Objective To explore the effects of Six-Step standardized communication procedure in improving the communication ability of nurses.Methods C-I-CARE communication procedure was converted into Chinese.The Chinese version of Six-Step standardized communication procedure was Yi Kan,Er Yin,San Gaozhi,Si Wen,Wu Da,Liu Zaijian.The procedure was propagandized by making posters,setting up computer desktop,training nurses by lectures,video and role play.The effects were evaluated by pre and post self-control test among 100 nurses.Results The average score of communication behavior of 100 nurses after applying standardized communication procedure increased from 2.55±0.67 to 4.44±0.59 (t=-23.174,P＜0.001).In 2015,the nursing department received 622 silk banners and commendatory letters for appreciating nursing work,increased by 18.9％ compared to 2014.The discharged patient satisfaction increased from 94.2％ to 96.93％.The satisfaction of doctors to nurses' collaboration was 99.86％.There was no nursing complaint or dispute caused by bad communication.Conclusion The application of procedure and standardized communication method can improve the communication ability of nurses,optimize the relationship between nurses and patients and increase patient satisfaction.

Objective:To explore the risk factors of catheter-related thrombosis（CRT）in femoral vein indwelling catheter for patients undergoing artificial liver therapy.Methods:The clinical data 1 060 patients who received non biological artificial liver therapy with femoral vein catheterization at the Artificial Liver Center of the First Affiliated Hospital，Zhejiang University School of Medicine from February 26，2019 to March 30，2022 were retrospectively analyzed. During the treatment，CRT occurred in femoral vein indwelling catheter in 574 cases（54.2%，CRT group）and did not occurred in remaining 486 cases（non-CRT group）. The influencing factors of CRT were analyzed with multiple Logistic regression.Results:Univariate analysis showed that gender，D-dimer before and after catheterization，international normalized ratio（INR），total bilirubin，catheterization location，and catheter retention time were significantly associated with the occurrence of CRT（all P<0.05）. Multiple Logistic regression analysis showed that male gender（ OR=1.627，95% CI 1.233-2.148， P<0.001），right femoral vein catheterization（ OR=2.101，95% CI 1.130-3.908， P=0.019），catheter retention time（ OR=1.039，95% CI 1.003-1.077， P=0.035），D-dimer >500 μg/L FEU after catheterization（ OR=1.697，95% CI 1.191-2.416， P=0.003）and INR≥1.5（ OR=1.343，95% CI 1.001-1.801， P=0.049）were independent risk factors for CRT in femoral vein indwelling catheter for artificial liver therapy. Conclusion:The incidence of CRT is high in patients undergoing artificial liver therapy with femoral vein catheterization. In clinical practice，medical staff should early identify high-risk populations for CRT and take timely preventive measures.

Objective To investigate the risk factors and improvement measures of thrombosis in internal arteriovenous fistula in maintenance hemodialysis patients .Methods Case control studies were performed in this study . Totals of 100 maintenance hemodialysis patients with thrombosis in internal arteriovenous fistula from January 2009 to June 2015 in Lishui Central Hospital were included in observation group, while another 100 patients with maintenance hemodialysis who did not have thrombosis in internal arteriovenous fistula were involved as control group .The related clinical and nursing data were collected , and the correlation between the thrombosis in internal arteriovenous fistula and related factors were analyzed to improve targeted nursing .Results Prevalence of diabetes , puncture failure rate , hematoma occurrence rate , high intensity in site-directed oppression , tightly binding after hemodialysis rate , oppression time longer than 30 min after hemodialysis rate, ultrafiltration rate, hemoglobin, high-sensitivity C-reactive protein, fasting blood glucose, total cholesterol, low density lipoprotein cholesterol , calcium-phosphorus product and D-dimer in observation group were higher than those in control group .The differences were statistically significant ( P<0.05 ) .There were statistically significant differences in the systolic pressure and low molecular weight heparin usage between two groups (P<0.05).The multi-factor logistic regression analysis showed that the diabetes[OR=1.417, 95%CI (1.196 -1.803), P =0.001], puncture failure[OR=1.393, 95%CI (1.185 -1.638), P =0.000], tightly binding after hemodialysis [OR=1.249, 95%CI (1.101-1.416), P=0.001], oppression time longer than 30 min after hemodialysis[OR=8.369, 95%CI (1.725 -40.596), P=0.008], systolic pressure[OR=1.031, 95%CI (1.001 -1.061), P =0.040], ultrafiltration rate[OR =1.490, 95%CI (1.146-1.937), P=0.003], high-sensitivity C-reactive protein[OR=1.594, 95%CI(1.085-2.342), P=0.017], low-density lipoprotein cholesterol [OR=9.456, 95%CI (2.534 -55.040), P=0.007] and D-dimer[OR=11.711, 95%CI (5.310-69.231), P=0.005] were independent risk factors for thrombosis in internal arteriovenous fistula in maintenance hemodialysis patients .Usage of low molecular weight heparin [ OR=0.101, 95%CI (0.017 -0.590), P=0.011] was protective factor.Conclusions Thrombosis in internal arteriovenous fistula in patients with maintenance hemodialysis is not only related to metabolic factors , but also related to nursing factors .We should strictly control the ultrafiltration rate , improve puncture success rate , strengthen the health education and nursing observation post operation so as to early spot and prevent the thrombosis in internal arteriovenous fistula .

