From the perspective of palliative care， focusing on the entire process surrounding the death of terminally ill children， with an emphasis on the value of death for children. It explores the children’s understanding of death and the process of self-value pursuit， elucidating the construction of the value of death. Furthermore， it interprets the multifaceted implications of the value of death for children from three dimensions： terminally ill children， caregivers， and society. Additionally， it explores the role of the construction of the value of death in achieving a good death for terminally ill children， optimizing care models， and accelerating the formation of a societal environment of good death， as so to enhance contemporary society’s understanding and appreciation for the value of death for children， bridging the gap in pediatric palliative care and providing a theoretical basis for improving the quality of life for terminally ill children.

Objective Based on the background of disease diagnosis related groups(DRGs)in public hospitals to construct the nursing quality evaluation index system for percutaneous radiofrequency ablation(PRFA)of liver cancer so as to improve the nursing quality for PRFA of liver cancer.Methods Using three-dimensional quality model and through interview,literature analysis,two rounds of Delphi expert letter inquiry and analytic hierarchy process,the evaluation standard of PRFA nursing quality of liver cancer was established,and its effect was validated in clinical practice.Results The evaluation index system of PRFA nursing quality for liver cancer was constructed,which included 3 first-level indexes,9 second-level indexes and 22 third-level indexes.After clinical application,the incidence of intraoperative and postoperative moderate-severe pain,the incidence of high fever,and the 24-hour number of times required care in the intervention group were lower than those in the control group(P＜0.05),the incidence of postoperative Ⅲ degree vomiting in the intervention group was remarkably lower than that in the control group(P＜0.01),and the average hospitalization days in the intervention group were less than those in the control group(P＜0.05),and the average hospitalization expense in the intervention group was lower than that in the control group,but the difference was not statistically significant(P＞0.05).Conclusion The PRFA nursing quality evaluation index system for liver cancer is scientific and practical,which is helpful for improving the outcome of patients and promoting the quality of nursing.

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 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 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 explore the research hotspot and trends of home rehabilitation exercise for patients with Parkinson's disease.Methods:Literature related to home-based rehabilitation exercises for Parkinson's disease patients included in the core set of Web of Science database from establishment of databases to March 31, 2023 was retrieved. The source countries, institutions, authors, key words and references of the literature were visually analyzed by CiteSpace software, and the scientific knowledge map was drawn.Results:A total of 472 articles were included, and the annual publication volume was increasing year by year. The top three countries in terms of publication volume were the United States (176 articles) , the United Kingdom (54 articles) and Australia (54 articles) . The top three institutions with the highest number of publications were La Trobe University, Catholic University of Leuven and Radboud University. The research in this field mainly focused on randomized controlled trials and Meta-analysis. The initial stage of the research mainly focused on the effect of Parkinson's disease on the body, later transferred to gait research, and in recent years, began to focus on the application of virtual reality technology in the home-based rehabilitation of Parkinson's disease patients.Conclusions:Home-based rehabilitation exercises for Parkinson's disease patients can be carried out in many ways, but it is limited by disease symptoms and other influencing factors. Virtual reality technology, telemedicine, wearable devices and other technologies can promote the development of home-based rehabilitation exercises. It is necessary to increase the research efforts of such technology in the future and explore comprehensive home-based rehabilitation exercises programs.

As one of the common benign gynecological diseases, endometriosis (EM) can have a serious impact on the physical and mental health and quality of life of women of childbearing age. Studies have shown that the risk of ovarian cancer in patients with EM is significantly higher than that in the general population. EM is closely related to the occurrence of some types of ovarian cancer, and this kind of ovarian cancer is named endometriosis-related ovarian cancer (EAOC). The incidence rate, pathogenesis, treatment and prognosis of EAOC are summarized in order to better understand it.

