Objective To investigate the clinical features in children with invasive pneumococcal disease (IPD) and early warning indicators of severe case.Methods The case data of 101 children inpatients with IPD isolated Streptococcus pneumoniae (Sp) at least once blood culture in this hospital from January 2007 to De-cember 2021 were collected retrospectively.The children patients were divided into the pediatric intensive care unit (PICU) group (35 cases) and general ward group (66 cases) according to whether or not entering PICU during hospitalization.The general clinical data,infection types and results of drug sensitivity test and bacteri-al strain serotype identification were compared between the two groups and analyzed.Results Compared with the general ward group,the male proportion,proportions of complicating nervous system disease and iron-defi-ciency anemia,winter incidence rate,disturbance of consciousness,convulsion,dyspnea,heart rate increase,oc-currence rate of vomiting and diarrhea,proportion of peripheral blood neutrophilic granulocytes,C reactive protein (CRP),lactic dehydrogenase (LDH) level,Hb<90 g/L,LDH>700 U/L,creatine kinase isoenzyme-MB (CK-MB) abnomality,proportions of bacterial meningitis,sepsis and severe pneumonia in the PICU group were higher,the proportion of 3-97 percentile of body weight,bronchopneumonia and no-focus blood stream infection were lower,WBC,Hb and albumin level were lower,and the differences were statistically significant (P<0.05).Eleven kinds of serotypes were identified in this study,ranking the top five in order were 6B,14,19F,23F and 19A.Pneumococcal 13-valent conjugate vaccine (PCV13) could cover 96.9％ of the IPD sero-types.The multivariate logistic regression analysis showed that consciousness disturbance,convulsion,per-centage of neutrophils increase,Hb<90 g/L,LDH>700 U/L and CK-MB abnormality indicated the condition of IPD children patients was critical,which was the early-warning indicator of entering PICU (P<0.05).Con-clusion Severe IPD lacks the early specific early-warning indicator,and the cover rate of PCV13 is high.

Objective:To conduct visual analysis of neonatal hospice care based on Web of Science database and explore the research hotspots and frontiers, so as to provide reference for the development of neonatal hospice care in China.Methods:The literatures related to neonatal hospice care included in the core collection of Web of Science from 1991 to 2023 were retrieved and screened. CiteSpace 6.1.R6 was used for visual analysis from the aspects of author, country/region, institution, journal co-citation frequency, keyword knowledge map and so on.Results:A total of 1 452 articles were included, and the number of articles was on the rise. The United States, the United Kingdom and Canada occupied the core position of neonatal hospice care related research. Research hotspots included hospice care for different stages and types of diseases, key links in neonatal intensive care unit hospice care, innovation in neonatal hospice care service models, the needs and psychological support strategies of family members and medical staff. The forefront of research focused on the role and challenges of healthcare professionals in hospice care, disease diagnosis and ethical dilemmas related to decision-making.Conclusions:China can learn from international research hotspots and frontiers to explore the applicability of different hospice service models, enrich research types, strengthen guidance at the level of laws and policies, improve education and training systems and build a neonatal hospice service system that conforms to national conditions and culture in China.

Objective:To understand the cognition and attitude of medical staff towards medical ethics review, analyze possible influencing factors, to put forward relevant suggestions for strengthening ethical management in the future.Methods:From November 2021 to May 2022, a self-designed questionnaire and general data questionnaire on the cognition and attitude of medical staff to ethical issues in clinical research were used to investigate 408 medical staff from two first-class ternary hospitals in Hunan Province, data was analyzed to explore the respondents′ cognition and attitude, as well as related influence factors.Results:The average cognitive score of medical staff was 65.41, and the average attitude score was 91.83. Many possible influence actors regarding the cognition were identified, including degree, technical title, professional field, number of clinical research projects engaged as investigators, number of clinical research projects conducted as principle investigators, whether the hospital has established an ethics committee, and research ethics training experiences. While the influence factors of attitude were experiences of conducting and engaging in clinical research, the construction of hospital ethics committee and research ethics trainings.Conclusions:Medical staffs have the willingness to explore more research ethics knowledge, while their cognition of research ethics should be improved. Root-cause analysis should be conducted to identify influencing factors for improvement. The research management department should strengthen the publicity and training of clinical research ethics of medical staff, to improve their clinical research ethics knowledge literacy, and ensure the well-functioning of clinical research ethics review.

