Objective To investigate the post-intervention experiences in elderly stroke patients who received the group-based acceptance and commitment therapy(ACT)and to provide a reference to improve the group-based ACT intervention strategies for the patients.Methods With the descriptive phenomenological research,the semi-structured in-depth interviews were conducted with 15 elderly stroke patients who had received the group-based ACT intervention for 6 months in a Tier-IIIA hospital in Hunan Province between May and July 2023.The data acquired from the interviews were analysed using the Colaizzi method.Results The experiences in elderly stroke patients with the group-based ACT intervention were categorised into three main themes and ten sub-themes:(1)The impact of intervention on the psychology and spirit(change cognition and accept oneself;enhance awareness and reflect on oneself;clarify values and adapt to oneself;disengage from suffering and achieve dissociation;understand suffering and discover a sense of meaning in life);(2)Behavioural changes brought by the intervention(change approaches to improve health;engage in rehabilitation exercises and build confidence;enhance social interactions and integrate into life);(3)Suggestions for the intervention program(tailor to the physiological characteristics of the elderly;adapt to the psychological characteristics of the elderly).Conclusion The group-based ACT intervention has a beneficial effect on the psychological,spiritual and behavioural changes in the elderly stroke patients.The intervention programs should be improved according to the physical and mental characteristics therefore to improve the mental health of elderly stroke patients.

Objective To investigate the post-intervention experiences in elderly stroke patients who received the group-based acceptance and commitment therapy(ACT)and to provide a reference to improve the group-based ACT intervention strategies for the patients.Methods With the descriptive phenomenological research,the semi-structured in-depth interviews were conducted with 15 elderly stroke patients who had received the group-based ACT intervention for 6 months in a Tier-IIIA hospital in Hunan Province between May and July 2023.The data acquired from the interviews were analysed using the Colaizzi method.Results The experiences in elderly stroke patients with the group-based ACT intervention were categorised into three main themes and ten sub-themes:(1)The impact of intervention on the psychology and spirit(change cognition and accept oneself;enhance awareness and reflect on oneself;clarify values and adapt to oneself;disengage from suffering and achieve dissociation;understand suffering and discover a sense of meaning in life);(2)Behavioural changes brought by the intervention(change approaches to improve health;engage in rehabilitation exercises and build confidence;enhance social interactions and integrate into life);(3)Suggestions for the intervention program(tailor to the physiological characteristics of the elderly;adapt to the psychological characteristics of the elderly).Conclusion The group-based ACT intervention has a beneficial effect on the psychological,spiritual and behavioural changes in the elderly stroke patients.The intervention programs should be improved according to the physical and mental characteristics therefore to improve the mental health of elderly stroke patients.

In order to improve the disaster response ability of resident physicians under standardized training, this study designed a disaster medicine curriculum of traditional Chinese and Western medicine with reference to domestic and foreign experience. The curriculum consisted of 8 modules with a total of 26 class hours. The definition and classification of disasters and the status of traditional Chinese medicine in disaster medicine were introduced. This study evaluated the teaching effect of disaster medicine curriculum of traditional Chinese and Western medicine carried out by the Emergency Trauma Center of the Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine in 84 resident physicians under standardized training. The results showed that the objective test scores of resident physicians under standardized training before and after the course were (45.00±2.51) and (76.25±2.76), respectively ( P<0.001). A questionnaire survey on the subjective understanding of knowledge related to disaster medicine of traditional Chinese and Western medicine was conducted among resident physicians under standardized training before and after the course. The results showed that the test scores before and after the course were (50.88±1.41) and (64.64±1.80), respectively ( P<0.001). This study showed that the theoretical knowledge, skills, and comprehensive ability of resident physicians under standardized training in disaster relief have been greatly improved through the disaster medicine-related curriculum, providing a reference for the establishment of disaster medical education-related curriculum of integrated traditional Chinese and Western medicine.

Objective: To understand the prevalence and pattern of abnormal uterine bleeding (AUB) among female medical college students in Shanghai，to provide a basis for menstrual health intervention for female college students. Methods: A total of 912 female medical students from a university in Shanghai were selected through cluster sampling. An anonymous questionnaire survey on menstrual history and related factors was conducted in March 2021. Results: The prevalence of AUB among female medical college students was 39.9%, with cycle disordered and non cycle disordered AUB of 24.7% and 15.2%, respectively. Among female college students with AUB, 21.7% had two or three abnormal menstrual symptoms. Multivariate Logistic analysis showed that sleep quality was associated with both types of AUB, and female undergraduates with poorer and poor sleep quality were at increased risk of both cyclic disordered AUB ( OR =2.05) and non cyclic disordered AUB ( OR =2.00). Low BMI ( OR =1.66) and weight gain and loss ( OR =1.76) were associated with cycle disordered AUB. Frequent insomnia ( OR =2.45) was associated with non cyclic disordered AUB( P <0.05). Conclusion Abnormal uterine bleeding (AUB) is common in female college students, female medical college students with AUB have multiple concurrent abnormal bleeding patterns. Factors associated with AUB varied according to the type of AUB, with sleep quality correlates with both types of AUB.

