Nurse-led clinics is an important milestone in the development of nursing and a way to achieve universal health coverage and the sustainable development goals. The establishment and improvement of medical and nursing systems have become the key in achieving steady development of nurse-led clinics. This article summarizes the improvement of training systems for specialty nurses, the rights and obligations of the post, charge system of nurse-led clinics, the integration with continuous nursing and information construction, and provides some ideas for the innovation development path of nurse-led clinics.

Objective: To explore the sustainable development construction mode and innovative operation mode of nursing studios in the management of patients with diabetic foot, and to evaluate its practical effects. Methods: A nursing studio was set up where a multidisciplinary team led by wound nurses was established. An evidence-based management model of diabetic foot, a talent training mechanism and a scientific research path were formed, and the trinity of nursing, teaching and research was carried out. Results: After the establishment of the nursing studio, the annual number of diabetic foot outpatient visiting increased, reaching 2000 people in 2019; the healing time of wounds due to diabetic foot was significantly shortened (P<0.05); the nursing team of diabetic foot specialists was expanded; and the scientific research outputs including papers and patents increased. Conclusion: The operation mode based on nursing studios is helpful in promoting the recovery of diabetic foot, improving the quality of specialized nursing, and facilitating the training of specialized nursing personnel and the construction of nursing disciplines.

Objective: To improve the maintenance outcomes, medical experience and satisfaction of patients with PICC catheters. Methods: 1 403 patients recruited in the PICC clinic were divided in accordance with the care modes used into a control group adopting an offline mode (n=755) and an observation group employing the O2O mode (n=648). Results: Patients in the observation group showed better performance and results regarding duration of visit, data integrity, satisfaction, infection in the puncture sites and better acceptance in health education such as awareness of emergency situation, contact information, abnormal puncture sites and dressing conditions, functional exercise and precautions compared with the control group (P<0.01). Conclusion: The O2O mode can improve the maintenance outcomes, medical experience and satisfaction of patients with PICC catheters.

Based on the background introduction and construction of the case management clinic in our hospital, this paper focuses on case collection, case management, closure and information system establishment related to its operation process. Through multidisciplinary integration and joint care, case management clinic service has significant effects in improving patients' satisfaction of hospital services and their self-management ability and compliance. It can provide more comprehensive treatment and care for patients with chronic diseases, improve their qualities of life, reduce medical costs, as well as expand the functions and scope of nursing, which will provide more direction for career development of nursing staff. Thus it is worth learning and promoting in chronic disease management.

Standard anticoagulation treatment of pulmonary embolism, which is closely related with the outcomes of patients, is a complex, systematic and meticulous work. The establishment of a nurse-led anticoagulant clinic can provide criteria of anticoagulant treatment for patients. Ever since the set up of the anticoagulant clinic led by specialist nurses in March 2016, pretty good results have been achieved including improved patients' compliance, better international normalized ratio level and reduced rate of bleeding events. This article introduces the establishment and implementation of the nurse-led anticoagulant clinic to share our experience of standard anticoagulant treatment for patients with pulmonary embolism.

Objective: To investigate the reliability and validity of the Chinese version of Children's Amblyopia Treatment Quality of Life Questionnaire (CATQoL). Methods: The original CATQoL was translated into Chinese and adjusted by the expert panel. The reliability and validity of the Chinese version of CATQoL was tested on a sample of 122 children with amblyopia treatment. Results: The scores of each item are positively correlated with the total score of the scale, the correlation coefficient were between 0.45 and 0.80 (P<0.01). The content validity index of the scale was 0.93. The correlation coefficients between the scores of the two dimensions and the total score were 0.58 and 0.55, respectively, and the difference was statistically significant (P<0.01). The exploratory factor analysis extracted two common factors, which explained a total of 62.85% of the total variance. The total Cronbach 's α coefficient of the scale is 0.91. The retest reliability is 0.85. Conclusion: The Chinese Version of CATQoL has good reliability and validity, and is suitable for evaluating the quality of life of children with amblyopia in China.

