Massive open online courses (MOOCs) , which has caused a large scale of medical edu-cation in recent years, has led to an exploration boom in medical education. By the end of November 2014, on four large domestic and foreign MOOCs platform, a total of 178 medical related MOOCs were found, accounting for 12.2% of the total number of courses, among which public health MOOCs accounted for 44.9%. In terms of medical education, MOOCs are not only a powerful supplement of existing medical ed-ucation and can assist dissemination of medical knowledge, they can also promote pedagogy innovation and improve teaching quality to a certain extent. Moreover, the huge amounts of data collected by MOOCs can also be used to develop research of students' learning behavior. In addition, by recruiting study objects, the researchers have begun to use MOOCs supporting scientific research. As a novel educational development, MOOCs face many challenges while they bring opportuni-ties for medical education. However, active prac-tice and exploration will bring more powerful vitality for its development in the medical field.

Objective To explore a new training method of nursing skills under 24 hours shift system in the practical training base in the college. Methods The practical training base in the college was rebuilt into a simulated hospital. 120 three-year-course nursing students in grade 2007 were divided into the control class and the experimental class with 60 students in each class. The control class adopted routine teaching method, including teacher demonstration, single project training, concentrated training before clinical practice. The experimental class participated in the tutoring mode of nursing skills under 24 hours shift system in simulated hospital. The cases were pre-designed and students acted as patients by tums. One teacher led 4 students into nursing skill training by day shift, evening shift and mid-night shift. The teaching effect was compared between two classes. Results There was significant difference between the two groups in comprehensive technique test and graduation theoretical test score. Clinical nursing teachers thought the skill training in simulated hospital under 24 hours shift system can help students prepare for the nursing work in hospital ahead of time and improve their comprehensive capability. Conclusions Training mode of nursing skills in simulated hospital under 24 hours shift system is feasible for enhancing nursing skills.

Objective To investigate the clinical significance of serum CEA , CA19-9, CA72-4, CA242, CA50, PGⅠand PGR ( PGⅠ/PGⅡ) in the Diagnosis of preoperative and postoperative gastric cancer.Methods Retrospective study.The levels of CEA , CA19-9, CA72-4, CA242, CA50, PGⅠand PGⅡin serum of 41 patients with gastric cancer preoperative and postoperative and 60 healthy people were detected by AutoLumo A2000 chemiluminescence immunoassay and compared.Statistical analysis was performed using Rank-sum test by SPSS 17.0.Results The median of CEA, CA19-9, CA72-4, CA242, CA50, PGI, PGII and PGR in postoperative gastric cancer group were 3.79 ng/ml, 17.85 U/ml, 3.50 U/ml, 14.52 U/ml, 17.62 U/ml, 32.81 ng/ml, 11.48 ng/ml, 3.35.The postoperative gastric cancer group were 1.67 ng/ml, 7.76 U ml, 1.73 U/ml, 6.30 U/ml, 7.57 U/ml, 20.56 ng/ml, 5.71 ng/ml, 2.94.The healthy group were 1.53 ng /ml, 7.59 U/ml, 1.47 U/ml, 6.08 U/ml, 5.68 U/ml, 90.86 ng/ml, 14.85 ng/ml, 6.67.There were statistical differences in the serum levels of CEA , CA19-9, CA72-4, CA242, CA50, PGⅠ, PGⅡand PGR among different groups (chi-squared values were 79.108, 20.678, 20.374, 7.252, 56.73, 131.212, 20.38, 86.37, P<0.05).By the Mann-Whitney rank sum test,the serum levels of CEA , CA19-9, CA72-4, CA242 and CA50 in patients with preoperative gastric cancer were significantly higher than those in healthy controls (Z values were -8.598, -4.425, -4.365, -2.000,-7.420, P<0.05).The level of postoperative group was significantly lower than that of preoperative group (Z value were -4.641, -2.383, -2.459, -2.399, -2.903, P<0.05).The serum PGⅠ, PGⅡand PGR levels in patients with preoperative gastric cancer were significantly lower than those in healthy controls (Z values were -10.309, -2.695, 8.637, P<0.05).The PGⅠlevel in the postoperative group was significantly lower than that in the preoperative group (Z value was -2.109, P<0.05).PGⅡ,PGR levels of postoperative group were lower than those of preoperative group , but the difference were not statistically significant.(Z values were -1.506,-0.838, P values were 0.132,0.402).Conclusion The detection of the seven serum markers can help to preoperative diagnosis and postoperative monitoring of gastric cancer .

Objective:To analyze the reform actions on raising the appropriateness of inpatient care use, as well as the current situation, so as to provide suggestions on improving the appropriateness.Methods:Policies and literatures on the appropriateness of inpatient care use released from 2009 to 2021 were collected from such official websites as the State Council and China National Health Commission as well as literature databases from home and abroad, for a text analysis. Based on the data of China Health Statistics Yearbook(2010-2021) and The Sixth National Health Service Survey Report (2018), descriptive methods were adopted to analyze the situation of inpatient care use in China. Results:Since the new healthcare reform, the Chinese government had standardized the hospitalization standards and procedures to minimize inappropriate use of inpatient care, increased financial subsidies for public hospitals to minimize their inappropriate patient attraction merely for economic interests, and reformed the medical insurance payment methods so as to regulate physicians′ behavior. Under the influence of the above policies, the average length of stay decreased from 10.5 days in 2009 to 9.1 days in 2019, with an average annual growth rate of -1.42%. The average waiting time in hospitals decreased from 3.6 days in 2008 to 1.5 days in 2018.From 2012 to 2019, the admission rate increased from 13.2% to 19.0%.Conclusions:Since the new healthcare reform, the average length of stay in China has decreased year by year, but the admission rate has increased year by year. Therefore, it is necessary to further reduce the inappropriate utilization of inpatient care use by speeding up the construction of the close-type medical alliances, improving the reform of payment methods, refining the performance appraisal standards for medical staff and strengthening supervision mechanism.

