Two-way referral system is an important measure to promote the rational distribution of medical resources and promote the health of patients, but now there is a typical characteristic of"referrals up easy but downward referral difficult". while the transitional care of downward referral patients is one of the important impetus to promote the implementation of downward referral, this paper summarizes the necessity, connotation, main service forms, application effects and problem analysis status of the transitional referral of patients in the two-way referral mode in our country, in order to provide the basis for the establishment of a nursing security system suitable for two-way referral of patients.

Objective:To explore transition care needs among the parents of children with primary nephrotic syndrome and analyze the influencing factors.Methods:With convenient sampling method, parents of children with primary nephrotic syndrome were selected in the children's nephrology department of a tertiary grade A hospital in Shandong province. A total of 240 parents were enrolled in the study and they were investigated by using a self-designed questionnaire of transitional care needs of parents of children with primary nephrotic syndrome.Results:The total score of transitional care needs for parents was (4.12±1.08) points. The demand for disease knowledge, complication prevention and condition monitoring was the highest (4.67±0.53) points. 52.80% (113/214) of parents hope to receive transitional care services through network communication. 64.49% (138/214) of the parents want specialist doctors and nurses to provide nursing services for them. Multivariate stepwise regression analysis showed that age, education level, monthly income, hospitalization time and hormone use time of the children were the factors influencing the parents' demand for transitional care services ( P < 0.01). Conclusion:Parents of children with primary nephrotic syndrome have a high demand for transitional care. It is suggested to give full play to the leading role of professional medical teams and gradually form a hospital-community linkage transitional nursing mode; Parents of children with different age, education level, monthly income, hospitalization time and hormone use time have different needs for transitional care thus individualized transitional nursing for different patients are expected.

Objective:To investigate the status of the professional construction of head nurses in the tertiary hospitals of Shandong Province, and to master the professional cognition and attitude of the head nurses, and to provide reference for the formulation of the professional construction plan for the head nurses in the tertiary hospitals.Methods:A cross-sectional survey of 2 629 head nurses from 55 tertiary hospitals in Shandong Province was conducted using a self-designed questionnaire survey on the status of professional construction of head nurses in tertiary hospitals in Shandong Province.Results:The selection and training system of the head nurses in the tertiary hospitals in Shandong Province was mature. 93.00%(2 357/2 534) of the head nurses were undergraduate degrees, 18.40%(465/2 534) of the head nurses used all the working hours for nursing management, and 86.00%(2 179/2 534) were the main economic sources with the current position; 68.20%(1 728/2 534) were believed that the head nurse should be a trained nurse, 87.90%(2 227/2 534) thought that the head nurse′s professional construction was necessary, and the professional feasibility score was 77.93±19.75. The regression analysis showed that the factors affecting the head nurse′s own professional construction were age, satisfaction with salary satisfaction and self-worth ( P<0.05); 32.50%(257/791) of the head nurses suggested improving the management training system, 20.61%(163/791) recommended that the hospital should pay attention to the professional construction of the head nurse, and 7.33%(58/791) recommended establishing the standardization of professional standards. Conclusions:To improve the investment time of the head nurses and encourage the head nurses to continue the education management; the hospital should appropriately reduce the age requirements of the head nurses and improve the salary; establish a sound professional system and management training system for the head nurses, and comprehensively recommend the head nurses. Promote the professional development of the head nurse team

Objective:To explore the current needs for the personnel, service mode and service duration of continuous nursing services in patients with permanent colostomy and provide support for developing continuous nursing services.Methods:Totally 120 patients with permanent colostomy who were discharged after surgery and attended outpatient services in a ClassⅢ Grade A general hospital in Shandong province between January and December 2018 were selected by convenient sampling and investigated using a self-designed questionnaire for continuous nursing needs in patients with permanent colostomy.Results:The top 3 needs for continuing nursing services were telephone, outpatient service, and home follow-up. The top 3 needs for service personnel were interdisciplinary teams, doctors, and stoma therapists. The most demanding service duration after discharge was 3 to 6 months. The most demanding service time was from 18∶00 to 20∶00. In terms of service frequency, the telephone follow-up was once a week or once every two weeks; the home follow-up was once every 2 weeks; and the outpatient follow-up was once every 2 weeks or once a month.Conclusions:Clinical medical staff should explore more optimized continuous nursing service plans and promote the establishment of a high-quality and efficient continuous nursing service system based on the main needs of patients with permanent colostomy for continuous nursing services.

