Objective:To explore the specialty work engagement dilemma among wound therapists in non-specialist clinics, so as to provide a reference basis for improving wound therapists' work engagement and reducing job burnout.Methods:This study was a phenomenological study. Semi-structured interviews with 12 wound therapists in non-specialist clinics from 12 hospitals were conducted between May and July 2024 using purposive sampling. Colaizzi seven-step method was used for data analysis and topic refinement.Results:A total of five themes and 13 sub-themes were extracted, including the role change dilemma (focus dispersion due to transfer of positions in clinical departments, and identity challenges due to adjustment of the field of job posting) , career development dilemma (reduced motivation due to obstacles to in-depth development in specialized fields, and limited conditions for scientific research training and implementation impeding the recognition and return of work) , support environment dilemma (insufficient medical insurance support increased job burden, lack of hospital support reduced work efficiency, lack of team support weakened work focus, poor self-support limited the depth of work engagement, lack of support from patients and their families increased the difficulty of maintaining work motivation) , pros and cons weighing dilemma (unclear delineation of risk and responsibility, difficult to weigh risk and benefit) , dilemma of whole-course management of disease (lack of communication between hospitals weakened the continuity of work, lack of home follow-up increased the uncertainty of the work) .Conclusions:Specialty work engagement dilemmas among wound therapists in non-specialist clinics are influenced by a variety of factors. It is necessary for medical institutions, healthcare workers and patients' families to work together to create a favorable working environment for wound therapists in order to promote the high-quality development of wound therapy nursing services in China.

Objective:To explore the specialty work engagement dilemma among wound therapists in non-specialist clinics, so as to provide a reference basis for improving wound therapists' work engagement and reducing job burnout.Methods:This study was a phenomenological study. Semi-structured interviews with 12 wound therapists in non-specialist clinics from 12 hospitals were conducted between May and July 2024 using purposive sampling. Colaizzi seven-step method was used for data analysis and topic refinement.Results:A total of five themes and 13 sub-themes were extracted, including the role change dilemma (focus dispersion due to transfer of positions in clinical departments, and identity challenges due to adjustment of the field of job posting) , career development dilemma (reduced motivation due to obstacles to in-depth development in specialized fields, and limited conditions for scientific research training and implementation impeding the recognition and return of work) , support environment dilemma (insufficient medical insurance support increased job burden, lack of hospital support reduced work efficiency, lack of team support weakened work focus, poor self-support limited the depth of work engagement, lack of support from patients and their families increased the difficulty of maintaining work motivation) , pros and cons weighing dilemma (unclear delineation of risk and responsibility, difficult to weigh risk and benefit) , dilemma of whole-course management of disease (lack of communication between hospitals weakened the continuity of work, lack of home follow-up increased the uncertainty of the work) .Conclusions:Specialty work engagement dilemmas among wound therapists in non-specialist clinics are influenced by a variety of factors. It is necessary for medical institutions, healthcare workers and patients' families to work together to create a favorable working environment for wound therapists in order to promote the high-quality development of wound therapy nursing services in China.

