ObjectiveA survey of the status quo of community nursing health resources in Shao xing countryside was carry out in order to rationally allocate medical resource,optimize quality of medical employees and construct modern rural community nursing patterns.MethodsA survey for 19 health service organizations and 381 nurses in rural communities was carried out with questionnaires.Results There existed regional differences in medical resources.The medical resources per ten thousand people were limited,only 0.7 health education room,1.2 recovery rooms,0.4 women and children′s health center.There was 1 nurse for every 1877 rural residents.The average age of nurses was (30.84±6.88) years old.Nurses on professional health education,community arevention of diseases only accountel for 43.8％.Community nuses of different ages and with different degrees had different knowledge requirements.ConclusionsThe medical resources are limited and imbalanced.The employees are too young and they have only low level of education and are not professional enough.Rational allocation of resources,optimization of personnel structure and abundance of on-the-job training is urgently needed.

Objective In order to grasp the status quo of the internship nursing students' evidence awareness in our province, to improve the teaching measures, and to promote nursing safety. Methods We delivered questionnaires to 480 nursing students who were exercising practice in some major hospitals in our province about their contemporary consciousness of evidence, the results underwent analysis. Results The results showed that the awareness of nursing evidence was very poor in the new period. Conclusions It's imperative to enhance the normative education about evidence awareness among the nursing students.

BACKGROUND: The complex prescription of lujiao prescription is made up of antle, malytea scurfpea fruit, korean epimedium herb, dogwood, glossy privet fruit, and Chinese eaglewood wood. It is characterized by its positive myodynamia as well as promoting diuresis and expanding vessels. OBJECTIVE: To observe the effect of lujiao prescription in reversing left ventricular remodeling in rats with pressure overload. DESIGN: A randomized controlled trial. SETTING: Department of Integrated Traditional Chinese Medicine and Western Medicine, Nanjing General Hospital of Nanjing Military Area Command of Chinese PLA; Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; Postdoctor Institute of Hebei Medical University.MATERIALS: The experiment was conducted at the Laboratory of Shanghai University of Traditional Chinese Medicine from January to December 1998. Totally 153 male Wistar rats were provided by the Experimental Animal Center of Shanghai Medical College. There were five experiments with 36 rats selected for each experiment except 9 rats for the fourth one.METHODS: Totally 36 Wistar male rats selected for each experiment were randomly divided into sham operation group, model group and lujiao prescription group. Sham-operation group: The rats' abdominal aortas were separated, but not narrowed by silver clip. After four weeks, the rats were treated with twice-distilled water (15 mL/mg, ig), once a day for 4 consec utive weeks. Model group: Four weeks after modeling, the rats were treated with twice-distilled water (15 mL/mg, ig) once a day for 4 consecutive weeks. Lujiao prescription group: Four weeks after rat modeling, the ratswere given orally liquid decoction of lujiao prescription (15 mL/mg, ig),once a day for 4 weeks. Observations on left ventricular mass index (LVMI): Collagen type Ⅰ and Ⅲ was measured by immunohistochemistry. mRNA expression of collagen type Ⅰ and Ⅲ was measured by RT-PCR. Ang Ⅱ, ANF and ALD were measured by radioimmunoassay. MAIN OUTCOME MEASURES: LVMI, left ventricular myocardium collagen type Ⅰ and Ⅲ, mRNA expression of collagen type Ⅰ and Ⅲ, and changes of plasm, myocardium Ang Ⅱ, plasm ANF and serum aldosterone.RESULTS: Totally 153 rats entered the final analysis. During the detection of mRNA expression of collagen type Ⅰ , 3 rats in sham-operation group died and 1 in lujiao prescription group died. The other 29 rats en tered the final analysis. During the detection of mRNA expression of collagen type Ⅲ, 3 rats in sham-operation group died, 3 in lujiao prescription group died, and 6 in model group died. The other 26 rats entered the final analysis. All rats were lost because of operation injury. ① LVMI: It was lower in sham-operation group and lujiao prescription group than in model group [(2.24±0.12)/1 000, (2.60±0.44) /1 000, (3.15±0.47)/1 000,t=2.959-6.499, P < 0.05]. ② Changes of absorbency of collagen type Ⅰ :It was lower in sham-operation group and lujiao prescription group than in model group [(0.56±0.23, 0.57±0.19, 2.79±2.00), t=0.661-3.964,P < 0.01]. ③ Changes of absorbency of collagen type Ⅲ: It was lower insham-operation group and lujiao prescription group than in model group [(0.48±0.10,0.55±0.09,0.84±0.27), t=2.898-3.560, P < 0.01]. ④ mRNA expression of collagen type Ⅰ: It was lower in sham-operation group and lujiao prescription group than in model group [58.0±36.0)%, (79.1±18.6)%,(139.0±29.2)%, t=3.027, P < 0.05]. ⑤ Changes of myocardium Aug Ⅱ: It was lower in sham-operation group and lujiao prescription group than in model group [(2.49±0.57, 2.64±0.57,3.96±0.77) pg/mL, t=4.773-5.315,P < 0.001]. ⑥ Changes of serum aldosterone: It was lower in sham-operation group and lujiao prescription group than in model group [(501.6±94.6,476.6±85.7, 647.8±72.2) ng/mL, t=4.256-5.292, P < 0.001].CONCLUSION: Indexes of integrating absorbency of myocardial collagen type Ⅰ and type Ⅲ, mRNA expression of collagen type Ⅰ , myocardial Aug Ⅱ and serum aldosterone are all similar to the changes LVMI. Lujiao prescription can reverse left ventricular remodeling and myocardial fibrosis.

