Objective: To compare the dosimetric differences in forward intensity-modulated radiotherapy using field-in-field (FIF-F-IMRT) and inverse intensity-modulated radiotherapy (I-IMRT) for the left-sided breast cancer. Methods: A total of 18 patients with left-sided breast cancer undergoing breast-conserving surgery in Shanxi Provincial People's Hospital from January to July 2015 were enrolled. For each patient, two treatment plans were designed. The plans were compared by means of target dose distribution and dose for organ at risk. Results: The two methods met the requirements of the prescribed doses. There were no differences for maximal dose (D_max), mean dose (D_mean), and 100%, 105%, 110% prescription dose percent volume (V₁₀₀, V₁₀₅, V₁₁₀) of the target (all P > 0.05). The percentage volume of heart receiving 5 Gy (V₅), 20 Gy (V₂₀), 30 Gy (V₃₀), D_mean of heart of FIF-F-IMRT [(11±4)%, (7±4)%, (8±3)%, (15±3) Gy] were lower than those of I-IMRT [(42±8)%, (14±10)%, (14±4)%, (18±7) Gy] (t values were 29.457, 5.542, 5.064, 4.165, all P = 0.000). V₅ of left-sided lung of FIF-F-IMRT [(26±6)%] was lower than that of I-IMRT [(47±12)%] (t = 6.708, P = 0.000), but there was no significant difference between the two groups in V₂₀, V₃₀, V₄₀, D_mean of left-sided lung (all P≥0.05). V₅ of right-sided lung and right-sided breast, D_mean of right-sided lung of FIF-F-IMRT [(7±4)%, (26±5)%, (60±19) Gy] were lower than those of I-IMRT [(31±9)%, (48±11)%, (489±67) Gy] (t values were 12.304, 6.708, 42.489, all P = 0.000). The number of the monitor units and spending time of FIF-F-IMRT were lower than those of I-IMRT (t values were 12.214 and 29.899, both P = 0.000). Conclusion FIF-F-IMRT has a good dose distribution in the target volume, and could reduce the dose for organ at risk, especially reduce the unnecessary low dose irradiation, and consume less planning time and equipment consumption.

Objective To clarify the significance of chest radiotherapy in the treatment of oligometastatic stage Ⅳ non-small cell lung cancer ( NSCLC ) and to explore the optimal time of interventional therapy during chest radiotherapy. Methods A total of 192 patients with oligometastatic stage Ⅳ NSCLC admitted to Shanxi Provincial Cancer Hospital from 2008 to 2014 were randomly and evenly divided into the chemotherapy alone, radiotherapy+ early intervention, radiotherapy+ middle intervention and radiotherapy+ late intervention groups. Survival analysis was performed with Kanplan-Meier method. Results The median survival of 192 patients with oligometastatic stage Ⅳ NSCLC was 14. 50 months, and the 1-,2-and 3-year survival rates were 57. 4％,24. 0％ and 10. 7％, respectively. The median survivalin the chemotherapy alone, radiotherapy+ early intervention, radiotherapy+ middle intervention and radiotherapy+late intervention groups was 10,21,18 and 13 months, respectively. The 1-year survival rates were 34％, 73％,71％ and 51％,10％,40％,32％ and 13％ for the 2-year survival rates, and 0％,24％,16％ and 3％for the 3-year survival rates ( P=0. 000) . The median survival of patients with radiotherapy dose ≥ 60 Gy and< 60 Gy was 21 and 13 months, 76％ and 53％ for the 1-year survival rates, 34％ and 21％ for the 2-year survival rates, and 17％ and 10％ for the 3-year survival rates ( P=0. 002 ) . Conclusion Early interventional therapy and high-dose radiotherapy can improve the local control rate and prolong the survival time of patients with oligometastatic stage Ⅳ NSCLC.

