To explore the scoring level and related factors of autoimmune disease-related skin ulcers by collecting data from multiple centers, and to provide ideas and references for targeted intervention measures and management plans for clinical medical and nursing staff.

Objective:To construct an evaluation index system for the development of compact county medical communities, so as to provide evaluation tools for promoting the high-quality development of county medical communities in China.Methods:Based on the evaluation criteria and monitoring system related policy documents for the construction of county medical communities released at the national level, an evaluation index system for compact county medical community development was constructed through policy text analysis and expert discussions. The system was applied to evaluate the construction of medical communities in Shaxian County of Fujian Province, A County of Shanxi Province, and B County of Yunnan Province.Results:The evaluation index system included four primary indicators: responsibility community, management community, service community, and interest community, covering 11 secondary indicators and 32 tertiary indicators. The evaluation results showed that the construction level of the compact county medical community in Shaxian County (91.3 points) was slightly higher than that of A County and B County (83.1 and 83.9 points), and its advantages were mainly reflected in management community and interest community. There was still room for improvement in the construction of compact medical communities in all three regions.Conclusions:The evaluation system in this study combined scientific rigor and practical guidance value. It could provide guidance for promoting the construction of compact county medical communities in various regions of China, and provide a basis for relevant policy formulation and optimization.

Enhancing the antimicrobial stewardship level is an important issue in curbing the development and spread of microbial resistance as well as maintaining the health of the people.This study reviews the current situa-tion of antimicrobial application both in China and abroad,sorts out the history of antimicrobial management,finds out the existing problems in the current work,and puts forward measures including attaching importance to patho-gen detection,improving the infection control strategy for antimicrobial-resistant organisms,establishing a multile-vel service mechanism,forming a multidisciplinary core team,and perfecting the management system,so as to pro-vide references for actively responding to the challenges posed by antimicrobial resistance.

Objective To investigate the impact of smoking cessation on high-resolution compu-ted tomography(HRCT)phenotypes in smokers with chronic obstructive pulmonary disease(COPD)and its relationship with the frequency of acute exacerbations.Methods A retrospective study was conducted in 237 smokers with COPD who could cooperate with a 1-year follow-up.Among them,160 patients underwent a comprehensive 1-year smoking cessation intervention,and were divided into smoking cessation failure group(87 patients)and smoking cessation success group(73 patients)based on whether they successfully quited smoking.The remaining 77 smokers with COPD who did not receive smoking cessation intervention were designated as smoking group.HRCT phenotypes,total lung volume(TLV),total emphysema volume(TEV),emphysema index(EI)and the number of acute exacerbation at different time points were compared among the three groups.Pearson correlation analysis was used to explore the correlation between smoking cessation and the number of acute exac-erbations.Results There was no statistically significant difference in the proportion of A phenotype patients among the three groups before intervention and at 3 and 6 months of intervention(P＞0.05).At the 9th and 12th months of intervention,the proportion of patients with A phenotype in the smoking group was lower than that in the smoking cessation failure group and smoking cessation success group(P＜0.05).Before the intervention and at the 3rd,6th and 9th months of interven-tion,there were no statistically significant differences in the proportion of patients with E phenotype among the three groups(P＞0.05).Before intervention and at the 3rd and 6th months of interven-tion,there were no statistically significant differences in the proportion of patients with M phenotype among the three groups(P＞0.05).At the 9th and 12th months of intervention,the proportion of patients with M phenotype in the smoking group was higher than that in the smoking cessation failure group and smoking cessation success group(P＜0.05).Before intervention,there were no statisti-cally significant differences in TLV,TEV and EI among the three groups(P＞0.05).One year af-ter the intervention,TLV,TEV and El in the smoking cessation failure group and smoking cessation success group were lower than those in the smoking group(P＜0.05).At the 3rd,6th,9th and 12th months of intervention,the number of acute exacerbations in the the smoking cessation failure group and smoking cessation success group was less than that in the smoking group(P＜0.05).At the 9th and 12th months of intervention,the number of acute exacerbation in the smoking cessation success group was less than that in the smoking cessation failure group(P＜0.05).The results of Pearson correlation analysis showed that smoking cessation was negatively correlated with the number of acute exacerbation in smokers with COPD(P＜0.05),and this negative correlation gradually in-creased with the extension of smoking cessation duration.Conclusion Smoking cessation can im-prove HRCT phenotypes and effectively reduce the number of acute exacerbation in smokers with COPD.

