Objective To enhance the qualified rate of preoperative bladder filling and improve the experience of embryo transfer by implementing a nursing intervention based on the root cause analysis and plan-do-check-act(RCA-PDCA)cycle.Methods A before-after comparative study was conducted among the patients who received embryo transfer at a Tire-ⅢA specialist hospital between January and April 2024.The patient who received embryo transfer between January and February 2024(n=130)were assigned to the control group with routine nursing.Those who received embryo transfer between March and April 2024 were assigned to the trial group(n=136)with nursing intervention based on RCA-PDCA.The two groups were compared in terms of the qualified rate of bladder filling,endometrial visualisation rate,instrument-assisted transfer rate and level of comfort.Results A total of 126 women in the control group and 131 in the trial group completed the study.The patient in the trial group demonstrated significantly higher qualified rate of bladder filling and endometrial visualisation rate in comparison with those in the control group(70.2％vs.38.1％,81.7％vs.51.6％,respectively).The trial group also had lower rates in both of the instrument-assisted transfer and the incidence of mild pain than those in the control group(2.3％vs.7.9％,32.1％vs.53.2％,respectively;P<0.05).Conclusion RCA-PDCA is effective in improving preoperative bladder filling and endometrial visualisation,reducing instrument-assisted transfer and enhancing preoperative bladder comfort in the women receiving embryo transfer.

Objective:To explore the job preference and willingness to pay of resident training physicians in Chengdu, China.Methods:The questionnaire was designed by means of the discrete choice experiment. The questionnaire contains the basic information of the survey object and the discrete choice set (including workplace, working intensity, monthly salary, staffing of public institution, and career development, each with several levels). A total of 116 resident training physicians recruited by three standardized residents training centers in Chengdu were selected to conduct the questionnaire survey, and grouped based on their identity and major. The mixed logit model was used to analyze job preferences and willingness to pay of resident training physicians.Results:Except for career development, other four attributes had statistically significant effects on job selection of resident training physicians ( P<0.05), of which working intensity was the most influential attribute, with the highest willingness to pay. The subgroup analysis results showed that staffing of public institution was concerned by clinical postgraduates and resident training physicians in non-scarce majors. Conclusions:Economic and non-economic factors both affect the job preferences of resident training physicians, while working intensity is the most important factor. Resident training policy should focus on adjusting the scale and type of resident physician enrollment, and strengthen humanistic care and career education of resident training physicians.

Objective To enhance the qualified rate of preoperative bladder filling and improve the experience of embryo transfer by implementing a nursing intervention based on the root cause analysis and plan-do-check-act(RCA-PDCA)cycle.Methods A before-after comparative study was conducted among the patients who received embryo transfer at a Tire-ⅢA specialist hospital between January and April 2024.The patient who received embryo transfer between January and February 2024(n=130)were assigned to the control group with routine nursing.Those who received embryo transfer between March and April 2024 were assigned to the trial group(n=136)with nursing intervention based on RCA-PDCA.The two groups were compared in terms of the qualified rate of bladder filling,endometrial visualisation rate,instrument-assisted transfer rate and level of comfort.Results A total of 126 women in the control group and 131 in the trial group completed the study.The patient in the trial group demonstrated significantly higher qualified rate of bladder filling and endometrial visualisation rate in comparison with those in the control group(70.2％vs.38.1％,81.7％vs.51.6％,respectively).The trial group also had lower rates in both of the instrument-assisted transfer and the incidence of mild pain than those in the control group(2.3％vs.7.9％,32.1％vs.53.2％,respectively;P<0.05).Conclusion RCA-PDCA is effective in improving preoperative bladder filling and endometrial visualisation,reducing instrument-assisted transfer and enhancing preoperative bladder comfort in the women receiving embryo transfer.

Objective:To explore the job preference and willingness to pay of resident training physicians in Chengdu, China.Methods:The questionnaire was designed by means of the discrete choice experiment. The questionnaire contains the basic information of the survey object and the discrete choice set (including workplace, working intensity, monthly salary, staffing of public institution, and career development, each with several levels). A total of 116 resident training physicians recruited by three standardized residents training centers in Chengdu were selected to conduct the questionnaire survey, and grouped based on their identity and major. The mixed logit model was used to analyze job preferences and willingness to pay of resident training physicians.Results:Except for career development, other four attributes had statistically significant effects on job selection of resident training physicians ( P<0.05), of which working intensity was the most influential attribute, with the highest willingness to pay. The subgroup analysis results showed that staffing of public institution was concerned by clinical postgraduates and resident training physicians in non-scarce majors. Conclusions:Economic and non-economic factors both affect the job preferences of resident training physicians, while working intensity is the most important factor. Resident training policy should focus on adjusting the scale and type of resident physician enrollment, and strengthen humanistic care and career education of resident training physicians.

