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 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.