Objective:To analyze the correlation between thymus dose-volume parameters and lymphopenia in patients with early-stage breast cancer (BC) receiving adjuvant radiotherapy (RT).Methods:Medical records of 54 patients with early-stage BC who received postoperative adjuvant RT in the Second Affiliated Hospital of Soochow University from January to December 2019 were retrospectively analyzed. Absolute lymphocyte counts (ALC) were collected at 1 month before (baseline) and weekly during RT. Lymphopenia was graded based according to the common terminology criteria for adverse events version 5.0 and nadir/baseline ALC was calculated. The thymus was delineated according to anatomical boundaries in the original RT planning system. Dosimetric parameters were obtained from the dose volume histograms. Stepwise multiple linear regression analysis was used to explore the factors associated with nadir/baseline ALC. The cutoff values of dosimetric parameters for predicting ≥grade 3 lymphopenia were obtained using the receiver operating characteristic (ROC) curve.Results:The proportion of 54 patients experiencing ≥ grade 3 lymphopenia was 38.9%. The median value of thymus volume, mean dose, V 5 Gy, V 10 Gy were 14.02 cm 3, 4.95 Gy, 36.18%, and 6.61%, respectively. Stepwise multiple linear regression analysis revealed that baseline ALC ( P=0.005), quadrant location ( P=0.005) and mean thymus dose ( P<0.001) were significantly associated with nadir/baseline ALC. ROC curve analysis indicated that the cutoff values of thymus mean dose, V 5 Gy and V 10 Gy for predicting ≥ grade 3 lymphopenia were 6.12 Gy, 35.2%, and 7.4%, respectively. Conclusions:Lymphopenia in early-stage BC patients is significantly correlated with high dosimetric parameters of the thymus during postoperative adjuvant RT. Thymus may be considered as an organ at risk during RT.

Objective:To analyze the correlation between thymus dose-volume parameters and lymphopenia in patients with early-stage breast cancer (BC) receiving adjuvant radiotherapy (RT).Methods:Medical records of 54 patients with early-stage BC who received postoperative adjuvant RT in the Second Affiliated Hospital of Soochow University from January to December 2019 were retrospectively analyzed. Absolute lymphocyte counts (ALC) were collected at 1 month before (baseline) and weekly during RT. Lymphopenia was graded based according to the common terminology criteria for adverse events version 5.0 and nadir/baseline ALC was calculated. The thymus was delineated according to anatomical boundaries in the original RT planning system. Dosimetric parameters were obtained from the dose volume histograms. Stepwise multiple linear regression analysis was used to explore the factors associated with nadir/baseline ALC. The cutoff values of dosimetric parameters for predicting ≥grade 3 lymphopenia were obtained using the receiver operating characteristic (ROC) curve.Results:The proportion of 54 patients experiencing ≥ grade 3 lymphopenia was 38.9%. The median value of thymus volume, mean dose, V 5 Gy, V 10 Gy were 14.02 cm 3, 4.95 Gy, 36.18%, and 6.61%, respectively. Stepwise multiple linear regression analysis revealed that baseline ALC ( P=0.005), quadrant location ( P=0.005) and mean thymus dose ( P<0.001) were significantly associated with nadir/baseline ALC. ROC curve analysis indicated that the cutoff values of thymus mean dose, V 5 Gy and V 10 Gy for predicting ≥ grade 3 lymphopenia were 6.12 Gy, 35.2%, and 7.4%, respectively. Conclusions:Lymphopenia in early-stage BC patients is significantly correlated with high dosimetric parameters of the thymus during postoperative adjuvant RT. Thymus may be considered as an organ at risk during RT.

Objective:To construct a scientific performance evaluation index system for online contracted nurses and provide evaluation tools for managers to evaluate their performance.Methods:Based on the KRIF theory, literature search, qualitative interview results initially constructed performance evaluation indexes of online contracted nurses, used Delphi method to carry out two rounds of expert correspondence from April to July, 2023, and used hierarchical analysis to determine the performance evaluation index system of online contracted nurses and the weights of the indexes at all levels.Results:The questionnaire recovery rate of the two rounds of expert correspondence was 18/18, the coefficient of basis of judgment was 0.91, the coefficient of familiarity was 0.89 and 0.86, the coefficient of authority was 0.90 and 0.89, and the coefficient of coordination of experts was 0.222 and 0.190, respectively (all P<0.001), and finally formed the performance evaluation index system of online contracted nurses including 4 first-level indexes, 9 second-level indexes, and 32 tertiary indicators. Conclusions:The performance evaluation index system of online contracted nurses based on the KRIF model covers various aspects, is scientific, reliable and comprehensive, and can provide a reference basis for the performance evaluation management of online nurses.

Objective:To construct a scientific performance evaluation index system for online contracted nurses and provide evaluation tools for managers to evaluate their performance.Methods:Based on the KRIF theory, literature search, qualitative interview results initially constructed performance evaluation indexes of online contracted nurses, used Delphi method to carry out two rounds of expert correspondence from April to July, 2023, and used hierarchical analysis to determine the performance evaluation index system of online contracted nurses and the weights of the indexes at all levels.Results:The questionnaire recovery rate of the two rounds of expert correspondence was 18/18, the coefficient of basis of judgment was 0.91, the coefficient of familiarity was 0.89 and 0.86, the coefficient of authority was 0.90 and 0.89, and the coefficient of coordination of experts was 0.222 and 0.190, respectively (all P<0.001), and finally formed the performance evaluation index system of online contracted nurses including 4 first-level indexes, 9 second-level indexes, and 32 tertiary indicators. Conclusions:The performance evaluation index system of online contracted nurses based on the KRIF model covers various aspects, is scientific, reliable and comprehensive, and can provide a reference basis for the performance evaluation management of online nurses.

