The Occupational Classification Dictionary of the People's Republic of China (2015 Edition) has added a new occupation type, Medical Nursing Assistants, aiming to meet the strong demand for medical care in the context of the aging population in China.In order to standardize the services of medical nursing assistants for the elderly in home and community settings and contribute to healthy aging, the National Health Commission issued the " Service Standards for Medical Nursing Assistants of Older Adults in Home and Community" ( WS/ T 803—2022) on September 28, 2022.The standards regulate the service processes, service items and requirements, as well as service evaluation and improvement for elderly medical nursing assistants.The interpretation of the standard's formulation background, the compilation process, and the standard's content are as follows.

The Occupational Classification Dictionary of the People's Republic of China (2015 Edition) has added a new occupation type, Medical Nursing Assistants, aiming to meet the strong demand for medical care in the context of the aging population in China.In order to standardize the services of medical nursing assistants for the elderly in home and community settings and contribute to healthy aging, the National Health Commission issued the " Service Standards for Medical Nursing Assistants of Older Adults in Home and Community" ( WS/ T 803—2022) on September 28, 2022.The standards regulate the service processes, service items and requirements, as well as service evaluation and improvement for elderly medical nursing assistants.The interpretation of the standard's formulation background, the compilation process, and the standard's content are as follows.

【Objective】 To evaluate the predictive value of isoform [-2] proprostate-specific antigen, p2 PSA (p2PSA) and its derived indexes for prostate cancer in a Chinese cohort with PSA 4-20 ng/mL. 【Methods】 A total of 139 males scheduled for biopsy were enrolled in the prospective study from Nov.2021 to Jun.2022. The total PSA (tPSA), free PSA (fPSA), fPSA/tPSA (f/t) and p2PSA were collected, and the percentage of p2PSA(%p2PSA) and prostate health index(PHI) were calculated. The predictive value of p2PSA and its derived indexes were compared with traditional indexes with receiver operating characteristic (ROC) curve and Logistic analysis. 【Results】 Prostate cancer was found in 54 cases (38.8%). There were significant statistical differences in tPSA(10.68 vs.8.14, P=0.021), f/t(0.13 vs.0.16, P=0.006), p2PSA(30.25 vs.19.81, P<0.001), %p2PSA(21.52 vs.13.15, P<0.001) and PHI(64.3vs.38.2, P<0.001) between prostate cancer patients and non-prostate cancer patients. The area under the ROC curve (AUC) of tPSA, fPSA, %fPSA, p2PSA, %p2PSA and PHI were 0.63, 0.51, 0.63, 0.71, 0.73, and 0.80, respectively. The inclusion of %p2PSA and PHI significantly increased the prediction efficiency of the basic prediction model (AUCbase+PHI=0.81, AUCbase+%p2PSA=0.78, AUCbase=0.67). With 35 as the recommended cut-off value of PHI, the incidence of meaningless puncture was reduced by 25.8%(36/139). 【Conclusion】 The application of p2PSA and its derived indexes have good predictive value for patients with PSA 4-20 ng/mL. The combined detection of %p2PSA and PHI can significantly increase the detection efficiency of prostate cancer and reduce the incidence of meaningless prostate puncture by 25.8%.

Objective:To investigate the current situation of psychological distress in patients after pulmonary nodule surgery and to explore the effect path of perceived stress and nurses' caring ability on psychological distress.Method:From October 2019 to May 2021, a total of 415 patients with pulmonary nodules after surgery in the First Medical Center of Chinese PLA General Hospital were selected as the investigation objects by the convenient sampling method. The Psychological Distress Thermometer, Caring Ability Scale, Perceived Stress Scale and General Information Questionnaire were used for investigation and analysis. Structural equation model was used to analyze the effect of perceived stress on psychological distress. A total of 415 paper questionnaires were distributed and 411 valid questionnaires were recovered, with an effective recovery rate of 99.04%.Results:The psychological distress score of 411 patients with pulmonary nodules after operation was (4.82±1.42) , and 179 patients (43.55%) had a score greater than or equal to 4. There were statistically significant differences in the psychological distress scores of inpatients with different marriage, pulmonary nodule types, fear of cancer, emotional self-regulation ability, e-health literacy and disease awareness after pulmonary nodule surgery ( P<0.01) . Psychological distress was negatively correlated with nurses' caring ability ( r=-0.626, P<0.01) , and positively correlated with perceived stress ( r=0.596, P<0.01) . The mediating effect value of nurse' caring ability between sense of loss of control and psychological pain was 0.132, accounting for 32.84% (0.132/0.402) of the total effect. Conclusions:The psychological pain of patients after pulmonary nodule surgery is closely related to perceived pressure and nurses' caring ability. The nurses' caring ability has a partial mediating effect between the sense of loss of control and psychological pain. Improving nurses' caring ability can reduce the psychological distress of patients after pulmonary nodule surgery.

