Objective To design a storage device for lymph node specimens of gynecological malignant tumors and to evaluate its application effect. Methods The specimen depository is composed of 3 parts，including storage frame，partition plate and marking plate. 391 patients with gynecological malignant tumor surgeries requiring collection of retroperitoneal lymph nodes were selected in the operating room of a tertiary A hospital in Zhejiang Province from January to December 2022 in accordance with the operation schedule. They were randomly divided into an experimental group（n=196） and a control group（n=195）. Patients in the experimental group used a newly developed storage device，while the control group was with traditional device. The incidence of additional verification specimens by doctors，the average time for disposing of lymph node specimens，and the job satisfaction survey of doctors and nurses were compared. Results Within a period of 12 months after utilizing this easily recognizable specimen storage device，the additional verification rate in the experimental group was 10.62% compared with the rate of 72.48% in the control group. The average time of disposing lymph node specimens was reduced from（8.3±0.9）to（5.2±0.3） minutes. Doctors and nurses in the experimental group reported a higher level of satisfaction for the specimen storage device （P<0.05）. Conclusion Utilizing the newly designed specimen storage device can help medical staff to alleviate their workload，enhance their work efficiency，raise their job satisfaction，and ensure the accuracy of pathological results.

Objective To explore the effects of repetitive transcranial magnetic stimulation（rTMS） combined with cognitive training on apathy symptoms in patients with apathy after ischemic stroke. Methods From January to December 2021，96 patients with ischemic stroke complicated with apathy in a tertiary A Hospital in Haikou City were randomly divided into a control group （n=24），r group （n=24），s group （n=24） and a combined group （n=24）. Using 2×2 factorial experimental design，the control group was given routine treatment，rehabilitation and nursing care. On the basis of interventions in the control group，the r group was treated with rTMS，and the s group was treated with card Stroop paradigm cognitive training，and the combined group was treated with rTMS combined with card Stroop paradigm cognitive training. The intervention cycle was 15 days. The apathy evaluation scale-informant（AES-I） was used to evaluate the improvement of apathy level. Results （1）87 patients completed the intervention，and there was no significant difference in baseline balance among the 4 groups（P>0.05）. （2）rTMS had a main effect on reducing the total score of AES-I and each dimension（P<0.001）. Card-based Stroop paradigm cognitive training had a main effect on reducing the total score of AES-I and the dimensions of interest，cognition and behavior（P<0.05）. Combined application had no interactive effect on improving apathy AES-I and all dimensions（P>0.05）.（3）The improvement of the total score of AES-I in the intervention groups were more effective than that in the control group（P<0.05），and the improvement effect was from large to small in the combined group，r group and s group，and the effect of the combined group was best in interest，cognition and behavior（P<0.05）. Conclusion rTMS combined with cognitive training or single training can reduce the level of apathy in PSA patients. The effect of combined application was most obvious，but there was no interaction between rTMS and cognitive training. The effect of combined application may only be the superposition of the effect of a single measure.

The self-management interventions based on mobile applications have been proven to improve the self-management ability of patients with bipolar disorder，then improve the functional outcomes of patients，promote disease prognosis and functional outcomes，and reduce the disease burden of society and families. At present，there is still a lack of relevant research in China. This paper summarizes the implementation of self-management interventions based on mobile applications for patients with bipolar disorder and then puts forward existing problems and suggestions，intending to provide references for better mobile medical services for bipolar patients in China.