Objective:To explore the impact of sleep quality on depression symptoms in perimenopausal women in urban communities.Methods:Using the convenient sampling method, a total of 2 300 perimenopausal women were selected as the research subjects from communities in four cities of Ya'an, Chengdu, Leshan and Deyang in Sichuan Province in March 2019. General Information Questionnaire, Patients Health Questionnaire-9 Items (PHQ-9) and Pittsburgh Sleep Quality Index (PSQI) were used to investigate the perimenopausal women. A total of 2 300 questionnaires were sent out in this study, and 2 300 were effectively received, with the effective recovery of 100% (2 300/2 300) .Results:The detection rate of depressive symptoms in perimenopausal women was 12.5% (288/2 300). The dominance analysis showed that sleep quality was the most important factor affecting depressive symptoms, followed by life events, marital status, chronic illness, per capita monthly household income and education level.Conclusions:Sleep quality is the most important factor affecting the depressive symptoms of perimenopausal women. It should be emphasized to improve the level of depression in perimenopausal women.

Cancer is the leading cause of death in children. With the development of family participatory care, it has become a trend to use home chemotherapy for children with cancer in stable stages. Therefore, this article introduces the current situation of home chemotherapy medication safety, elaborates on the influencing factors of family chemotherapy medication safety for cancer children from two aspects including oral chemotherapy and intravenous chemotherapy, and proposes intervention measures to optimize the family chemotherapy medication process for cancer children, improve their home chemotherapy medication ability and effectively ensure the medication safety of cancer children.

Objective:To deeply understand the real emotional experience and needs of the parents of dying newborns, so as to provide a reference for future neonatal palliative care.Methods:From February to October 2021, purposeful sampling was used to select 15 parents of dying newborns in the Department of Neonatology of Hunan Children's Hospital as the research object. A qualitative research design was conducted, and the semi-structured interview method was used to conduct in-depth interviews with the research subjects, and NVivo 10.0 software was used for data analysis.Results:A total of 3 themes were extracted, namely, the ambivalence when giving up treatment, negative life effects after giving up, needs and expectations.Conclusions:Parents of dying newborns generally have ambivalence when they give up treatment. After giving up, they will show emotions such as sadness and helplessness, self-blame and regret, and depression. Understanding the real emotions and inner needs of the parents of dying newborns helps medical and nursing staff to pay attention to parents' negative psychology and understand their needs, and provide parents with targeted psychological support and other care, so as to help the parents of dying newborns and their families through a special period.

Objective:To construct the evaluation index system of pediatric specialized nurses' core competence, so as to provide a basis for accurate measurement of pediatric specialized nurses' core competence.Methods:A research group was established in August 2021. Based on the quality onion model and literature analysis, a qualitative interview was conducted in September 2021 with 10 provincial and above hospitals pediatric specialist nurses, 5 pediatric nursing managers, 5 pediatric chief physicians and 5 primary caregivers for children selected by objective sampling. From September 2021 to February 2022, questionnaires were sent to 16 experts via email or WeChat for three rounds of Delphi expert consultation. The evaluation indexes of pediatric specialized nurses' core competence were determined according to the authority coefficient, Kendall coordination coefficient, coefficient of variation and other factors.Results:Among three rounds of expert consultation, the effective recovery rates of the questionnaire were all 100.00% (16/16) , and the authority coefficients were 0.813, 0.888 and 0.895, respectively, and the Kendall coordination coefficients were 0.175 (χ 2=289.348, P<0.01) , 0.239 (χ 2=408.131, P<0.01) and 0.288 (χ 2=467.280, P<0.01) , respectively. The final evaluation index system of pediatric specialized nurses' core competence included 6 first level indicators, 18 second level indicators and 84 third level indicators. Conclusions:The evaluation index system of pediatric specialized nurses' core competence is scientific and reliable, which can be used as an effective tool to measure the core competence of pediatric specialized nurses.

