OBJECTIVE T o explore the long-term effect of multidimensional evidence-based interventions based on i-PARIHS theoretical framework on reduction of incidence of central line-associated bloodstream infections(CLABSI)in pediatric intensive care units(PICU)of pediatrics department and evaluate the impact on nurses'compliance to taking the interventions and use intensity of catheters.METHODS By means of quasi-experimental design,the multidimensional intervention system covering multidisciplinary collaboration,standardized operation procedures,information system optimization and hierarchical training was established and staged for implementa-tion of 5 years(from T0 baseline stage to T3 maintenance stage).The variations in implementation rates of cathe-ter maintenance(daily maintenance,dressings change,catheter removal)were analyzed by Chi-square test,and the change of incidence of CLABSI was monitored with the use of statistical process control U chart.RESULTS The nurses'compliance to operations was remarkably improved(P＜0.05)o The implementation rate of dressings change continuously increased from 52.91％in T0 to81.62％in T3(x2=72.444,P＜0.001),the implementa-tion rate of catheter removal increased from 48.72％to 79.31％(x2=8.179,P=0.042).The incidence rate of CLABSI decreased from 1.92％0 in 2019 to 0.5％0 in 2022,and the control chart showed that most of the months fluctuated within control limits.CONCLUSIONS The multidimensional evidence-based interventions can achieve a long term control of CLABSI by raising the nurses' compliance to operations.The information monitoring and closed-loop management are crucial to maintenance of the interventional effect,and the risk early warning system should be optimized with the combination of artificial intelligence technology.

OBJECTIVE T o explore the long-term effect of multidimensional evidence-based interventions based on i-PARIHS theoretical framework on reduction of incidence of central line-associated bloodstream infections(CLABSI)in pediatric intensive care units(PICU)of pediatrics department and evaluate the impact on nurses'compliance to taking the interventions and use intensity of catheters.METHODS By means of quasi-experimental design,the multidimensional intervention system covering multidisciplinary collaboration,standardized operation procedures,information system optimization and hierarchical training was established and staged for implementa-tion of 5 years(from T0 baseline stage to T3 maintenance stage).The variations in implementation rates of cathe-ter maintenance(daily maintenance,dressings change,catheter removal)were analyzed by Chi-square test,and the change of incidence of CLABSI was monitored with the use of statistical process control U chart.RESULTS The nurses'compliance to operations was remarkably improved(P＜0.05)o The implementation rate of dressings change continuously increased from 52.91％in T0 to81.62％in T3(x2=72.444,P＜0.001),the implementa-tion rate of catheter removal increased from 48.72％to 79.31％(x2=8.179,P=0.042).The incidence rate of CLABSI decreased from 1.92％0 in 2019 to 0.5％0 in 2022,and the control chart showed that most of the months fluctuated within control limits.CONCLUSIONS The multidimensional evidence-based interventions can achieve a long term control of CLABSI by raising the nurses' compliance to operations.The information monitoring and closed-loop management are crucial to maintenance of the interventional effect,and the risk early warning system should be optimized with the combination of artificial intelligence technology.

Purpose: This study aimed to identify the risk factors and sonographic variables that could be integrated into a predictive model for endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) in women with abnormal uterine bleeding (AUB). Materials and Methods: This retrospective study included 1837 patients who presented with AUB and underwent endometrial sampling. Multivariable logistic regression was developed based on clinical and sonographic covariates [endometrial thickness (ET), resistance index (RI) of the endometrial vasculature] assessed for their association with EC/AEH in the development group (n=1369), and a predictive nomogram was proposed. The model was validated in 468 patients. Results: Histological examination revealed 167 patients (12.2%) with EC or AEH in the development group. Using multivariable logistic regression, the following variables were incorporated in the prediction of endometrial malignancy: metabolic diseases [odds ratio (OR)=7.764, 95% confidence intervals (CI) 5.042–11.955], family history (OR=3.555, 95% CI 1.055–11.971), age ≥40 years (OR=3.195, 95% CI 1.878–5.435), RI ≤0.5 (OR=8.733, 95% CI 4.311–17.692), and ET ≥10 mm (OR=8.479, 95% CI 5.440–13.216). :A nomogram was created using these five variables with an area under the curve of 0.837 (95% CI 0.800–0.874). The calibration curve showed good agreement between the observed and predicted occurrences. For the validation group, the model provided acceptable discrimination and calibration. Conclusion The proposed nomogram model showed moderate prediction accuracy in the differentiation between benign and malignant endometrial lesions among women with AUB.

