Objective To analyze the existing problems in the management of outpatient, to change the traditional manage-ment mode and to provide convenience for outpatient medical care.Methods By adopting the establishment of outpatient manage-ment by walking -around team, making the inspection content and quality standards of walking -around management and implemen-ting three class patrol management, We realized the transformation of the traditional outpatient management mode .Results After im-plementing the management by walking around, outpatients'satisfaction were improved and complaints reduced.Conclusion Man-agement by walking around has great effect on meeting the medical needs of patients, improving the quality of clinic service, optimi-zing the management process, and improving the hospital's reputation.

ObjectiveTo investigate the effect of delayed cord clamping on outcomes of neonatal resuscitation.MethodsTotally, 7 429 full term infants born in the Maternal and Child Health Care Hospital of Jilin from January 2013 to January 2015 were randomly divided into two groups, the observation group (n=3 727) and the control (n=3 702). The cords were clamped 2 min delayed in the former group, while those in the latter group were clamped within 10 s after birth. The rate of asphyxia and successful resuscitation, Apgar score at 1 and 5 min after birth, and pH value, base excess (BE), blood glucose, cardiac troponin (cTn) I at 1 h after birth were compared witht-test orChi-square test.ResultsThe incidence of neonatal asphyxia in the observation group was lower than in the control [0.75%(28/3 727) vs 1.21%(45/3 702),χ2=4.115,P<0.05], but no significant difference was found in the rate of mild or severe asphyxia between the two groups [0.62% (23/3 727) vs 0.89% (33/3702), 0.13% (5/3 727) vs 0.32% (12/3 702), allP>0.05]. In observation group, those newborns who suffered from severe asphyxia had higher Apgar score at 1 and 5 min than control (1 min: 2.80±0.45 vs 2.08±0.67,t=2.181; 5 min: 8.00±1.00 vs 6.25±1.66,t=2.176; bothP<0.05). Higher blood pH value and lower glucose level were shown in the observation group than in the control group [7.16±0.41 vs 7.13±0.72, (5.91±1.19) vs (6.60±1.56) mmol/L,t=2.068 and 2.046, bothP<0.05]. However, no difference was found in BE and cTnI levels between the two groups (bothP>0.05). For those babies with severe asphyxia, the blood pH, BE, blood glucose and cTnI levels in the observation group were significantly different from the control group [7.08±0.29 vs 7.02±0.56, (-16.82±0.60) vs (-17.43±0.35) mmol/L, (7.93±0.78) vs (8.02±0.53) mmol/L and (0.203±0.041) vs (0.249±0.035) ng/ml,t=2.270, 2.387,-2.371 and-2.341, allP<0.05].Conclusion Two minutes delayed in cord clamping could help to reduce the incidence of asphyxia and improve the effect of resuscitation in severe asphyxia.

To explore the correlation between nucleated red blood cell (NRBC) count and perinatal asphyxia in neonates.Full-term newborns born from May 2011 to November 2012 were recruited and divided into perinatal asphyxia (n =40) and normal (n =30) groups.Apgar score was recorded immediately at delivery.The umbilical arterial blood was also collected into anticoagulant-treated tube and NRBC was counted by Japan OlympusCX41 biological microscope.NRBC count for perinatal asphyxia group [(10.70 ± 2.61)/100 WBC] was significant higher than that for normal group [(2.67 ± 0.35)/100 WBC].A statistically significant negative correlation existed between NRBC and umbilical arterial blood pH,Apgar score at 1 min,BE value (r =-0.802,P ＜ 0.05 ; r =-0.639,P ＜ 0.05 ; r =-0.566,P ＜ 0.05).Associated with perinatal asphyxia in neonates,NRBC may be used as a simple index for assessing the severity of neonatal perinatal asphyxia.

Objective To investigate the current status and influencing factors of work engagement in emergency nurses, put forward a feasible strategy, improve the emergency department nurses work engagement for the emergency department to build effective human resource management to provide the reference. Methods A total 226 emergency nurses from 8 hospital of first-class in Tianjin city were recruited by the convenience sampling method and investigated with a self designed, the Medical Personnel′s Work Engagement Questionnaire. Results The total score of Medical Personnel′s Work Engagement Questionnaire was 111-166(137.32 ± 12.48) points and the scores were the highest in interpersonal concordance (4.20 ± 0.46) points and the lowest in work vigor (3.01 ± 0.61) points. Variance analysis and multiple linear regression analysis showed that gender, employment category and number of years as an emergency nurses were the influencing factors of work engagement, which could explain 51.3%of the variance. Conclusions Work engagement emergency of nurses is at a relatively moderate-to-high level, through establishing an effective incentive mechanism, increasing social benefits, accelerating the construction of emergency specialist nurse training system and paying attention to occupational development, work engagement level and quality of emergency medical care can be improved.