Objective To conduct a meta-synthesis of the experience of patients with chronic kidney disease and their caregivers on home hemodialysis（HHD） and provide evidence-based guidance for the development and implementation of HHD in patients with chronic kidney disease. Methods 10 databases（CNKI，Wanfang database，VIP database，Pubmed，Embase，JBI evidence-based database，CINAHL，Web of Science，ProQuest，and Scopus） were included to retrieve the literature on the experience of patients with chronic kidney disease and their caregivers on HHD from inception to July 2022. The quality of the literature was evaluated according to JBI Critical Appraisal Tool for qualitative studies in Australia. Meta-synthesis was used to conduct the synthesis. Results 116 findings were extracted from 11 qualified studies，and similar research results were integrated into 12 categories. Finally，4 synthesized results were summarized：the process of adapting themselves to HHD，the process of training before HHD，personal and family difficulties，perceiving the flexibility of HHD. Conclusion At the beginning of HHD，more attention should be paid to the change of patient attitude and experience on HHD. Patients should be guided to adapt and accept HHD technology. Appropriate training concerning the characteristics of patients’ access to information and personalized requirements should be provided. Nurses need to focus on the care burden of caregivers and overcome the barriers of HHD to promote the implementation and development of HHD in China.

Objective To explore the relationship between health literacy （HL）,empowerment and quality of life （QOL） in disabled elderly and their spouses based on the theory of “dyadic coping”. Methods From December 2020 to June 2021,498 disabled elderly and their spouses in Guangzhou,Zhuhai and Shenzhen of Guangdong province were surveyed by sociological data questionnaire,Katz Index ADL Scale,Health literacy Scale for chronic disease patients,Chinese Elders Health Empowerment Scale and Chinese Short Form-36 Health Survey. Spearman correlation analysis and structural equation model were used to analyze the data. Results The median scores of HL,empowerment and QOL of the disabled elderly were 86.00,30.00 and 391.39,respectively. The median scores of HL,empowerment and QOL of the spouses were 93.00,32.00 and 617.28,respectively. Correlation analysis showed that there were positive correlations between all variables（r=0.156~0.657,P<0.05）,except correlation between spouses’ empowerment and QOL of the disabled elders（P=0.91）. The structural equation model showed that the HL of the disabled elderly could affect the QOL directly or indirectly through empowerment （path coefficients were 0.30 and 0.23,P<0.001）,and the model fitted well（GFI=0.811,AGFI=0.788,RMSEA=0.057）. The HL of the disabled elders and their spouses had a positive interaction（path coefficient was 0.47,P<0.001）. The QOL of the disabled elders was positively correlated with the QOL of their spouses（path coefficient was 0.18,P=0.004）. Conclusion The interaction of HL and QOL between the disabled elders and their spouses suggests that the disabled elders and their spouses should not be considered separately under the pressure of disability,which verifies the rationality of the application of “dyadic coping” theory. The disabled elders and their spouses should be educated and empowered together to improve their QOL.

Objective To retrieve relevant evidence of the postoperative home rehabilitation nursing for elderly patients with hip fracture，and provide evidence for clinical nurses to formulate home rehabilitation nursing pro-grams. Methods The relevant evidence of postoperative home rehabilitation nursing for elderly patients with hip fracture was systematically searched from domestic and foreign databases and websites，including clinical decision-making，guidelines，systematic reviews，expert consensuses and evidence summaries，and the search time limit is from the establishment of the databases to Oct.31，2021. There were 2 researchers who evaluated the quality of various literature and extracted recommendations and research conclusions from the included literature. Results A total of 15 articles were involved，including 3 articles on clinical decision-making，3 guidelines，2 systematic reviews，5 expert consensuses，2 evidence summaries. 27 pieces of the best evidence were formed on suitable population，discharge plan，rehabilitation assessment，rehabilitation expectation，exercise strategy，intensive training，health education and health follow-up. Conclusion The best evidence summary for postoperative home rehabilitation nursing in elderly patients with hip fracture was summarized. When applying the evidence，health care professionals should fully consider the specific clinical setting and formulate individualized rehabilitation nursing plans based on the needs and preferences of patients.

