Objective:To analyze the risk factors of medical damage liability in the ambulance management in China, and provide reference for strengthening such management and improving the pre-hospital emergency system.Methods:The judgment documents released by China Judgment Online from 2013 to 2022 regarding damages incurred by improper ambulance management, were used as the sample. Based on the setting of such elements as software, hardware, environment, and liveware in the SHEL model, the text analysis method was applied to encode the text content at three levels according to " main category-sub category-risk behavior" by means of NVivo 12.0 software.Results:A total of 136 valid sample documents were included, finalizing such four main categories as software, hardware, environment, and liveware. Also finalized were 11 subcategories and 30 risk behaviors. The subcategories included the professional awareness and ability of pre-hospital emergency managers, the professional awareness of medical staff, the professional quality and ability of medical staff, as well as vehicle equipment among others. A total of 187 reference points were identified for coding risk behaviors. Risk behaviors with higher reference points included failure of pre-hospital emergency managers to dispatch vehicles (45), incomplete, malfunctioning, or no backup equipment in vehicles (20), failure of medical staff to take treatment measures in vehicles (18), failure to dispatch accompanying medical staff or stretchers (14), and insufficient medication (14), and fall of patients or medical equipment incurred by sudden braking of the drivers (6) among others.Conclusions:Insufficient ambulance equipment, shortage of human resources in the emergency system, inadequate equipment and medication in emergency vehicles, and safety issues for drivers are risk factors in the management of ambulances in China. It is recommended to expand the first aid talent team and enhance first aid capabilities; Reasonably deploy ambulance vehicles and improve the emergency networks; Develop a list of pharmaceutical equipment and establish an early warning mechanism; Strengthen the multi-party coordination, improve the efficiency of referral, further reduce the probability of risk, ensure the quality of emergency treatment, and enhance the effectiveness of pre-hospital emergency treatment.

Objective:To explore the relationship and mechanism among job stressors, perceived professional benefits and humanistic practice ability in midwives, so as to provide reference for the training and management of midwives.Methods:Used the convenient sampling method to conduct a cross-sectional survey on 216 midwives in 6 comprehensive or specialized hospitals in Zhejiang Province by using Stressor Scale, Perceived Professional Benefits Questionnaire and Humanistic Practice Ability Scale from May to September 2020. The mediating effect was analyzed on the basis of the current situation analysis and correlation analysis.Results:The total scores of humanistic practice ability, job stressors and perceived professional benefits of midwives were (102.13 ± 25.91), (72.77 ± 14.49) and (138.23 ± 18.71) respectively. The job stressors of midwives were negatively correlated with humanistic practice ability ( r=-0.206, P<0.01), perceived professional benefits were positively related to humanistic practice ability ( r=0.289, P<0.001) and were negatively correlated with job stressors ( r=-0.507, P<0.001). Perceived professional benefits played a major mediating role in the influence of stressors on humanistic practice ability (the total standardized effect was -0.233, and the indirect effect was -0.144). Conclusions:Perceived professional benefits act as a main mediator between job stressors and humanistic practice ability in midwives. Managers should reduce job stressors, enhance perceived professional benefits, and promote the formation, development and practice of humanistic practice ability of midwives.

Shaken baby syndrome, also known as abusive head trauma, is one of the deadliest and most devastating forms of child abuse.This paper reviewed the risk factors, cognitive status and preventive measures of shaken baby syndrome, in order to provide reference for the prevention of shaken baby syndrome and further research on shaken baby syndrome.

Objective:To investigate the effect of citric acid-induced cough on swallowing function and serum substance P in stroke patients with early tracheotomy.Methods:Forty-nine post-stroke tracheotomy patients admitted to the Department of Neurosurgery at the First Affiliated Hospital of Soochow University from January 2018 to July 2019 were selected as study subjects. They were divided into intervention group ( n=24) and control group ( n=25) using the random digit table. The control group was subjected to routine nursing, while the intervention group was given citric acid to induce cough based on routine care. The intervention time was 1 week. The swallowing function and serum substance P levels were compared between the two groups before and after the intervention. Results:After the intervention, 45.8% (11/24) of the patients in the intervention group were assessed as having "strong" swallowing function, compared to 28.0% (7/25) in the control group, with a statistically significant difference in swallowing function between the two groups ( Z= -2.22, P<0.05), and the level of substance P in the intervention group was (283.40 ± 134.82) ng/L, significantly higher than that of the control group (203.59 ± 126.16) ng/L ( t=2.14, P<0.05). Conclusions:Citric acid-induced cough helped stroke patients with early tracheotomy to produce effective swallowing action and up-regulate substance P in serum to promote recovery of swallowing function.

Objective To investigatethe status of physician-nurse collaboration in nutritional support among neurosurgical patients in secondary and tertiary hospitals in Suzhou, and to analyze the influence factors and to provide the basis for promoting cooperation consciousnes and quality of work. Methods One hundred and seventy-seven physicians and 506 nurses were investigated by the Nurse-Physician Collaboration Scale(NPCS) in 15 secondary hospitals and 15 tertiary hospitals in Suzhou. Results The cooperative status of physicians in tertiary hospitals was better than that of nurses (t=2.597, P=0.010). The cooperative status of nurses in tertiary hospitals was better than that in secondary hospitals (t=2.080, P=0.009). There was no significant difference in the cooperation between physicians and nurses in secondary hospitals (t=1.845, P=0.066). Multiple regression analysis showed that sex, profession, professional title, age, education degree and work seniority were the influence factors of physician-nurse collaboration intertiary hospitals (t=2.771, 2.597,F=3.745-12.513,P<0.01 or 0.05). Conclusions The physician-nurse collaboration in nutritional support among neurosurgical patients in secondary and tertiary hospitals is in good shape.Administrators should pay attention to influence factors of physician-nurse collaboration, and take measures to promote quality of medical care and nursing care.