Objective:To investigate the efficacy of 99Tc m-pyrophosphate (PYP) SPECT imaging for the differential diagnosis of transthyretin-related cardiac amyloidosis (ATTR-CA) and hypertrophic cardiomyopathy (HCM). Methods:Data of patients who were definitively diagnosed with ATTR-CA (35 patients (28 males, 7 females); age 62.5(58.6, 64.3) years) or HCM (14 patients (13 males, 1 female); age 60.5(57.3, 68.7) years) by extracardiac biopsy and echocardiography in the Second Xiangya Hospital of Central South University between June 2020 and March 2023 were retrospectively analyzed. All patients underwent planar and SPECT imaging 1 h after injection of 370-720 MBq 99Tc m-PYP. Visual scoring was performed (0-1 was negative, 2-3 was positive), and heart-to-contralateral lung uptake ratio (H/CL) was calculated based on planar images. The χ2 test was used to compare the difference in visual scores between ATTR-CA and HCM groups, and the diagnostic efficacy of the visual score was calculated. The H/CL differences between ATTR and HCM groups were compared with Mann-Whitney U test, and the ROC curve was used to analyze the efficacy of H/CL for the differential diagnosis of ATTR-CA and HCM. Results:There were 34 patients with visual scores≥2 and 1 patient with visual score<2 in the ATTR-CA group, 6 patients with visual scores =2 and 8 patients with visual scores <2 in HCM group, and there were significant differences between the 2 groups ( χ2=16.20, P<0.001). The diagnostic sensitivity of the visual score was 97.1%(34/35), and the specificity was 8/14. The H/CL in the ATTR-CA group was significantly higher than that in the HCM group (2.08(1.97, 2.20) vs 1.26 (1.17, 1.35), z=-5.09, P<0.001). The ROC curve analysis suggested that the optimal cut-off value was 1.45 (AUC: 0.980, 95% CI: 0.946-1.000; P<0.001); the sensitivity of H/CL differential diagnosis between HCM and ATTR-CA was 97.1%(34/35), and the specificity was 14/14. Conclusion:99Tc m-PYP SPECT imaging is useful in differentiation of ATTR-CA and HCM, and the optimal cut-off value of H/CL for differential diagnosis of these 2 diseases is 1.45.

ObjectiveTo compare the differences in clinical characteristics between kidney deficiency and stasis obstruction syndrome and damp-heat stasis obstruction syndrome in patients with ankylosing spondylitis （AS）， thereby providing reference for clinical differentiation and treatment. MethodsThe clinical data of 2339 patients with AS were collected， including 1075 cases of kidney deficiency and stasis obstruction syndrome and 1264 cases of damp-heat stasis obstruction syndrome. The basic information including age， gender， course of disease， history of ophthalmia， family history and human leukocyte antigen B27 （HLA-B27） positive history， Bath ankylosing spondylitis disease activity index （BASDAI） score， Bath ankylosing spondylitis functional index （BASFI） score， Bath ankylosing spondylitis measurement index （BASMI） score， Depression Anxiety Stress Scale 21 （DASS-21） score， single symptom score in terms of spinal pain， peripheral joint pain， tendon tenderness， morning stiffness degree and morning stiffness time， patient-reported outcomes including patient global assessment （PGA） score， chronic disease therapy function-fatigue scale （FACIT-F） score and night pain visual analog scale （VAS） score， laboratory indicators including serum C-reactive protein （CRP） and erythrocyte sedimentation rate （ESR）， and CT grading of sacroiliitis were measured and compared between groups. ResultsPatients with kidney deficiency and stasis obstruction syndrome were older and had a longer course of disease （P＜0.01）. The BASDAI， BASFI and BASMI scores of the patients with kidney deficiency and stasis obstruction syndrome were 3.84±1.79， 2.78±2.00 and 3.42±2.36， respectively， while those in patients with damp-heat stasis obstruction syndrome were 4.30±1.99， 3.43±2.12， and 2.92±1.76. The BASDAI score， BASFI score， PGA score， FACIT-F score， spinal pain score， peripheral arthralgia score， tendon tenderness score， morning stiffness degree score， depression score， anxiety score， and stress score in patients with damp-heat stasis obstruction syndrome were all higher than those with kidney deficiency and stasis obstruction syndrome， with longer duration of morning stiffness and higher CRP （P＜0.05 or P＜0.01）. BASMI score and night pain VAS score were more higher in patients with kidney deficiency and stasis obstruction syndrome （P＜0.01）. There was no significant difference in the ESR level and CT grading of the sacroiliac joint between the two groups （P＞0.05）. ConclusionAS patients with kidney deficiency and stasis obstruction syndrome have poorer spinal mobility， while those with damp-heat stasis obstruction syndrome have higher disease activity， poorer physical function， and are more prone to adverse psychological reactions.