Objective: This study’s objective is to assess the efficacy and safety of Pulsed Magnetic Therapy System (PMTS) in improving insomnia disorder. Methods: Participants with insomnia disorder were randomly assigned to receive either PMTS or sham treatment for four weeks (n= 153; PMTS: 76, sham: 77). Primary outcomes are the Insomnia Severity Index (ISI) scores at week 0 (baseline), 1, 2, 3, 4 (treatment), and 5 (follow-up). Secondary outcomes are the Pittsburgh Sleep Quality Index at baseline and week 4, and weekly sleep diary-derived values for sleep latency, sleep efficiency, real sleep time, waking after sleep onset, and sleep duration. Results: The ISI scores of the PMTS group and the sham group were 7.13±0.50, 11.07±0.51 at week 4, respectively. There was a significant group×time interaction for ISI (F3.214, 485.271=24.25, p<0.001, ηp 2=0.138). Only the PMTS group experienced continuous improvement throughout the study; in contrast, the sham group only experienced a modest improvement after the first week of therapy. At the end of the treatment and one week after it, the response of the PMTS group were 69.7% (95% confidence interval [CI]: 58.6%–79.0%), 75.0% (95% CI: 64.1%–83.4%), respectively, which were higher than the response of the sham group (p<0.001). For each of the secondary outcomes, similar group×time interactions were discovered. The effects of the treatment persisted for at least a week. Conclusion PMTS is safe and effective in improving insomnia disorders.

Objective:To construct a training course system for online appointment nurses based on post competence,and to provide references for the training and development of online appointment nurses in China.Methods:From January 2021 to May 2022, based on the theory of post competence, literature review, policy research, questionnaire survey and and expert consultation were used to establish the training course system of online appointment nurses.Results:The effective recovery rates of the two rounds of expert consultation questionnaires were 18/18 and 17/18, respectively; the expert authority coefficient was 0.928 and 0.938, respectively; and the Kendall harmony coefficient was 0.185 and 0.284, respectively, the differences were statistically significant (all P<0.001). The final content of the training course system for online appointment nurses included 4 first-level indicators,which were professional knowledge, professional skills, professional abilities and traits, 19 second-level indicators and 58 third-level indicators. Conclusions:The training course system of online appointment nurses based on post competency is scientific, reasonable and prominent,which can provide reference for training of online appointment nurses in China.

Objective:To survey the job satisfaction of online contracted nurses who provide " Internet plus nursing services" for reference of hospital managers in improving their management mechanism in this regard.Methods:Based on the two-factor theory, a questionnaire was designed and a purposive sampling method was used to survey the online contracted nurses in Anhui province in April and May 2022. The motivational factors included such five dimensions as workload, work content, colleague relationship, doctor-patient relationship, and their own development, and the healthcare factors included such three dimensions as salary, job recognition and social status. The questionnaire data and job satisfaction scores were analyzed descriptively, and the correlation between the overall job satisfaction of the online contracted nurses, while each dimension was analyzed by Pearson correlation analysis, and the influence of each dimension on job satisfaction was analyzed by stepwise regression analysis.Results:A total of 335 valid questionnaires were recovered. The mean score of job satisfaction of online contracted nurses was (2.26±0.38), with the highest score of (2.56±0.53) for salary satisfaction and the lowest score of (1.78±0.67) for job recognition, and each dimension was positively correlated with job satisfaction ( r=0.34-0.88, P<0.01). Regression analysis showed that workload ( B=0.07), salary ( B=0.11), job content ( B=0.23), social status ( B=0.12), and self-development ( B=0.15) were the main factors affecting their job satisfaction ( P<0.01). Conclusions:The job satisfaction of online contracted nurses was at a medium level, mainly influenced by workload, salary, job content, social status and their own development. It is recommended that hospitals implement multiple targeted measures to improve the job satisfaction of online contracted nurses and promote the healthy development of " Internet plus nursing services" .

Objective:To evaluate the effect of WeChat platform in the diagnosis and treatment of menopausal-related diseases for gynecologists.Methods:In March 2017, 47 gynecologists who voluntarily participated in the offline continuing medical education project "Diagnosis and Treatment training of menopause-related diseases" in Beijing Shijitan Hospital Affiliated to Capital Medical University were selected as the control group (traditional teaching mode), and 52 gynecologists who volunteered to participate in WeChat platform training were selected as the experimental group (WeChat teaching mode). The main outcome measure was the knowledge level of menopause-related diseases and curriculum satisfaction before and after training. SPSS was used to perform t-test or chi-square test for inter-group data. Results:All gynecologists completed the study, the recovery rate of the evaluation questionnaire before and after training was 100%. Before training, the average score of menopause-related disease knowledge and the test passing rate of knowledge examination in experimental group were (63.65±21.42) and 65.4%, while those in the control group were (60.85±24.83) and 63.8%, respectively. No significant difference was found ( P>0.05). After training, the knowledge level of menopause-related diseases and the test passing rate significantly improved in both groups ( P<0.05). The average score of students and the passing rate in the experimental group were (77.50±16.19) and 90.1%, which were better than those in the control group [(78.72±16.89), 87.2%]. However, there was no significant difference between the two groups ( P>0.05). Besides, the experimental group was more satisfied, but the difference was not statistically significant compared with control group ( P>0.05). Conclusion:WeChat platform training for gynecologists not only has the same effects as the traditional teaching model on menopausal disease diagnosis and treatment training, but also gains higher training satisfaction, suggesting WeChat platform training can be further applied to other subdisciplines.