Vitamins are classified as either fat-soluble (vitamins A, D, E, K) or water-soluble (vitamins B and vitamin C). Traditional methods of immunoassay have only been developed for vitamins D,B6, B9 and B12. However, they cannot distinguish between vitamin subtypes such as D2, D3 and associated epi isomers (which has higher leveks in infants),giving false positive or negative results. Mass spectrometry has become a gold standard method for small molecule analysis in biological samples with its advantages in speed,resolution,sensitivity and specificity. It is widely used in clinical research and diagnosis and provides an efficient method for simultaneous detection of multivitamins in one injection using one low volume sample collection.

Clinical application of mass spectrometry technology has attracted the attention of clinical laboratory experts due to its high sensitivity, high specificity, and capacities of simultaneous detection of multiple compounds. In recent years, mass spectrometry technology has made significant achievements in the fields of identification of pathogenic microorganism, detection of trace elements and heavy metals, small molecule hormones, vitamins, amino acids, peptides and proteins, as well as therapeutic drug monitoring (TDM) and poisoning drugs screening. In order to further clarify the opportunities and challenges brought by this complex mass spectrometry technology in the field of clinical laboratory, the Chinese Journal of Laboratory Medicine invited experts and scholars of laboratory medicine to share their experience and opinions on related items focusing on the positioning of mass spectrometry technology in the clinical laboratory, the development and improvement of the clinical laboratory by mass spectrometry technology, the challenges of interpreting mass spectrometry test results, the challenges of operating and managing clinical mass spectrometry laboratories, and ways of improving the application of clinical mass spectrometry laboratories with this technology. Agreement was achieved in that the introduction of mass spectrometry technology into the clinical laboratory could bring new directions and opportunities for clinical testing and research, and also is associated with a series of challenges such as the difficulty of sample pretreatment, the high cost and complexity of mass spectrometry technology, the complexity of data processing and interpretation, the lack of standards and norms, and the issue of determining the price of mass spectrometry examinations.

Objective In this research,we constructed a nurse-led intra-abdominal pressure(IAP)management program in children undergoing liver transplantation,and explored its clinical application effect.Methods Based on literature review,semi-structured interviews,and expert meetings,a nurse-led program for IAP management is constructed.By convenience sampling method,162 children admitted to the pediatric liver transplant intensive care unit of a tertiary hospital in Zhejiang Province from January to December 2023 were selected.The experimental group implemented a nurse-led IAP management program,while the control group received routine postoperative care after liver transplantation.The average IAP values during ICU period,incidence and grading of intra-abdominal hypertension(IAH),duration of mechanical ventilation,and length of ICU stay were compared between 2 groups.Results Finally,the IAP management program in children undergoing liver transplantation included 4 first-level items,10 second-level items and 20 third-level items.During the application of this program,4 cases dropped,and 78 cases were finally included in the experimental group and 80 cases in the control group.After the intervention,the IAP value in the experimental group was(8.63±2.40)mmHg(1 mmHg=0.133 kPa),lower than(9.23±3.19)mmHg in the control group,but there was no statistically significant difference between the 2 groups(P=0.186).The incidence of IAH in the experimental group was 23.07％,lower than 41.25％in the control group.The difference between the 2 groups was statistically significant(P=0.015).13 cases(16.67％)in the experimental group developed grade Ⅰ IAH,while 22 cases(27.50％)in the control group;5 cases(6.41％)in the experimental group developed grade Ⅱ IAH,while 9 cases(11.25％)in the control group;no cases in the experimental group developed grade Ⅲ IAH,while 2 cases(2.50％)in the control group.There was no statistically significant difference between the 2 groups(P＞0.05).The mechanical ventilation time in the experimental group was 3.00(1.00,13.25)hours,and 7.50(1.00,27.75)hours in the control group.The difference between the 2 groups was statistically significant(P=0.034).The length of ICU stay in the experimental group was 6.00(4.00,8.25)days,and 5.00(3.00,8.00)days hours in the control group.The difference between the 2 groups was statistically significant(P=0.061).Conclusion The nurse-led IAP management program in children undergoing liver transplantation can effectively reduce the incidence of IAH,shorten the duration of mechanical ventilation.

Objective To form the expert consensus on the limb management of patients with transvenous temporary cardiac pacing,standardize the limb management of patients with transvenous temporary cardiac pacing,and reduce complications related to the limb.Methods Using evidence-based methods,the evidence in this field was searched,evaluated and summarized,and relevant recommendations and research conclusions were extracted and classified by the level of evidence quality,and then the first draft of the consensus was formed.From December 2023 to January 2024,through 2 rounds of expert consultation and 4 rounds of expert meetings,the content was adjusted and the consensus was reached.Results Totally 16 experts participated in the consultation.The positive coefficient is 100%;the authoritative coefficient is 0.847 and 0.836;the average value of each index is more than＞3.8;the coefficient of variation is less than 0.21.The Kendall's harmony coefficient of the 2 rounds of expert consultation is 0.372 and 0.314,respectively,which were statistically significant.The consensus covers the preoperative,intraoperative and postoperative on limb management of patients with transvenous temporary cardiac pacing.Totally 11 themes were involved,including the preoperative preparation,position and catheter fixation in operation,position and catheter fixation in postoperative,activity,turn and transfer,duty shift on limb,nursing care after withdrawal of the catheter,prevention of deep vein thrombosis of the operative limb and prevent infection.Conclusion The consensus is highly scientific,and it is helpful to standardize the limb management of patients with transvenous temporary cardiac pacing.