Objective To systematically evaluate and synthesize the experience and coping process of bowel symptoms in patients after sphincter-preserving surgery for rectal cancer,and to provide the evidence for the subsequent development of bowel symptom management strategies.Methods A comprehensive search was conducted across the Pubmed,Cochrane Library,CINAHL,Embase,Web of Science,CNKI,Wanfang Database,VIP Database and CBM Database for qualitative studies on the experience of bowel symptoms in post-sphincter-preserving surgery patients with rectal cancer.The search period was from database inception to October 2024.The quality of the included literature was assessed according to the Australian Joanna Briggs Institute Center for Evidence-Based Health Care Quality Assessment Criteria for Qualitative Research,and the results were synthesized through the aggregative integration method.Results 14 studies were included,yielding 52 research findings,which were grouped into 10 subcategories and further synthesized into 4 results:the physical and psychological experiences of patients with bowel symptoms;the impact of bowel symptoms on patients'daily lives;coping styles for bowel symptoms in patients;facilitators of patients bowel symptom coping.Conclusion Bowel symptoms have significant negative impacts on the lives of patients following sphincter-preserving surgery for rectal cancer,and healthcare professionals should address these patients'needs by developing effective symptom management strategies and supporting patients in enhancing self-management abilities to improve quality of life.

Objective To develop a refined management model for operating rooms and assess its clinical impact on op-erational efficiency and cost control.Methods The study included 10,728 elective surgeries from January to June 2024 as the study group and 9 414 elective surgeries from January to June 2023 as the control group.The differences in operational metrics before and after implementing the refined management model were compared.The model was developed through comprehensive management by hospital leadership and multi-department collaboration,focusing on management structure,systems,processes,information technology,and resource allocation.Results In terms of efficiency,the on-time start rate of the first surgeries in the study group was significantly higher than in the control group(P＜0.05).The turnover time between surgeries was shorter in the study group(P＜0.01),and the rate of unexpected surgery cancellations was lower(P＜0.01).The average cost per surgery for consumables,excluding the impact of centralized procurement of consumables,was approximately 971 yuan,representing an 11% reduction compared to the previous year,despite a 14% increase in surgical volume.The average daily operating cost per operating room was about 12 303 yuan,a 7% reduction.Economic benefits increased by 8.43 million yuan,a 38% year-on-year increase.Conclusion Implementing a refined management model in operating rooms can significantly enhance efficiency,re-duce costs,and achieve dual improvements in social and economic benefits.

Objective To systematically evaluate and synthesize the experience and coping process of bowel symptoms in patients after sphincter-preserving surgery for rectal cancer,and to provide the evidence for the subsequent development of bowel symptom management strategies.Methods A comprehensive search was conducted across the Pubmed,Cochrane Library,CINAHL,Embase,Web of Science,CNKI,Wanfang Database,VIP Database and CBM Database for qualitative studies on the experience of bowel symptoms in post-sphincter-preserving surgery patients with rectal cancer.The search period was from database inception to October 2024.The quality of the included literature was assessed according to the Australian Joanna Briggs Institute Center for Evidence-Based Health Care Quality Assessment Criteria for Qualitative Research,and the results were synthesized through the aggregative integration method.Results 14 studies were included,yielding 52 research findings,which were grouped into 10 subcategories and further synthesized into 4 results:the physical and psychological experiences of patients with bowel symptoms;the impact of bowel symptoms on patients'daily lives;coping styles for bowel symptoms in patients;facilitators of patients bowel symptom coping.Conclusion Bowel symptoms have significant negative impacts on the lives of patients following sphincter-preserving surgery for rectal cancer,and healthcare professionals should address these patients'needs by developing effective symptom management strategies and supporting patients in enhancing self-management abilities to improve quality of life.