Objective: To explore the effects of oral care based on dynamic assessment of dental Plaque Index in patients with nasal feeding. Methods: Totally 116 patients with nasal feeding were randomly divided into experimental group and control group. The control group were provided routine oral care. The experimental group were applied oral nursing program based on dynamic evaluation of dental Plaque Index. The oral hygiene, oral comfort and the incidence of aspiration pneumonia were compared between the two groups. Results: The dental Plaque Index and the Beck score of the experimental group after nursing were significantly lower than that of the control group (P<0.05). The oral comfort of the experimental group was significantly higher than that of the control group (P<0.05). Incidence of aspiration pneumonia in the experimental group was significantly lower than that in the control group (P<0.05). Conclusion: Oral nursing based on dynamic evaluation of dental Plaque Index can improve oral comfort and reduce the incidence of oral complications in patients with nasal feeding.

Objective: To explore the effect of ICU diary on Post-Traumatic Stress Disorder (PTSD) among adult patients in ICU. Methods: Totally 98 adult patients in ICU were enrolled and were randomly divided into the experimental group and the control group. Patients in the control group were with adopted routine nursing, whereas patients in the experimental group were kept ICU diary based on the routine nursing. The event impact score and the incidence of PTSD were compared between the two groups in the first and third months after leaving ICU. Results: There were significant differences between the score of event impact scale (24.70±10.61 vs 34.77±12.70, P<0.001) and the incidence of PTSD (52.17% vs 81.40%, P=0.007) in the first month after ICU among patients in the experimental group and the control group, and the score of event impact scale and the positive rate of PTSD in the experimental group were lower than those in the control group. However, there were no significant differences in the two variables between the two groups at the third month (P>0.05). Conclusion: ICU diary can reduce the incidence of PTSD in patients one month after their transfer out of ICU.

Objective: To investigate the cognition, attitudes and clinical practice of medical staffs on the early rehabilitation of ICU patients. Methods: The questionnaire of medical staffs' cognition, attitudes and clinical practice about early ICU rehabilitation was applied. Totally 528 ICU medical staffs were included. Results: The cognition and attitudes of medical staffs on the early ICU rehabilitation were at low level and the clinical practice was below average score. There were many obstacles to early ICU rehabilitation. Medical staffs with different educational degree, occupations, professional titles, age, and ICU working period had different cognition scores, and the differences were significant (P<0.05). Medical staffs with different educational degree, age, occupations, ICU types, ICU working period, professional titles and positions had different attitudes scores, and the differences were significant (P<0.05). There were significant differences between doctors and nurses in 6 items including concept, stop indication and effect (P<0.05). Conclusion: The medical staffs' cognition and attitudes on early ICU rehabilitation were not optimistic. There were still many difficulties in clinical practice, which limited the clinical implementation and development of early ICU rehabilitation.

Objective: To understand the coping experience of young and middle-aged lymphoma patients and their spouses during the course of disease, and to identify the problems to provide targeted interventions. Methods: Phenomenological approach in qualitative research was used in the study. Semi-structured interviews were conducted with 11 pairs of young and middle-aged lymphoma patients and their spouses. The interview data were analyzed by Colaizzi phenomenological methodology. Results: The disease coping experience of young and middle-aged lymphoma patients and their spouses can be summarized into three themes: negative dyadic coping and disease information needs after diagnosis; positive dyadic coping during the treatment period; many factors affect dyadic coping. Conclusion: Couples with lymphoma patients have serious psychological problems. Worries about family, uncertainty of disease, concealment between couples during the course of disease are not conducive to disease adaptation. Understanding the coping experience of young and middle-aged lymphoma patients and their spouses can provide theoretical basis for targeted interventions.

