Clown care is a non-drug intervention based on therapeutic humor，which plays a very important role in alleviating the pressure on pediatric patients，improving their bad behaviors and treatment compliance. This article reviewed the development process，implementation methods，impact on pediatric patients，difficulties and challenges in the implementation of clown care，and put forward practical suggestions to provide a reference for further application of clown care in pediatric patients in China.

Objective To retrieve and obtain relevant evidence on the prevention and management of medical adhesive-related skin injury（MARSI） in neonates to guide clinical practice. Methods We searched UpToDate,BMJ Best Practice,Guidelines International Network（GIN）,National Guideline Clearinghouse（NGC）,Registered Nurses Association of Ontario （RNAO）,Medlive,Joanna Briggs Institute （JBI）,Cochrane Library,Embase,PubMed,Science Direct,CNKI to collect relevant guidelines,recommended practice,evidence summaries,systematic reviews and expert consensuses published form January 1,2011 to February 18,2021. There were 2 researchers who evaluated the quality of the literature and extracted evidence according to the Australian JBI Centre for Evidence-Based Health Care’s literature evaluation criteria and evidence grading system. Results A total of 10 articles were included,including 2 guidelines,2 evidence summaries,2 systematic reviews,4 expert consensuses. A total of 18 pieces of best evidence were collected,mainly involving 5 aspects of skin assessment,skin protection,employment choices,operation methods,management and training. Conclusion This study summarized the best evidence for the prevention and management of MARSI in neonates. It suggests that the nursing administrators should take the actual situation into consideration to formulate relevant nursing measures in clinical practice. We should solve the problem of MARSI in neonates in a scientific way,which can reduce the occurrence of skin injury and improve nursing quality.

Objective To improve the project of reducing the incidence of catheter-associated urinary tract infection（CAUTI）through the management by objectives（MBO）,so as to enhance the quality by setting,implementing and completing goals. Methods The data of patients with indwelling catheters hospitalized in a tertiary Grade A General Hospital from April 2020 to September 2020 were analyzed. The project objectives and plans were developed through MBO. Besides,the project was implemented according to the plans,and an assessment of the process was carried out. Actions were taken to improve the project based on the feedback of assessment results. A month is set as a quality cycle. The quality of the first cycle is the baseline,and then the quality of each cycle is compared with the baseline data and the quality of the previous cycle. Results Compared with the baseline quality of 12 process indexes,6 indexes were statistically significant in the second cycle（P<0.05）. The results that were better than the baseline quality and the quality of the second cycle were statistically significant,compared with the baseline quality（P<0.001）. The baseline completion rate of 5 process indexes has reached a greater extent. Similar measurement data were obtained after that,indicating that high-quality nursing care was given. The indexes of the incidence of CAUTI at the end of the project were statistically significantly lower than the baseline（P<0.05）. The completion rate of the process indexes was over 95%,indicating that objectives were met. Conclusion MBO can be used for improvement in projects and goal-oriented management of indexes. It can also verify the effectiveness and further improve the quality by objectively measuring and scientifically comparing the quality of nursing care.

Objective To use a special injection tube for neonatal alveolar surfactant to explore the best way to administer neonatal alveolar surfactant. Methods To design a special injection tube for neonatal alveolar surfactant. 126 neonates with respiratory distress syndrome admitted to the neonatal ICU of a tertiary hospital in Wuhan from April to September 2019 were selected as the research subjects,and were divided into an experimental group and a control group according to the order of admission. 66 cases in the experimental group received a special injection tube for neonatal alveolar surfactants for intratracheal administration;60 cases in the control group had traditional scalp needles and ordinary tracheal intubation methods for intratracheal administration. The differences of SpO₂ fluctuations,heart rate fluctuations,and drug reflux during the medication in the 2 groups were observed and the administration time was calculated. Results The differences in SpO₂ fluctuations and heart rate fluctuations in the experimental group were smaller than those in the control group（P<0.05）. The incidence of drug reflux in the experimental group was lower than that in the control group,and the administration time was shorter than that in the control group with statistical significance（P<0.05）. Conclusion The special injection tube for neonatal alveolar surfactants is easy to operate,and it can reduce the fluctuation of SpO₂ and heart rate of neonates during the administration process,ensure the stability of neonatal vital signs. It can also reduce the incidence of drug reflux,drug waste and the administration medicine time.