BackgroundAs a high prevalence disorder， schizophrenia has caused significant burden to family and society due to the impairment of occupational and social function. Currently， the dominant vocational training model in China follows a paternalistic， clinician-led decision-making approach. Although it improves patients' social function to some extent， it undermines their autonomy and treatment adherence. Therefore， it is urgently necessary to explore a new intervention method to enhance treatment compliance and social function in patients. ObjectiveTo explore the impact of shared decision-making oriented vocational training on social function in hospitalized schizophrenia patients， so as to provide references for rehabilitation interventions. MethodsA total of 68 patients diagnosed with schizophrenia according to the International Classification of Diseases， tenth edition （ICD-10） criteria were consecutively enrolled from January to June 2024 at The Third People's Hospital of Wenjiang Distric， Chengdu. Participants were randomly allocated into the research group （n=34） and the control group （n=34） using a random number table method. Both groups received routine rehabilitation training， while the research group received shared decision-making oriented vocational training for 12 weeks， 2 times a week for 2 hours each time. Before and at the 4^th and 12^th week of intervention， two groups were evaluated by General Self-Efficacy Scale （GSES）， Stigma Scale for Mental Illness （SSMI）， Scale of Social function of Psychosis Inpatients （SSFPI） and Inpatient Psychiatric Rehabilitation Outcome Scale （IPROS）. ResultsA total of 63 participants completed the study， with 30 cases in the research group and 33 cases in the control group. Repeated measures ANOVA revealed statistically significant time effects and interaction effects in both groups for GSES， SSMI， SSFPI and IPROS scores （F=20.451， 16.022； 26.193， 12.944； 23.957， 5.023； 11.776， 3.985， P<0.05 or 0.01）， while no significant group effects were observed （F=0.188， 0.742， 1.878， 0.474， P>0.05）. At the 12^th week of intervention， there were statistically significant differences in GSES， SSMI， SSFPI and IPROS scores between the two groups. ConclusionShared decision-making oriented vocational training may help to improve social function in patients with schizophrenia. ［Funded by 2023 Chengdu Medical Research Project （number， 2023468）］

Performance appraisal of public hospitals have given a guidance for the development of public hospitals at all levels.A Class A tertiary hospital reviewed the problems in the development of the hospital at the present stage and focused on the following four aspects:①insufficient fine management;②No clear orientation of discipline development;③The bottleneck of the improvement of medical operation efficiency;④New challenges in the reform of payment mode.The tertiary hospital launched a fine management practice in May 2022,in order to solve the problems by taking the Department of Surgery as a pilot area,laying the foundation for fine management through information system construction,improving the efficiency of medical operation through management process optimization,improving the overall competitiveness of disciplines through the construction of sub-specialty and Discipline Alliance and adjusting the performance appraisal index system to play the role of performance incentives.The measures effectively improve the overall capacity and efficiency of hospital medical services and help the hospital to achieve high-quality development.

Objective To analyze the coding quality of multiple primary malignant tumors in a tertiary hospital,identify existing problems,and improve the accuracy of coding for multiple primary malignant tumors.Methods We collected 393 medi-cal records from a tertiary hospital from June 1,2021,to June 30,2023,with ICD-10 code C97 for the discharge diagnosis.By carefully reading the medical records,we analyzed the reasons for coding errors in multiple primary malignant tumors with code C97.Results Among the 393 medical records,there were 34 cases with coding errors in C97,including 11 cases where meta-static malignant tumors were erroneously coded as multiple primary malignant tumors,9 cases where malignant tumors of the same organ system with non-adjacent sites and the same histological type were erroneously coded as multiple primary malignant tumors,7 cases where distant metastasis or local invasion was erroneously coded as multiple primary malignant tumors,4 cases where be-nign tumors were mistakenly coded as malignant tumors,and 3 cases where suspected malignant tumors were coded as confirmed cases.Conclusion To improve the quality and efficiency of C97 coding,coders need to have a clear understanding of the defini-tion of multiple primary malignant tumors,read the medical records carefully and completely,determine the location and histolog-ical type of the tumors accurately,and strengthen communication with clinical physicians.

This commentary was based on the paper "Calorie Restriction with or without Time-Restricted Eating in Weight Loss" (TREATY trial) published recently in N Engl J Med, with the aim to introduce the study design of TREATY trial and discuss the main findings along with its clinical applicability. This trial offers additional evidence on the time-restricted eating and provides insights for future research.

China is stepping up its standardized management of investigator initiated trials(IIT)carried out by medical and health institutions, spotlighting the establishment and improvement of the quality control system of IIT projects than ever before. The authors retrieved official websites of clinical research related units of medical institutions and research institutes at home and abroad, and by means of literature review analyzed the current quality management of IIT projects at home and abroad. They found such setbacks as lack of quality management standards and norms, imperfect quality control mechanism, poor awareness of quality risk, insufficient quality supervision and poor quality control ability of clinical researchers. Based on the above, the paper made the following recommendations for building an IIT project quality control system in China: developing quality management standards and norms, setting up a systematic quality control mechanism(i.e., exploring a three-level quality control mode composed of the project team/department-hospital-national supervision institution/peer review expert team, and implementing the whole process quality control mechanism), strengthening policy guidance and system construction, and strengthening the standardized training of clinical researchers.