Objective To investigate the expression of Rab11 in children with sepsis at different sta-ges and severe sepsis and its relationship with the occurrence and development of sepsis in children. Methods A prospective control study was performed. All cases were enrolled from Bao′an Maternal and Children Health Care Hospital, and they were divided into sepsis group(40 cases) who were diagnosed as sepsis, severe sepsis group(20 cases) with diagnosis of severe sepsis,and healthy control group(40 healthy chil-dren) . Venous blood samples were collected at admission,and the expression level of blood leukocyte Rab11 was determined by Western blot. In the sepsis group,the expression levels of Rab11 were evaluated at the initial,the extreme and the recovery stages of sepsis,and were compared with those in severe sepsis group and healthy control group, respectively. Spearman correlation analysis was used to evaluate the relationship between the expressions of Rab11 and the levels of some parameters in blood,including white blood cell,neu-trophils,lymphocytes,monocytes,eosinophilic granulocyte,C-reactive protein and procalcitonin in blood,at the extreme stage. Meanwhile,the levels of Rab11 at extreme stage of sepsis,caused by different diseases, such as severe pneumonia,bronchiectasis complicated pulmonary infection,biliary tract infection,urinary tract infection, necrotizing enterocolitis and severe enteric viruses infection, were compared with each other. Results At the initial and the extreme stages of sepsis, as well as in severe sepsis group,the levels of Rab11 were significantly lower than that in the healthy control group(0. 54 times,0. 23 times and 0. 07 times, P<0. 05,respectively). There were no significant differences in the expression levels of Rab11 at the recovery stages of sepsis compared with that in the healthy control group(P>0. 05). There was no relation-ship between the level of Rab11 and the number of white blood cell, neutrophils, lymphocytes, monocytes, eosinophilic granulocyte, while the level of Rab11 was negatively correlated with C-reactive protein ( r =-0. 58,P=0. 014) and procalcitonin(r= -0. 63,P=0. 003) at the extreme stage of sepsis. There was no significant difference in the expression level of Rab11,at the extreme stage of sepsis,among those patients with severe pneumonia,bronchiectasis and pulmonary infection,biliary tract infection,urinary tract infection, necrotizing enterocolitis and severe enterovirus infection(P>0. 05). Conclusion The level of Rab11 is differently expressed at different stages of sepsis,and could be used as a predictor of the severity of sepsis in children.

Objective To observe and evaluate the clinical efficacy and safety of Xiaoerzhili syrup in attention deficit/hyperactivity disorder(ADHD) in children.Methods This study was performed by a multicenter self-controlled clinical observation trial.A total of 1 833 children with ADHD selected from 18 clinical centers from June 2013 to December 2015 were treated by Xiaoerzhili syrup for 6 months,and the clinical efficacy and safety were evaluated.Chinese Version of ADHD Rating Scale-Ⅳ-Parent(ADHDRS-Ⅳ-P) and Clinical Global Impression (CGI) were used to evaluate the clinical efficacy,and the registration form of side reaction and the questionnaire of drug safety grade were used to assess the safety.Results Compared with the scores before treatment,the total scores of ADHDRS-Ⅳ-P,attention deficit subscale scores and hyperactivity impulsivity subscale scores decreased with statistically significant differences after treatment with Xiaoerzhili syrup in the total ADHD group,male ADHD group,female ADHD group,mild ADHD group,moderate ADHD group and severe ADHD group(all P ＜0.01).The statistically significant differences in the total scores of ADHDRS-Ⅳ-P,attention deficit subscale score and hyperactivity impulsivity subscale scores were not found in different gender before and after treatment (all P ＞ 0.05).According to the results of CGI-Ⅰ,the proportion of "improved obviously" and above were 80.98％ (1 379 cases),79.95％ (1 089 cases) and 85.05％ (290 cases),in the total poptlation group,male group and female group,respectively.The side effects of drugs were found in six male cases.After treatment,safety problems were not found in the analysis of the safety evaluation.Conclusion Xiaoerzhili syrup treatment is effective in children with ADHD treatment,and security problems are not found.

Objective To optimize the treatment process of patients in Ophthalmology Outpatient, so as to enhance patient′s satisfaction and quality of care service. Methods The nurse manager of Department of Ophthalmology experienced treatment process in other hospital with team and summarized the feeling of other hospital′s treatment process, and improve the treatment process according to the existed problems including reconstruction of Outpatient work process, the implementation of registration system in Outpatient, building up Office of Returning Visit, doing extended nursing, developing “I am patient” activity, training communication ability and skills for constructing doctor-patient relationship, strengthening health education and other nursing services. Results 2014 and 2015 in Ophthalmology Outpatient of our hospital, the patients′ waiting time for treatment became short after carrying out the experience of nurses′transposition experience ( P<0.05) , and the patients′satisfaction were significantly improved after exchanging ( P<0. 05 ) , as well as the reduction of effective complaint rate (P<0.05).Conclusions To optimize the treatment process of patients in Department of Ophthalmology can shorten the time of treatment waiting time, improve the satisfaction of outpatients, so as to improve the quality of nursing service.