Objective To explore the effect of the clinical scenario-based simulation communication education based on Calgary-Cambridge Guide for undergraduate nursing students.Methods Totally 87 undergraduate nursing students were enrolled and divided into the experimental group (n=44) and the control group (n=43).The experimental group received clinical scenario-based simulation communication education based on Calgary-Cambridge Guide for communication.The control group received traditional class-based education for communication.The chnical communication skills questionnaire and Communication Observing Questionnaire were administered before and after the training.The testing results of both groups were compared.Results After participating in the education project,six dimensions of clinical communication competence and the total score were significantly improved after training compared with those before training in the experimental group.After training,the experimental group was better than the control group in establishment of harmonious relationship,confirming patients' problems,efficient information transfer,validation experience and communication competence,t values were 2.64,2.32,2.19,2.20 and 4.36,P＜ 0.05.In testing of integrated cases,scores of six aspects such as case design,information collection,explaining behavior,relationship development,conflict coordination and service behavior in the experimental group were significantly higher than those of the control group,t values were 2.15,2.10,3.26,2.84,2.14 and 2.61,P＜0.05.Conclusions The clinical scenario-based simulation education based on the Calgary-Cambridge Guide can improve communication competence of nursing students.

Objective To evaluate the incidence and significance of perineural invasion (PNI) in cervical cancer. Methods Retrospective chart review of patients with cervical cancer (stages Ⅰa2-Ⅱb) who underwent radical hysterectomy and pelvic lymphadenectomy from 2007 to 2012. To evaluate the incidence and significance of PNI in cervical and uterine tissues by microscopic examination. Results A total of 238 patients were included, 9.2% (22/238) patients with PNI in the cervical stroma. Patients with PNI were more likely to have adverse histopathologic features, including lymphoma vascular space invasion, parametrical invasion, depth of invasion, tomor size and lymph nodes metastases (all P<0.05). PNI were independent of age, international federation of gynecology and obstetrics (FIGO) stage, histopathology type and grade, and positive vaginal margin (all P>0.05). Patients with PNI had shorter disease-free and overall survival (P=0.002 and P=0.008, respectively). On multivariate analysis, risk factors for recurrence and death included parametrical invasion and depth of invasion (P<0.05). Similarly, risk factors for recurrence included lymph nodes metastases (P=0.024). However, PNI was not identified as an independent risk factor for either recurrence or death (P>0.05). Conclusions PNI exists in early cervical cancer. PNI is associated with tumor size, depth of invasion, parametrical invasion, lymphoma vascular space invasion and lymph nodes metastases. PNI represente a decreasing disease-free and overall survival in patients with early-stage cervical cancer, and is independently associated with multiple high-risk factors, which be informed management decisions regarding adjuvant therapy.

The pre-hospitalization service is an important initiative for medical institutions to implement the national reform of the medical security system. In 2018, Zhejiang province proposed the " most run once reform", requiring the establishment of an admission preparation center to carry out pre-hospitalization services. In June 2021, a certain maternal and child health hospital conducted a process reengineering for the pre admission process of the admission preparation center by applying the combined process analysis and failure mode and effects analysis, high-risk points of the hospitalization process were screened, the job value and job functions of each sector were sorted out, and the sector for improvement sector was evaluated, to launch an independent information system, establish a one click automatic import of pre hospital medical orders function, and remove on-site billing physicians from various specialties for improvement measures. The steps of the process had been optimized, inlcuding issuing pre hospital medical orders, waiting for pre-hospitalization, pre-hospitalization, and so on. The completeness rate of pre hospital medical orders, average waiting days before hospitalization, and patient satisfaction scores of pre hospitalization centers had changed from 91%, 2.99 days, and 93.46 points before process reengineering to 92%, 2.44 days, and 95.80 points after reengineering, respectively. This practice had achieved dual improvements in pre admission service quality and efficiency, so as to provide a reference for China′s medical institutions to carry out safe and efficient pre admission services.

