Objective:To explore the relationship between psychological resilience,professional identity and employment pressure of nursing students with different educational levels,and analyze its influencing factors.Methods:A total of 208 nursing students with different educational levels were investigated by using the general information questionnaire,the employment pressure questionnaire of nursing students,the psychological resilience scale and the professional identity questionnaire.The correlation among psychological resilience,professional identity and employment stress was analyzed by Pearson correlation analysis.Results:The total score of professional identity,psychological resilience,and employment stress was(54.46±12.34),(57.62±18.66),and(98.30±20.25),respectively.There was no significant difference in professional identity score and psychological resilience score among nursing students with different educational levels(P＞0.05).There was no significant difference in the employment stress scores between nursing students upgrading from a junior college and undergraduate and junior college nursing students(P＞0.05),while the employment stress score of junior college nursing students were significantly higher than that of undergraduate nursing students(P＜0.05).Pearson correlation analysis showed that the total score of employment stress was positively correlated with the total score of psychological resilience(r=0.252),and the total score of professional identity(r=0.312)(P＜0.01).Conclusions:The psychological resilience of nursing students is at the average level,professional identity is low,and the employment pressure of junior college nursing students is higher than that of undergraduates.Targeted interventions should be developed to improve the psychological resilience and professional identity of nursing students,and reduce the employment pressure level of junior college nursing students.

Objective To analyze the research trends and hotspots of tenecteplase and provide a reference for clinical research and rational drug use in China.Methods A comprehensive search was conducted on tenecteplase studies in the Web of Science database from its inception to April 2024.CiteSpace 6.1.R6 software was used to analysis authors,countries/regions,research institutions,keywords,and co-cited references.Results A total of 673 articles were included in this study.The annual publication volume showed an overall upward trend,rapidly increasing in the past three years.The United States,Canada,and Australia were the top 3 countries in terms of publication volume in this field.Among the top 10 institutions in publication volume,9 were from above 3 countries.The research hotspots were the efficacy and safety of tenecteplase in patients with acute myocardial infarction and acute ischemic stroke.In recent years,research hotspots have mainly focused on the field of acute ischemic stroke.Conclusion The application of tenecteplase in the field of acute ischemic stroke is currently a research hotspot.However,there is still a gap between the research level in China and that in developed countries such as the United States.Future research hotspots may still focus on the application of tenecteplase in patients with different types of acute ischemic stroke,suggesting that scholars should pay close attention to this area.

Objective:To analyze the results of the practice test and formal test of the annual professional proficiency test for residents in 2022, to investigate related influencing factors and the effectiveness of the practice test, and to propose the measures for improving the results of the annual professional proficiency test.Methods:The scores of the annual professional proficiency test were analyzed for 202 residents who participated in the test in 2022, and the data on sex, education background, type of personnel, whether they passed the medical licensing examination, and practice test scores were analyzed to investigate related influencing factors. SPSS 23.0 and GraphPad Prism 8 were used for the chi-square test, the t-test, the one-way of variance, and the Fisher's exact test. A multiple linear regression analysis was used to identify influencing factors, and a Pearson correlation analysis was also performed. Results:The scores of the annual professional proficiency test for 202 residents were normally distributed with the highest number of the residents with a score of 90-99 points and the lowest number of the residents with a score of <70 points. The residents who passed the medical licensing examination had a significantly higher score of the annual professional proficiency test than those who failed the examination ( t=2.87, P=0.005), and the residents who passed the three practice tests had a significantly higher score of the annual professional proficiency test than those who failed the practice tests ( P<0.05). The score of the second practice test, the score of the third practice test, and the passing of medical licensing examination were independent influencing factors for the score of annual professional proficiency test ( R2=0.236, R2=0.201, F=6.60, P<0.05). The correlation analysis showed that the scores of the three practice tests were positively correlated with the final score ( r=0.189, 0.373, and 0.311, P<0.05). Conclusions:Improving the passing rate of medical licensing examination and strengthening pre-examination practice tests can help to improve the score of annual professional proficiency test. At the same time, it is necessary to improve the quality of training through the measures such as strengthening the homogenization management of different types of students, improving the attention and enthusiasm of all levels, and accelerating the construction of question banks.

