Objective To investigate the efficacy of medial plantar flaps with cutaneous nerves on fixing palm skin defects for patients injured while working.Methods All cases with palm skin defects who received medial plantar flaps grafting from June 2003 to January 2013,were analyzed retrospectively.The data included 13 males and 10 females,with the mean age of 36 years old (range,18-61 years old).There were 16 cases with right hand injury and 7 cases with left,whose skin defects ranged from 3.6 cm×2.8 cm to 7.0 cru×5.5 cm.All cases had skin and soft tissue injury while 5 cases with vascular and nerve injury,3 cases with tendon involvement and being exposed,6 cases with open metacarpal fractures.15 patients were treated with emergency surgery within 8 hours after injury,while 8 patients were treated 10 days after debridement surgery.Results Altogether,23 patients who received medial plantar flaps grafting operations,with palm skin defects,were included in this study.All cases were followed up for 3 to 36 months with a average period of 18 month.The grafted flaps range from 4.6 cm×3.8 cm to 8.0 cm×6.5 cm.Among the patients,19 of them recovered excellently with healing by first intention,with 7-14 d healing time,fully-retained hand functions and palm appearance,and 4-8 mm for between two points distinguish test.Flaps survived fairly well in 3 patients because partial necrosis happened at plantar skin graft donor site.After being debrided and dressed,the wound healed at second phase with a healing time of 12-21 d and 5-9 mm for between two points distinguish test.The operated hands could flex and extend functionally in the follow-up period.Only one patient did not recovered from medial plantar flap grafting and the flap did not survive operationally.The patient recovered after another operation with groin skin grafting later.According to Gu Yudong et al' evaluation criteria,such as improved hand function,19 cases were scored as excellent recovery,3 cases as good,and 1 as poor.The excellent rate was 95.7％ (22/23).Conclusion Medial plantar flaps with cutaneous nerves are ideal flaps for palm skin defects restoration,which characterized by the advantages of fixed anatomical position,high survival rate and being good to the functional recovery and palm appearance.

Purpose:To investigate the management and prognosis of urethral calcali.Methods:46 case of urethral calculi have been studied and followed up, 45 cases are males, 1 case is female. Mean age of the patients was 41 years. All patients complained of dysuria and urinary pains, acute retention was present in 10 cases. 3 cases have haematuria. Associated urethral disease was found in 12 patients.Results:The 37 cases were treated by endoscopic manipulation of choice for urethral calculi and have been followed up and have been all recovered except only 1 case.Conclusions:Endoscopic manipulation was found to be the safest and the most effective procedure.

Objective:To conduct reliability and validity test of Chinese versions of TeamSTEPPS medical teamwork perceptions questionnaire and TeamSTEPPS medical teamwork attitudes questionnaire so as to evaluate whether they are applicable to the current situation of medical teamwork in China.Methods:From January to April 2019, the Chinese versions of TeamSTEPPS teamwork perceptions questionnaire and TeamSTEPPS teamwork attitudes questionnaire were used to evaluate 900 emergency department workers in 9 ClassⅢGrade A hospitals in Shanghai by cluster sampling, and reliability and validity of the questionnaires were analyzed and evaluated. In this study, a total of 900 questionnaires were issued, 870 were recovered and 861 were valid, with an effective recovery rate of 96%.Results:The exploratory factor analysis of the Chinese versions of Chinese versions of TeamSTEPPS medical teamwork perceptions questionnaire and TeamSTEPPS medical teamwork attitudes questionnaire was carried out to extract the five dimensions of team structure, leadership, situation monitoring, mutual assistance and communication. The cumulative variance contribution rates were respectively 71.248% and 71.010%. In addition, a confirmatory factor analysis was performed on the questionnaires. The Chi-square degrees of freedom ratio (χ 2/ df) values were 2.870 and 2.214, normed fitting index ( NFI) values were 0.861 and 0.906, Tucker-Lewis index values were 0.896 and 0.940, incremental fit index ( IFI) values were 0.905 and 0.946, comparative fit index (CFI) values were 0.904 and 0.946, and root mean square error of approximation ( RMSEA) values were 0.066 and 0.053. The fitting values all reached the judgment standard, and the structural validity of the two questionnaires was good. The content validity indexes were good and they were respectively 0.94 and 0.95. The overall Cronbach's α coefficients of TeamSTEPPS medical teamwork perceptions questionnaire and TeamSTEPPS medical teamwork attitudes questionnaire were respectively 0.949 and 0.938, the split-half reliability was respectively 0.848 and 0.959, and the test retest reliability were respectively 0.959 and 0.964. Conclusions:The Chinese versions of TeamSTEPPS medical teamwork perceptions questionnaire and TeamSTEPPS medical teamwork attitudes questionnaire have good reliability and validity and high applicability, which can be used to measure the attitude and perceptions of medical teamwork in China.

Objective? To construct the nurse training course based on intercuLturaL target incentive seLf-management modeL of eLderLy patients with chronic heart faiLure (CHF). Methods? From August 2017 to November 2017, the three rounds of enquiry of 16 experts were carried out with the DeLphi method to construct the nurse training course based on intercuLturaL target incentive seLf-management modeL of eLderLy CHF patients. ResuLts? Among three rounds of enquiry, the recovery rates of vaLid questionnaire were aLL 100%; the expert authority coefficient was 0.863;the totaL KendaLL coordination coefficients were 0.194, 0.431 and 0.371 respectiveLy (P＜ 0.05). The nurse training course incLuded 18 primary indexes and 39 secondary indexes. ConcLusions? The construct of the nurse training course based on intercuLturaL target incentive seLf-management modeL of eLderLy CHF patients is scientific and practicaL which provides a reference for carrying out personaLized seLf-management education.