Objective:To explore the influencing factors of accidental falls outside the hospital in elderly patients with accidental injury in the Emergency Department, so as to provide a basis for preventing accidental injuries.Methods:Convenience sampling was used to select 210 emergency elderly patients who visited the hospital due to accidental injuries from November 2017 to May 2020 in the Second Medical Center, People's Liberation Army General Hospital as the research object. Patients were investigated with the self-designed Out-of-hospital Accidental Injury Consultation Questionnaire. Single factor analysis and binomial Logistic regression were used to analyze the influencing factors of falls in elderly patients. A total of 210 questionnaires were distributed in this survey, and 180 valid questionnaires were returned with the valid response rate of 85.71%.Results:A total of 147 falls occurred among 180 elderly patients in the Emergency Department, and the incidence of falls was 81.7%. Binomial Logistic regression analysis showed that old age, outdoor, chronic diseases and no use of walking aids were independent risk factors for falls ( P<0.05) . Conclusions:The main types of accidental injuries in elderly patients are falls. Strengthening the nursing education of fall prevention measures, improving compliance with medications, choosing suitable walking aids or trying other new fall prevention technologies, and establishing a multi-party participation model can effectively prevent and reduce the occurrence of falls in elderly patients.

Objective:To explore the reference interval of urinary iodine concentration(UIC)/urinary creatinine(UCr) ratio evaluating the iodine nutritional status in early pregnancy women.Methods:A reference interval of UIC/UCr ratio was determined among 5 609 early pregnant women with normal thyroid function, negative thyroid autoantibodies, and no history of diseases or taking drug that may affect thyroid function. Then we verified the reliability of this reference interval in a group of 7 514 women in early pregnancy.Results:We determined the UIC/UCr ratio of 75-149 μg/g as the reference interval. In the reference interval, thyroglobulin antibody(TgAb), thyroid peroxidase antibody(TPOAb), and thyroglobulin(Tg) were all at lower levels, and the overall distributions were approximately U-shaped. The prevalence of thyroid dysfunction, the positive rates of antibodies and the proportion of Tg>40 μg/L were the lowest within the reference interval, while higher on both sides of the interval.Conclusion:The reasonable reference interval of the UIC/UCr ratio in iodine-sufficient regions is 75-149 μg/g in early pregnerty women.

Objective:To explore the suitability of mechanical insufflation-exsufflation combined with external diaphragm pacemaker in elderly patients with mechanical ventilation and its effect on the complications and prognosis of mechanical ventilation.Methods:Using the convenient sampling method, a total of 40 elderly patients undergoing mechanical ventilation through nasal tracheal intubation who were admitted to the Geriatric Ward of the PLA General Hospital from September 2018 to December 2019 were selected as the research objects. The patients were divided into the observation group and the control group by random number table method, with 20 cases in each group. The control group continued the traditional airway nursing technique and limb rehabilitation training, while the observation group added mechanical insufflation-exsufflation combined with external diaphragm pacemaker on the basis of the control group. The incidence of pulmonary infection, changes in sputum production at 1 h and 24 h, diaphragm thickening rate, weaning time, success rate of weaning and mortality rate were observed in the two groups before and after intervention.Results:After the intervention, the incidence of pulmonary infection in the observation group was lower than that of the control group, the sputum production and diaphragm thickening rate at 1 h and 24 h were higher than those in the control group, the weaning time was shorter than that of the control group, and the success rate of weaning was higher than that of the control group. All differences were statistically significant ( P<0.05) . There was no statistically significant difference in mortality rate between the two groups ( P>0.05) . Conclusions:Compared with traditional airway nursing techniques, mechanical insufflation-exsufflation combined with external diaphragm pacemaker can help elderly patients with mechanical ventilation achieve airway clearance and respiratory muscle exercise more safely and effectively, improve strength and endurance of diaphragmatic muscle and enhance the ability of spontaneous cough in elderly patients. In addition, the intervention method is mild and easy for patients to accept, and it is worthy of being widely used in elderly patients with mechanical ventilation.