Objective:To investigate the promoting effect of individualized instruction combined with a blended learning model (IIBLM) in continuing training of neurology.Methods:A total of 93 trainees who received continuing training in Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, from August 2022 to December 2024 were enrolled as subjects. The 50 trainees registered since January 2024 were enrolled as observation group and received IIBLM teaching, including sub-specialty modular training, a cycle-adaptive cultivation system, a "mutual-selection" mentorship program, an on/off-line dual-track curriculum system, a dynamic course allocation mechanism based on "mutual selection", and a competency growth evaluation system, while the 43 trainees registered before January 2024 were enrolled as control group and received traditional teaching. A questionnaire survey and comprehensive competency assessments were performed to evaluate the effect of teaching, and the t-test, the chi-square test, and the qualitative analysis were used for statistical analysis. Results:Compared with the control group, the experimental group showed systematic improvements in clinical contents, theoretical curriculum, faculty competency, and workflow arrangement during continuing training, with a significant difference in the score of workflow arrangement between the two groups [(9.58±0.67) vs. (9.07±1.44), t=-2.13, P=0.037]. The observation group had a score of (97.70±1.30) for dynamic course allocation, an overall satisfaction rate of 97.15%, and a course benefit rate of 97.55%. The qualitative analysis showed that the trainees in the control group mainly complained of course monotony, while those in the observation group expected to enhance interdisciplinary integration and the cultivation of scientific research abilities. In addition, the results of competency assessment showed a continuous improvement in teaching effect after reform, with no significant difference. Conclusions:IIBLM teaching effectively enhances professional qualities, clinical competency, and the degree of satisfaction with courses among the trainees receiving continuing training, and it also revealed the necessity of interdisciplinary collaborative teaching and the integration of research and clinical practice.

Objective To develop a refined management model for operating rooms and assess its clinical impact on op-erational efficiency and cost control.Methods The study included 10,728 elective surgeries from January to June 2024 as the study group and 9 414 elective surgeries from January to June 2023 as the control group.The differences in operational metrics before and after implementing the refined management model were compared.The model was developed through comprehensive management by hospital leadership and multi-department collaboration,focusing on management structure,systems,processes,information technology,and resource allocation.Results In terms of efficiency,the on-time start rate of the first surgeries in the study group was significantly higher than in the control group(P＜0.05).The turnover time between surgeries was shorter in the study group(P＜0.01),and the rate of unexpected surgery cancellations was lower(P＜0.01).The average cost per surgery for consumables,excluding the impact of centralized procurement of consumables,was approximately 971 yuan,representing an 11% reduction compared to the previous year,despite a 14% increase in surgical volume.The average daily operating cost per operating room was about 12 303 yuan,a 7% reduction.Economic benefits increased by 8.43 million yuan,a 38% year-on-year increase.Conclusion Implementing a refined management model in operating rooms can significantly enhance efficiency,re-duce costs,and achieve dual improvements in social and economic benefits.

Objective:To investigate the promoting effect of individualized instruction combined with a blended learning model (IIBLM) in continuing training of neurology.Methods:A total of 93 trainees who received continuing training in Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, from August 2022 to December 2024 were enrolled as subjects. The 50 trainees registered since January 2024 were enrolled as observation group and received IIBLM teaching, including sub-specialty modular training, a cycle-adaptive cultivation system, a "mutual-selection" mentorship program, an on/off-line dual-track curriculum system, a dynamic course allocation mechanism based on "mutual selection", and a competency growth evaluation system, while the 43 trainees registered before January 2024 were enrolled as control group and received traditional teaching. A questionnaire survey and comprehensive competency assessments were performed to evaluate the effect of teaching, and the t-test, the chi-square test, and the qualitative analysis were used for statistical analysis. Results:Compared with the control group, the experimental group showed systematic improvements in clinical contents, theoretical curriculum, faculty competency, and workflow arrangement during continuing training, with a significant difference in the score of workflow arrangement between the two groups [(9.58±0.67) vs. (9.07±1.44), t=-2.13, P=0.037]. The observation group had a score of (97.70±1.30) for dynamic course allocation, an overall satisfaction rate of 97.15%, and a course benefit rate of 97.55%. The qualitative analysis showed that the trainees in the control group mainly complained of course monotony, while those in the observation group expected to enhance interdisciplinary integration and the cultivation of scientific research abilities. In addition, the results of competency assessment showed a continuous improvement in teaching effect after reform, with no significant difference. Conclusions:IIBLM teaching effectively enhances professional qualities, clinical competency, and the degree of satisfaction with courses among the trainees receiving continuing training, and it also revealed the necessity of interdisciplinary collaborative teaching and the integration of research and clinical practice.