Objective To investigate the distribution of vaginal microbiota in women with early-onset pre-eclampsia(PE)complicated by preterm premature rupture of membranes(PPROM)and the effect of differ-ent vaginal microbiota distribution on pregnancy outcomes.Methods A total of 120 pregnant women with early-onset PE admitted to this hospital from January 2019 to January 2022 were selected as the research ob-jects.Among them,67 pregnant women complicated with PPROM were selected as the observation group,and 53 pregnant women without PPROM were selected as the control group.The distribution of vaginal microflora was compared between the two groups,and the pregnancy outcomes of patients with early-onset PE complicat-ed with PPROM were analyzed.Results In terms of dominant bacteria,the proportion of Lactobacillus in the observation group was lower than that in the control group,and the proportion of Gram-positive bacilli,Gram-negative bacilli and Gram-positive cocci in the observation group were higher than that in the control group,and the differences were statistically significant(P＜0.05).In terms of pathogenic bacteria,the proportion of Glucococcus haemolyticus and Enterobacter cloacae in the observation group were higher than that in the con-trol group,and the differences were statistically significant(P＜0.05).In terms of vaginal flora density,the proportion of Ⅱ and m grade in the observation group were lower than that in the control group,and the differences were statistically significant(P＜0.05).In terms of the diversity of vaginal flora,the proportion ofⅡ and m grade in the observation group were lower than that in the control group,and the differences were statistically significant(P＜0.05).The imbalance rate of vaginal microecosystem in the observation group was 80.60％,which was higher than 45.28％in the control group,and the difference was statistically signifi-cant(x2=81.340,P＜0.001).Compared with the control group,the blood pressure was higher,24 h urine volume was lower,24 h urinary protein was higher,platelet was higher,prothrombin time and activated partial thromboplastin time were prolonged in the observation group after treatment(all P＜0.05).There were 10 cases of fetal growth restriction,8 cases of fetal intrauterine distress and 4 cases of neonatal asphyxia in the observation group,and 3 cases of fetal growth restriction,1 case of fetal intrauterine distress and 0 case of neo-natal asphyxia in the control group.The incidence of perinatal complications in the observation group(32.84％)was significantly higher than that in the control group(7.55％),and the difference was statistically significant(P＜0.05).Among 67 cases of early-onset PE complicated with PPROM,54 cases had dysbiosis(dysbiosis group)and 13 cases had normal microflora(normal microflora group).The incidence of adverse pregnancy outcomes in the dysbiosis group was 81.48％,which was higher than 46.15％in the normal micro-flora group(x2=5.089,P=0.024).Compared with the normal microflora group,the neonatal birth weight of the dysbiosis group was significantly lower(t=2.196,P=0.032),and the length of hospital stay was signifi-cantly longer(t=7.463,P＜0.001).Conclusion The imbalance of vaginal flora in women with early-onset PE complicated with PPROM may lead to adverse pregnancy outcomes.In clinical practice,it is necessary to pay attention to the changes of vaginal flora and intervene in time to reduce the risk of adverse pregnancy out-comes.

Objective:To assess the status quo of uncertainty in illness among patients undergoing daytime ophthalmic surgeries and to identify its influencing factors.Methods:Patients who underwent surgery in the Ophthalmic Daytime Surgery Wards of Beijing Tongren Hospital, Capital Medical University, from January to June 2023, were selected by convenience sampling. Data were collected using a general demographic survey and the Medical Uncertainty Inventory Scale (MUIS/MUIS-A). Multiple linear regression analysis was employed to investigate the factors influencing the uncertainty in illness among these patients.Results:Out of 248 questionnaires distributed, 243 were effectively collected, resulting in a 97.98% response rate. The scores on the MUIS/MUIS-A ranged from 55 to 144, with a median of 102. Multiple linear regression analysis indicated that acceptance of the disease, educational level, and the number of surgeries were significant factors influencing the uncertainty in illness among these patients ( P<0.05) . Conclusions:The uncertainty in illness among patients undergoing daytime ophthalmic surgery is above the medium level. Factors such as acceptance of the disease, educational level, and the number of surgeries significantly influence this uncertainty.

ObjectiveTo compare the effects of different processing methods in ancient and modern times on the chemical components of Lilii Bulbus decoction， and to provide experimental support for the origin processing， decoction piece processing and clinical application of this herb. MethodUltra high performance liquid chromatography tandem quadrupole electrostatic field orbitrap high resolution mass spectrometry（UHPLC-Q-Orbitrap HRMS） was used for structural identification of the compounds using excimer ions， secondary MS and characteristic fragment ions， and referring to relevant literature and database information. Principal component analysis（PCA） and orthogonal partial least squares discriminant analysis（OPLS-DA） were used to screen the main differential components， the differential components were quantitatively studied by high performance liquid chromatography（HPLC）， in order to compare the types and contents of chemical components in the decoction of different processing products of Lilii Bulbus. ResultA total of 24 chemical components were identified from the decoction of different processed products of Lilii Bulbus， water extract and scalding liquid of fresh Lilii Bulbus， including 17 phenols， 5 saponins and 2 alkaloids. Compared with the fresh Lilii Bulbus decoction， the contents of regaloside A， p-coumaric acid， colchicine and other components in the decoction of dry Lilii Bulbus processed by scalding method decreased， the content of regaloside C in the decoction of dry Lilii Bulbus processed by steaming method decreased， and the contents of regaloside A and regaloside C in the decoction of fresh Lilii Bulbus processed by water immersion also decreased. Compared with the decoction of dry Lilii Bulbus processed by scalding method， the overall content of components in the fresh Lilii Bulbus decoction and the decoction of fresh Lilii Bulbus processed by water immersion was higher， the contents of components in the decoction of dry Lilii Bulbus processed by steaming method was higher， except for the slightly lower content of regaloside C. ConclusionDifferent processing processes have a certain effect on the types and contents of chemical components in Lilii Bulbus decoction. Scalding process is beneficial to the preservation of Lilii Bulbus， but can cause the loss of effective components. Compared with scalding method， steaming method can prevent browning of Lilii Bulbus and reduce the loss of its active ingredients. The processing method of removing foam after overnight immersion proposed by ZHANG Zhongjing may be more conducive to the treatment of Baihe disease， which can provide reference for the clinical rational application and mechanism research of different processed products of Lilii Bulbus.