Objective:To investigate the effect of water intake on bladder filling time before embryo transfer.Methods:A total of 189 patients were collected from February to June 2023 who were to undergo embryo transfer in Guangdong Women and Children Hospital. The patients were divided into group A ( n=61), group B ( n=64) and group C ( n=64) using a random number table and they were respectively given 300 mL, 500 mL and 700 mL water to drink. Abdominal ultrasound was performed every 15 min, a total of 1-5 times, from 45 min after drinking water until the bladder filling. The bladder filling time and bladder volume were collected. Kaplan-Meier method was used to compare the difference of bladder filling time among the three groups. The multivariate Cox regression was used to analyze factors of bladder filling time. Results:The cumulative bladder filling rates of group A, group B and group C at 105 min after drinking water were 57.4% (35/61), 90.6% (58/64) and 98.4% (63/64), respectively, and the median survival time (95% CI) of bladder filling was 105.0 (89.9-120.1) min, 60.0 (55.4-64.7) min and 60.0 (55.4-64.6) min, respectively. Pairwise comparison of Kaplan-Meier analysis revealed that the bladder filling time of group A was longer than that of group B and group C ( P<0.001), and there was no statistically significant difference between group B and group C ( P>0.05). The results of age-stratification analysis showed that the bladder filling time of younger patients in group A [90.0 (75.2-104.8) min] was longer than that in group B [60.0 (55.8-64.2) min, P<0.001] and group C [60.0 (55.1-64.8) min, P<0.001], and there was no statistical significance between group B and group C ( P>0.05); the bladder filling time of older patients in group C [60.0 (59.1-70.9) min] was shorter than that in group A [105.0 (89.9-120.1) min, P<0.001] and group B [75.0 (64.3-85.7) min, P=0.027], there was no statistical significance between group A and group B ( P>0.05). Multivariate Cox regression analysis showed that taking group A as reference, the hazard ratio ( HR, 95% CI) of groups B and C were 2.71 (1.78-4.21) and 3.23 (2.10-4.96), both P<0.001. The HR (95% CI) of the elderly patients was 0.69 (0.49-0.99), P=0.044. Conclusion:Water intake and age are independent factors affecting bladder filling time in embryo transfer patients. Patients are recommended to drink 500 mL of water 75 min before embryo transfer and appropriately increase the amount of water or extend the bladder preparation time after drinking water for elderly patients.

Objective:To investigate the effect of water intake on bladder filling time before embryo transfer.Methods:A total of 189 patients were collected from February to June 2023 who were to undergo embryo transfer in Guangdong Women and Children Hospital. The patients were divided into group A ( n=61), group B ( n=64) and group C ( n=64) using a random number table and they were respectively given 300 mL, 500 mL and 700 mL water to drink. Abdominal ultrasound was performed every 15 min, a total of 1-5 times, from 45 min after drinking water until the bladder filling. The bladder filling time and bladder volume were collected. Kaplan-Meier method was used to compare the difference of bladder filling time among the three groups. The multivariate Cox regression was used to analyze factors of bladder filling time. Results:The cumulative bladder filling rates of group A, group B and group C at 105 min after drinking water were 57.4% (35/61), 90.6% (58/64) and 98.4% (63/64), respectively, and the median survival time (95% CI) of bladder filling was 105.0 (89.9-120.1) min, 60.0 (55.4-64.7) min and 60.0 (55.4-64.6) min, respectively. Pairwise comparison of Kaplan-Meier analysis revealed that the bladder filling time of group A was longer than that of group B and group C ( P<0.001), and there was no statistically significant difference between group B and group C ( P>0.05). The results of age-stratification analysis showed that the bladder filling time of younger patients in group A [90.0 (75.2-104.8) min] was longer than that in group B [60.0 (55.8-64.2) min, P<0.001] and group C [60.0 (55.1-64.8) min, P<0.001], and there was no statistical significance between group B and group C ( P>0.05); the bladder filling time of older patients in group C [60.0 (59.1-70.9) min] was shorter than that in group A [105.0 (89.9-120.1) min, P<0.001] and group B [75.0 (64.3-85.7) min, P=0.027], there was no statistical significance between group A and group B ( P>0.05). Multivariate Cox regression analysis showed that taking group A as reference, the hazard ratio ( HR, 95% CI) of groups B and C were 2.71 (1.78-4.21) and 3.23 (2.10-4.96), both P<0.001. The HR (95% CI) of the elderly patients was 0.69 (0.49-0.99), P=0.044. Conclusion:Water intake and age are independent factors affecting bladder filling time in embryo transfer patients. Patients are recommended to drink 500 mL of water 75 min before embryo transfer and appropriately increase the amount of water or extend the bladder preparation time after drinking water for elderly patients.

