Objective:To investigate the application effects of a two-way six-step nursing teaching model based on the Kolb's learning cycle in the teaching of nurse interns in an emergency department.Methods:We assigned 52 undergraduate nursing students interning at the department of emergency from February 2020 to February 2022 to receive conventional teaching (control group) and 50 nurse interns from March 2022 to February 2023 to receive two-way six-step nursing teaching based on the Kolb's model (observation group). We evaluated the changes in core competencies before and after learning using the Competency Inventory for Registered Nurses (CIRN); assessed self-learning abilities using a nursing student self-learning ability assessment scale; recorded the incidence rates of related errors in the emergency department after learning; and assessed the level of satisfaction with nursing using the Patient Satisfaction Questionnaire (PSQ-18). SPSS 22.0 was used to perform the chi-square test and t-test. Results:After learning, the scores of CIRN dimensions and self-learning ability dimensions were all increased in both groups, and these scores were significantly higher in the observation group [(31.78±2.34), (50.22±4.33), (28.56±2.09), (19.22±3.11), (22.34±2.78); (30.07±3.14), (24.11±2.99), (30.11±3.41), (33.33±3.09)] than in the control group [(30.88±2.22), (48.34±3.88), (27.59±2.52), (17.77±3.08), (20.88±2.55); (28.67±2.09), (22.56±2.44), (27.99±3.03), (31.33±3.44)]. Compared with the control group, the observation group showed significantly lower incidence rates of errors in the execution of medical orders (19.23% vs. 2.00%, P=0.008) and errors in practice in accordance with standards (15.38% vs. 0.00%, P=0.006). There were no significant differences in the incidence rates of poor response on the spot, medical record errors, and medical dispute errors between the observation group and the control group (all P>0.05). The PSQ-18 scores in all dimensions of the observation group were significantly higher than those of the control group ( P=0.002, 0.001, 0.014, 0.008, <0.001). Conclusions:The two-way six-step nursing teaching model based on the Kolb's model can significantly improve the core competencies and self-learning abilities of nursing students in the department of emergency, and reduce errors in the execution of medical orders and practice in accordance with standards, thus improving their nursing service levels.

Atopic dermatitis (AD) is a chronic, relapsable and pruritic skin disease, commonly found in children and adolescents. The prevalence of AD is increasing worldwide. It is reported that AD is related to many factors such as genetic inheritance, environment, immunity and skin barrier dysfunction, suggesting a very complex pathogenesis. In recent years, high-throughput technologies in the field of genomics and metabolomics have opened up new perspectives on the pathogenesis of AD, and shown potential application prospects in microbiome transplantation therapies for AD. This review summarized the current advances in the relationship between skin microecology and skin health, the pathogenesis and microbiomic characteristics of AD, features of pathogenic microorganisms, and microbiome transplantation therapies for AD. Based on our own practical experience, we put forward a culturomics research protocol to study the human skin microbiome and a method for quantitative microbiological examination, aiming to provide reference for the prevention, clinical treatment and therapeutic monitoring of AD.

Objective: To identify and characterize the 4 strains of Prototheca isolated from the clinical samples of skin or ascites samples in China. Methods: The taxonomic position of 4 yeast-like organisms was revealed by polyphasic taxonomic approach, i.e., cultural and morphologic characteristics, commercial biochemical systems of Vitek 2 (YST kit) and Vitek matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometry (MS) systems in combination with phylogenetic analysis based on the gene sequences of 16S and 28S rRNA. Results: The 4 strains of Prototheca were characterized as cream-white, smooth, moist yeast-like colonies on Sabouraud gentamicin chloramph agar after incubation for 3 days. However, round, oval-shaped or elliptical sporangiums with mulberry-like or strawberry-like endospores were observed by optical microscope, which showed distinct differences from the general yeast species. The 4 isolates were identified as Prototheca wickerhamii with Vitek YST kits by Vitek 2 systems and Vitek MALDI-TOF MS systems. The genome for the 4 isolates was characterized with the existence of the prokaryotic 16S rRNA gene and eukaryotic 28S rRNA gene. The 16S rRNA gene sequence of the 4 strains showed more than 99.7% similarity to that of P. wickerhamii. Sequence analysis of 28S rRNA gene showed that the organisms included multiple copies of different sequences, which showed sequence similarities of 91.9% to 100% even in the same strain. The phylogenetic dendrogram based on 16S rRNA and 28S rRNA gene sequences showed that the 4 strains of Prototheca formed a cluster along with P. wickerhamii. Conclusion The 4 yeast-like organisms could be identified as P. wickerhamii, and 16S rRNA gene should be the suitable molecular target for the identification.