Objective To study the effect of age and sex on physiological and biochemical indexes of SJ5-SPF chickens at the age of different weeks. Methods Blood biochemical indexes of SJ5-SPF chickens at the age of different weeks were measured using an automatic blood analyzer, including 19 items: ALT, ALP, GGT, AST, LDH, TP, GLB, ALB, TB, DB, IBIL, GLU, TG, TCH, BUN, CRE, K+, Na+, and Ca2+. At the same time, the body temperature (T), respiratory frequency (R), heart rate (HR), diastolic pressure (DBP) and systolic pressure (SBP) of the SJ5-SPF chickens were measured using a RM6240C multi-channel physiological signal acquisition and processing system. Results (1) Among the physiological parameters, the body temperature, respiratory rate, heart rate, diastolic blood pressure and systolic blood pressure showed significant differences between the 4-week old chickens and the chickens at ages of 20, 25, and 25 weeks (P ＜ 0. 05), but there were significant differences between the males and females at the same weeks of age except body temperature. The diastolic blood pressure was only significantly different in the 40-week old male and female chickens (P ＜ 0. 01). The heart rates showed significant differences between the male and female chickens at 4, 20 and 25 weeks of age (P ＜ 0. 01). The respiratory rate and systolic blood pressure in the 4-week old male and female chickens were significantly different (P ＜ 0. 05). (2) The 19 blood biochemical indexes showed significant differences between the male and female chickens: the GGT, ALT, AST, TB, DB, IBIL, GLU, BUN and Na+at an week-age (P＜ 0. 05), the LDH, TP, GLB, ALB and CRE at two different week-ages (P＜ 0. 05), the ALP, TG and Ca2+at three different week-ages (P＜ 0. 05), and the TCH and K+at four different week-ages (P＜ 0. 05). Conclusions The above results can provide a scientific basis for diagnosis of SJ5-SPF chicken disease, animal quarantine and other related research.

Objective:To understand the current situation of physicians′ innovative behavior and its influencing factors in Beijing municipal hospitals, for reference in improving their innovation ability and encouraging high-quality development of public hospitals.Methods:A stratified sampling was conducted with 22 practicing (assistant) physicians in Beijing municipal hospitals as subjects. From October to November 2022, a questionnaire survey was conducted to understand the innovative behavior, innovative self-efficacy and innovative atmosphere of such practicing (assistant) physicians. SPSS 25.0 was used for descriptive analysis of the data, while t-test, variance analysis and linear regression were used for univariate analysis. Furthermore, multiple linear regression was adopted to explore the influencing factors of innovative behavior of such practicing(assistant) physicians. Results:A total of 2 178 questionnaires were distributed in this study, and 1 906 valid ones were recovered, with effective recovery of 87.51%. Scores of innovative behavior, innovative self-efficacy and innovative atmosphere of 1 906 practicing (assistant) physicians scored (4.00±0.70) points, (3.85±0.74) points and (3.98±0.66) points respectively. The results of univariate analysis showed scores of statistical significance regarding the innovative behavior of practicing (assistant) physicians with different marital status, educational background, professional title, position, department type, innovative self-efficacy level and innovative atmosphere level. Multiple linear regression results showed that position, innovation self-efficacy score, innovation atmosphere score and subordinates′ incentive mechanism, as well as teamwork and resource security had statistical significance on innovation behavior score.Conclusions:The practicing (assistant) physicians in Beijing municipal hospitals are highly enthusiastic for innovation, but their innovative behavior is expected to be upgraded. In this regard, public hospitals should improve their innovation incentive mechanism, strengthen resource assurance, encourage cooperation and exchange, and create a desirable atmosphere for innovation. Furthermore, greater supply of continuing education resources is expected, supporting these physicians in their further study, advanced education, and promotion of professional titles.