Objective:To investigate the current situation of general practitioners' occupational pressure in Heilongjiang Province, and explore its relationship with professional identity and perceived organizational support. It aims to provide references for the construction of general practitioners and the development of general medical education.Methods:The general situation questionnaire, perceived organizational support scale, occupational pressure scale, and professional identity scale were applied through network and site surveys for collecting data. A total of 288 questionnaires were collected with 263 valid questionnaires (91.3%). Pearson correction analysis and bootstrap analysis were performed for data analysis.Results:The average score of occupational pressure among general practitioners was (115.95±22.40), and the results of Pearson correction analysis showed that perceived organizational support was negatively correlated with occupational pressure ( r=-0.413, P<0.01) and positive correlation with professional identity ( r=0.587, P<0.01). There were also significant negative correlations between professional identity and occupational pressure ( r=-0.442, P<0.01). Moreover, the mediating effect showed that professional identity had a certain mediating effect on the relationship between perceived organizational support and occupational pressure (LLCI=-0.2039, ULCI=-0.0760, P<0.05). Conclusion:General practitioners' occupational pressure was at a high level, which can be reduced through improving the perceived organizational support and professional identity.

A 61-years male patients with chronic hepatitis B developed hypophosphatemic osteomalacia following long-term use of adefovir dipivoxil in our hospital.With "adefovir dipivoxil" and "osteomalacia" as the search terms,we searched Wanfang database and Chinese Biomedical bibliographic database since 2005,and retrieved 79 cases of adefovir dipivoxil-induced hypophosphatemic osteomalacia.Of the 80 cases,there were 63 males and 17 females with a mean age of (52 ± 11) years.The average duration of disease to first diagnosis made was 17 months,the average duration of adefovir dipivoxil administration to the onset of the disease was 62 months,and the average duration of hepatitis B was 11 years.The most common clinical manifestation was progressive bone pain in all parts of the body (80/80 cases);the most common laboratory finding was decreased serum phosphorus (80/80 cases),followed by abnormal urine tests (55/56 cases) including increased urinary phosphorus,urinary protein and positive urinary occult blood.The X-ray,CT and MRI showed different degrees of decreased bone density,osteoporosis,and bone fracture in severe patients (76/77 cases).It is suggested that clinicians should pay attention to the renal damage during the treatment of adefovir dipivoxil,and the renal function,electrolyte and bone density should be monitored regularly.

Objective To investigate the factors affecting platelet transfusion efficiency.Methods A total of 102 cases of leuke-mia patients were recruited in the study,whose platelet count were measured before platelet transfusion and 1,24 h after platelet transfusion,then corrected count increment(CCI)values were calculated.By using CCI combined with clinical manifestations,the ef-ficacy of platelet transfusion were evaluated.The platelet antibody were detected before platelet transfusion.Depending on whether there were platelet antibodies,complications,the number of times of platelet transfusion,the types of platelet,patients were grouped and their platelet transfusion efficiency and CCI values were compared.Results The total effective rate of platelet transfusions were 71.6%(73/102 ).Invalid transfusion group had higher platelet antibody positive rate (17.2%)than effective transfusion group (2.7%),the difference were statistically significant(P <0.05).Among the groups of different transfusion times,the tansfusion effi-ciency was statistically different(P <0.05).With the increase of the number of times of platelet transfusion,the platelet transfusion efficiency decreased.Comparison between different types of platelets showed different platelet transfusion efficiency,which was sta-tistically significant(P <0.05).1 h and 24 h CCI value,platelet antibodies and whether patients with complications were related(P<0.05).1 h and 24 h CCI values were both associated with platelet antibodies and complications(P <0.05).Conclusion Platelet antibodies,complications,times of platelet transfusion and types of platelet transfusion are affecting factors of the transfusion effica-cy in patients with leukemia.

Objective To observe the effect of hemoperfusion on micro-inflammation in patients with maintenance hemodialysis (MHD).Methods Fifty MHD patients (MHD group) and 25 healthy volunteers (control group) were involved in this study.The MHD patients were divided into two groups by random digits table:hemoperfusion combined with hemodialysis group (HP + HD group,25 cases) and hemodialyais group (HD group,25 cases).The plasma levels of micro-inflammatory cytokines including high-sensitive C-reactive protein (hs-CRP),interleukin-6 (IL-6) and tumor necrosis faetor-α (TNF-α ) were measured before and after treatment.Results The plasma levels of hs-CRP,IL-6 and TNF-α in MHD group were significantly higher than those in control group [(6.72 ± 2.63) mg/L vs.(1.35 ± 0.92) mg/L,(348.83 ± 64.41) ng/L vs.(54.49 ±22.47) ng/L,(7.52 ± 3.17) ng/L vs.(2.53 ±0.88) ng/L](P＜0.05).There was no significant difference in the plasma levels of hs-CRP,IL-6,TNF-α before treatment between HD group and HP+HD group (P＞0.05),Compared with those in HD group,the plasma levels of hs-CRP,IL-6 and TNF-α after treatment in HP+HD group were significantly decreased [(4.78 ±2.49) mg/L vs.(6.89 ±2.69) mg/L,(260.54 ±56.72) ng/L vs.(357.14 ±56.37) ng/L,(5.36 ±2.41) ng/L vs.(7.49 ±2.87) ng/L] (P <0.05).Conclusion Hemoperfusion improves micro-inflammation in patients with MHD.