Objective:To investigate the clinical efficacy of transfer of a free segment of the proximal second toe interphalangeal joint composite tissue flap in reconstruction of defects of interphalangeal joint of fingers, and simultaneously reconstruct the donor site defect left with the second toe by a transfer of a pedicled bone flap of the fibular proximal great toe.Methods:From December 2020 to April 2023, a total of 9 patients with interphalangeal joint defects of fingers were treated in the Department of Hand Microsurgery of Shunde Heping Surgery Hospital. The patients were 7 males and 2 females, aged 18-55 years old, with an average age of 31 years old. Firstly, transfers of a free segment of the proximal second toe interphalangeal joint composite tissue flap were performed to reconstruct the defects of finger joints. Simultaneously in the surgery, transfers of the fibular pedicled bone flap of the proximal great toe were conducted to reconstruct the donor site defects left in the second toe. Patients were instructed with appropriate postoperative functional exercises. K-wires were removed at 8-12 weeks after surgery. Outpatient visits, telephone and WeChat follow-ups were conducted to evaluate the appearance and functional recovery of the reconstructed interphalangeal joints and donor feet. Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, Vancouver Scar Scale (VSS) and American Orthopedic Foot and Ankle Society (AOFAS) foot function scoring standards were employed in the evaluation.Results:Postoperative follow-up lasted for 6 to 30 months. All of the 9 interphalangeal joint composite tissue flaps in the fingers survived with complete and good appearance. Function of the reconstructed interphalangeal joints of the fingers recovered well. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the average score achieved 12 points, with 6 patients of excellent, 2 of good and 1 of fair. After surgery, the appearance and function of the donor great toes and second toes all recovered well. The average score of the scars in donor second toe evaluated by VSS was 4 points. All the donor feet were kept with 5 toes, with full, intact and good in appearance. According to the AOFAS foot function scoring standard, the average score achieved 95 points, and were excellent.Conclusion:Application of transfer of free proximal segment of interphalangeal joint composite tissue flap of the second toe in reconstruction of the interphalangeal joint defect of a finger, and simultaneously reconstruct the defect left with the donor second toe with a fibular proximal great toe flap pedicled with bone tissue can achieve good clinical efficacy in reconstruction of the defects of interphalangeal joint of fingers, restore the function of the interphalangeal joint of fingers and the appearance and function of the donor foot.

Objective:To analyze the status quo and advanced trend of voice training research in the world, and provide new ideas for voice training research in China.Methods:The literature on voice training in Web of Science core collection database was searched from January 1, 2013 to July 31, 2023, and visual analysis was performed using CiteSpace 6.1.R6 software.Results:A total of 964 papers were retrieved, and the number of published papers showed an increasing trend. The country with the largest number of publications was the United States, with 387. The Journal with the most publications was Journal of Voice. The research focused on voice rehabilitation of patients with different voice disorders, voice training intervention methods, improvement of quality of life and improvement of training compliance. The application of voice training in geriatric diseases might be a future research trend. Conclusions:At present, the field of voice training is deepening in the direction of new research and application, and the public's demand for voice rehabilitation is increasing. It is suggested that multidisciplinary collaboration should be strengthened in the future to explore the clinical efficacy of voice training in more different populations and diseases.