ObjectiveTo develop a self-assessment questionnaire for menstrual abnormalities and test its reliability and validity. To provide an assessment tool for self-identification of abnormal menstruation in young women and to investigate the health seeking situation of abnormal menstruation in the population. MethodsFifteen physicians with clinical experience were invited to participate in the Delphi expert consultations. Medical indications for menstrual abnormalities were constructed and questionnaires were formed based on domestic and international literature， expert meetings and 2 rounds of Delphi expert consultations. A whole-group sampling was used to select 923 female college students from a medical school in Shanghai for the survey， and 306 of them were retested. The internal consistency， retest correlation， researcher-investigator evaluation correlation， and structural and response validity of the questionnaire were examined. ResultsThe questionnaire formed 6 dimensions with 17 indications. The positive coefficients for the two rounds of consulting experts were >90%. The mean authority coefficient was 0.857. The Kendall W coordination coefficient was 0.465 and 0.455， respectively （P<0.001）. The questionnaire Cronbach's alpha coefficient was 0.622. The retest correlation coefficient was 0.459. The correlation coefficient between the researcher's score and the respondents' self-assessment was 0.562. The five common factors extracted by factor analysis were consistent with the structure of the questionnaire， and the cumulative contribution of variance was 54.4%. Total questionnaire scores were moderately to highly correlated with each dimension score （0.409 to 0.699）. There was low correlation between the dimensions （-0.002 to 0.203）. Girls who had sought medical care had higher scores on the total questionnaire， category A， category B， cycle dimension， menstrual dimension， and dysmenorrhea/PMS dimension than girls who had not sought medical care （P<0.01）， and the difference between the two groups in menstrual volume dimension scores was not statistically significant. ConclusionThe self-assessment questionnaire for menstrual abnormalities developed in this study has acceptable reliability， good structure validity and response validity. It can provide a self-examination tool and medical consultation guidance for young women with abnormal menstruation.

Objective:To explore the clinical effect of antibiotic bone cement combined with delayed lateral supramolleolar perforator fascial flap in the treatment of diabetic foot(DF).Methods:From April 2020 to July 2021, a total of 6 patients with DF were treated with antibiotic bone cement combined with delayed lateral supramolleolar perforator fascial flap. The patients were 5 males and 1 female, aged from 45 to 67 years old with an average of 56.2 years old. The wounds were all located in dorsal foot, 4 in right foot and 2 in the left. The wound area was 2.4 cm×5.0 cm-6.5 cm×10.0 cm. The depth of wound were: 3 cases up to tendon layer, and 3 cases up to metatarsal bone. Two of the wound were complicated with metatarsal osteomyelitis. The wounds at Wagner grade 3 in 4 patients and grade 4 in 2 patients. The flap size was 3.0 cm×6.0 cm-8.0 cm×11.0 cm. All of the wounds were repaired with delayed supramolleolar perforator fascia flap after debridement, application of antibiotic bone cement and fumigation with Sanhuang decoction(a traditional Chinese medicine). The affected limbs were externally fixed with plaster and raised after surgery, and the colour, temperature, tension and capillary reaction of the flaps were closely observed. Stitches were removed 2 weeks after surgery and rehabilitation of the affected limb was performed. Regular follow-up was made postoperatively. The appearance of flaps and the scar of donor and recipient sites were observed. The foot and ankle function were evaluated by the American Orthopaedic Association foot and Ankle Surgery(AOFAS) score scale.Results:Six cases of DF had no recurrence of wound infection. All flaps survived well. The average follow-up time was 6(3-14) months. The postoperative follow-up revealed satisfactory appearance of the flap, only linear scars remained in the donor and recipient sites. The function of foot and ankle recovered well with full weight-bearing and normal walk. AOFAS scores ranged from 81 to 95.Conclusion:It is an effective method to treat DF by applying antibiotic bone cement combined with delayed superior lateral malleolus perforator fascial flap. The operation is simple, safe and can cut down the time of treatment, quickly control the wound infection. It deserves further trials.

