Objective:To construct a leadership evaluation indicator system for managers in primary healthcare institutions.Methods:This study was a qualitative research. Based on the Chinese Academy of Sciences′ Five Forces Model of Leadership, the framework of the leadership evaluation indicator system for primary healthcare institution managers was initially constructed through literature review, expert interviews, surveys, and group discussions. From November 2020 to June 2021, 19 experts were invited to participate in two rounds of Delphi expert consultations. Based on the consultation results, the leadership evaluation indicator system for primary healthcare institution managers was developed, and the analytic hierarchy process (AHP) was used to determine the weight of each indicator.Results:Nineteen consulting experts were included in the study, 13 of whom were aged 40 years or older, and seven of whom had 20 years or more of professional experience. The response rates of the two rounds of Delphi expert consultation questionnaires were 18/19 and 19/19, respectively; the authority coefficients of the experts were 0.92 and 0.91, respectively. In the second round of consultation, the coordination coefficients of each level of indicators were 0.640, 0.557, and 0.512 ( P<0.05), respectively. The constructed leadership indicator system for managers of primary healthcare institutions included five primary indicators, 16 secondary indicators, and 44 tertiary indicators. The primary indicators, in order of their weight, were "influence"(0.299),"decisiveness"(0.245),"control"(0.156),"inspiration"(0.150), and "foresight"(0.150). Conclusions:This study is a preliminary construction of a leadership evaluation indicator system for managers of primary healthcare institutions, which can be a reference for the training and evaluation of relevant talents.

Objective:To investigate the current status of research on the construction of leadership indicator system in the medical field at home and abroad, and to analyze the characteristics of the indicator system therein.Methods:This was a bibliometric study. The group applied subject keywords to search relevant literature on the construction of leadership indicator system in the medical field at home and abroad on English websites PubMed, Web of Science, Google Scholar, CINAHL, Scopus and Chinese websites Baidu Academic, CNKI, CQVIP, Wanfang Data Knowledge Service Platform, with a time frame of 2016-2023. The basic characteristics of the literature, the theoretical framework of the research application and the research theme were extracted, and the content of the indicator system in the literature was reviewed and summarized.Results:A total of 21 literatures were included, including 7 Chinese literatures and 14 English literatures. Of these literatures, 10 focused on physician leadership, 5 on medical manager leadership, and 2 on general practitioner leadership. Among 16 research literatures, 9 informed the theoretical basis of leadership, and 4 literatures were applied research. Five main themes were identified: leadership studies of individual healthcare administrators, leadership development in healthcare, interest and attitudes of healthcare workers towards leadership learning, applications of leadership in healthcare, and the impact of leadership in healthcare on patients and healthcare organizations.Conclusions:At present, research on the construction of the leadership indicator system in the medical field presents is diverse, with differences in theoretical basis and content. The original and empirical research is still insufficient.

Children′s bronchial lumen is relatively narrow, pulmonary interstitial development is superior to elastic tissue, and ciliary clearance is weak, which makes children more prone to pulmonary infection and pneumonia.The development of artificial intelligence (AI) and its application in medicine is changing the traditional disease diagnosis, assessment and treatment.AI with deep learning as the core is increasingly used in the diagnosis and prognosis evaluation of pneumonia in children, which is conducive to the early diagnosis and accurate assessment of the disease.In addition to novel coronavirus pneumonia and acute respiratory distress syndrome, researchers rarely pay attention to other viral pneumonia, bacterial pneumonia, mycoplasmal pneumonia, and fungal pneumonia.Meanwhile, there are still problems, such as small datasets, small sample sizes, incomplete algorithms, and little attention paid to pneumonia types and subtypes.In the future, a large-sample dataset of children′s pulmonary infections should be established, and learning about AI should be promoted among medical students and medical staff, so as to explore the value of AI in children′s pulmonary infection and play its auxiliary role in clinical decision-making related to diagnosis and treatment.