Objective:To explore the status quo of the readiness of evidence-based nursing practice for the maintenance and removal of children's central venous catheter (CVC) in 6 domestic medical institutions Pediatric Intensive Care Unit (PICU), analyze the obstacles faced by the application of CVC maintenance and removal evidence in PICU, so as to provide basis for formulating reform strategies.Methods:This study was a cross-sectional survey. In December 2019, 169 nurses from PICU of 6 medical institutions in Shanghai, Guangzhou, Shenzhen, Hangzhou, Xiamen and Hefei were selected by convenience sampling for investigation. The General Information Questionnaire and Clinic Readiness to Evidence-based Nursing Assessment (CREBNA) were used to evaluate the readiness of clinical nurses to evidence, organizational environment and promoting factors in the process of evidence-based practice. A total of 169 questionnaires were issued, and 169 valid questionnaires were recovered, with a valid recovery rate of 100%.Results:A total of 169 nurses were investigated in 6 evidence application sites. The total score of the multi center CREBNA was (136.96±15.33), which was 88.36% of the full score. The scores of the three dimensions were as follows: organizational environment (40.31±4.45), evidence dimension (53.43±6.14), and promoting factors (43.22±5.81). Four of the last five items in the score ranking were from the promoting factor, and the low score items in four places were all from the promoting factor.Conclusions:The best practice project of children's CVC maintenance in PICU is feasible. However, there are still some deficiencies in the preparation of various evidence application sites, especially in the promoting factors, which should be constantly improved to further promote and maintain the implementation of change.

This paper aims to push health scientific popular knowledge and carry out targeted patient health education for certain patients, based on the demand of health education for specific diseases and population. Taking the female climacteric health scientific popularization as an example, the authors summarized the practice of popularizing scientific education in a tertiary specialized hospital based on the cognitive level and health education needs of outpatients and the general public. A multidisciplinary health scientific popularization team was set up to communicate popular science knowledge to patients and other menopausal women in need through multi-channel and multi-platform forms. Such means include online ones, offline ones, and cooperation with various social organizations. The implementation of health scientific popularization mode meets the needs of patients and the general public. The implementation of this mode of health popularization could improve their self-health management ability and health accomplishment. It provides a good reference for public hospitals to carry out health science popularization.

Pathophysiological changes, such as the vulvovaginal atrophy, reduction in the proportion of lactobacilli, unbalance of the vaginal flora and impaired vaginal immune barrier, can result in a series of symptoms, signs and diseases affecting the health and quality of life in postmenopausal women.This article reviews the change characteristics and related mechanisms of the microbial flora in postmenopausal women in terms of the type, quantity and proportion of vaginal flora, and clarifies efficacy and its mechanisms of systemic and topical estrogen therapy on the improvement of intravaginal environment and urogenital symptoms, in order to improve the quality life in postmenopausal women.

The cause of perimenopausal depression is not clear, decrease in ovarian function and increase in hormonal fluctuations are considered to be the main causes. With the aging of the population, the incidence of perimenopausal depression increased significantly, which seriously impacts the physical and mental health of women. Screening of depression in perimenopausal women should be conducted to recognize depression in the early stage. In 2018, the North American Menopause Society (NAMS) and the National Network of Depression Centers Women and Mood Disorders Task Group (NNDC) have developed the guideline for the assessment and treatment of perimenopausal depression, which defined the diagnostic criteria for perimenopausal depression. Antidepressants is considered as first-line treatment for perimenopausal depression. However, studies have confirmed that estrogen has antidepressant effects, but there are still different opinions on the application of hormone therapy. This article reviewed this guideline and the latest literatures of the screening, diagnosis and treatment of perimenopausal depression.