Objective:To explore the current status and influencing factors of meaning in life among postoperative lung cancer patients, providing reference and guidance for the development of nursing interventions.Methods:From January to March 2023, convenience sampling was used to select 170 lung cancer patients with surgery in Department of Chest Surgery of the Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College as the study subject. The patients were surveyed using the General Information Questionnaire, Chinese version of Meaning in Life Questionnaire (C-MLQ), and the Cancer Fatigue Scale (CFS) .Results:The score of meaning in life among postoperative lung cancer patients was (45.71±5.90). Hierarchical linear regression analysis showed that living alone, educational level, and cancer-related fatigue were the influencing factors on the meaning in life among postoperative lung cancer patients ( P<0.05) . Conclusions:The meaning in life of postoperative lung cancer patients is at a moderate level. Medical and nursing staff should focus on patients who live alone and have a low level of education, and can also improve their meaning in life by alleviating cancer-related fatigue.

Objective:To understand the effect of standardized residency training for residents with different identity types, and put forward targeted optimization and improvement measures to achieve the homogenization of training effect.Methods:Combined with literature review and expert consultation results, a self-designed questionnaire was conducted for 324 residents who completed their courses in 2019 and 2020. The effective recovery rate of the questionnaire was 87.65%. By comparing the passing rate of first-time medical admission and completion examination of different identity types, and the training standards of six core competencies, the training effect conclusion was drawn. T-test and Fisher exact probability test were also made by SPSS 21.0. Results:The passing rates of first-time doctors and completion examinations were higher in professional masters and units than in the general population, with the highest passing rates reaching 100% (10/10) and 97.3% (72/74) respectively. There was no statistical difference between the passing rates of residents with different identity types. The overall standard of the six core competencies of the integrated professional masters was better than that of the society and unit personnel. There were statistical differences between the groups in the training standards of the four abilities of the residents with different identity types in professional literacy ( P=0.048), patient management ( P=0.030), communication and cooperation ( P=0.026) and learning promotion ( P=0.003). There was no significant difference in professional ability ( P=0.131) and teaching ability ( P=0.061). Conclusion:There is no difference in the passing rate of residents with different identity types in a military hospital, which achieves the goal of homogenization training to a certain extent. However, there are obvious differences in the standards of the six core competencies, and further optimization measures need to be explored.

Objective:To construct the standardized preventive nursing training scheme for venous thromboembolism (VTE) , so as to provide a basis for hospitals to carry out the standardized preventive nursing training scheme for VTE.Methods:Under the guidance of the National Medical Quality and Safety Improvement Goal, the standardized preventive nursing training scheme for VTE was initially developed through preliminary investigation, literature review and group discussion. Using the convenient sampling method, a total of 20 experts were selected from March to June 2022 for two rounds of Delphi expert consultation. After modification, the VTE standardized preventive nursing training scheme was finally determined.Results:In the two rounds of correspondence, the effective response rates of the questionnaire were 90.00% and 100.00%, respectively. The expert authority coefficients of two rounds were both 0.95 and Kendall coordination coefficients were 0.20 and 0.14, respectively ( P<0.01) . After two rounds of expert consultation, a standardized preventive nursing training scheme for VTE was finally established, which included 4 primary indicators, 12 secondary indicators and 78 tertiary indicators. Conclusions:The VTE standardized preventive nursing training scheme constructed in this study has strong reliability and scientific nature, which can provide a basis for hospitals to carry out VTE standardized preventive nursing training scheme.