Objective To construct a decision-making assistant tool for free body position delivery in the second stage of labor,and to explore its clinical application effect. Methods Under the guidance of Ottawa Decision Support Framework Theory,the first draft of the decision aid tool is formed after searching and analyzing the literature and combining the basis of previous research. After 2 rounds of expert consultations and the semi-structured interview revision with 30 parturients,the final version of the tool was formed. 69 pregnant women who delivered in a tertiary A hospital in Beijing from July to October 2021 were selected as the research subjects. They were randomly divided into an experimental group and a control group. On the basis of routine nursing education,the experimental group used the free body position delivery decision-making tool,and the control group received the routine nursing. The scores of free body position delivery knowledge,decision-making dilemma,decision-making preparation and decision-making participation were compared between the 2 groups. Results The decision-making assistant tool for free body position delivery in the second stage of labor includes 7 first-level indicators and 31 second-level indicators. After the intervention,the score of free posture knowledge questionnaire in the experimental group was[4.50（3.75,5.50）],which was higher than[1.50（0.75,5.50）] in the control group. The score of decision preparation scale（79.27±15.34） in the experimental group was higher than（46.07±20.68） in the control group. The score of decision distress scale（20.26±11.34） was lower than（42.50±20.66） in the control group,with statistical significance（P<0.05）. The willingness and degree of pregnant women to participate in medical decision-making increased. Conclusion The decision aid tool is scientific and practical. The tool can help pregnant women understand the advantages and disadvantages of different delivery positions,clearly select their preferences,and reduce decision making conflicts. It is helpful to realize doctor-patient shared decision-making and improve the delivery experience of pregnant women.

Objective To explore the fatigue development trajectory and influencing factors of postoperative patients with acute myocardial infarction（AMI）. Methods From December 2019 to January 2021,206 patients with first AMI in the cardiology department of a tertiary hospital in Huzhou were selected by convenience sampling method. The multidimensional fatigue scale-20 was used to investigate the patient’s fatigue level on the second day after admission and 1,2,4 months after discharge,and the latent class growth model and single factor analysis were used for data processing. Results It is recognized that the fatigue trajectory of AMI patients is divided into 3 potential categories,namely,the obvious improvement group（15.2%）,the slow remission group（62.8%）,and the continuous fatigue group（22.0%）;single factor analysis shows that the 3 trajectory categories are different with statistical significance in gender （χ²=29.384,P<0.001）,marital status （χ²=6.774,P=0.034）,number of comorbidi-ties（χ²=27.131,P<0.001） and cardiac function classification（χ²=20.416,P<0.001）. Conclusion The fatigue of most patients with AMI can be improved within 4 months from acute admission to discharge. There is group heterogeneity in fatigue trajectory. Medical staff should formulate staged and specific full-course nursing interventions according to different trajectory categories.

Objective To develop a self-management scale for patients with bipolar disorder and to test the reliability and validity of the scale. Methods This study uesd Lorig and Holman’s self-management theory and Bandura’s social cognition theory as theoretical framework,combined with the results of semi-structured interviews with 20 patients,carers and medical personnel. The pretest scale was formed through literature research method and 2 rounds of expert evaluations. A convenience sample of 397 patients with bipolar disorder was selected for item analysis,the pretest scale of the reliability and validity. Results The self-management scale for patients with bipolar disorder includes 3 dimensions and 18 items. The overall Cronbach’s α coefficient of the scale was 0.906;the split-half reliability was 0.853;the retest reliability coefficient of the scale was 0.658. There were 3 factors being extracted from exploratory factor analysis,explaining 54.814% of the total variances. The correlation coefficient between the self-management scale and the Brief version of Quality of Life in Bipolar Disorder was 0.535（P<0.001）. Conclusion The self-management scale for patients with bipolar disorder has good reliability and validity,and it can effectively assess the status of self-management.