Objective:To evaluate the ultrasound diagnostic value of portal vein complications after liver transplantation by monitoring changes in portal vein hemodynamic parameters using the color Doppler ultrasound technology and to determine its clinical significance.Methods:The clinical data of 99 patients who underwent liver transplantation at the Organ Transplantation Center of the Affiliated Hospital of Qingdao University from July 2015 to December 2018 were analyzed retrospectively. There were 81 males and 18 females, aged (51±9) years old. These patients were divided into the portal vein complication ( n=23) and the non-portal vein complication ( n=76) groups, based on whether portal vein complications had developed within 2 years after surgery. In addition, 30 healthy volunteers at the Affiliated Hospital of Qingdao University, including 16 males and 14 females, aged (40±14) years old were selected to form the control group. The patients’ morphology of liver was studied using color Doppler ultrasound at days 1, 7, 14, 30, 180, 365 and 730 after liver transplantation, and the maximum portal vein blood flow velocity and portal blood flow were recorded. Results:Compared with the control group, the maximum portal venous flow velocity and portal venous blood flow significantly increased on days 1, 7, 14, 30, and 180 after liver transplantation in the non-portal complication group (all P<0.05). With time, these changes showed a decreasing trend. By day 365 after surgery, the differences between the maximum portal venous flow velocity and the portal venous blood flow between the two groups became not significant ( P>0.05). Of the 23 patients in the portal vein complication group, 9 developed portal vein stenosis (PVS) and 14 portal vein embolism. The 9 patients with PVS had a maximum portal flow velocity of 63.8 (46.0, 78.6) cm/s at 1 month after surgery, and this flow velocity was significantly higher than that in the non-portal complication group [35.0(29.6, 41.8) cm/s, Z=-3.35, P<0.001]. The portal blood flow was 993 (887, 1168) ml/min in the 9 patients with portal vein stenosis at 1 month after surgery, and it was significantly higher than those in the non-portal complication group [811(682, 1 018) ml/min, Z=-2.37, P=0.020]. Conclusions:After liver transplantation, both the portal venous blood flow velocity and the blood flow were at high levels in the early postoperative period and they returned to normal levels with time. Ultrasound dynamic monitoring of portal venous blood flow changes was of clinical significance in diagnosing portal vein stenosis and portal vein embolism after liver transplantation.

Purpose: Elder self-neglect is a global public health issue and should be taken seriously at large. Nurses,usually working directly with elderly patients, have a better understanding of what factors may causeelder self-neglect. In this qualitative study, we explored the influencing factors of elder self-neglect fromthe perception of nurses in the context of Chinese culture. Methods: Face-to-face, in-depth interviews were conducted from November 2018 to December 2018.Purposive sampling was used. Twenty one participants recruited from eight geriatric wards of a generalhospital located in Wuhan were interviewed. A content analysis of qualitative nature was performed toanalyze the data. Results: Our conceptual model illustrated the findings based on the three themes of the conflict betweenpersonal recognition and social judgment, the choice between current needs and individual beliefs, aswell as the compromise between insufficient abilities and limited resources. Conclusion Nurses together with family members and social workers can help older adults improvetheir awareness of self-neglect to bridge the gap with social judgment, learn to focus on their own needs,as well as seek as much support as possible. Nurses should also respect the autonomy and selfdeterminationof elder self-neglecters because self-neglect is related to older adults' values. Furthermore,larger studies are needed to quantitatively test and refine the model.

