Objective To analyze the effect and the problems of the comprehensive application of quality management tools in order to improve nursing quality and ensure patient safety.Methods To summarize the implementation of Plan,Do,Check,Action(PDCA),quality control circle(QCC),root cause analysis(RCA),healthcare failure mode and effect analysis(HFMEA) in the nursing quality improvement.Aiming at problems arising in application process,the measures such as systematic training of quality management knowledge,case demonstration,standardized evaluation throughout the whole process,holding competition activities,inviting experts to give immediate guidance were applied.Results Among 1 798 PDCA and QCC programs,the result of 1 795 programs reached the target value,3 substandard programs reached the expected outcome finally after cause analysis,procedure break down and adjust of improvement contents.No nursing error or adverse events occurred.The indicators of nursing quality improved and patient satisfaction was 98.58％,which got the third position among all national hospitals.Conclusions The comprehensive application of four quality management tools was helpful in enhancing the effect of nursing quality improvement.

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Objective To investigate the effect of wire?reinforced epidural catheters on the success rate of epidural catheterization for labor analgesia. Methods A total of 200 nulliparous parturients who re?ceived labor analgesia voluntarily, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 20-45 yr, with body mass index<35 kg∕m2, were divided into 2 groups (n=100 each) using a random number table: common catheter group ( group Ⅰ) and reinforced catheter group ( group Ⅱ) . After suc?cessful epidural puncture, the corresponding catheter was inserted inⅠandⅡgroups. The development of difficult insertion, intravascular catheter insertion or paresthesia during insertion was defined as a failure of epidural catheterization. The occurrence of the failure of epidural catheterization was recorded. Results Compared with group Ⅰ, the failure rate of epidural catheterization was significantly decreased in groupⅡ( P<0.05) . Conclusion Wire?reinforced epidural catheters can raise the success rate of epidural catheter?ization for labor analgesia.

Objective: To investigate the influence of job burnout on subjective well-being and health status among employees in China. Methods: The data from the 2014 China Labor-force Dynamic Survey were used to analyze the association of job burnout with subjective well-being and health status among 7289 employees aged 18-64 years from 29 provinces in China.Some items from the Maslach Burnout Inventory-General Survey were used to investigate job burnout; subjective well-being assessment included life happiness and degree of satisfaction with living condition; the questions for self-evaluation of health status were used to analyze health status. Results: Of all employees,30.5% had low subjective well-being and 4.7% had poor health status based on self-evaluation. The logistic regression analysis showed that emotional exhaustion(two items), reduced sense of personal accomplishment,and cynicism were risk factors for low subjective well-being(OR=1.07,1.11,1.10,and 1.06,P<0.001),and emotional exhaustion(two items)was a risk factor for poor health status (OR=1.10 and 1.07,P<0.001).Reduced sense of personal accomplishment and cynicism had no significant influence on health status(P>0.05). Conclusion Emotional exhaustion is a major influencing factor for health status,and reducing job burnout may be an effective method for improving subjective well-being and health status.

Under the background of efficiency medical reform, the authors introduced the nursing efficiency management system of a large public hospital, which was divided into two dimensions: nursing resource allocation efficiency and nursing service efficiency. The specific four measures included the establishment of multi-campus unified management organization structure based on nursing management committee, nursing performance reform based on structured big data information platform, the construction of nurse-led patient whole process management model and the accelerated rehabilitation nursing practice from surgery to the whole hospital, so as to provide reference for the nursing efficiency management of large general public hospitals under the medical reform.

Objective:To explore the characteristics and influencing factors of blood carnitine metabolism in premature infants.Methods:A retrospective analysis of 37 037 neonates with negative results of genetic metabolic disease screening at Guangxi Newborn Disease Screening Center from 2018 to 2021, of which 34 517 normal full-term infants were the control group and 2 520 preterm infants were the research group.According to gestational age, the preterm infants were further divided into three groups: extremely preterm group( n=232), moderately preterm group( n=324)and late preterm group( n=1 964). According to birth weight, they were divided into three groups: very low birth weight group( n=188), low birth weight group( n=1 276)and normal birth weight group( n=1 056). According to blood collection time, they were divided into three groups: 3~7 days group( n=1 990), 8~14 days group( n=342) and 15~28 days group( n=188). Tandem mass spectrometry was used to detect the levels of 31 carnitines in dried blood spots and analyze the differences in the levels of metabolic indicators in each group. Results:Carnitine levels in preterm infants are most affected by gestational age.Adjusting the physiological and pathological conditions of premature infants and other related factors, grouped by gestational age, there were differences in the levels of 31 carnitines among the groups(all P<0.05), the smaller the gestational age, the greater the difference in carnitine levels; grouped by blood collection time, there were statistically significant differences in carnitine levels between preterm infants with different blood collection age groups and full-term 3~7 days groups(all P<0.05), and showing age-related; there are differences among 31 carnitines grouped by body weight(all P<0.05), the smaller the body weight, the greater the difference in carnitine levels.Combined with the analysis of gestational age, birth weight and blood collection date, 17 indicators including C0, C2, C3, C4, C6DC, C10, C10∶1, C12, C12∶1, C14, C14∶1, C14OH, C16, C16∶1, C18, C18∶1 and C18∶1OH are important biomarkers of carnitine metabolism in premature infants. Conclusion:Carnitine in premature newborns has different metabolic differences at different gestational ages, birth weights and blood collection ages, which provides a strong basis for establishing reference standards and interpretation of preterm infants in the laboratory in this region, and provides reasonable and effective early diagnosis and treatment for clinical practice.Meanwhile, it provides an optimized program for timely detection of carnitine deficiency and carnitine supplementation to improve nutrition of premature infants.