Objective To investigate the expression of serum levels of small mothers against decapentaplegic homolog 2(SMAD2)and tumor necrosis factor receptor-related associated factor 3(TRAF3)in patients with lupus nephritis(LN)and their correlation with prognosis.Methods A total of 150 patients with LN(LN group)and 80 patients with systemic lupus erythema-tosus(SLE)without nephritis(non-LN group)treated at Yulin Hospital,the First Affiliated Hospital of Xi'an Jiaotong University from January 2021 to March 2023 were selected.Patients with LN were followed up for 1 year and divided into the poor progno-sis group(n=61)and the good prognosis group(n=89).Serum levels of SMAD2 and TRAF3 were measured using enzyme-linked immunosorbent assay(ELISA).Multivariate unconditional logistic regression was used to identify factors affecting poor progno-sis in LN patients,and receiver operating characteristic(ROC)curves were constructed to evaluate the predictive efficacy of se-rum SMAD2 and TRAF3 levels for LN prognosis.Results Compared with the non-LN group,serum SMAD2(5.34±1.16ng/ml vs 2.98±1.11ng/ml)and TRAF3(91.23±12.58ng/L vs 74.38±11.91ng/L)levels were significantly elevated in the LN group,and the differences were statistically significant(t=14.917,9.852,all P＜0.05).During the 1-year follow-up,the incidence of poor prognosis among the 150 LN patients was 40.67%(61/150).Compared with the good prognosis group,serum SMAD2(6.03±1.02ng/ml vs 4.86±1.00ng/ml)and TRAF3(98.65±10.49ng/L vs 86.15±11.35ng/L)levels were significantly higher in the poor prognosis group,and the differences were statistically significant(t=7.015,6.830,all P＜0.05).The independent risk factors for poor prognosis in LN patients were advanced chronic kidney disease stage,elevated SMAD2 and elevated TRAF3,while the independent protective factor was increased estimated glomerular filtration rate(eGFR)(Wald χ2=9.633～16.666,all P＜0.05).The area under the curve(AUC)of predicting poor prognosis in LN patients by serum SMAD2 and TRAF3 levels was larger than that predicted by serum SMAD2 alone and TRAF3 levels alone,and the differences were statistically significant(Z=3.658,3.606,all P＜0.05).Conclusion Elevated serum SMAD2 and TRAF3 levels in LN patients are closely associated with poor prognosis.The combination of serum SMAD2 and TRAF3 levels has high predictive efficacy for poor prognosis in LN patients.

Objective To investigate the expression of serum levels of small mothers against decapentaplegic homolog 2(SMAD2)and tumor necrosis factor receptor-related associated factor 3(TRAF3)in patients with lupus nephritis(LN)and their correlation with prognosis.Methods A total of 150 patients with LN(LN group)and 80 patients with systemic lupus erythema-tosus(SLE)without nephritis(non-LN group)treated at Yulin Hospital,the First Affiliated Hospital of Xi'an Jiaotong University from January 2021 to March 2023 were selected.Patients with LN were followed up for 1 year and divided into the poor progno-sis group(n=61)and the good prognosis group(n=89).Serum levels of SMAD2 and TRAF3 were measured using enzyme-linked immunosorbent assay(ELISA).Multivariate unconditional logistic regression was used to identify factors affecting poor progno-sis in LN patients,and receiver operating characteristic(ROC)curves were constructed to evaluate the predictive efficacy of se-rum SMAD2 and TRAF3 levels for LN prognosis.Results Compared with the non-LN group,serum SMAD2(5.34±1.16ng/ml vs 2.98±1.11ng/ml)and TRAF3(91.23±12.58ng/L vs 74.38±11.91ng/L)levels were significantly elevated in the LN group,and the differences were statistically significant(t=14.917,9.852,all P＜0.05).During the 1-year follow-up,the incidence of poor prognosis among the 150 LN patients was 40.67%(61/150).Compared with the good prognosis group,serum SMAD2(6.03±1.02ng/ml vs 4.86±1.00ng/ml)and TRAF3(98.65±10.49ng/L vs 86.15±11.35ng/L)levels were significantly higher in the poor prognosis group,and the differences were statistically significant(t=7.015,6.830,all P＜0.05).The independent risk factors for poor prognosis in LN patients were advanced chronic kidney disease stage,elevated SMAD2 and elevated TRAF3,while the independent protective factor was increased estimated glomerular filtration rate(eGFR)(Wald χ2=9.633～16.666,all P＜0.05).The area under the curve(AUC)of predicting poor prognosis in LN patients by serum SMAD2 and TRAF3 levels was larger than that predicted by serum SMAD2 alone and TRAF3 levels alone,and the differences were statistically significant(Z=3.658,3.606,all P＜0.05).Conclusion Elevated serum SMAD2 and TRAF3 levels in LN patients are closely associated with poor prognosis.The combination of serum SMAD2 and TRAF3 levels has high predictive efficacy for poor prognosis in LN patients.