Objective:To construct a core competency evaluation index system for midwives of different levels suitable for the current midwifery environment in China.Methods:From December 2019 to June 2020, based on preliminary qualitative research, the core competency evaluation index system of midwives of different levels were determined through the methods of literature review, semi-structured interviews, group discussions and Delphi expert consultations.Results:The harmony coefficients of the first, second, and third-level indicators in the second round of expert consultation were 0.175, 0.357, and 0.213 with statistical differences ( P<0.01) . The importance of each indicator was from 4.28 to 5.00, and the coefficient of variation was from 0 to 0.158. In the 2 rounds of expert consultations, the expert positive coefficient was 100%, and the expert authority coefficient was 0.924. The final index system included 4 first-level indicators, 10 second-level indicators, and 37 third-level indicators. Conclusions:This research has a high degree of enthusiasm, authority, and coordination of opinions from experts. The core competency evaluation index system of midwives of different levels based on the Delphi method can provide a scientific and effective reference for the hierarchical management and training of midwives.

Objective:To explore the effect of staged intervention based on the theory of planned behavior (TPB) on breastfeeding self-efficacy and exclusive breastfeeding among women with gestational diabetes mellitus (GDM) .Methods:From January to May 2019, continuous sampling was used to select 380 delivery women who were diagnosed with GDM in Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University and met the inclusion and exclusion criteria as the research object. According to the random number table method, the delivery women were divided into the control group and the intervention group, 190 cases in each group. The delivery women in the control group received routine breastfeeding health education, while the delivery women in the intervention group implemented the TPB-based staged intervention on the basis of routine breastfeeding health education. The exclusive breastfeeding rate, knowledge and self-efficacy were compared between the two groups. As of four months postpartum, 169 delivery women were included in the intervention group and 157 delivery women in the control group.Results:The exclusive breastfeeding rate of delivery women in the intervention group at four months postpartum was 63.3% (107/169) , which was higher than that [47.1% (74/157) ] in the control group, with a statistically significant difference ( P<0.05) . The breastfeeding knowledge scores of the intervention group and the control group were (15.01±2.04) and (13.05±2.78) respectively, and the difference was statistically significant ( P<0.01) . The GDM breastfeeding knowledge scores were (8.86±1.85) and (4.80±2.76) , and the difference was statistically significant ( P<0.01) . There were significant differences in breastfeeding self-efficacy scores between the two groups at 38 to 40 weeks before delivery, three days, 42 days, and four months after delivery ( P<0.01) . There were significant differences in the exclusive breastfeeding rates between the two groups of GDM women at different time points ( P<0.05) . Conclusions:The staged intervention based on TPB can improve the effect of breastfeeding in GDM women, enhance maternal knowledge and self-efficacy, and increase the rate of exclusive breastfeeding.

At present, number of puerpera with gestational diabetes mellitus (GDM) is increasing. However, the rate of breast feeding decreases among GDM puerpera which has a large difference with the target of breast feeding by World Health Organization. As a special group of puerpera, breast feeding of GDM puerpera has not been paid attention to. This paper reviewed the status, influencing factors and interventions of breast feeding among GDM puerpera at home and abroad so as to provide a reference for exploring the deep researches and effective methods of breast feeding among GDM puerpera in the future.

Objective:To construct a standard index system for the outpatient job competency of midwife, and to clarify the midwives' abilities when providing outpatient services, so as to improve the midwives' core competencies and service satisfaction.Methods:A research group was established in December 2018. On the basis of literature review and survey of midwives' outpatient needs in the early stage, referring to expert opinions, and taking job competency theory as the theoretical framework, the standard index system for the outpatient job competency of midwife were initially constructed. From December 2018 to March 2019, convenience sampling was used to select 24 experts from different ClassⅢ Grade A hospitals of Beijing, and the Delphi method was used to conduct 2 rounds of expert consultations.Results:Among 2 rounds of expert consultations, the effective recovery rates of the questionnaires were all 100.0% (24/24) , the positive coefficient of experts was 100.0%, and the coefficient of authority of experts was 0.786. The Kendall coordination coefficients of the 2 rounds of correspondence were 0.030 and 0.400, respectively ( P<0.05) . The final construction of standard index system for the outpatient job competency of midwife included 4 first-level indicators, 9 second-level indicators and 24 third-level indicators of knowledge and skills, professional quality, health education ability, and ability to improve the quality of professional services. Conclusions:The standard index system for the outpatient job competency of midwife is scientific and reasonable, comprehensive in content, and strong in specialty, which can provide a reference for the training and assessment of midwife.