Non-invasive respiratory support（NIRS）has developed rapidly in the field of pediatric respiratory support.It is increasingly popular in sequential treatment after acute respiratory failure and adjuvant extubation withdrawal.It reduces the need for invasive mechanical ventilation and the occurrence of related complications,which improves the compliance and comfort of the children.NIRS contains high flow nasal catheter oxygen inhalation (HFNC) and non-invasive ventilation (NIV).The selection and comparison between these two methods has become a hot research topic in recent years.We introduced the advantages and disadvantages of HFNC and NIV as initial respiratory support treatment options in different clinical situations.

A case of a 69-year-old female patient, with cough, expectoration, chest tightness and shortness of breath for 10 days accompanied by left pleural effusion, was reported. Initially, a large number of suspected malignant lymphoma cells were found in the patient′s pleural effusion through routine cell morphological examination after admission, which was the direction of clinical diagnosis and treatment in the next step. Then the patient was diagnosed as primary pulmonary diffuse large B-cell lymphoma (DLBCL) through imaging, bone marrow and lung biopsy pathology. Finally, the patient was treated effectively with R-CHOP regimen, but she died of respiratory failure 9 weeks later, because she did not receive regular follow-up and treatment after the sixth chemotherapy cycle. Primary pulmonary DLBCL, an extremely rare extranodal lymphoma' lacks specificity clinical manifestations and is easy to be missed and misdiagnosed. DLBCL with a large number of malignant pleural effusion progresses rapidly and has a poor prognosis. The routine cell morphology examination of pleural effusion is simple and intuitive, which can capture key information in the shortest time, preliminarily provide clinical diagnosis and treatment ideas, and provide accurate basis for disease diagnosis.

Sepsis-associated encephalopathy (SAE) is a serious complication of sepsis, which can greatly increase the mortality of patients with sepsis, and may result in prolonged cognitive dysfunction in SAE survivors.Therefore SAE has received more and more attention in the field of critical illness.However, there are few studies on the mechanism of poor prognosis and possible predictors of SAE, and no specific rehabilitation methods have been reported.In this article, progress in the research on the prognosis and rehabilitation of SAE is summarized, in order to provide a reference for the long-term prognosis and rehabilitation treatment of severe sepsis in children.

Objective To explore the clinical application value of the continuous blood purification (CBP) technology in pediatric intensive care unit (ICU). Methods A retrospective study was conducted. All CBP patients admitted to pediatric ICU of Children's Hospital of Nanjing Medical University from 2015 to 2017 were enrolled. The disease diagnosis, CBP treatment mode, catheter placement, anticoagulation way, treatment time and adverse reactions were summarized and analyzed. Results ① A total of 203 children were included, male accounted for 59.1%; age 37 days to 14 years old, with an average of (4.52±3.60) years old; weight 3.3-68.0 kg, with an average of (21.38±13.77) kg.② There were a total of 660 CBP treatments, with an average of 3.25 times per person. The main treatment modes of CBP were plasma exchange (PE, 38.64%), and followed by continuous veno-venous hemodiafiltration (CVVHDF, 38.64%), hemoperfusion (HP, 16.51%) and continuous veno-venous hemofiltration (CVVH, 6.21%).③ Central venous catheterization was mainly placed in the right internal jugular vein (90.64%), followed by the right femoral vein (5.42%) and the left femoral vein (3.94%).④ Heparin sodium was the main anticoagulant in pipeline filters (84.73%), followed by low molecular weight heparin calcium (11.33%), sodium citrate and non-anticoagulant (both 1.97%). Mixed anticoagulants were used 21 children. ⑤ Primary diseases included poisoning (26.11%), liver failure (25.62%), sepsis (12.32%), shock after cardiopulmonary resuscitation (11.82%), acute respiratory distress syndrome (ARDS, 8.37%), central nervous system diseases (5.41%) and metabolic diseases (4.93%). The lowest efficacy of CBP was metabolic diseases, with mortality rate of 60.00%; followed by ARDS, shock after cardiopulmonary resuscitation, sepsis and liver failure, with mortality was 58.82%, 41.67%, 36.00% and 32.69%, respectively. The length of hospitalization stay of children with central nervous system diseases was (30.89±15.13) days.⑥ Adverse events of CBP treatment included uncontrollable restlessness (2.88%), hypotension (1.82%), allergic rash (1.21%), catheterization and pipeline coagulation (1.21%), filter coagulation (1.06%), decreased heart rate and oxygen saturation (0.76%); CBP was stopped in 8 children due to cardiac arrest during the treatment. Conclusion At present, the application of CBP technology in pediatric ICU is universal, and it is an important way to rescue critical illness.