【Objective】 To develop a prognosis model based on CT images using radiomics method for patients with osteonecrosis of the femoral head (ONFH) and to investigate the additional prediction value of the imaging features of the contralateral normal femoral head regions for the prognosis prediction. 【Methods】 A total of 51 patients were included in this retrospective study. All the patients had preoperative CT images. For each patient, two regions of interest (ROIs) were involved, including the osteonecrosis region and the contralateral normal femoral head region. A total of 968 radiomics features were extracted for each patient. We made both the univariate and multivariable analyses. Three models were developed based on the features of osteonecrosis region, contralateral normal femoral head region, and both regions. The 10 times of repeated random experiments were used for model construction and validation. The average performance of the 10 times of experiments was reported as the results. 【Results】 For the features of osteonecrosis region, 37 features showed significant predictive value, with the mean AUC value of 0.708 2±0.029 9. The AUC of the constructed prediction model was 0.911 0±0.029 4 and 0.688 6±0.089 3 for the training set and validation set, respectively. For the features of contralateral normal femoral head region, 14 features showed significant predictive value, with the mean AUC value of 0.703 6±0.006 9. The AUC value of the constructed model for the training set and validation set was 0.867 2±0.039 5 and 0.669 0±0.072 6, respectively. For the models developed based on combined features, the AUC value was higher than that of the models developed based on osteonecrosis region features (training set: 0.935 8±0.016 6 vs. validation set: 0.737 9±0.090 8). 【Conclusion】 We developed a novel CT images-based radiomics method to predict postoperative prognosis in patients with ONFH. Furthermore, the features of contralateral normal femoral head region has additional prediction value. Combining the imaging features of osteonecrosis region and contralateral normal femoral head region can obtain more accurate prediction of prognosis in patients with ONFH.

Objective:To investigate the classification and prevalence of simple congenital coronary artery anomalies (CCAA) in Chinese in a large samples of coronary CT angiography (CCTA), and briefly summarize the CT characteristics of "malignant" anomalies.Methods:The data of patients who had undergone CCTA from July 2009 to January 2017 and were diagnosed as simple CCAA were analyzed retrospectively. CCAA were classified according to the origination, number of orifices and termination, and the prevalence of various CCAA was statistically analyzed. Anomalous origin of coronary artery included the origin of coronary artery from the opposite coronary sinus, the non-coronary sinus, the aorta or around the primary sinus, the pulmonary artery, and left circumflex artery originated from the diagonal branch. Abnormal number of orifices included single coronary artery (SCA), right coronary artery and conus branch arising separately, and left anterior descending branch and circumflex branch arising separately. Abnormal termination was coronary artery fistula (CAF). Anomalous origin of coronary artery from the opposite sinus, anomalous origin of the coronary artery from the pulmonary artery, SCA, and multiple or large CAFs were defined as"malignant"anomalies.Results:Among 165 133 patients, 2 148(1.301%) had coronary anomalies, including 1 302 (0.789%) of origin anomalies, 298 (0.181%) of abnormal number of orifices and 548 (0.332%) of abnormal termination. There were 700 cases (0.424%) with coronary artery rising from the opposite sinus, 179 of which had opening or proximal lumen stenosis due to compression, 7 of which had subendocardial myocardial ischemia or infarction on CCTA without coronary artery disease (CAD). The coronary arteries originated from posterior sinus, the aorta or around the primary sinus were found in 48 cases (0.029%), 531 cases(0.322%), respectively. Coronary artery originating from pulmonary artery was detected in 20 cases (0.012%), all of which were left main trunk originating from pulmonary artery, showed tortuous dilation of coronary arteries. Five cases showed obvious subendocardial myocardial ischemia or infarction without CAD. SCA, right coronary artery and conus branch arising separately, left anterior descending branch and circumflex artery arising separately were detected in 102 (0.062%), 53 (0.032%) and 143 (0.087%) cases respectively. Only 1 of 102 cases with SCA showed myocardial ischemia without CAD. A total of 548 cases (0.332%) were diagnosed as CAF, of which the coronary-pulmonary fistula was most common with a highest prevalence of 0.277% (458 cases). Coronary artery-atrial fistula and coronary artery-ventricular fistula were detected in 22 (0.013%) and 60 (0.036%) cases. There were 6 cases (0.004%) of coronary artery-coronary venous fistula and 2 cases (0.001%) of coronary artery-superior vena cava fistula.Conclusions:The occurrence of CCAA is not uncommon, among which anomalous origin of coronary artery is the most common, and special attention should be paid to "malignant"anomalies.