Artificial intelligence (AI) is an emerging science and technology that studies and develops theories, methods, technologies, and application systems for simulating and expanding human intelligence. AI has made great breakthroughs in the field of intelligent medicine, and has shown great potential in the diagnosis and treatment of diabetic retinopathy (DR), retinopathy of prematurity, and other fundus diseases. A number of clinical trials on the application of AI technologies to DR screening have been carried out in the domestic and overseas, which not only have a high accuracy rate, but also save doctors' reading time and reduce the burden of society, medical work and patients. However, due to the lack of evaluation system for DR intelligent diagnosis technology, the accuracy of AI system still lacks of big data verification. Secondly, most of the color fundus photographs are taken in the posterior 45°, which only show the most vulnerable areas, making some lesions undetectable. In addition, the current DR screening system has not yet been applied to the clinic, most of which are in the stage of prospective research and trials. There are still many obstacles from the environment to the hospital or the clinic. Doctors cannot use real patient data to evaluate the AI system, so it is not popular in clinical practice. In the future, DR screening algorithms and diagnostic models can be further improved and established to make DR AI screening more accurate.

Objective:To analyze the lifestyle for brain health related factors and demographic characteristics through machine learning to achieve the assessing effect of mild cognitive impairement prevalence risk among rural elderly people in Guizhou.Methods:From July to August 2019, a multi-stage cluster random sampling method was used to select 1 235 rural elderly people aged 60 years and above in Guizhou Province as the subjects, and the investigation was performed with questionnaire and physical examination.The Mini-Mental State Examination (MMSE) was used to assess cognitive function, and the important features and optimal number of features based on 12 LIBRA factors and 4 demographic characteristics were selected.Logistic regression and random forest algorithm were used to establish a evaluation model for the risk of mild cognitive impairment in the elderly.The evaluation efficacy of the model was also assessed using a combination of precision, accuracy, sensitivity, specificity, F1 score and area under curve (AUC) of receiver operating characteristic curve, and the Delong method was used to check the difference of AUC values between the two models.Results:A total of 291 subjects were diagnosed with mild cognitive impairment, with a detection rate of 23.56% (291/1 235). The AUC values of logistic regression and random forest models evaluating the risk of mild cognitive impairment in the rural elderly were 0.758 and 0.820, respectively, and the differences were statistically significant(both P<0.05). The random forest model had better evaluations with an accuracy of 0.823, precision of 0.805, sensitivity of 0.874, specificity of 0.767 and F1 score of 0.838, all of which were better than those of the logistic regression model.And the random forest model was also more stable after 10-fold cross-validation. Conclusion:The lifestyle for brain health related factors combined with demographic characteristics can more accurately evaluate the risk of mild cognitive impairment among rural elderly people in Guizhou.The random forest model is better than the logistic regression model.

Objective To explore oncology nurses′attitudes and beliefs and its influencing factors toward sexuality care. Methods A total of 208 oncology nurses were investigated by convenience sampling method. The nurses were investigated with the Sexuality Attitudes and Beliefs Survey Scale and the Literacy of Sexual Health Care Scale. Results The total score of attitudes and beliefs of oncology nurses toward sexuality care was (44.88 ± 11.45). Multivariate linear regression analysis showed that age, sexual health education and training experience, knowledge of sexual health care and efficacy of sexual health care were the influencing factors of SABS. A total of 41.2％variance was explained. Conclusions We should strengthen the training of oncology nurses about sexuality care to reduce the barriers of sexual health education in clinical work and help nursesform the right attitudes and beliefs of health care so that they can provide patients with better care.

OBJECTIVE To establish the quality standard of Triadica cochinchinensis and to perform the acute toxicity study. METHODS Appearance properties, powder microscopic identification, and thin-layer chromatography(TLC) identification were researched. The specific chromatogram was established by HPLC. The content of cadmium(Cd), lead(Pb), arsenic(As), copper(Cu), and mercury(Hg) was determined by inductively coupled plasma-mass spectrometry(ICP-MS). Acute toxicity was studied by maximum dose. RESULTS The outer skin of herbs was dark brown, and the inner surface was light yellow brown and fibrous. Besides, crystal sheath fiber was common, and calcium oxalate clusters arranges in rows. In the TLC diagram of the test product, the fluorescent spots of the same color were displayed at the corresponding position of the control product(scopoletin, isofraxidin). Five common peaks were calibrated in the characteristic map and the three characteristic peaks(scopoletin, isofraxidin, dimethylfraxetin) were recognized. The content of the measured heavy metal elements was lower than the national limit standard. The linear correlation coefficient was R2 > 0.999. The precision, stability, repetitive RSD were < 10%. The average recovery rate of the added sample was 80%−120%, and the RSD was < 10%. The maximum dose of the acute toxicity test was 184.09 g·kg−1. The 14 d internal body mass, food intake, organ-body ratios, the serum glutamic pyruvic transaminase, glutamic oxaloacetic transaminase, blood urea nitrogen, and creatinine were not significantly different by comparing with the normal controls. Therefore, no significant toxicity was observed. CONCLUSION The established standard can provide a reference for evaluating the quality of Triadica cochinchinensis. The heavy metal content of ten batches of medicinal materials is within the safe range. Acute toxicity test show that there is no obvious significant adverse teactions after oral administration, and the safe dose range is large, which can provide a reference for the subsequent development and utilization.