Objective To describe the status quo of readiness for hospital discharge of liver cancer patients accepted transcatheter arterial chemoembolization(TACE)treatment and to explore its influencing factors. Methods A cross-sectional survey was conducted. A self-designed general information questionnaire and the Readiness for Hospital Discharge Scale were delivered to 113 liver cancer patients accepted TACE from the Second Hospital of Dalian Medical University. Results The score of readiness for hospital discharge of liver cancer patients accepted TACE treatment was(171.73±14.71)points,and each item was divided into (7.81±0.67) points. Multiple linear regression analysis showed that age and education level were important factors influencing the degree of readiness for hospital discharge(t=-5.591,5.982,P<0.05). Conclusions The level of readiness for hospital discharge of liver cancer patients accepted TACE treatment is relatively satisfactory. Medical staff should provide targeted health education and intervention measures to improve their discharge readiness and ensure their safety after discharge.

Objective:To use the methods of Health Care Failure Mode and Effects Analysis to reduce the paediatric wards noise pollution, Ensure the physical and mental health of medical staff and children, and maintain a good medical environment.Methods:The sampling method is adopted, noise investigation questionnaire was used in our study and we use the noise instrument to monitor the sound, and the focus source, the key time period and the key section of the room noise are obtained, then the HFMEA is carried out, we listed the work flow of the pediatric ward, and the flow is analyzed and discussed, calculate the Risk Priority Number (RPN). Then, some improvement measures were carried out aimed at the failure mode ,the noise survey questionnaire were used for evaluation.Results:After the implemented the HFMEA , The RPN value was significantly decreased ( P < 0.05). the degree of noise interference of children and their families decreased from 38 to 29, the difference was statistically significant ( χ2 value was 21.82, P<0.05) , and the satisfaction with control noise was improved from 18 to 30, the difference was statistically significant ( χ2 value was 36.28, P<0.05) .The intensity of noise key areas, The intensity of noise source and intensity in each period of the day were significantly improved and the difference was statistically significant ( P < 0.05), and the critical value was significantly decreased. Conclusion:Applying HFMEA can reduce ward noise pollution, improve patient satisfaction, ensure the physical and mental health of medical staff and children, and create a good medical environment.

Objective:To construct the selection index system of clinical nursing teachers, and to provide theoretical basis for improving the comprehensive quality of clinical teachers and the comprehensive clinical practice ability of undergraduate nursing students.Methods:Using the methods of literature review, brainstorming and semi-structured interview, the selection index system of clinical nursing teachers was initially constructed. Delphi method was used to conduct two rounds of consultation on 25 experts. SPSS 20.0 was used to analyze the consulting data and calculate the experts' positive coefficient, authority coefficient, degree of concentration of opinions and degree of coordination, and the index contents were modified and improved according to the expert opinions. Finally, the selection index system of clinical nursing teachers was established.Results:Based on the two rounds of expert consultation, the positive coefficient of experts was 96%, the authoritative coefficient of experts was 0.857 and 0.848 respectively, and the coordination coefficient of experts was 0.277~0.442 ( P<0.001). Four first level indexes, 12 second level indexes and 45 third level indexes were determined. Conclusion:The selection index system of clinical nursing teachers is scientific and reliable, which can provide a theoretical basis for the selection of clinical nursing teachers.

Objective To evaluate the value of 3T magnetic resonance imaging (MRI) in the preoperative T staging of potentially resectable esophageal cancer(EC), compared with endoscopic ultrasonography (EUS). Methods Patients with resectable EC pathologically confirmed by biopsy from March 2015 to September 2016 were prospectively enrolled. All patients underwent MRI (including T2-TSE-BLADE,DWI and radial-VIBE)and EUS one week after the biopsy,and MRI were performed prior to EUS, both MRI and EUS were acquired within one week before surgery. Two readers with more than 5 years experiences in the MRI diagnosis evaluated the MR image quality using a 5-point score independently. T staging was assigned on MRI and EUS by the two MRI readers using double-blind method and one endoscopist in accordance with the 7th edition of AJCC TNM Classification for EC, and any disagreement between two MRI readers was resolved by consensus with discussion to the third senior MRI doctor. The inter-observer agreement between two MRI readers were calculated using Kappa test for image quality scores and T staging results. Considering postoperative pathological T staging results as the gold standard, the performances of MRI and EUS were evaluated based on the accuracy rate and analyzed by χ2 test. Results A total of 70 patients were enrolled in the study, the good image quality cases (≥ 3 scores) were 66 in reader 1 and 68 in reader 2. The inter-observer agreement of the image quality scores by two readers was excellent (Kappa=0.824, P<0.05). The pathological results revealed 16 cases of T1 stage, 18 cases of T2 stage, 30 cases of T3 stage, and 6 cases of T4a stage. The inter-observer agreement of the preoperative T staging of EC by two readers was excellent (Kappa=0.809, P<0.05). The accuracy rates of MRI and EUS for preoperative T staging of EC were 92.9% (65/70) and 67.1% (47/70), respectively, and the difference in accuracy rates of two techniques was statistically significant (χ2=14.5, P<0.05). Conclusions The accuracy rate of MRI for preoperative T staging of EC is significantly higher than that of EUS. MRI can be used as a noninvasive method for preoperative T staging of EC.