Objective : To investigate the establishment of smoke-free environments in medical and healthcare institutions in Zhejiang Province, so as to provide the evidence for improving the implementation of the tobacco control policy in medical and healthcare institutions. Methods: Health administrative sectors and public health institutions at provincial, city and county levels, secondary and tertiary medical institutions, and community health service/township health centers in Zhejiang Province were enrolled. The status of institutional establishment of smoke-free environments was investigated through concealed photography and consulting medical service guides by the assigned the third-party professional investigation company in 2021. The layout of smoke-free environments and indoor smoking were assessed according to the Criteria for Scoring Smoking-free Medical and Healthcare Institutions. Results: Totally 547 medical and healthcare institutions were enrolled in this undercover investigation, including 102 health administrative sectors, 209 public health institutions, 146 secondary and tertiary medical institutions, and 90 community health service/township health centers. The gross mean scores of establishment of smoke-free environments were 83.41±12.19 among all medical and healthcare institutions, 82.02±10.73, 85.56±9.70 and 83.18±12.59 among province-, city- and county-level medical and healthcare institutions, respectively, and the gross mean scores of establishment of smoke-free environments were 82.60±12.27, 85.79±10.74, 80.89±13.85, 82.27±11.62 scores among health administrative sectors, public health institutions, secondary and tertiary medical institutions and community health service/township health centers, respectively. There were 315 institutions with no smoking signs at entrances (57.59%), 255 institutions posting no smoking signs ( 46.62% ), 245 institutions assigning two and more types of health education materials for tobacco control ( 44.79% ), 110 institutions with outdoor smoking areas ( 51.16% ), 66 secondary and tertiary medical institutions with smoking cessation clinics ( 45.20% ) and 354 institutions with carpet smoking bans in indoor places ( 64.72% ). Conclusions The overall establishment of smoke-free environments is satisfactory among medical and healthcare institutions in Zhejiang Province. Nevertheless, improving the coverage of no smoking signs and health education of tobacco control, promoting the standardized construction of smoking cessation clinics and establishing a long-action tobacco control mechanism are still needed.

Objective: To evaluate the effect of a tobacco control intervention for college students under the advocate-promoting model, and to provide evidence for methods to improve smoking control and health decisions. Methods: Four colleges were selected from the list of colleges that participated in a survey of college student tobacco use in Zhejiang Province in 2015, and we conducted a tobacco control intervention with them under the advocate-promoting model for two years. A total of 1 007 students were selected using a random sampling method and surveyed before intervention, and 991 students were selected using a random sampling method and surveyed after the intervention. A chi-square test was used to compare the differences between tobacco use, second-hand smoke exposure, and tobacco knowledge among students before and after the intervention. Results: After the tobacco control intervention, the attempted smoking rate among students in the four colleges dropped from 34.36% to 22.30%, the current smoking rate dropped from 12.12% to 7.87%, the second-hand smoke exposure rate decreased from 75.47% to 70.53%, the difference was statistically significant (χ²=37.73, 9.99, 6.18, P<0.05). After intervention, the proportion of students who had seen tobacco advertisements in the past 30 days decreased from 60.38% to 54.4%, the proportion of students who "saw smoking scenes in video media" decreased from 25.02% to 19.58%, and the proportion of students who "learned smoking control knowledge in class" increased from 14.20% to 18.16%, the difference was statistically significant (χ²=7.08, 8.55, 5.79, P<0.05). Conclusion The advocate-promoting model of "advocacy alliance" can help colleges to establish a smoke-free campus environment and improve college students’ tobacco knowledge and reduce their attempted and current smoking rates.

Objective To investigate the clinical effect of alprostadil in the treatment of coronary heart disease and its effect on myocardial microcirculation and hemorheology.Methods From January 2015 to October 2017,100 patients with coronary heart disease admitted to the First People's Hospital of Wenling were randomly divided into two groups according to the digital table,with 50 cases in each group.The control group was treated with routine therapy.The observation group was treated with alprostadil on the basis of routine treatment.The clinical efficacy,myocardial microcirculation index and hemorheology index were compared between the two groups.Results The total effective rate of the observation group was 96％ (48/50),which was higher than 82％ (41/50) of the control group,and the difference between the two groups was statistically significant (x2 =5.005,P ＜ 0.05).After treatment,the cardiac troponin Ⅰ and myocardial troponin T in the observation group were (0.023 ±0.014)μg/L,(0.012 ±0.006)μg/L,respectively,which in the control group were (0.037 ± 0.015) μg/L,(0.019 ± 0.008) μg/L,respectively,the differences between the two groups were statistically significant (t =4.825,4.950,all P ＜ 0.05).The erythrocyte hematocrit,plasma viscosity,erythrocyte sedimentation rate,erythrocyte electrophoresis time in the observation group were (25.69 ± 3.87) ％,(293.42 ± 12.73) s,(15.21 ± 4.59) mm/h,(1.29 ± 0.37) mp/s,respectively,which in the control group were (32.54 ± 4.52) ％,(326.17 ± 18.65) s,(21.85 ± 5.93) mm/h,(1.76 ± 0.43) mp/s,respectively,the differences between the two groups were statistically significant (t =8.140,10.256,6.261,10.256,all P ＜ 0.05).Conclusion Alprostadil in the treatment of coronary heart disease can improve the clinical efficacy and improve the patients'myocardial microcirculation and hemorheological indicators.