Objective:To investigate the correlation between specific expression of serum micro ribonucleic acid (miRNA) and dilated cardiomyopathy (DCM) in children.Methods:Sixteen children diagnosed with DCM in Pediatric Heart Center of Beijing Anzhen Hospital from November 2013 to March 2016 were enrolled in the DCM group.Meanwhile, 12 age- and gender-matched healthy children who underwent medical examinations at the same time in the same hospital were selected as the healthy control group.Their serum was collected and miRNA sequencing was performed.The sample size was expanded at the later stage (the DCM group included 30 cases, and the healthy control group included 16 cases). The real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) verification experiment was conducted on 11 miRNAs with statistically significant sequencing results.Results:Serum miRNA sequencing showed that 172 miRNAs were up-regulated but no miRNAs were down-regulated in the DCM group, compared with the healthy control group (fold change>2, P<0.001). Top 11 significantly up-regulated miRNAs were verified by qRT-PCR, and it was found that 8 of the 11 miRNAs (let-7f, let-7g, miR142-5p, miR143-3p, miR26a, miR27a-3p, miR27b-3p, and miR126-3p) in the DCM group were significantly up-regulated (all P<0.05). In the receiver operating characteristic (ROC) curves of DCM patients, the area under the curves of serum miR142-5p, miR143-3p, miR27b-3p, and miR126-3p were 0.983, 0.992, 0.915 and 0.950, respectively, which were statistically significantly different from those of the healthy control group (all P<0.05). Conclusions:Four serum miRNAs (miR-142-5p, miR-126-3p, miR-143-3p and miR-27b-3p) can distinguish children with DCM from healthy children.Circulating miRNAs are effective in screening DCM children.

Objective: A more safe and efficient "classification" items validity management method is proposed through the comparative analysis of the merits and demerits of the common items validity management methods, combined with the exploration and practice of the gynaecological ward of a specialized hospital in Shanghai, Methods: The "classification" item validity management method includes setting up a special task group and formulating a work flow. The critical point is to adopt different management methods according to the classification of items. Results: According to the supplier of items, it is divided into Class I and Class II. Items of Class I adopt the management method of validity turnover rate and Class II items adopt the effective period safety area management method. Conclusion The validity management method of "classification" items ensures the quality of special task and improves the work efficiency.

Objective To investigate the situation of nurse job burnout and the occurrence of nursing adverse events in western area of Chongqing,and to analyse the correlation between them.Methods A total of 5 hospitals in different district of west area of Chongqing was randomly selected.Then the sample of nurses meeting the inclusion and exclusion criteria was selected by random number table method,200 nurses were selected in each hospital.Multivariate logistic regression analysis was used to analyze the factors influencing the adverse events of nursing,and the structural equation model was applied to analyze the relationship between nurses job burnout and nursing adverse events.Results A total of 1 000 nurses were surveyed,and 998 valid questionnaires were collected.The rate of nurse job burnout and the incidence of nursing adverse events in the survey year were 56.41％ and 54.21％,respectively.Among nurses with job burnout,85.08 ％ occurred nursing adverse events.The increased workload,night shift,no officially budgeted post and with occupational burnout were factors affecting the incidence of nursing adverse events (OR=1.250,1.445,1.615,1.991,P＜ 0.05).The emotional exhaustion dimension of job burnout had the greatest effect on nursing adverse events (the standard partial regression coefficient was 0.31,P＜0.05),followed by the disintegration of personality (the standard partial regression coefficient was 0.29,P＜0.05),while the reduction in the sense of accomplishment had no direct effect on nursing adverse events.Conclusion In hospitals of the western area of Chongqing,the prevalence of nurse job burnout is comparatively serious,and the incidence of nursing adverse events is relatively high.The nurse job burnout and nursing adverse events might be positively correlated.

Objective To establish an evaluation index system for the quality and safety of the specialized nursing care in cardiovascular medicine. Methods To screen and evaluate the safety quality evaluation index via a group discussion with Delphi method and analytic hierarchy process referenced to the literatures from the evaluation index of domestic nursing safety quality (NSQ)and on the base ofthe factor quality- quality of links-final quality3-dimensional quality structure theory by Donabedian. Results The first and second round of expert consultation and the recovery rate were 97.05% (33/34) and 94.12% (32/34) respectibely, the effective rate was 100%;The authoritative coefficient of expert of the safety quality evaluation index of the specialized nursing care is 0.867 and 0.879 respectively. In the first round, the average of the importance rating is 3.50-5.00, the standard deviation is 0-0.042 and full mark rate is 34.10%-100%. In the second round, the average of the importance rating is 3.80-4.70, the standard deviation is 0~0.047 and full mark rate is 31.60%-100%. The fluctuation degree of the first round is more than 0.10 with a low coordination degree. However, the fluctuation degree of the second round result is less than 0.10. The coordination coefficients from all qustionnair scores by experts in the two roudns are 0.169 and 0.286. The difference was statistically significant according to the chi-square analysis (X2=6.842, P=0.002). The NSQ evaluatin index included 3 first degree indexes (weight coefficient including 0.2684,link qualing 0.6144,and quality 0.1172),16 second degree indicators (weight coefficient 0.034~0.0859) and 61 third degree indexes ( weight coefficient 0.034~0.0859) and 61 third degree indexes (weight coefficient 0.0052~0.0412). Conclusions This paper preliminary established a specialied NSQ evaluation index with factor quality- quality of links-final quality 3-dimensional quality structure in the field of cardiovascular medicine, which is based on Delphi method and analytic hierarchy process. NSQ provides a measurement tool for nurses in CME.