Objective To evaluate the effects of aerobic exercise during dialysis on physical function and life quality among hemodialysis patients.Methods The randomized controlled trials on aerobic exercise during dialysis published in PubMed,Embase,Cochrane Library,WanFang data,China National Knowledge Infrastructure (CNKI) and VIP database were retrieved from setting up the database to 31 December 2017.The RevMan 5.1 was used in statistical analysis.Results A total of 13 documents were included consisting of 11 English articles and 2 Chinese articles.Meta analysis showed that the peak oxygen uptake,times of situp within one minute,the 6-minute walk distance and grip strength of hemodialysis patients in the group of aerobic exercise during dialysis all improved compared with those of control group (P ＜ 0.05) especially in the peak oxygen uptake in long term movement training (＞ 12 weeks).There was no statistical difference in blood pressure and life quality of patients between two groups (P ＞ 0.05).Conclusions Aerobic exercise during dialysis can significantly improve patients' physical function,however,has no significant effects on enhancing patients' life quality.

Objective To investigate the status and influencing factors of the methods used by nurses verifying the nasogastric tube placement blinded inserted in adult, and to explore the best practice of nursing staff to verify the nasogastric tube placement. Methods We designed the questionnaire and conducted survey to the clinical nursing staff in accordance with the American Association of Critical-Care Nurses practice alert. Results Air bolus auscultation (70.53％,675/957) and aspirate appearance (68.97％,660/957) were the most used method during insertion procedure. There was insufficient in the cognition of X-ray as the gold standard and the use in clinical.The department, work years, specialist nursesand hospitallevel impact X-ray use(all P <0.05).Age, education,title,hospital level, specialist nurses and department impact the cognition of X-ray as the gold standard(all P <0.05). Conclusions Nurses still use the traditional methods to verify the nasogastric tube placement. There is a certain gap between clinical practice and AACN practice alert in themethods used to verify nasogastric tube placement.As the gold standard to verify gastric tube placement, the use and cognition of X-ray are impacted by many factors, including the department, specialist nurses, hospital level, et al. Therefore, hospital should establish a knowledge sharing platform, which will help to spread the advantages and disadvantages of various methods used in verifying the nasogastric tube placement, and then to strengthen the cognition with different people. Furthermore, based on potential influencing factors, it is necessary to further explore new bedside effective method of verifying the nasogastric tube placement and seek the best practice to validate the method of blind intubation of nasogastric tube.

Objective To systematically evaluate the relationship between stroke location and post-stroke depression (PSD) in first-ever stroke patients.Methods The studies on the relationship between stroke location and PSD published from January 1980 to March 2016 were retrieved from databases,including Chinese science and technology journal full-text database (VIP),China journal full-text database (CNKI),Wanfan database,PubMed,ISI Web of Science,Ovid database and Elsevier Science Direct.RevMan5.3 software was adopted for data consolidation and analysis.Results A total of 14 studies,including 1 952 cases of patients were included.The meta analysis indicated that no direct relationship was found between stroke location and PSD in first-ever stroke patients [random effects model,95 ％CI(0.89,1.43),P＜0.01].The results of subgroup analysis indicated that the PSD was associated with the right hemisphere lesion when the Hamilton Depression Scale (HAMD) was adopted for assessment [fixed effects model,95 ％ CI(1.21,1.76),P＜0.01],while the relationships were not found in the subgroup analysis of time course after stroke and the aphasia occurrence.Conclusion Stroke location may be not directly associated with PSD,further studies are needed to ascertain the relationship between stroke location and PSD.

Objective To investigate the status and influencing factors of cooperation of doctors and nurses in the nutritional support of critically ill patients, and provide the basis for future improve the physician-nurse collaboration in the nutritional support. Methods Doctors and nurses who from ICU in Soochow were investigated by the Nurse-Physician Collaboration Scale (NPCS). Results The doctors′score of physician-nurse collaboration in the nutritional support of critically ill patients was 87.42 ±15.73, which was significantly higher than 80.97 ± 13.80 the nurses′(t=3.279, P= 0.001).In addition, under the item 1, 3, 5 in the dimension one as well as the total items in the dimensions two and three, the doctors′score was similarly higher than the nurses, and the differences are also statistically significant (Z=-3.894--1.964, all P<0.01 or 0.05). Technical titles, educational level and age was significantly related to the cooperative level between doctors and nurses respectively (χ2=11.037, P=0.012;F=3.488, P=0.037; F=3.499, P=0.016). Conclusions Doctors have higher levels of perceived collaboration than nurses in the nutritional support of critically ill patients, while both require further improvement. We should highlight the physician-nurse collaboration in feeding critically ill patients, and should improve the nutrition quality through standardized process management and active team cooperation.

Objective To revise the Symptom Distress Scale for postoperative patients with pituitary tumor and to test its reliability and validity. Methods On the base of previous qualitative interview and literature review, Delphi consultation was performed to identify items of the Symptom Distress Scale for postoperative patients with pituitary tumor. By convenience sampling method, totally 191 patients from four first-class ternary hospitals in Jiangsu province were investigated effectively by this scale. Results A scale of 4 factors and 16 items was identified by expert interviews, item analysis, exploratory factor analysis and the four factors could explain 69.812%of the variance. The Cronbachαcoefficient of the scale was 0.920, the content validity index was 0.915, and the interrater reliability was 0.860. Conclusions Symptom Distress Scale for postoperative patients with pituitary tumor has good reliability and validity to assess the symptom distress of pituitary tumor patients after operation.