Objective To investigate the knowledge and attitude of nurses on the prevention and nursing of common complications among bedridden patients in Wuhan City, and provide scientific basis for the implementation of targeted training in improving clinical nursing quality. Methods A total of 748 clinical nurses from 4 hospitals in Wuhan City were selected in November 2016 using convenient sampling method. A self-designed questionnaire was applied to investigate the common complications nursing knowledge and attitude of nurses on bedridden patients. Results The accuracy of nurses' knowledge on the prevention and nursing of common complications among bedridden patients were listed as follows: deep vein thrombosis (DVT) (77.44%), pneumonia (73.88%), urinary tract inflammation (70.63%), and pressure ulcers (61.44%). The scores of nurses' attitude were listed successively: pressure ulcers (88.21%), urinary tract inflammation (86.81%), pneumonia (86.66%), and DVT (85.92%). There were positive correlation between the scores of knowledge and attitude of nurses on four kinds of complications (P< 0.05). Conclusions Nursing administrators should improve the training and update of common complications knowledge on nurses, and promote their positive attitude to the prevention of common complication to increase the quality of nursing.

Objective To understand the probability of suicide and demographic characteristics of cancer inpatients and to analyze the correlation between depression and probability of suicide.Methods From June to October 2017, we selected 310 inpatients in oncology department of two hospitals in a province as subjects by convenience sampling. The questionnaire survey was carried out in patients with the general information questionnaire, Patient Health Questionnaire-9 (PHQ-9) and Suicide Probability Scale (SPS). Pearson correlation was used to analyze the correlation between depression and probability of suicide. We also compared the differences of probability of suicide among patients with different characteristics.Results Among 310 cancer inpatients, the score of PHQ-9 was (3.96±3.46) with 7.1％ (22/310) for the incidence of depression;the score of SPS was (57.35±8.38) with 11.0％ (34/310) for the incidence of suicide idea. Depression of patients had a positive correlation with the probability of suicide (r=0.381,P<0.001). There were statistical differences in the probability of suicide among cancer inpatients with different sexes, ages, education levels, marital status and living conditions (P<0.05).Conclusions When evaluating the probability of suicide of cancer inpatients, we should pay attention to high-risk population according to different demographic characteristics. Clinical nursing workers should show solicitude for patients with depressive symptoms and provide timely medication and mental regulation for patients diagnosed with depression.

Objective Based on the objective test (A type) results of the 2014 comprehensive clinical course graduation test of 3+2 assistant general practitioners training,this article analyzed the differences between different teaching units,so as to provide objective basis for improving the teaching level of each unit.Method We established a database with EXCEL 2000,and put each question's ID and points,and the score of each student into the computer,so we could get the difficulty coefficient,distinction degree and reliability of the test paper,and calculate the difficulty coefficient and difference of each question.Then we analyzed the difficulty coefficient,the difference and the reliability of the 122 students' testing results,and compared the accuracy to the same question of the 6 teaching units.Result The objective test's (A type) difficulty coefficient is 0.77,distinction degree is 0.19,and reliability is 0.99.The highest score of the 122 students is 47 points,and the lowest score is 28 points,the average score is (38.5 ± 3.9) points.In the 50 questions,3 questions' difficulty coefficient is less than 0.4,14 questions' difficulty coefficient is between 0.4-0.7,33 questions' difficulty coefficient is above 0.7,so the difficulty degree of the paper is relatively low.In the 50 questions,23 questions' distinction degree is less than 0.15,17 questions' distinction degree is between 0.15-0.30,10 questions' distinction degree is above 0.30,so the distinction degree of the paper is relatively high.In the 50 questions,20 questions' accuracy appears larger differences between each unit:9 questions' accuracy has decreased significantly among 1-2 units,4 questions' accuracy decreased significantly among 3 units,3 questions' accuracy decreased significantly among 4 units,only 1 unit has high accuracy among 2 questions,and 2 questions' accuracy decreased significantly among all units.These problems are related to the teachers' teaching ability,the difficulty in mastering the key points of the curriculum,the lack of the concept of the general practitioners training.Conclusion The design of the examination paper is basically in line with the study purpose and the objectives of the training course.This examination paper was highly reliable,and suitable for the professional theory and ability test.There are site differences between each unit,which can provide an objective basis for improving the teaching level of different teaching unit,and we will solve the problems in the form of collective preparation next step.

Objective To explore the methods of the standardized management used in humanistic nursing care and to assess its effects.Methods Measures of the standardized management began to be used in such care at the hospital since January 2013.Questionnaires of patient satisfaction with nursing care for inpatients and those discharged were used to assess the effects of the standardized management measures periodically and synthetically.Results The patient satisfaction with humanistic nursing care keeps increasing year by year from 2013 to 201 5.The differences among three sets of data are statistically significant(P < 0.05 ).Conclusions Humanistic nursing care calls for promotion of standardized management.It is high time to build such a standardized management system at the hospitals.

Objective To analyze the risk factors of suicide of inpatients , and to provide a theoretical basis for the reduction of inpatient suicide and consolidation of nursing safety management .Methods To analyze the data related to inpatient suicide , using descriptive statistical analysis and “5M1E”method to analyze the data from six aspects of human , machine, material, method, measurement and environment .Results For the human factors , the medical staff lacked the suicidal awareness , and patients had personality disorder , cognitive defects, lack of company or social support of inpatients .For the machine factors, the doors, windows and other facilities had defects in design .For the material factors , it was easier to access to suicide tools for inpatients.For the method factor , there were management weaknesses , lack of suicidal assessment and defense mechanisms .For the measurement factors , there was a lack of psychological evaluation and intervention system . Fort the environment factors , there were flawed management of hospital physical and human environment . Conclusions Using“5M1E”method to comprehensively analyze the risk factors of suicide of inpatients , and proposing the preventive measures can avoid or reduce inpatients suicide and improve the quality of nursing safety .