Objective: To understand the psychological distress of Radiotherapy-Induced Oral Mucositis (RTOM) in patients with head and neck tumors, and analyze the influencing factors, so as to provide a reference for the clinical development of targeted prevention or treatment measures. Methods: Totally 105 inpatients with head and neck cancer of a tertiary oncology hospital were selected by convenient sampling. The subjects were admitted from October 2018 to September 2019. A questionnaire included general information, the Distress Thermometer (DT) and Problem List (PL) was used to investigate and analyze the influencing factors of psychological distress. Results: The score of psychological distress in patients with RTOM was (4.46±1.65), of which 35 cases (33.3%) were <4 points, and 70 cases (66.7%) were ≥4 points. Logistic regression analysis showed that actual problems, communication problems, and belief/religious issues were not the influencing factors of psychological distress. Physical and emotional problems were the influencing factors of psychological distress. Conclusion: Patients with RTOM are generally suffering psychological distress. Medical staff should conduct timely assessment, focusing on patients' emotional problems. Physical problems can be alleviated by necessary nursing measures. Nursing intervention should be conducted according to the severity of psychological distress and the influencing factors, in order to reduce psychological distress of patients and improve the quality of life of patients.

To explore the barriers and facilitators of breast cancer patients' participation in Shared Decision-Making, in order to provide reference for clinical implementation. Methods: By using purposive sampling and convenience sampling method, 16 breast cancer patients were recruited for semi-structured interviews from February to April 2019. Inductive content analysis was used to analyze the data, including identifying the meaningful unit, compressing the meaningful unit, encoding, inducting categories and themes. Results: Four themes and nine categories were extracted, which were the patients' cognition (cognitive diversification, the need for Shared Decision-Making); decision-making process (information exchange, value clarification); doctor-patient interaction (doctor-patient trust, decision support, doctor-patient relationship); clinical situation (time, workload). Conclusion: Several influencing factors of breast cancer patients' Shared Decision-Making implementation were identified. Clinical managers should pay attention to the needs of patients participate in Shared Decision-Making and identify the superiority of the influencing factors in clinical work, in order to develop a suitable Shared Decision-Making model in China.

Objective: To analyze the effects of case management model on improving self-care ability, urinary symptoms and patient experience of patients with prostate cancer experiencing endocrine therapy. Methods: A cluster random sampling method was used to recruit 90 patients with prostate cancer experiencing endocrine therapy from January to August of 2018 in a tertiary grade A hospital in Changsha, Hunan province. They were randomly divided into experimental group and control group, with 45 cases in each group. Patients in the control group received routine care and follow-up, while patients in the experimental group received 6 months of case management in addition to the routine care and follow-up. Self-care ability, urinary symptoms and patient experience of the two groups were compared. Results: After 6 months of intervention, the total score of self-care ability of the experimental group was higher than before and the control group. The scores of the International Prostate Symptom Scale and patient experience were lower than before and the control group. All differences were statistically significant (P<0.05). Conclusion: The case management model can effectively improve the self-care ability, urinary symptoms and experience of patients with prostate cancer experiencing endocrine therapy.

Objective: To investigate the prevalence of physical restraint in medical-nursing care combined institutions and to analyze the influencing factors. Methods: A total of 847 elderly people from two medical-nursing care combined institutions in Chongqing were recruited by convenience sampling. Participants were investigated by using a self-designed questionnaire of Physical Restraint Use in medical-nursing combined institutions. Results: The prevalence of elderly people with physical restraints was 23.9%. 67.8% of physical restraints were signed with informed consent; 81.2% physical restraints were due to fall prevention; and 85.6% of physical restraints were not recorded. Wrist band (60.9%) and belt (63.9%) were the most frequently used restraint tools. According to the logistic regression analysis, cognitive dysfunction, low ADL scores, mobility limitations, physical agitation behaviors, risk of fall, having indwelling tubes and no regulations for physical restraints were independent risk factors for the use of physical restraints. Conclusion: The use rate of physical restraints in medical-nursing care combined institutions was at a high level, which had complex risk factors and lack of regulations. It is suggested that the assessment of ability and cognition of the elderly should be strengthened, and relevant regulations should be established to reduce the use of physical restraints, so as to improve the quality of long term care.

Stroke has seriously endangered the lives and health of middle-aged and elderly people in our country. The situation of rehabilitation of stroke patients needs urgent improvement. This research was mainly based on the telemedicine integrated service platform, and discussed the construction ideas of stroke rehabilitation nursing model from the aspects of tele-rehabilitation nursing technology architecture, functional modules, implementation process, evaluation scale, follow-up monitoring, quality assurance and feasibility. It is expected to provide individualized and continuous scientific medical services for the rehabilitation of stroke patients.

