and VP before and after infusion of 3%hypertonic saline (△VP/△Na)≤0.5 pg/mmol were defined as non-responders,and who>0.5 pg/mmol were defined as responders. The levels of lactic acid,C-reactive protein (CRP),and vasoactive drug〔dopamine(DA)and norepinephrine(NE)〕usage between the two groups were compared. The 28-day mortality,live time in the dead,and ICU day in survivors were analyzed between the two groups. The receiver operating characteristic curve (ROC curve)was drawn to assess prognostic value of VP. Results There were 30 cases (54.5%) in non-responsive group,and 25 (45.5%)in responsive group. There were no significant differences in the age,acute physiology and chronic health evaluationⅡ (APACHEⅡ)score,central venous pressure (CVP),blood pressure, plasma albumin level,sodium level before and after hypertonic saline solution infusion between the two groups. The baseline level of VP in the non-responsive group was markedly lower than that of the responsive group (ng/L:10.66± 1.57 vs. 17.13 ±5.12,t=6.091,P<0.001). After hypertonic saline solution infusion,the VP level was also significantly decreased compared with that in the responsive group(ng/L:11.65±1.74 vs. 22.50±5.31,t=9.758,P<0.001). The non-responders showed higher lactic acid (mmol/L:3.04±0.55 vs. 2.28±0.38,t=-5.881,P<0.001) and CRP (mg/L:117.9±23.0 vs. 94.9±17.0,t=-4.143,P<0.001),and received larger dosage of vasoactive drugs〔DA(μg·kg-1·min-1):14.8±3.9 vs. 8.9±1.6,t=-5.725,P<0.001;NE(μg·kg-1·min-1):0.96±0.42 vs. 0.40± 0.09,t=-5.625,P<0.001〕for maintaining blood pressure compared with those in responders. The non-responsive group showed higher 28-day mortality(66.7%vs. 40.0%,χ2=3.911,P=0.048)and longer ICU day(days:9.9±2.3 vs. 6.7±1.7,t=-4.044,P<0.001),but the live time in the dead showed no difference between non-responsive group and responsive group(days:5.8±1.9 vs. 6.1±2.3,t=0.384,P=0.704). ROC curve showed that the area under ROC curve(AUC)forΔVP/ΔNa predicting the outcome was 0.828,and theΔVP/ΔNa threshold value of 0.5 pg/mmol had the sensitivity of 66.7%and specificity of 64.0%for prediction of the outcome(95%confidence interval:0.722-0.934). Conclusion Osmotic pressure-regulated VP secretion was impaired and decreased in the late-phase of septic shock, and made the sense in prognosis.
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OBJECTIVE:To study the resistance of methicillin-resistant Staphylococcus aureus(MRSA) and detect its Panton-Valentine leukocidin (PVL) gene. METHODS:45 strains of MRSA were clinically isolated from the patients in The First Hospital of Hebei Medical University from January 2007 to June 2008. The susceptibility of the MRSA strains to 17 kinds of antibiotics was tested by Kerby-Bauer disk diffusion test,and the PVL gene was detected by polymerase chain reaction(PCR) technology. RESULTS:The resistant rates of the 45 strains of MRSA to penicillin G,erythromycin,clindamycin,ciprofloxacin and tetracycline were all above 70%. PVL genes were found in 12 of the total 45 MRSA strains,with a detection rate of 26.7%. CONCLUSION:MRSA shows multi-drug resistance,and PVL gene is a key causative agent of MRSA.