Objective To investigate the spatiotemporal distribution characteristics and potential influencing factors of newly diagnosed echinococcosis cases in Qinghai Province from 2016 to 2022, so as to provide insights into the formulation of the echinococcosis control strategy in Qinghai Province. Methods The number of individuals screened for echinococcosis, number of newly diagnosed echinococcosis cases, number of registered dogs and number of stray dogs were captured from the annual reports of echinococcosis control program in Qinghai Province from 2016 to 2022, and the detection of newly diagnosed echinococcosis cases was calculated. The number of populations, precipitation, temperature, wind speed, sunshine hours, average altitude, number of year-end cattle stock, number of year-end sheep stock, gross domestic product (GDP) per capita, and number of village health centers in each county (district) of Qinghai Province were captured from the Qinghai Provincial Statistical Yearbook, and county-level electronic maps in Qinghai Province were downloaded from the National Platform for Common Geospatial Information Services. The software ArcGIS 10.8 was used to map the distribution of newly diagnosed echinococcosis cases in Qinghai Province, and the spatial autocorrelation analysis of newly diagnosed echinococcosis cases was performed. In addition, the spacetime scan analyses of number of individuals screened for echinococcosis, number of newly diagnosed echinococcosis cases and geographical coordinates in Qinghai Province were performed with the software SaTScan 10.1.2, and the spatial stratified heterogeneity of the detection of newly diagnosed echinococcosis cases was investigated with the software GeoDetector. Results A total of 6 569 426 residents were screened for echinococcosis in Qinghai Province from 2016 to 2022, and 5 924 newly diagnosed echinococcosis cases were found. The detection of newly diagnosed echinococcosis cases appeared a tendency towards a decline over years from 2016 to 2022 (χ² = 11.107, P < 0.01), with the highest detection in Guoluo Tibetan Autonomous Prefecture in 2017 (82.12/10⁵). There were spatial clusters in the detection of newly diagnosed echinococcosis cases in Qinghai Province from 2016 to 2018 (Moran’s I = 0.34 to 0.65, all Z values > 1.96, all P values < 0.05), and the distribution of newly diagnosed echinococcosis cases appeared random distribution from 2019 to 2022 (Moran’s I = −0.09 to 0.04, all Z values < 1.96, all P values > 0.05). Local spatial autocorrelation analysis showed high-high clusters and low-low clusters in the detection of new diagnosed echinococcosis cases in Qinghai Province from 2016 to 2022, and space-time scan analysis showed that the first most likely cluster areas of newly diagnosed echinococcosis cases in Qinghai Province from 2016 to 2022 were mainly distributed in Yushu Tibetan Autonomous Prefecture and Guoluo Tibetan Autonomous Prefecture. GeoDetector-based analysis of the driving factors for the spatial stratified heterogeneity of detection of newly diagnosed echinococcosis cases in Qinghai Province showed that average altitude, number of village health centers, number of cattle and sheep stock, GDP per capita, annual average sunshine hours, and annual average temperature had a strong explanatory power for the spatial distribution of newly diagnosed echinococcosis cases, with q values of 0.630, 0.610, 0.600, 0.590, 0.588, 0.537 and 0.526, respectively. Conclusions The detection of newly diagnosed echinococcosis cases appeared a tendency towards a decline in Qinghai Province over years from 2016 to 2022, showing spatial clustering. Targeted control measures are required in cluster areas of newly diagnosed echinococcosis cases for further control of the disease.