Objective: To describe the characteristics of occupational benefits among Enterostomal Therapists (ETs) and explore its influencing factors. Methods: Following convenient sampling, information from a total of 173 ETs in Henan, Shaanxi, Guangdong, Beijing, Jiangsu and Sichuan provinces were collected in this study using a survey. Results: The overall score on occupational benefit among ETs in the current study was 137.39±16.86. The mean scores on the subdimensions of positive occupational perception, good nursing relationship, family and friends identification, team affiliation and self-growth were 28.03±3.98, 25.70±3.26, 24.77±3.40, 24.82±3.05 and 34.07±4.33, respectively. Among ETs included in our study, their children's current educational stage, number of years in ET work, whether or not participated in the specialist care consultation were factors related to occupational benefits. Conclusion: The occupational benefits perceived by ETs are still in need for improvement. It suggests that nursing administrative personnel should implement interventions by considering the identified factors in the current study to improve the perceived occupational benefits among ETs.

Objective: To construct the responsibility index system of case manager in chronic kidney diseases. Methods: The first draft of the responsibility index system was drawn up by literature review and semi-structured interview. Delphi method was used to evaluate the draft. Totally 20 experts in the field of chronic kidney diseases and chronic care management from nursing colleges and the third Grade A hospitals were selected and two rounds of consultation were conducted. Results: The final responsibility index system of case manager in chronic kidney diseases included 6 first-level indexes (assessment, planning of care, consultation &education, coordination, evaluation and research), 15 second-level indexes and 48 third-level indexes. The positive coefficients and authority coefficients for 2 rounds of consultation were 100% and 0.860 respectively. Conclusion: Expert opinions on the responsibility index system of case manager in chronic kidney diseases were concentrated and the results are logical and reliable. It can be used as reference for appointment and evaluation of the case manager in chronic kidney diseases.

Objective: To investigate the work stress of nurses returning to work after the second childbirth and its influencing factors as well as the peer support system for them. Methods: 167 nurses returning to work after the second childbirth from 3 tertiary general hospitals in Fuzhou were recruited through convenient sampling and investigated using questionnaires including the general information questionnaire, Chinese Nursing Job Stress Inventory and Peer Support Scale. Results: (1) The total score of the work stress of nurses investigated was (71.54±24.89). The average score of the five dimension from high to low was: workload and time distribution (2.12±0.80), nursing profession and working property (2.10±0.74), patient care (2.05±0.76), management and interpersonal relations (1.97±0.76) and working environment and equipment (1.96±0.74). The score of peer support for nurses after the second childbirth was (67.50±27.51) and the support from peer colleagues was stronger than that of nursing managers with the difference being statistically significant (P<0.05). (2) Multivariate stepwise regression analysis showed that peer support, the time of return-to-work, night shift rotation, social competence and average working hours per week were statistically significant influencing factors of work stress (P<0.05). Conclusion: The work stress of nurses returning to work after the second childbirth is in the medium. It is important to take measures focusing on the influencing factors to establish a reasonable nurse scheduling system to adjust their workload, and provide more support both physical and emotional to ensure quality nursing service and patient safety.

Nurses have emotional labor in clinical work, and having emotional labor ability is of great significance to build a harmonious doctor-patient relationship, nurse-patient relationship, and to improve patients' satisfaction. Through the interpretation of the related concepts of emotional labor, theoretical analysis, and a review and comparison of research tools, methods and current status of nurses' emotional labor at home and abroad, we provide references for further in-depth, systematic research and application of nurses' emotional labor.

Objective: To construct a new online platform combining Hyper Text Marked Language(HTML) technology, online consultation and telephone instruction, and develop home management program for patients with meibomian cysts who have been suspended from surgery during the outbreak of COVID-19. Methods: Totally 71 patients with surgical indications of meibomian cyst were included. The nursing care information, home care guidance, information collection and feedback registration were integrated through HTML technology. The home management-Internet hospital diagnosis and treatment process of patients with meibomian cysts was optimized. Online diagnosis, treatment and regular telephone consultation was performed for four weeks. Results: Twenty nine patients cancelled surgery, 4 patients continued to take conservative treatment, and 38 patients were still waiting for surgery. Conclusion: The online platform, which combines HTML technology, online consultation and telephone instruction, can be performed effectively during the outbreak of COVID-19. It can improve the patients' condition and anxiety, provide the patients with high satisfaction and effective home management strategies, and reduce the risk of hospital acquired infection of COVID-19. Therefore, the online platform is an effective management platform for patients with meibomian cysts in special period. It can be recommended in daily diagnosis, treatment and nursing care.