Fluid resuscitation is one of the most important advances in the treatment of septic shock in recent 20 years. Although saving many children's lives,this technique has been challenged by some studies. This article re-viewed systematically hemodynamics characteristic,myocardial depression and capillary leak syndrome in septic shock in children.

Objective To explore the establishment and application of specific nursing quality indicators for infectious disease. Methods On the basis of nursing system, nursing criterion, nursing routine and nursing process, the specific nursing quality indicators were established and implemented in our hospital from October 2015 to June 2016. The specific nursing quality indicators were established according to different characteristics of patients, including psychological nursing, isolation protection, high fever nursing and so on. Every indicator was standardized by structure, process and result modules. The 3 modules included 7 items, which is organization management, nursing assessment, measures implementation, shift execution, nursing records, health guidance and related knowledge, and every item was composed of several standard rules. The correct rate of nursing assessment, the rate of measures implementation, the awareness rate of patients′ disease knowledge, the accuracy of nursing record writing, the qualified rate of shift duty, patients′ satisfaction and qualified rate of specific nursing knowledge were compared before and after implementing the specific nursing quality indicators.Results After the implementation of the specific nursing quality indicators, the correct rate of nursing assessment increased from 74. 89% to 89. 33%, the rate of measures implementation increased from 75. 79% to 88.44%, the awareness rate of patients′disease knowledge increased from 65.47% to 79.56%, the accuracy of nursing record writing increased from 65.02% to 88.00%, the qualified rate of shift duty increased from 60.08% to 81.33%, patients′satisfaction increased from 92.06% to 97.08%, the qualified rate of specific nursing knowledge increased from 69. 59% to 86. 49%. Conclusions The establishment and application of specific nursing quality indicators for infectious disease can normalize and standardize nursing work, improve the process quality and final quality of nursing care, help continuous improvement of nursing quality, and ensure the effective implementation of nursing care.

Objective To evaluate the effectiveness of intravenous immunoglobulin (IVIG) in critical hand-foot-mouth disease (HFMD).Methods The data from PubMed, MEDLINE, EMBASE, EBSChost, Cochrane Library, Cochrane Central Register of Controlled Trials, Ovid, China Biology Medicine disc, Wanfang Data, China National Knowledge Infrastructure, Chinese Citation Database, and other references and grey literatures were retrieved, screening out all those related to clinical trials on treating critical HFMD by IVIG.Standard methods of the Cochrane Collaboration were employed to evaluate the methodological quality of the trials.Meta analysis was performed with Rev man 5.3 software.Results Eleven trials including 967 cases were investigated.The meta analysis showed that IVIG had significantly clinical efficacy (OR =6.84,95％ CI:3.74-12.52 ,P ＜ 0.05).IVIG could significantly decrease duration of fever (MD =-1.94,95％ CI:-3.07--0.81 ,P ＜0.05) ,hospitalization time (MD =-4.56,95％ CI:-8.95--0.17,P ＜0.05).There was no significant difference in duration of fever (MD =-0.28,95 ％ CI:-0.59-0.03, P ＞ 0.05), duration of herpes (MD =0.18,95％ CI:-0.22-0.59, P ＞ 0.05), hospitalization time (MD =-0.12,95％ CI:-0.47-0.23, P ＞ 0.05) when the dosage of injection was adjusted.Conclusions IVIG is recommended for treating critical HFMD because it is effective in decreasing the duration of fever and hospitalization.Well designed studies with more sample in multi-center are required in further study to explore the efficacy and safety of IVIG on critical HFMD.