Objective: To discuss the application effect of Nursing-Mini-Clinical Evaluation Exercise (Nursing-Mini-CEX) based on the theory of extended skill circle to construct and implemented the clinical practice teaching scheme. Methods: Applied convenient sampling in a hospital in Dalian and taked 42 grade 2012 undergraduates as control group, which will be given Nursing-Mini-CEX teaching model. 47 students of grade 2013 undergraduates as observation group, given on the Nursing-Mini-CEX teaching model based on extended skill circle theory, At the end of the clinical practice, we used the Nursing-Mini-CEX tools and the Teaching ability of Clinical Teaching Teachers questionnaire and the satisfaction scale of Nursing students' practice to evaluate the effect of the Nursing-Mini-CEX teaching model based on extended skill circle theory. Results: The score of control group in Special care, nursing examination, nursing diagnosis, humanistic care, organizational effectiveness and overall evaluation were (6.26±1.01) 、(6.40±1.00) 、(6.37±1.11) 、(6.77±1.03) 、(6.37±1.17) 、(7.06±1.11) 、(6.89±1.11) , The experimental group students′ performance was higher than the control group in the Special care, nursing examination, nursing diagnosis, humanistic care, organizational effectiveness and overall evaluation, The scores were(7.10±1.14), (6.90±0.81), (7.19±0.86), (7.12±0.97), (7.43±0.91), (7.43±0.91), (7.43±0.80), with significant differences (t=1.523~3.640, P˂0.05) . The scores of clinical teachers′ teaching ability were higher than that of the control group (80.27 ± 13.90) ,the score was (86.68 ± 12.21) , With significant differences (t=3.83,P˂0.05) ,and the satisfaction degree of the experimental group was higher than that of the control group, With significant differences (t=0.827,P˂0.05) . Conclusion Nursing-Mini-CEX teaching model based on extended skill circle theory made the clinical teaching more systematic and standardized. It can improve clinical teaching quality and the nursing students′ clinical ablity, and it is well worth to apply in clinical.

Objective To monitor the antifungal resistance of clinical isolates of Candida spp.in the East China region.Methods MALDI-TOF MS or molecular methods were used to re-identify the strains collected from January 2018 to December 2022.Antifungal susceptibility testing was performed using the broth microdilution method.The susceptibility test results were interpreted according to the breakpoints of 2022 Clinical and Laboratory Standards Institute(CLSI)documents M27 M44s-Ed3 and M57s-Ed4.Results A total of 3 026 strains of Candida were collected,65.33％of which were isolated from sterile body sites,mainly from blood(38.86％)and pleural effusion/ascites(10.21％).The predominant species of Candida were Candida albicans(44.51％),followed by Candida parapsilosis complex(19.46％),Candida tropicalis(13.98％),Candida glabrata(10.34％),and other Candida species(0.79％).Candida albicans showed overall high susceptibility rates to the 10 antifungal drugs tested(the lowest rate being 93.62％).Only 2.97％of the strains showed dose-dependent susceptibility(SDD)to fluconazole.Candida parapsilosis complex had a SDD rate of 2.61％and a resistance rate of 9.42％to fluconazole,and susceptibility rates above 90％to other drugs.Candida glabrata had a SDD rate of 92.01％and a resistance rate of 7.99％to fluconazole,resistance rates of 32.27％and 48.24％to posaconazole and voriconazole non-wild-type strains(NWT),respectively,and susceptibility rates above 90％to other drugs.Candida tropicalis had resistance rates of 29.55％and 26.24％to fluconazole and voriconazole,respectively,resistance rates of 76.60％and 21.99％to posaconazole and echinocandins non-wild-type strains(NWT),and a resistance rate of 2.36％to echinocandins.Conclusions The prevalence and species distribution of Candida spp.in the East China region are consistent with previous domestic and international reports.Candida glabrata exhibits certain degree of resistance to fluconazole,while Candida tropicalis demonstrates higher resistance to triazole drugs.Additionally,echinocandins resistance has emerged in Candida albicans,Candida glabrata,Candida tropicalis,and Candida parapsilosis.