Objective:Based on the theory of planned behavior (TPB), the exercise intervention program for breast cancer patients undergoing chemotherapy was constructed, and its application effect was preliminarily explored.Methods:A total of 116 patients receiving chemotherapy in the department of breast surgery from June to December 2021 in Shanxi Provincial Cancer Hospital were selected by purpose sampling method. The subjects were randomly divided into control group and experimental group by flipping a coin. The control group was given routine nursing, and the experimental group was given routine nursing on the basis of exercise intervention based on the theory of planned behavior. After three cycles of chemotherapy, the effects of the intervention were evaluated by piper Revised Fatigue Scale (RPFS), Exercise Self-efficacy Scale and Quality of Life Core Scale (EORTC QLQ-C30).Results:In the intervention stage, there were 2 cases in the experimental group and 3 cases in the control group lost. After the intervention, the total score and all dimensions (behavioral, emotional, sensory and cognitive) of cancer-induced fatigue in the experimental group were (2.30 ± 0.58), (2.21 ± 0.85), (2.32 ± 0.70), (2.66 ± 0.71) and (2.03 ± 0.58), which were lower than those in the control group (2.84 ± 0.44), (2.79 ± 0.60), (3.04 ± 0.75), (3.04 ± 0.60) and (2.53 ± 0.56), the differences were significant ( t values were 3.05-5.23, all P<0.05). The total scores of exercise self-efficacy and the dimensions of physical, psychological and social environment were higher than those of the control group ( t values were -7.63 - -3.31, all P<0.05). The scores of overall quality of life, physical function and emotional function were higher than those of the control group ( t = -3.48, -3.14,-2.34, all P<0.05), while the scores of fatigue and insomnia symptoms were lower than those in the control group ( t = 5.13, 3.14, both P<0.05). Conclusion:The exercise program based on the theory of planned behavior can improve the exercise self-efficacy of breast cancer patients undergoing chemotherapy, reduce cancer-related fatigue and improve their quality of life.

Objective:To explore the influencing factors of instrument and equipment alarm fatigue risk of nurses in pediatric intensive care unit (ICU) , establish a prediction model and verify its prediction efficiency.Methods:A multi-stage sampling method was used to select 300 pediatric ICU nurses from 2 tertiary children's specialized hospitals in Henan Province from October 2020 to March 2021 as the research objects for model construction. A total of 300 questionnaires were distributed and 225 valid questionnaires were recovered. From April to May 2021, 110 pediatric ICU nurses in Henan Children's Hospital were selected for model validation, 110 questionnaires were distributed and 100 valid questionnaires were recovered. A self-made baseline rating scale was used to collect relevant baseline information. The medical equipment alarm management questionnaire and the equipment alarm fatigue related scale were used for investigation. The Logistic regression model was used to establish the prediction model, Hosmer-Lemeshow test was used to test the fitting effect of the model and the receiver operating characteristic curve was used to evaluate the prediction value.Results:The 225 pediatric ICU nurses scored (48.67±4.35) for medical equipment alarm management factors, (39.67±3.67) for obstacles to medical equipment alarm management and (22.32±2.83) for clinical alarm fatigue. The results of multivariate analysis showed that the factors of age less than 30 years old, working years less than 5 years, working with illness, nurses with professional titles below, shift work, no habit of setting medical equipment alarms, and medical equipment management factors were all pediatric ICU nurses' equipment alarm fatigue. The independent risk factor of ICU ( P<0.05) . In this study, a prediction model was finally constructed. The area under the receiver operating characteristic curve (AUC) of the model was 0.887, the sensitivity was 0.891 and the specificity was 0.843. The validation data results showed that AUC value of the model was 0.901, the sensitivity was 0.912 and the specificity was 0.857. Conclusions:Pediatric ICU nurses have different degrees of equipment alarm fatigue. This research model can reliably predict the alarm fatigue risk of their equipment and equipment, suggesting that high-risk factors should be paid attention to and timely intervention measures should be carried out to reduce the risk of related adverse events.