Objective: To evaluate the effect of online teaching following the Presentation-Assimilation-Discussion (PAD) format in Fundamental Nursing during COVID-19 epidemic. Methods: The study period is from February to May 2020, and the sampling method is cluster sampling. A total of 102 nursing students in class 2019 with a study focus on midwifery participated in the study. During the COVID-19 epidemic, the online teaching was designed, it adopted the PAD format as a teaching methodology. To evaluate the learning effect among nursing students, information on students' independent learning ability, satisfaction were collected along with a summary of the students' learning experience through interviews. Results: The mean overall subject score among 102 nursing students was (83.22±2.76). After 8 weeks of online learning, students' self-learning ability was significantly improved, and the overall satisfaction of online teaching was high among nursing students. The result of qualitative interview was consistent with the results of quantitative survey. Conclusion: During the COVID-19 epidemic, the online teaching of "Fundamental Nursing" can meet the learning needs of nursing students with highly acceptable academic performance. The online teaching proved that it is helpful in improving students' self-learning ability and satisfaction among nursing students. It provides references for selection of alternative teaching method in carrying out teaching and learning activities in cases of major emergencies in the future.

Objective: To explore the sense of mission of frontline nurses and its influencing factors in the context of fighting COVID-19 to provide references for improving nurses' career calling. Methods: Questionnaires including a general data questionnaire, Connor-Davidson Resilience Scale and Career Calling Scale were used to investigate 510 frontline nurses who joined the treatment and care of patients with COVID-19 in Tai'an. Results: The total resilience score and the career calling score of the those nurses were (66.24±14.36) and (42.87±6.56), indicating a positive correlation between the psychological resilience of those nurses and their career calling (r=0.547, P<0.01). Working years, participation in public emergencies, resilience and strength were the predictors of professional mission of frontline nurses, which accounted for 33.1% of the total variance. Conclusion: In the context of COVID-19, the career calling of frontline nurses including also those contract nurses was relatively high, which was related to their psychological flexibility. Nursing leaders were supposed to give more encouragement and support to senior and experienced nurses, and try to improve the psychological flexibility of frontline nurses at the same time to enhance their inner tenacity and strength.

Objective: To evaluate the effects of blended teaching on the course of functional experimentation. Methods: From March 2019 to December 2019, 178 undergraduate students from six classes of 2018 in The Department of Nursing, Fenyang College, Shanxi Medical University were selected as research participants. The six classes were numbered and three random Numbers were selected. A total of 90 students from the corresponding classes were enrolled in the experimental group. From March 2018 to December 2018, a total of 89 students from three classes of 2017 were randomly selected to be included in the control group by the same method. The control group adopted the traditional teaching method, and the experimental group adopted the blended teaching method based on the virtual simulation experiment platform. The experiment success rate, scores for the final exam and the Autonomous Learning Competencies Scale were used to evaluate the teaching effect. Results: The success rates of the experiment in the experimental group and the control group were 79.2% and 63.0%, respectively, with statistical significance (χ2=13.790, P<0.001); the scores for the final exam in the experimental group and the control group were (81.24±6.77) and (76.36±9.36), respectively, with statistical significance (t=3.991, P<0.001); as for the Autonomous Learning Competencies Scale, there was no statistical difference in the scores of each dimension between the two groups before the whole-year teaching began (P>0.05). After the whole-year teaching ended, the competency scores for self-management in the experimental group and the control group were (32.01±1.89) and (30.82±1.47), respectively; the competency scores for information were (33.53±1.95) and (31.99±2.12), respectively; the competency scores for learning cooperation were (29.79±1.58) and (22.26±3.34), respectively; the total competency scores were (95.33±3.35) and (85.07±3.47), respectively. All the differences were statistically significant (P<0.001). Conclusion: The blended teaching based on virtual simulation experiment platform can improve the experiment success rate and autonomous learning competencies of undergraduate nursing students.