Purpose: Elder self-neglect is a global public health issue and should be taken seriously at large. Nurses,usually working directly with elderly patients, have a better understanding of what factors may causeelder self-neglect. In this qualitative study, we explored the influencing factors of elder self-neglect fromthe perception of nurses in the context of Chinese culture. Methods: Face-to-face, in-depth interviews were conducted from November 2018 to December 2018.Purposive sampling was used. Twenty one participants recruited from eight geriatric wards of a generalhospital located in Wuhan were interviewed. A content analysis of qualitative nature was performed toanalyze the data. Results: Our conceptual model illustrated the findings based on the three themes of the conflict betweenpersonal recognition and social judgment, the choice between current needs and individual beliefs, aswell as the compromise between insufficient abilities and limited resources. Conclusion Nurses together with family members and social workers can help older adults improvetheir awareness of self-neglect to bridge the gap with social judgment, learn to focus on their own needs,as well as seek as much support as possible. Nurses should also respect the autonomy and selfdeterminationof elder self-neglecters because self-neglect is related to older adults' values. Furthermore,larger studies are needed to quantitatively test and refine the model.

Objective? To explore the risk factors of incontinence-associated dermatitis(IAD) in intensive care uni(t ICU) patients, so as to provide evidence for early clinical prevention of IAD. Methods? The relevant literature about IAD in ICU patients were retrieved from multiple electronic databases including Cochrane library, PubMed, Ovid Medline, Web of Science, CBM, CNKI, Wanfang Data and VIP from buiding database to November 2018. The Meta-analysis was performed after searching databases, extracting data and assessing quality of included studies using the software of RevMan 5.3. Results? Finally, 14 articles were included with totally 691 case groups, and 1 377 cases in the control group with 2 068 subjects, the incidence of IAD was 20.00%-50.00%. The results of Meta-analysis indicated that feve[r OR=1.79, 95%CI (1.43-2.26), P＜0.05], diabetes[OR=2.73, 95%C(I 1.77-4.21), P＜0.05], the use of antibiotics[OR=2.45, 95%C(I 1.71-3.53), P＜ 0.05], level of albumin[OR=-3.81, 95%C(I -4.61- -3.00), P＜ 0.05], Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ) score[OR=1.70, 95%C(I 0.06-3.33), P＜0.05], fecal incontinence[OR=1.80, 95%C(I 1.07-3.03), P＜ 0.05], incontinence frequency (＞ 3 times/day) [OR=1.86, 95%CI(1.56-2.22), P＜ 0.05]and watery stoo[l OR=2.22, 95%CI(1.81-2.73), P＜0.05]significantly associated with the onset of IAD. Through the sensitivity analysis of the combined effect of the fixed effect model and the random effect model, it was found that the combined effect values were close, indicating that the analysis results were robust and credible. Conclusions? According to the present evidence, the risk factors of IAD in ICU patients are fever, diabetes, antibiotics, low albumin level, high APACHE score, fecal incontinence, incontinence frequency (＞ 3 times/day) and watery stool. Medical staff should pay attention to these risk factors in clinical practice, and actively implement targeted preventive measures to reduce the incidence of IAD in ICU patients and improve the quality of nursing practice.

Objective To compare the effects of gastric residual volume (GRV) set at different thresholds on intensive care patients receiving enteral nutrition (EN),so as to inform clinical practice.Methods Controlled clinical trials involving different GRV thresholds in ICU patients undergoing EN were retrieved from multiple electronic databases (including Cochrane Library,PubMed,Ovid Medline,Web of Science,CBM,CNKI,Wanfang Data,and VIP).Quality of the retrieved studies was evaluated for data extraction,and meta-analysis was performed.Results Four randomized controlled trials and one clinically controlled trial were included in the study,with a total of 658 subjects.Results of the meta-analysis suggested no statistically significant difference between the group with GRV threshold≥250 ml and the one with GRV threshold＜250 ml in the rates of pneumonia (OR =1.19,95％ CI =0.77-1.82,P =0.43),aspiration.(OR =1.59,95％ CI =0.42-6.03,P=0.50),vomiting (OR=1.35,95％ CI=0.48-3.80,P=0.57),reflux (OR=1.29,95％ CI=0.58-2.88,P=0.53),and diarrhea (OR=1.36,95％ CI=0.87-2.13,P=0.17).Nutrient intake and several other outcome measures were unable to be included in the meta-analysis for either the scarcity of studies or inconsistency in the measures adopted,and descriptive analysis was therefore employed instead.Conclusion There was no significant difference between the two groups in terms of complications,but the group with GRV threshold≥250 ml had higher intake of EN.