Enhancing the antimicrobial stewardship level is an important issue in curbing the development and spread of microbial resistance as well as maintaining the health of the people.This study reviews the current situa-tion of antimicrobial application both in China and abroad,sorts out the history of antimicrobial management,finds out the existing problems in the current work,and puts forward measures including attaching importance to patho-gen detection,improving the infection control strategy for antimicrobial-resistant organisms,establishing a multile-vel service mechanism,forming a multidisciplinary core team,and perfecting the management system,so as to pro-vide references for actively responding to the challenges posed by antimicrobial resistance.

Objective:To construct an evaluation index system for the development of compact county medical communities, so as to provide evaluation tools for promoting the high-quality development of county medical communities in China.Methods:Based on the evaluation criteria and monitoring system related policy documents for the construction of county medical communities released at the national level, an evaluation index system for compact county medical community development was constructed through policy text analysis and expert discussions. The system was applied to evaluate the construction of medical communities in Shaxian County of Fujian Province, A County of Shanxi Province, and B County of Yunnan Province.Results:The evaluation index system included four primary indicators: responsibility community, management community, service community, and interest community, covering 11 secondary indicators and 32 tertiary indicators. The evaluation results showed that the construction level of the compact county medical community in Shaxian County (91.3 points) was slightly higher than that of A County and B County (83.1 and 83.9 points), and its advantages were mainly reflected in management community and interest community. There was still room for improvement in the construction of compact medical communities in all three regions.Conclusions:The evaluation system in this study combined scientific rigor and practical guidance value. It could provide guidance for promoting the construction of compact county medical communities in various regions of China, and provide a basis for relevant policy formulation and optimization.

Objectives To explore the establishment and effects of a multilevel and inter-disciplinary management scheme for specialist nurses.Methods The multilevel and inter-disciplinary management scheme included establishing the pyramid hierarchical training model,exploring superimposed training mechanism for specialist nurses with horizontal expansion,vertical extension,and deep development,and constructing stereoscopic clinical evaluation and quantitative assessment system.Four hundred-forty two specialized nurses have been recruited to join the multilevel and inter-disciplinary management scheme from July 2021 to August 2023.The core competencies of specialized nurses were compared before and after the implementation of management scheme.Results The quality development of specialized nursing have been improved,and the total scores and the scores of 3 dimensions(research innovation,management,and professional development)in core competencies of specialized nurses after the intervention of multilevel and inter-disciplinary management scheme were higher than those before(P＜0.05).Conclusion The multilevel and inter-disciplinary management scheme can effectively improve the core competencies of specialized nurses,and promote the high-quality development of specialized nursing.

Objective:To gain a deeper understanding of the cognitive differences between lactating women and obstetric nurses regarding their breastfeeding counselling abilities.Methods:This study was a descriptive phenomenology qualitative study. From October 2021 to June 2022, purposive sampling was used to select 11 lactating women who received breastfeeding counselling and 13 obstetric nurses who provided breastfeeding counselling services in Department of Obstetrics at Peking Union Medical College Hospital for semi-structured interviews. Giorgi analysis method was used to extract and analyze data.Results:The cognitive differences between lactating women and obstetric nurses regarding breastfeeding counselling abilities were mainly manifested in four aspects, namely breastfeeding knowledge and skills, counselling practice ability, improving counselling ability, and personality traits.Conclusions:Lactating women and obstetric nurses have cognitive differences in breastfeeding counselling abilities. Obstetric nurses should improve their breastfeeding counselling skills based on the needs of lactating women and provide personalized breastfeeding counselling services.