Objective To evaluate the effects of kangaroo mother care (KMC) during cesarean section on neonatal health parameters in the "golden hour" of late preterm infants. Methods A total of 120 singleton pregnant women undergoing preterm cesarean section (34-36+6 gestational weeks) from January 1 to December 31, 2018 in Jiaxing Women and Children's Hospital Affiliated to Wenzhou Medical University were prospectively enrolled and divided into two groups (observation and control groups) with 60 cases in each by random number table method. During cesarean section, the both groups received the thorough drying immediately and delayed cord clamping, in addition, the observation group adopted KMC, while the control group received routine maternal and infant care. Several parameters including changes in body temperature, crying, respiration, oxygen saturation and other vital signs, as well as the incidence of hypothermia, transfer to the Department of Neonatology and the success rate of early breastfeeding initiation during the "golden hour" were compared between the two groups. Satisfaction of obstetricians, pediatricians, the pregnant women and their families to KMC and routine maternal and infant care were compared. Two-independent sample t test and Chi-square test were used as statistical methods. Results In total, 113 cases (58 in the observation group and 55 in the control group) were finally analyzed. The body temperature of the late preterm infants at 5 and 10 min after birth in the observation group was higher than that in the control group (36.5 vs 36.0 ℃, 36.4 vs 35.8 ℃, t=11.756 and 7.512, both P<0.05), and the body temperature during 15 min-1 h after birth was also higher in the observation group but without statistical significance (all P>0.05). The observation group had a lower incidence of hypothermia [0% (0/58) vs 15% (8/55), χ2=9.079, P<0.001] and a higher success rate of early breastfeeding initiation [86% (50/58) vs 58% (32/55), χ2=11.137, P<0.001] than the control group. The satisfaction scores of obstetricians (19.3±1.1 vs 13.4±1.9, t=20.517), pediatricians (18.2±1.8 vs 12.6±2.1, t=15.382), gravidas (19.6±0.4 vs 13.6±1.6, t=27.723) and their family members (18.2±0.9 vs 15.3±1.1, t=11.535) were all higher in the observation group than those in the control group (all P<0.001). Conclusions KMC during cesarean section can improve the body temperature of late premature infants in the "golden hour", reduce the occurrence of hypothermia, facilitate early initiation of breastfeeding and improve the satisfaction of doctors and patients on health care.

Objective To explore the effects of early essential newborn care (EENC) on short-term maternal and neonatal health and to evaluate the satisfaction and acceptability of both patients and medical staff in the operating room regarding the implementation of EENC during term cesarean section(CS). Methods Two hundred gravidas who underwent CS in Wenzhou Medical University Affiliated Women and Children Hospital from January 2018 to April 2018 were recruited in this prospective study. According to the odd or even number of their medical records, these women were randomly divided into EENC or control group, 100 in each. EENC was offered to those in the EENC group immediately after birth, including drying the newborn immediately and thoroughly, mother–infant skin-to-skin contact at least 90 min and initiating the first breastfeeding, and delayed cord clamping until l-3 min after birth. Routine neonatal care was provided to the control group, including regular drying, insufficient skin-to-skin contact and cord clamping within 1 min after birth. Differences were compared between the two groups in the incidence of abnormal pulse, low oxygen saturation, hypothermia and mild asphyxia from the neonatal aspect and the incidence of postpartum hemorrhage and early initiation of breastfeeding from the maternal aspect. The acceptability and satisfaction of all the participants and the medical staff were also analyzed. t-test and Chi-square test were used as statistical methods. Results All of the 200 participants were finally analyzed. In the EENC group, the incidence of neonatal hypothermia [2% (2/100) vs 13% (13/100), χ2=8.721, P=0.003] and maternal postpartum hemorrhage [1% (1/100) vs 6% (6/100), χ2=5.701, P=0.035] were lower comparing to the control group, while the initiation rate of early breastfeeding was higher [56% (56/100) vs 5% (5/100), χ2=61.352, P<0.001]. There was no significant difference in the incidence of neonatal abnormal pulse, low oxygen saturation or mild asphyxia between the two groups (all P>0.05). The scores of maternal satisfaction (24.6±0.4 vs 23.4±1.9, t=6.443, P=0.001) and acceptability (24.3±0.5 vs 23.5±1.4, t=5.436, P=0.001) in the EENC group were also significantly higher than those in the control. For the obstetric operation team, the acceptability scores among obstetricians (22.6±0.8 vs 21.6±1.3, t=2.379, P=0.019), instrument nurses (23.2±0.9 vs 21.3±1.1, t=13.592, P<0.001) and anesthetists (22.6±0.9 vs 21.5±1.7, t=5.625, P=0.001) in the EENC group were higher than those in the control group. However, no significant difference was observed in the acceptability among rounding nurses between the two groups (P=0.086). Conclusions EENC during CS could stabilize the neonatal temperature, reduce postpartum hemorrhage, promote early breastfeeding and improve the maternal satisfaction as well as the acceptability of both obstetric operation team and puerperae. There is a clinical significance to promote EENC during CS.