Objective To investigate the pressure changes of cuff in the tapered-cuff endotracheal tubes and the frequency of cuff pressure monitoring in patient with trachea intubation. Methods From December 2016 to October 2017, 80 patients with oral tracheal intubation in the emergency department were divided into group A (n =25) and group B (n =23) according to the principle of randomized control. Group A with odd number was treated and tapered-cuff endotracheal tubes and group B with ever number and cylindrical-cuff endotracheal tubes. Continuous cuff pressure monitoring device was used to continuously monitor the cuff pressure. The two groups were compared in terms of time for keeping the normal cuff pressure and cuff pressure (average pressure, maximum pressure and minimum pressure). Results The total time for keeping the normal cuff pressure in group A was significantly shorter than that in group B (P＜0.05). The average cuff pressure in group A was smaller than that of group B (P＜0.05). The maximum pressure in group A is larger than that in group B and the maximum cuff pressure in group A was smaller than that of group B (P＜0.05). Conclusion Compared with the cylindrical cuff catheter, the tapered-cuff tube can maintain the normal pressure for a shorter period and easily produce needed pressure. It is a need to enhance the monitoring of cuff pressure to ensure good airway closure and reduce artificial airway complications.

Objective:To investigate the mastery and application of medical ethics basic knowledge in geriatric ward medical staffs,and the way which they receive relevant education. Methods:From November 2016 to January 2017,240 questionnaires about medical ethics were distributed among medical staffs in clinical department in the Chinese PLA General Hospital,among them,30 were medical groups and 210 were nursing groups;and a total of 233 valid questionnaires were collected. The nurses were divided into geriatric ward nursing group and non - geriat-ric ward nursing group,according to whether they work in the geriatric wards or not. Results:Only 2. 14％ and 7. 72％ participants fully and correctly answered the core concepts and basic principles of medical ethics,respec-tively. The rate of informed consent in medical staffs in geriatric group was significantly higher than that of non -geriatric group (92. 66％ vs 82. 11％ ,P = 0. 02);the patient' s privacy protection in geriatric nursing group was significantly higher than that of non - geriatric nursing group (92. 66％ vs 31. 57％ ,P < 0. 001). 28. 75％ of the respondents received medical ethics continuing education curriculum,and the proportion of correctly receiving ex-pectable death in these medical staffs (71. 40％ ) was significantly higher than that of other education pathway groups (36. 17％ ). Conclusion:Medical staffs lack more knowledge on medical ethics. Clinical work in geriatric medicine has higher demand for medical ethics knowledge,and continuing medical education can help to improve the cognitive level of medical ethics in medical staffs.

To investigate the accuracy and feasibility of Brix value on monitoring gastric residual volume (GRV) in patients with enteral nutrition. Fifty patients with enteral nutrition via nasogastric tube were enrolled. The GRV was measured by both ultrasonography and Brix value. The results were compared according to the methods. The Pearson correlation coefficients showed that GRV measured by these two ways was positively correlated (r=0.986, P<0.05). Moreover paired sample t-test showed that the discrepancy was not statistically significant (P>0.05) between different measurements. The consistency was analyzed by Bland-Altman graph, showing that the two measurements were consistent. Brix value is recommended to measure GRV due to its convenience and easy operation.