Objective:To establish the clinical practice teaching protocol for nursing undergraduates in midwifery for the purpose to improve the clinical teaching efficiency.Methods:Under the guidance of the core competency index system of midwives established by Lu Hong, based on the literature review and focused group interviews, the preliminary clinical practice teaching protocol was developed by using the Competency Outcomes and Performance Assessment (COPA) model. The clinical practice teaching protocol was improved and finalized through the expert meeting.Results:The teaching objective of the clinical practice teaching protocol was confirmed, and four practical teaching blocks were formed: comprehensive professional skill training, prenatal care, intrapartum care (including neonatal care), postpartum care (including neonatal care and women's health care). Among them, comprehensive professional skill training ran throughout the whole practice teaching process, and the proportions of practice time in the other sections were: 25%, 55% and 20% respectively(practice time of each section/whole practice time). The core elements of teaching project included: core competency, teaching content, teaching method, practice quantity requirement, assessment method and major practice place.Conclusion:The construction process of the clinical practice teaching protocol was prudent and reasonable. The protocol could reflect the core competency of midwives and the characteristics of midwifery. It could also fit the current situation of midwifery practice, with good operability and easy implementation.

Objective:To evaluate the safety and clinical efficacy of primary suturing of dog bite injuries on the head and face.Methods:A total of 42 cases with the dog bite injuries of Grade Ⅲ rabies exposure on the head and face(20 females and 22 males, aged from 1 to 81) were enrolled from October 2015 to October 2018 at the Department of Plastic Surgery, The Second People’s Hospital of Gansu Province. The primary suturing was performed after meticulous wound debridement and sufficient irrigation, the patients who were under 11 years old only received rabies vaccine for the rabies post-exposure prophylaxis, whereas the others were reinforced with tetanus antitoxin (1 500 IU) and human rabies immunoglobulin (20 IU/kg) around the wound, followed by Dermatix anti-scarring treatment for at least one year. Post-operative observation included wound healing and potential complications. All patients were followed up for facial deformities and bilateral symmetry, and the scars were assessed using the Vancouver Scar Scale (VSS).Results:Among the 42 cases, 38 cases (90.4%) were Class-A healed, 2 cases (4.8%) were Class-B healed (one of the two cases had a mandibular wound deep in the muscular layer. A deep abscess appeared in the neck 10 days after surgery, and was cured after puncture and drainage), and 2 cases (4.8%) were Class-C healed. Thirty-two patients had fever to different extent 2 to 5 days after surgery, and their body temperatures were below 38.5 ℃. The body temperature returned to normal after 1 to 2 days. During 6-24 months of follow-up, no tetanus and rabies occurred in all cases. During 1 to 2 years of follow-up, 1 of 42 cases had asymmetrical cheek 1 year post-operation. 1 case had scars on the upper eyelid 1 year after operation, and both eyes were asymmetric when eyes were open. Other 40 cases were recovered with bilateral symmetry without dysfunction of opening and closing the mouth and eyes. Facial contour recovery was cosmetically satisfactory with VSS score 1-3.Conclusions:Primary suturing of dog bite injuries on the head and face, according to the rabies prevention and treatment guideline, is a safe and effective treatment. It prevents rabies, and facial deformities and severe scar deformity in patients.

Objective:To evaluate the safety and clinical efficacy of primary suturing of dog bite injuries on the head and face.Methods:A total of 42 cases with the dog bite injuries of Grade Ⅲ rabies exposure on the head and face(20 females and 22 males, aged from 1 to 81) were enrolled from October 2015 to October 2018 at the Department of Plastic Surgery, The Second People’s Hospital of Gansu Province. The primary suturing was performed after meticulous wound debridement and sufficient irrigation, the patients who were under 11 years old only received rabies vaccine for the rabies post-exposure prophylaxis, whereas the others were reinforced with tetanus antitoxin (1 500 IU) and human rabies immunoglobulin (20 IU/kg) around the wound, followed by Dermatix anti-scarring treatment for at least one year. Post-operative observation included wound healing and potential complications. All patients were followed up for facial deformities and bilateral symmetry, and the scars were assessed using the Vancouver Scar Scale (VSS).Results:Among the 42 cases, 38 cases (90.4%) were Class-A healed, 2 cases (4.8%) were Class-B healed (one of the two cases had a mandibular wound deep in the muscular layer. A deep abscess appeared in the neck 10 days after surgery, and was cured after puncture and drainage), and 2 cases (4.8%) were Class-C healed. Thirty-two patients had fever to different extent 2 to 5 days after surgery, and their body temperatures were below 38.5 ℃. The body temperature returned to normal after 1 to 2 days. During 6-24 months of follow-up, no tetanus and rabies occurred in all cases. During 1 to 2 years of follow-up, 1 of 42 cases had asymmetrical cheek 1 year post-operation. 1 case had scars on the upper eyelid 1 year after operation, and both eyes were asymmetric when eyes were open. Other 40 cases were recovered with bilateral symmetry without dysfunction of opening and closing the mouth and eyes. Facial contour recovery was cosmetically satisfactory with VSS score 1-3.Conclusions:Primary suturing of dog bite injuries on the head and face, according to the rabies prevention and treatment guideline, is a safe and effective treatment. It prevents rabies, and facial deformities and severe scar deformity in patients.