Optimizing pre-hospitalized services is a powerful measure for hospitals to improve patient experience. In June 2022, a certain maternal and child health hospital had carried out a value chain management for pre-hospitalized patient communication based on patient needs. The Kano model and value chain theory were used to analyze the patient demand attributes, clarify the value-added activities of pre-hospitalized patient communication value chain, and implement value-added activities, including carrying out the GLTC doctor-patient communication model, optimizing the information management system of the admission preparation center, establishing a hospital preparation group management platform, and introducing the " Zhejiang Nursing" platform, to achieve the added value of key value chains in patient communication, improve the quality of pre-hospitalized services, and improve patient experience. After one year of practice, the pre-hospitalized patient management indexes, including the unregistration rate after issuing the hospitalization certificate, the cancellation rate after registration, and the average length of stay had decreased from 9%, 3%, and 4.65 days before practice (June 2021 to May 2022) to 6%, 1%, and 4.13 days after practice (June 2022 to May 2023), respectively. As well as the timely completion rate of pre-hospital inspection and the average satisfaction rate of pre-hospitalized patients had increased from 93% and 94% to 98% and 97%, respectively. The practice had achieved good application effects, so as to provide references for improving the level of pre-hospitalized services and improving the patient experiences in medical institutions in our country.

Objective:To introduce the technical essentials of cytoreduction surgery (CRS) with extensive peritonectomy （“rolling carpet” surgery） in stage Ⅲc epithelial ovarian cancer (EOC) and evaluate the feasibility and safety of the operation by analyzing the incidence of surgical complications and perioperative mortality.Methods:From December 2017 to December 2019, 30 patients with stage IIIc EOC who underwent “rolled carpet” CRS and 30 patients who underwent traditional CRS at the same period in Sichuan Cancer Hospital were collected. To summarize the key points of “rolled carpet” CRS operation technology, i.e. the extraperitoneal space was the cut path of ovarian cancer operation, and the tumor in the pelvic cavity was dissociated from the extraperitoneal space of the pelvic cavity. The tumor in the pelvic cavity and all the implants or potential metastases on the parietal peritoneum were removed completely. The clinical and pathological characteristics between the two groups were analyzed retrospectively, and the feasibility and safety of “rolling carpet” CRS were evaluated by comparing the operation related indexes and the occurrence of surgical complications between the two groups.Results:(1) Clinicopathological features: the age of patients in “rolling carpet” CRS group and traditional CRS group were respectively (55.4±9.6) and (54.6±9.5) years, and the median peritoneal cancer index (PCI) was 12 (range, 4-24) and 10 (range, 5-18), respectively. There were no statistical significance between the two groups (all P>0.05). (2) Operation related indexes: in the “rolled carpet” CRS group, all patients （100%, 30/30） were performed optimal CRS, reaching completeness of cytoreduction score （CC score）, named CC-0 score, and there was no visible residual lesion after operation. While, in the traditional CRS group, 23 patients （77%, 23/30） reached CC-0 score, 5 cases （17%, 6/30） reached CC-1 score, 2 cases （7%, 2/30） reached CC-2 score, and there were statistical significance between the two groups ( P=0.011). The median surgical time was 315 minutes (range, 252-446 minutes) vs 268 minutes (range, 215-372 minutes), the median intraoperative blood loss was 589 ml (range, 300-900 ml) vs 450 ml (range, 250-800 ml), the median ICU hospital stay time was 2 days (range, 1-7 days) vs 1 day (range, 0-5 days), the median total hospital stay time was 14 days (range, 9-17 days) vs 12 days (range, 7-15 days). There were no statistical significance between the two groups (all P>0.05). (3) Surgical complications: there were respectively 5 cases (17%, 5/30) and 3 cases (10%, 3/30) complications with Clavien-Dindo grading Ⅰ-Ⅱ, which was significant no difference between the “rolled carpet” CRS group and the traditional CRS groups ( P>0.05). No re-operations were needed and the operative mortality was 0. Conclusion:It is safe and feasible to perform “rolled carpet” CRS in patients with advanced stage Ⅲc EOC with peritoneum implantation and metastasis, which could achieve optimal CRS, and has an acceptable incidence of perioperative complications, no perioperative death.