The cause of perimenopausal depression is not clear, decrease in ovarian function and increase in hormonal fluctuations are considered to be the main causes. With the aging of the population, the incidence of perimenopausal depression increased significantly, which seriously impacts the physical and mental health of women. Screening of depression in perimenopausal women should be conducted to recognize depression in the early stage. In 2018, the North American Menopause Society (NAMS) and the National Network of Depression Centers Women and Mood Disorders Task Group (NNDC) have developed the guideline for the assessment and treatment of perimenopausal depression, which defined the diagnostic criteria for perimenopausal depression. Antidepressants is considered as first-line treatment for perimenopausal depression. However, studies have confirmed that estrogen has antidepressant effects, but there are still different opinions on the application of hormone therapy. This article reviewed this guideline and the latest literatures of the screening, diagnosis and treatment of perimenopausal depression.

Objective: To evaluate the effect of low-dose hormone replacement therapy（HRT）on menopausal-related symptoms in young patients with cervical squamous cell carcinoma. Methods: From March 2016 to September 2018,eighty patients aged 45 years below with cervical squamous cell carcinoma of stage Ⅰ-Ⅱ and iatrogenic menopause were recruited,who were diagnosed at Zhejiang Cancer Hospital and Women's Hospital Affiliated to Medical College of Zhejiang University. Fourty of them performed low dose HRT（1 mg estradiol valerate a day or 1.25 mg tibolone a day）,twenty performed standard dose HRT（1 mg estradiol valerate and 1.25 mg tibolone a day）,another twenty do not perform HRT as a control group. The levels of follicle stimulating hormone（FSH）,estradiol（E2）,menopausal symptoms（the improved Kupperman score）and incidence of side effects were assessed before and 1,3,6 months after the intervention. Results: There were significant differences in E2 levels,FSH levels and improved Kupperman scores among the low dose group,the standard dose group and the control group（all P<0.05）. With the extension of intervention time,E2 levels in the low dose group and the standard dose group increased first and then decreased,FSH levels and improved Kupperman scores decreased（all P<0.05）. Compared with the control group,E2 levels,FSH levels and improved Kupperman scores in the standard dose group changed more significantly（all P<0.05）. E2 and FSH levels in the low dose group changed less than that in the standard dose group（all P<0.05）,while improved Kupperman scores was close to that in the standard dose group. The incidence rate of side effects in the low dose group was 2.50%,which was lower than 20.00% in the standard dose group（P<0.05）. Conclusion For young patients with cervical squamous cell carcinoma,using low dose HRT may less affects E2 and FSH levels than using the standard dose,but could achieve similar effects in treatment of menopausal-related symptoms.

Objective To know the patients′ and their families′ satisfaction to the nursing service and nursing quality in general intensive care unit ( ICU) . Methods A self-designed questionnaire was used in this study which contains two parts: the basic information of patients, and the satisfaction to 20 items during ICU. 374 patients and their families in general ICU of our hospital from April to December 2015 received follow-up investigation. The SPSS17.0 software was used for statistical analysis.Results Among the satisfaction survey of 20 entries in patients and their families: 5 entries were in low scores: sleep environment (4.72±0.63), life nursing (4.78±0.57), visitation arrangements (4.79±0.52), transfer process (4.79±0.48), and privacy protection (4. 80±0.52). The overall satisfaction score of nursing service quality in different surveyed object group:patients group (97.12±6.63) was higher than that of the family group (95.46±885) with significant difference ( P<0.05) . The differences in satisfaction score of privacy protection, convenience of bedside items and other 6 items were statistically significant in different groups ( P<0. 05 ) . Conclusions In order to comprehensively improve the overall satisfaction of ICU patients and their family members we should improve the working environment of ICU, optimize workflow, strengthen health guidance, refine nursing service, pay attention to privacy protection.