Objective To explore the status quo of nurse-nurse collaboration and perceived professional benefits in emergency service nurses and to analyze effects of nurse-nurse collaboration on perceived professional benefits.Methods Totally 200 emergency service nurses from 6 ClassⅢ Grade A hospitals in Zhejiang Province were selected by convenient sampling and investigated with the nurse-nurse collaboration scale and the nurses' perceived professional benefits scale between February and December 2017.A total of 200 questionnaires were distributed and 193 valid questionnaires were collected.Results The nurse-nurse collaboration score of the 193 nurses was (67.16±10.13),standing at a high level;their score of perceived professional benefits was (134.76±16.51),standing at an above-average level;and there was statistical difference in the score of perceived professional benefits between nurses with different type of employment (P＜0.05).According to the hierarchical regression analysis,communication and nurse-nurse collaboration were the influencing factors to the perceived professional benefits in emergency service nurses (P＜0.01).Conclusions The perceived professional benefits stand at an above-average level,and there is still headroom for improvement.Nursing managers may enhance the nurses' perceived professional benefits by improving nurse-nurse collaboration.

Objective To explore the practice and effect of peer education in improving the empathic ability of in-service nurses. Methods A total of 122 in-service nurses at a tertiary hospital scoring below 60％ in empathy ability, were randomly divided into a control group and a research group by data table method. The nurses in the control group received theoretical training in empathy, and the nurses in the research group participated in peer-educated periodic empathy training activities. The Chinese version of interpersonal response index scale ( IRI-C) , nurses'humanistic care quality table, general self-efficacy scale were used before and after intervention. Results Before the intervention, the scores of the two groups of Chinese version of interpersonal response index scale ( IRI-C) , perspective-taking ( PT) , Fantasies ( FS) , empathic concern (EC) and Personal Distress (PD) were not statistically significant (P >0. 05). After intervention, the scores of the two groups of Chinese version of interpersonal response index scale ( IRI-C) , Fantasies ( FS) and Personal Distress ( PD) scores in the research group were all higher than those in the control group (P<0. 05). There was no significant difference in the scoring before and after intervention in the control group (P>0. 05). The total score and personal pain (PD) dimensions of the Chinese version of interpersonal response index scale ( IRI-C) were significantly higher than those before the intervention ( P<0. 01). The total score of nurses' humanistic care quality, the score of humanistic care ability and humanistic care perception were all higher than those before intervention in the study group (P<0. 05), and differences are statistically significant. Conclusions The practice of peer-education empathy training can effectively improve the empathy and humanistic care quality of the in-service nurses, and improve the nursing service level.

Objective:To explore the experience of elderly patients with diabetes after the first use of real-time continuous glucose monitoring (rt-CGM) through qualitative research.Methods:From January to December 2022, 20 elderly patients with diabetes who received rt-CGM in Beijing Friendship Hospital Affiliated to Capital Medical University were selected as the research object with objective sampling. Semi-structured, personalized, one-to-one in-depth interviews were used to collect data. The qualitative research content analysis method was used to summarize interview data, extract and explain the theme.Results:In this interview, a total of five themes were obtained. There were two themes before continuous glucose monitoring, namely high recognition of rt-CGM by patients and the expectation of understanding blood glucose fluctuations, which was the main purpose for patients to receive rt-CGM. After continuous glucose monitoring, there were three themes, namely, the negative emotions caused by abnormal blood glucose alarms during rt-CGM, disagreements among patients regarding the calibration method of measuring finger blood glucose four times a day during rt-CGM, and patients questioning the accuracy of rt-CGM data.Conclusions:Elderly patients with diabetes are willing to receive rt-CGM, but there are still many misunderstandings. Medical and nursing staff should develop targeted nursing strategies from various aspects such as improving patients ' psychological state, enhancing patients ' correct understanding of treatment, and strengthening standardized training for nurses, so as to increase patients ' treatment compliance and effectively control blood glucose.