Objective: To evaluate and analyze the quality of clinical guidelines concerning prevention and management of neonatal hypoglycemia, so as to provide recommendations for reducing incidence of hypoglycemia and offer reference frame for clinical nursing. Methods: The included guidelines were recruited from websites of international guidelines, academy societies or institutions, and other relevant electronic databases (from inception to January 31st 2020). Results: Nine guidelines were included, four of which were evidence-based guidelines, three were expert consensus and the other two were about best practices. Evaluated according to AGREE II one of the four evidence-based guidelines was rated level A and the rest three were rated level B. Totally 14 recommendations which could be divided into three dimensions were summarized from nine guidelines. Conclusion: The overall quality of the included guidelines is high. There are yet no such evidence-based guidelines for China in this field, so national conditions and healthcare settings should be considered before referring to these recommendations in clinical practice.

Objective: To summarize the evidence on the application of discharge planning for patients with chronic heart failure. Methods: A review of the literature for discharge planning for patients with chronic heart failure in guide sites and databases was conducted, and all the available best practice evidences, recommendations for clinical practice, guidelines, evidence summaries, system reviews and expert consensuses were included. The Joanna Briggs Institute evidence appraisal and recommendation system was used to evaluate the quality of studies and the level of evidence. Results: Totally 14 literatures were included, including 1 best practice information sheet, 2 clinical practice guidelines, 4 evidence summaries, 6 systematic reviews and 1 expert consensuse, and 15 evidences on discharge planning for patients with chronic heart failure were extracted and summarized from the three aspects of objective, principle and contents. Conclusion: Selecting best evidence on the base of combining characteristics of hospital departments and clinical situations, to standardize the clinical nursing practice for discharge planning for patients with heart failure, to improve the nursing quality, and ultimately to improve patient outcomes.

Objective: To describe the characteristics, functions and evaluation of Clinical Decision Support System (CDSS) in the field of Gestational Diabetes Mellitus (GDM). Methods: Eleven electronic databases were searched using keywords. The literatures were selected and analyzed following the framework of Scoping Review addressed by Arksey and O' Malley. Results: A total of 8 articles published in 2000-2018 were included. The included studies described 8 different clinical decision support systems. The CDSSs of GDM management were mainly based on remote medical platforms such as mobile phone APP and networks. The CDSSs provided patients recommendations or assist doctors making decisions through algorithms and models based on GDM clinical guidelines or expert experience. The evaluation of the CDSS mainly included the accuracy and effectiveness of the decision-making system, professional workload, user experience, patient outcomes and compliance. Conclusion: The clinical decision support system can assist clinical staff to make the best decision. However, the current application of CDSS in GDM is limited. The CDSS based on telemedicine is the focus of future development.

Objective: To evaluate the quality and analyze the contents of the clinical practice guidelines on Post-Stroke Depression (PSD), and to provide references for nursing clinical practice for patients with PSD in China. Methods: Systematically searching of domestic and foreign guideline websites and databases related to PSD was conducted. The quality of the guidelines related to PSD was screened and evaluated using the AGREE II and the content of included guidelines was analyzed, therefore to reach combined and integrated recommendations for nursing clinical practice related to care of patients with PSD. Results: We identified seven guidelines, of which six were in English and one was in Chinese. For the overall quality, three of them were ranked as grade A and four as grade B. A total of 26 recommendations were sorted out. Conclusion: There are various guidelines for care of stroke patients having been published both nationally and internationally, which involved those with PSD. However, the guidelines have not been systematically summarized. We should customize the clinical nursing practice for PSD based on local clinical environment as soon as possible to improve the depression level of patients with PSD.