Objective:To explore the effect of the situational doctor-patient communication skills training course based on chest pain center.Methods:The "5+3" integrated students of clinical medicine were selected to take the doctor-patient communication skills training course. The typical cases of chest pain center were written as module units, and were divided into 3 modules according to the disease types and the training contents of doctor-patient communication. The effect evaluation was performed before the course and after each module course, including the Liverpool doctor communication skills assessment scale, the college student empathy ability scale and emotional intelligence evaluation scale.Results:The students' communication ability, empathy ability, and emotional intelligence were significantly improved by three modules of practical training courses (all P<0.05). Among them, the communication ability of medical students was improved after each lecture in module 1, module 2 and module 3 (all P<0.05), which was 84% higher than that before the course [(28.2±2.7) vs. (15.3±3.9)]. After each lecture in module 1 and module 2, the empathy ability of medical students was improved (both P<0.05), which was 34% higher than that before teaching [(132.7±12.5) vs. (99.0±17.4)]. After each lecture in module 2 and module 3, the emotional intelligence of medical students was improved by 34% [(138.5±13.0) vs. (103.0±16.6)] (both P<0.05). Conclusion:The situational doctor-patient communication skills training course based on chest pain center, as a practical course of doctor-patient communication for medical students at the undergraduate stage, can effectively improve students' doctor-patient communication ability, empathy ability and emotional intelligence.

Objective To explore the clinical features and risk factors of poor prognosis in neonatal necrotizing enterocolitis(NEC).Methods A retrospective study was carried out in the infants with NEC admitted to 6 cooperative hospitals in Guangdong Province between January 2005 and December 2014.The clinical features and risk factors of poor prognosis in preterm and full-term infants diagnosed NEC,early onset and late onset NEC were analyzed.Results A total of 449 cases who met the criteria were admitted during the study time.The mortality was 23.6％ (106/449 cases),of which the preterm group was 24.6％ (58/238 cases) while the full-term group was 22.7％ (48/211 cases),the early onset group was 22.1％ (45/204 cases) while the late onset group was 24.3％ (57/235 cases).The median number of NEC onset in preterm group was 11 d after birth while the number of the full-term group was 6 d.Full-term infants who diagnosed NEC were more likely to manifest themselves as abdominal distension (52.1％ vs.42.0％,x2 =4.597,P =0.032),vomiting(36.5％ vs.17.2％,x2 =21.428,P =0.000) and bloody stool(30.3％ vs.21.4％,x2 =4.653,P =0.031);but in the onset of NEC,preterm infants more likely to have feeding intolerance (21.0％ vs.12.8％,x2=5.309,P =0.021).The early onset group of full-term NEC was much common in twins or multiplets(9.4％ vs.1.1％,x2 =6.226,P =0.013),which rate of surgical therapy was much higher (41.0％ vs.27.0％,P =0.036) and the breast-feeding rate before NEC was lower than the late onset group(14.5％ vs.32.6％,x2 =9.500,P =0.002),the differences were statistically significant.The gestational age and birth weight were bigger in the early onset group of preterm NEC[(33.8 ±2.5) weeks vs.(32.2 ±2.8) weeks,t =4.261,P =0.000;(2.1 ±0.5) kg vs.(1.7 ± 0.5) kg,t =4.735,P =0.000)],but length of stay was shorter than the late onset group (18.0 d vs.26.5 d,P =0.000).Logistic regression analysis showed that the risk factors of poor prognosis of full-term NEC were shock,peritonitis and sepsis;while risk factors of poor prognosis of preterm NEC were small for gestational age infant,pulmonary hemorrhage,shock,intestinal perforation and sepsis;the risk factors of poor prognosis of the early onset group of full-term NEC was shock;while those of the late onset group were shock and peritonitis;the risk factors of poor prognosis in the early onset group of preterm NEC were shock and sepsis,while those in the late onset group were pulmonary hemorrhage,shock,intestinal perforation and sepsis.Conclusions Compared to the preterm NEC,the onset time of full-term NEC was earlier and the clinical manifestations were more typical.Early identification and management of shock,peritonitis,intestinal perforation,sepsis and pulmonary hemorrhage can reduce the risk of poor prognosis of neonate NEC.