Objective:To establish a calculation model of drug preparation difficulty coefficient for outpatient pharmacy intrave -nous admixture center ( OUIVA) in a children's hospital, and construct the performance model .Methods: All the prescriptions in a week in OUIVA of Shanghai children's medical center were randomly selected .According to the actual difficulty level in the process of outpatient and emergency drug preparation , a basic drug difficulty coefficient and difficulty coefficient addition method was constructed . The difficulty index of every prescription was calculated .All the prescriptions in a week were randomly selected , and according to the difficulty coefficient analysis method , the daily difficulty coefficient of the prescriptions was calculated in order to build a performance model for OUIVA in the hospital .Results:The difficulty coefficient of medicine mainly included four basic difficulty coefficients and nine difficulty addition coefficients .According to the statistics , the average difficulty coefficient of daily prescriptions was (3.83 ± 2.86 )with the highest difficulty coefficient of 35, and the prescription data showed that there was significant difference between outpa -tient and emergency prescriptions and daytime blood tumor prescriptions .Conclusion:A performance model based on the difficulty co-efficient for OUIVA in children ' s hospital is a more scientific reflection to the daily work .

Objective:To analyze the dosage distribution and the frequency of each dosage of high-risk tablets in the hospitalized patients in a children's hospital,and study whether the existing specifications of high-risk tablets meet the pediatrics clinical needs. Methods:All the prescriptions including high risk tablets were analyzed from 2014 to 2016 in Shanghai children's medical center. The frequency of every dosage of every drug was analyzed,and the current specifications were judged according to the frequency. New specifications were proposed when the existing specifications did not match the clinical needs. The new frequency of the proposed speci-fications was re-accounted for all the three-year prescriptions in order to evaluate whether the proposed new specifications met the clini-cal needs. Results:Among the five kinds of high-risk oral tablets,methotrexate tablets and vitamin A acid tablets were in accordance with the actual clinical requirements. Mercaptopurine tablets should add two specifications including 12.5 mg and 17 mg,and warfarin sodium tablets should add one specification(1.25 mg). Hydroxyurea tablets(250 mg) and warfarin sodium tablets(1 mg) were rec-ommended used in the children's hospital. Conclusion:The existing specifications of high-risk oral tablets can't fully meet the clini-cal needs,therefore,specifications still needs to be adjusted.

Objective:To analyze the safety of generics and lactation of commonly used drugs in outpatient and emergency department of a children's hospital in Shanghai to formulate the related high-risk medicines list. Methods:According to the drug directory for outpatient and emergency department in the sample hospital,the medication assistant software was used to check the safety level of the related drugs used during pregnancy and lactation. Drugs with pregnancy safety grade D or X,and the lactation safety grade L4 or L5 involved in the high-risk pregnancy or breast-feeding drug list. Results:Of the 151 kinds of infusion medicines commonly used in outpatient and emergency department in the sample hospital, a total of 118 kinds were with a specified level of pregnancy safety,which accounted for 78.15%,and a total of 86 kinds were with a clear indication of the safety level of lactation,which accounted for 56.95% of the total number of medicines. A total of 25 kinds of drugs labeled pregnancy safety grade D or X, which accounted for 16.56%, and 21 species were with lactation safety L4 or L5, which accounted for 13.90% of the total number of drugs. The drugs with high pregnancy or lactation risk in the outpatient and emergency department of the sample children's hospital were anti-tumor drugs,anti-infective drugs,some cardiovascular drugs and central nervous system drugs. Conclusion:There are still many deficiencies in the information about the safety of pregnancy or breast-feeding in the existing medicines used in the sample hospital,which need to be improved.

Objective: To analyze the common dosage of oral liquid preparations used in a children's hospital in order to provide reference for the best drug specifications for children's medicines. Methods: The prescription data of patients containing oral liquid preparations were collected from January 2014 to December 2016 and used for the analysis in the sample hospital. The most commonly used doses were compared with the existing specifications to provide suggestions on the best specifications for children. Results: There were 11 kinds of oral liquid preparations commonly used in the children's hospital. Only 4 kinds of drugs met with the best drug speci-fications for children, and the others were not able to meet the clinical needs in the children's hospital. Conclusion: The best specifi-cations of children's medicines need to be readjusted.

Objective: To study the dosages of capsules commonly used in children to provide reference for the addition of capsule specification for children.Methods: According to the application situation of capsule dosages commonly used for the inpatients in one children's hospital from January 1, 2013 to September 1, 2016, and combined with the usage rates of various drugs with different dosages, the addition of the minimum dosage of capsules was proposed.Results: Totally 10 species of commonly used capsules were selected from the children's hospital, and among them, 4 ones met the requirements of clinics, and the other 8 ones needed the specification addition, including clostridium butyricum capsules (210 mg) and polysaccharide ferric complex capsules (25 mg).Conclusion: The existing capsule specification can not fully meet the clinical requirements in the children's hospital.Therefore, appropriate dosage adjustments are still needed.

Objective To summarize the nursing key points in nursing ovarian cancer patients with early postoperative inflammatory intestinal obstruction after non-surgical treatment value. Method The nursing data of 32 ovarian cancer patients with early postoperative inflammatory intestinal obstruction in our department in January 2010 to October 2016 were retrospectively analyzed. Results About 32 patients were treated with non-surgical treatment, cure time within 2~30d, averaged (7.80 ±5.98)d. No intestinal obstruction happened after resuming to normal exhaustion, defecation and dieting. Conclusion Such nursing measures as psychological nursing, gastrointestinal decompression nursing, nutrition support nursing and auxiliary therapy like promoting peristalsis recovery are key to the increase of cure rate of early postoperative inflammatory intestinal obstruction.