Objective To evaluate the clinical performance of chemiluminescent immunoassay (CLIA) on anti-nuclear antibody(ANA) specific autoantibodies testing.Methods A multi-center clinical study A total of 811 Sera samples were collected from 6 collaborating hospitals during the period of April to July 2016, and tested with CLIA and line immunoassay (LIA) in parallel for autoantibodies to ribonucleoprotein(RNP), smith antigen(Sm), SSA/Ro60,SSB/La, centromere protein B(CENPB), double-stranded DNA(dsDNA), nucleosome(Nuc), and ribosome P protein(Rib-P).The positive rate,specificity and qualitative coincidence rate for each antibody between CLIA and LIA methods were analyzed.All discrepant samples for systemic lupus erythematosus (SLE) highly specific autoantibodies (including anti-Sm, dsDNA, Nuc and Rib-P) were retested by enzyme linked immunosorbent assay (ELISA) and further analyzed with SLE disease cohort using McNemar test.Results The positive rate and specificity of CLIA and LIA for antibodies to ANA specific antigens were comparable.Excellent qualitative coincidence were found between CLIA and LIA for the detection of anti-RNP, SSA/Ro60, SSB/La and CENPB (Kappa>0.75), while the coincidence rate foranti-Sm, dsDNA, Nuc and Rib-P detection were moderate (0.4

Objective:To systematically review the therapeutic effect of continuous high positive end-expiratory pressure (PEEP) ventilation in patients with non-acute lung injury/acute respiratory distress syndrome (non-ALI/ARDS) under general anesthesia mechanical ventilation in the intensive care unit (ICU).Methods:PubMed, JBI Evidence-based Nursing Center Library, Cochrane Library, Embase, Medline, Wanfang Date, CNKI and VIP Database were searched for randomized controlled trials (RCT) and clinical controlled trials (CCT) using different levels of PEEP for the treatment of patients (uncombined ALI/ARDS) in ICU. The search period was from January 1st, 1990 to November 30th, 2018. Compared with the control group, the experimental group was treated with relatively high levels of PEEP ventilation. Outcome indicators were hospital mortality or 28-day mortality, partial oxygen pressure, and incidence of ARDS, atelectasis, and lung infections, etc. The RevMan 5.3 software was used for Meta-analysis.Results:Twelve articles were included, all of which were RCT studies; with 2 Chinese articles and 10 English articles. Meta-analysis showd that there was no statistically significant difference in the effect of different levels of PEEP on the mortality of patients [hospital mortality: odds ratio ( OR) = 1.06, 95% confidence interval (95% CI) was 0.57 to 1.96, P = 0.85; 28-day mortality: OR = 0.34, 95% CI was 0.09 to 1.32, P = 0.12]. Compared with low PEEP, persistently high PEEP could increase the patient's partial oxygen pressure [weighted mean difference ( WMD) = 48.27, 95% CI was 22.56 to 73.97, P = 0.000 2], prevent the occurrence of ARDS ( OR = 0.32, 95% CI was 0.13 to 0.82, P = 0.02), and decrease the incidence of lung infection ( OR = 0.52, 95% CI was 0.30 to 0.89, P = 0.02), but there was no significant difference in the incidence of atelectasis between the two groups ( OR = 0.69, 95% CI was 0.23 to 2.06, P = 0.51). Conclusion:In the treatment of patients in ICU with non-ALI/ARDS under general anesthesia mechanical ventilation, using relatively high levels of PEEP (10-16 cmH 2O, 1 cmH 2O = 0.098 kPa) instead of low levels of PEEP (≤8 cmH 2O) can significantly increase the partial oxygen pressure and significantly reduce the incidences of ARDS and lung infection.

With the increasing diversification of family structures and fertility patterns， more and more unmarried women choose to have children alone. This new fertility model has aroused widespread discussion and controversy in society. Given the current situation and related research on single women’s fertility， the paper discussed the issues， such as Bianchin’s utility theory and feminist theory， the change in the views of marriage and fertility， the social problems existing in the clinical application of frozen eggs and assisted reproductive technology （ART）， as well as the protection of offspring’s rights and interests. It also proposed legal and policy recommendations and countermeasures to regulate frozen eggs and ART techniques， safeguard reproductive rights， and protect offspring’s rights and interests， with a view to providing ideas for the study of fertility policies for single women.