Objective:To analyze the clinical characteristics, etiological composition, imaging features, and prognosis of adrenal metastases.Methods:This study is a retrospective case series that included 96 patients with pathologically confirmed adrenal metastases who were treated at West China Hospital, Sichuan University, from 2007 to 2017. Clinical features such as sex, age, tumor size, biochemical tests, imaging characteristics, postoperative pathology, treatment methods, and prognosis were collected and analyzed. The prognosis of patients and its influencing factors were analyzed by Kaplan-Meier survival curve and single-factor Cox risk proportional model.Results:Among the 96 included patients, 64 were male and 32 were female, with a median age of 60 years. There were 89 cases of unilateral adrenal metastases, five cases of bilateral metastases, and two cases with unspecified laterality. The median diameter of the metastases was 3.5 cm×2.9 cm, with an average CT value of 31 HU. Thirty-four cases of adrenal hormones were evaluated, and no abnormality was found.The primary tumor sites were as follows: lung ( n=36), kidney ( n=19), liver ( n=12), pancreas ( n=7), rectum ( n=3), stomach ( n=2), and one case each of tumor in the esophagus, skin, thyroid, left maxillary muscle, breast, bladder, cervix, chest wall, and gastrointestinal tract. There were three cases with unknown primary tumors. The most common pathological type was lung adenocarcinoma (20.8%, 20/96), followed by hepatocellular carcinoma (9.4%, 9/96) and high-grade invasive urothelial carcinoma of the kidney (8.3%, 8/96). Thirty-nine cases were diagnosed concurrently with the primary tumor, while 37 cases were diagnosed after the primary tumor, with a median interval of 15 months (range: 2-144 months). There was no significant correlation between the death risk of adrenal metastatic tumor patients and gender, age, and the size of the metastatic tumor (all P>0.05). There were 4 patients with radiotherapy and chemotherapy alone, 19 patients with surgery alone, and 6 patients with combined radiotherapy and chemotherapy. The median overall survival was 1, 3, and 7 years, respectively. Conclusions:Adrenal metastases were mostly diagnosed at the same time as the primary tumor or within 15 months after the diagnosis of the primary tumor. Unilateral metastasis is common. The lungs are the most common primary lesion, followed by the kidney and liver. CT is the preferred method for the diagnosis of adrenal metastases, and the plain CT value is more than 30 HU. The overall prognosis of adrenal metastases is poor. The prognosis was better for patients who underwent surgery combined with radiotherapy and chemotherapy than those who received only surgery or radiotherapy and chemotherapy alone.

Objective: This study aimed to explore the existing knowledge about midwives' views and experiences of providing care for women in the context of task shifting.Methods: We conducted a qualitative systematic review using meta-ethnography to describe the views and experiences of midwives on providing care in the context of task shifting. Comparative textual analysis of published qualitative studies involved translation of first-order key concepts and meanings from included studies to generate second-and third-order concepts. A grid was made to identify core findings and compare them reciprocally. Results: Thirty-six qualitative studies met the inclusion criteria. The literature comprised of 32 first key concepts. Eight second-order constructs emerged, and three third-order interpretations were generated. The three overarching themes were: (1) midwives perceived themselves as providing culturally competent and high quality women-centered care; (2) they valued their profession but saw it as complex and challenging; (3) as health professionals, they reported a variety of organizational, cultural, and professional barriers to providing women-centered care. Conclusions: While performing a specific task in the task shifting context, midwives perceived their crucial roles and responsibilities, along with achieved value and reward. However, due to a range of existing barriers, the caring task posed great challenges in completely implementing women-centered care. It is essential for systems to identify and eliminate these barriers early, to consider midwives' emotional well-being, and to develop overall strategies to better support the midwifery workforce. Policy makers and administrators should establish a supportive environment to facilitate midwives to perform women-centered caring tasks in more effective and efficient ways.

In order to strengthen the supervision of the use of drugs in hospitals，the Sichuan Academy of Medical Sciences· Sichuan Provincial People’s Hospital took the lead in compiling the Principles for the Rational Use of National Key Monitoring Drugs （the Second Batch） with a number of experts from multiple medical units in accordance with the Second Batch of National Key Monitoring Rational Drug Use List （hereinafter referred to as “the List”） issued by the National Health Commission. According to the method of the WHO Guidelines Development Manual， the writing team used the Delphi method to unify expert opinions by reading and summarizing the domestic and foreign literature evidence of related drugs， and applied the evaluation， formulation and evaluation method of recommendation grading （GRADE） to evaluate the quality of evidence formed， focusing on more than 30 drugs in the List about the evaluation of off-label indications of drugs， key points of rational drug use and key points of pharmaceutical monitoring. It aims to promote the scientific standardization and effective management of clinical medication， further improve the quality of medical services， reduce the risk of adverse drug reactions and drug abuse， promote rational drug use， and improve public health.