Objective To systematically analyze and evaluate the prediction model of fall risk in convalescent stroke patients,in order to provide references for clinical practice. Methods Original articles in Chinese and English were systematically searched from Chinese databases（CNKI and Wanfang） and English databases（PubMed,Embase,Cochrane） published prior to June 2021. There were 2 researchers who independently screened the literature,extracted information,and analyzed and compared the characteristics of the population,study types,predictive factors,model construction methods and model prediction results. Results This systematic review included 12 pieces of the literature on the development of predictive models,including 15 models. In these models,10 models reported the area under the curve and 4 models simultaneously reported the confidence interval of the area under the curve;4 models showed good differentiation in the internal verification population. In addition,only 6 models were tested for goodness of fit test,4 of them reported P value,and the results showed that the consistency was good. All included studies have low concerns regarding applicability,but with a certain bias,which mainly due to insufficient number of dependent events in the field of analysis,neglect of missing data,screening predictors based on univariate analysis,lack of model performance evaluation and over-simulation of the model. Conclusion There are still some shortcomings in the fall risk prediction model of convalescent stroke patients. Future research should improve the research design and research report,and carry out internal and external verification.

For the main group of the patients with chronic diseases,how to improve the quality of life of the patients during the stable period of the disease is one of the main focuses. This review synthesized the status quo of discharge planning services for hospitalized elderly patients with chronic diseases,including the conceptualization,assessment tools,intervention strategies,quality appraisal and influencing factors. To provide information bases for the development of discharge preparation service model for the elderly patients with chronic diseases in China,findings from this review can provide guidance for better maintenance and promotion of rehabilitation and health of elderly patients with chronic diseases.

Objective To explore the establishment of patient-centered comprehensive,scientific,reliable,and practical home care service quality evaluation indicators,and to provide a reference for the improvement of home care service models. Methods From February to March 2021,based on the results of evidence-based and semi-structured interviews,preliminary evaluation indicators were drawn up,and expert letter questionnaires were formed,through 2 rounds of Delphi method. 19 nursing or medical-related work fields experts consulted on these indicators（3 first-level dimensions,9 second-level dimensions,and 61 third-level items） and determined the weights of indicators at all levels. Results The effective recovery rate of the 2 rounds of expert letter consultations was 100%,and the expert authority coefficient（Cr） was 0.88. Finally,a home care service quality consisting of 3 first-level dimensions,10 second-level dimensions and 46 third-level items was formed. The first-level dimension Kendall’s W increased from 0.18 to 0.32;the second-level dimension increased from 0.11 to 0.30,and the third-level index increased from 0.13 to 0.20（all P<0.01）. Conclusion The evaluation index of home care service quality basically conforms to the basic national conditions of our country and conforms to the patient-centered concept,with strong comprehensiveness,scientificity,reliability and practicability.

Objective To construct training curriculum system for ICU new nurses based on transition shock model,so as to guide clinical nursing practice and evaluate training quality for ICU new nurses. Methods Based on transition shock model,the training curriculum system were established by literature review,expert group discussion,Delphi method and semi-structured interviews with 9 nursing staff. Results The rates of return of questionnaire in the first and second round expert consultation were 100% and 94.44%. The authority coefficient of experts was 0.890,and the coordination coefficient of experts’ opinion was 0.412. The system included 4 first-level indexes,17 second-level indexes,and 126 third-level indexes. Conclusion The results of the study is reliable and the system can provide reference for training of new nurses in ICU.

Objective To establish and apply the heterotypic blood transfusion mode for patients with incompatible blood transfusion after allogeneic hematopoietic stem cell transplantation. Methods A retrospective analysis was conducted on 993 cases of heterotypic blood transfusion in our department from 2015 to 2017. We established a working group on heterotypic blood transfusion. From March to August 2018,based on the characteristics of heterotypic blood transfusion,the steps of heterotypic blood transfusion were refined on the basis of transforming the working mode of homotypic blood transfusion,and the program of improving nursing workflow of heterotypic blood transfusion was constructed. It was implemented in nurses of hematology ward and changed weekly according to feedback. Results After the construction and practice of allogeneic hematopoietic stem cell transplantation in patients with blood incompatibility,the incidence of distribution error（ P<0.01）,medical order error（ P<0.01） and transfusion reaction（ P<0.05） were significantly reduced. Conclusion The safe and efficient operating mode of heterotypic blood transfusion not only improves the nursing efficiency,but also prevents the occurrence of nursing errors,which is worthy of reference and promotion.