Objective: To monitor the quality of terminal cleaning of patient beds and nursing high-touch surfaces, to provide a basis for the improvement of the quality of nursing and hospital infection control. Methods: On-site investigations were conducted on the establishment and implementation of the cleaning system, procedures and implementation of terminal cleaning in 21 hospitals. Fluorescence labeling method and ATP bioluminescence detection method were used to detect the quality of terminal cleaning. Results: Totally 71.43% of the hospitals have established terminal cleaning systems and procedures. 66.67% of the hospitals met the requirements of the regulations, and 26.67% of the hospitals complied with the operation and implementation of the system. The overall clearance rate of each monitoring point in the patient bed was 74.29%, the median ATP cleanliness of the treatment room operation table and treatment vehicle was 41.0 (RLU), and the median ATP cleanliness of the high-touch surfaces in ICU was 43.0 (RLU). Conclusion: The terminal cleaning work of patient bed needs the full attention of the managers. The cleaning effect of therapeutic room operation table and treatment vehicle needs to be improved. The monitoring of the surface cleaning effect of high-touch surfaces in ICU should be included in the daily monitoring system.

Objective: To understand the application status of medical device instructions in Central Sterile Supply Departments (CSSDs), and put forward specific solutions standardizing the application of medical device instructions. Methods: Stratified sampling method was used to investigate the use of medical devices in sterilized supply centers (rooms) of 340 hospitals in China. Results: 84.12% of the implants and external medical devices were provided without instructions offered by manufacturers, 33.53% of the users did not understand the contents contained in the instructions. 41.18% of CSSD staff had not fully referred to the instructions of implants and external medical devices in usage and 87.65% of them had not regularly participated in relevant training. 62.35% of the departments had not formulate rules on the instructions and management system for medical devices, and 59.41% of the CSSDs investigated had not assigned staff to manage the instructions of medical devices. The status of instructions for medical devices in CSSD of hospitals on different levels were compared, such as the application of the instructions in verifying a newly purchased medical device for the first time as well as in long-term maintenance, and statistically significant differences were observed (P<0.05). Conclusion: Medical device manufacturers are unfamiliar with and have paid little attention to the state management requirements for medical device instructions. The medical device users in CSSD have also failed to understand the importance of the instructions of medical devices resulting from lack of professional training and standard management of instructions CSSD, which could cause a high risk for the management of surgical instruments.

As a new model of patient management, the Critical Care Outreach Services can effectively improve the prognosis of patients. This paper introduces the objectives of Critical Care Outreach Services and relevant patient classification, and then summarizes the related studies at home and abroad on the Critical Care Outreach Services in critical care outreach activities, early warning system, patients and medical system. Following this, it proposes prospects of further researches on the Critical Care Outreach Services.

This paper summarizes the application status and prospect of Decision Aids in breast cancer screening, including the concept and advantages of Decision Aids, and the influence of different forms of Decision Aids on women's decision-making for breast cancer screening. Suggestions on the development of Decision Aids for breast cancer screening in China are also provided, to promote women's informed decision-making and implement the concept of Shared Decision-Making.

Objective: To investigate the current status of Fear of Cancer Recurrence in lung cancer patients, and analyze its influencing factors. Methods: A survey was conducted in 222 patients with lung cancer who were hospitalized in three tertiary Grade A hospitals in Nanchang during March to November, 2019. The general data questionnaire, simplified scale for Fear of Progression Questionnaire-Short Form (FoP-Q-SF), General Self-Efficacy Scale (GSES), and Brief Illness Perception Questionnaire (BIPQ) were used in the survey. Multiple stepwise linear regression was used to analyze the influencing factors of lung cancer patients' Fear of Cancer Recurrence. Results: In 222 lung cancer patients, the score of FoP-Q-SF was (40.27±7.80), and 173 cases (77.93%) were≥34 points, the GSES score was (21.33±4.39), and the BIPQ score was (53.00±8.00). Multiple stepwise regression analysis showed that age, self-efficacy, disease duration, disease cognition, and consciousness of disease severity were the influencing factors of Fear of Cancer Recurrence (P<0.05), which explained 40.5% of the total variation. Conclusion: The Fear of Cancer Recurrence in lung cancer patients is not optimistic, and the incidence rate is high. Clinicians should pay attention to the psychological status of lung cancer patients, and adopt targeted interventions to enhance patients' self-efficacy and improve their disease awareness, guide and encourage them to actively respond to reduce the Fear of Cancer Recurrence level.