目的:探讨个性化专职带教在新入职护士动静脉穿刺培训中的效果研究.方法:选择2018年新入职的儿科护士7名,7位护理人员进行探究,经筛选留下的这些护理人员均刚进入儿童科室不久,并且已经拿到了专业资格证书.护士长根据实际情况为这7位护理人员进行统一安排.由一位专职带教老师带领学习,实现实施一对一个体性化的带教模式,带教的内容由护士长根据实际情况为7位护理人员进行统一安排.我们在带教活动开始前以及活动进行三个月后,这两个时间段都观察记录新护士的各项表现,如穿刺水平、静脉留置针穿刺的基础理论以及病人对护士的满意度等.结果:经过一段时期的带教后,新入职的护理人员在专业技术水平、与病人家属沟通等多个方面都有很大的进展,各项表现都要优于带教前.从新入职的护士对带教护士的评价来看,有八成左右的新护士对其带教老师表示满意.据统计,90％以上的病人家属对新护士的穿刺技术水平表示认可.结论:在新护士静脉留置针穿刺技术学习中应用一对一带教理念,不仅有效提高新护士的静脉穿刺能力,增加对带教老师的尊重信任感,赢得病人家属的信任,并减轻一些费用住院及家庭的经济压力.

Background: HIV self-testing (HIVST) may expand HIV testing, but there have been few pilot programmes among men who have sex with men (MSM). This purpose of this study was to evaluate HIVST implementation among MSM in China using qualitative methods. Methods: We undertook semistructured interviews among MSM and those organising HIVST programmes for MSM. Purposive sampling method was used to ensure men with different HIV serostatuses, ages and HIVST frequencies were included. Men were recruited from MSM community-based organisations and a local HIV clinic. An implementation science framework was used to interpret the findings. Two individuals used a standard code-based methodology to identify themes. Results: Forty-two MSM and six stakeholders were interviewed. Our data showed many MSM and stakeholders preferred HIVST to facility-based testing. Most men reported that HIVST empowered MSM and informed sexual decision making. Many men noted that decreasing the HIVST price may increase demand. Some men noted that HIVST could be scaled up through social media and by modifying bulky packaging. Minimal adverse events were reported. Conclusions: HIVST may expand HIV testing and promote empowerment of MSM. Minimal adverse outcomes were noted, but further implementation research is needed.

目的 阐述完全植入式静脉输液港在儿童血液肿瘤中的临床应用和护理方法,观察护理效果.方法 随机选取本院收治的血液肿瘤患儿31例,随机分组,所有患儿均应用完全植入式静脉输液港,对照组实施常规护理,实验组实施整体护理干预,对比护理效果.结果 实验组患儿依从性100％、输液港携带时间(14.5±0.2)m、并发症发生率6.3％、家长置入前、置入效果及置入后护理满意度,分别为(96.3±2.0)分、(94.5±1.5)分及(98.0±1.9)分.对照组患儿依从性66.7％、输液港携带时间(10.3±0.1)m、并发症发生率33.3％、家长置入前、置入效果及置入后护理满意度,分别为(80.5±2.3)分、(81.4±4.5)分及(82.6±3.3)分.两组数据对比,差异显著(P<0.05).结论 应用完全植入式静脉输液港,可减轻反复穿刺对血液肿瘤患儿所带来的痛苦.于围术期实施整体护理干预,则可延长输液港的携带时间,减少并发症,提升患儿的依从性,确保家长对护理工作满意.

目的:探讨纤支镜下肺灌洗术治疗小儿肺部感染的相关护理方法及其效果.方法:收集2017年1月至12月本院收治的肺部感染患儿92例,均接受纤支镜下肺灌洗术治疗.所有患儿随机分为观察组和对照组,每组46例.对照组采用常规护理措施,观察组采用综合护理措施.比较治疗前后两组患儿肺部感染评分及氧合指数.结果:治疗前两组患儿肺部感染评分及氧合指数组间比较,差异均无统计学意义(均P>0.05).治疗后观察组患儿肺部感染情况显著好转,肺部感染评分及氧合指数均优于对照组(均P<0.05).结论:纤支镜下肺灌洗术治疗肺部感染患儿,采用综合护理措施进行护理,能有效增强治疗效果,有利于患儿康复.

OBJECTIVE:HIV self-testing (HIVST) is now officially recommended by the WHO, yet much of HIVST evidence to date has focused on quantitative data and hypothetical concerns. Effective scale-up of HIVST in diverse local contexts requires qualitative data from experiences using and organizing HIVST. This qualitative systematic review aims to appraise and synthesize research evidence on experiences using and organizing HIVST.METHODS:We conducted a systematic search of seven primary literature databases, four gray literature sources, and reference lists reporting qualitative evidence on HIVST. Data extraction and thematic analysis were used to synthesize findings. Quality of studies was assessed using the Critical Appraisal Skills Programme tool. Confidence in review findings was evaluated using the Confidence in the Evidence from Reviews of Qualitative Research approach. The review protocol was registered (CRD42015027607).RESULTS:From 1266 potential articles, we included 18. Four studies were conducted in low-income countries, three in middle-income countries, 10 in high-income countries, and one in multiple countries. Generally, HIVST increased capacity to reach priority populations and expanded opportunities for service delivery. Self-testing was preferred to facility-based testing due to increased convenience and confidentiality, especially among stigmatized populations. HIVST decreased test-associated stigma compared with facility-based testing. HIVST generally empowered people because it provided greater control over individual testing needs. At the same time, HIVST rarely allowed husbands to coerce their wives to test.CONCLUSIONS:This review suggests that HIVST should be offered as an additional HIV testing option to expand testing and empower testers. Adapting national policies to incorporate HIVST will be necessary to guide scale-up.

目前新生儿PICC尖端定位的方法主要有体表测量法、X线尖端定位法、B超引导辅助定位和静脉腔内心电图定位.前3种方法分别存在局限性:个体生理结构的差异可能会影响体表测量结果的准确性;不同观察者采用影像学定位可能存在视觉和主观判断上的差异,且患儿易受到X线辐射;B超引导辅助定位不能显示导管的全程,对一些在中心静脉内打折或导管尖端过深的病例无法进行判断.腔内心电图定位技术通过观察置管过程中心电图上P波的特征性变化判断导管尖端位置,可在置管过程中及时定位,减少导管尖端位置不正确而引发的风险,避免术后行X线带来的辐射和术后再次调管,降低检查费用.本文从新生儿PICC尖端定位的方法、腔内心电定位技术的原理、研究现状、先进性及局限性等方面进行综述.

Objective:To explore the effect of family participation management model on family needs and nursing ability of premature infants.Methods:The families with infants born in our hospital and in line with inclusion and exclusion criteria were set as the research objects.They were divided into experimen-tal group and control group according to whether family members participated in the family nursing.At the time of enrollment and two weeks after , the criti-cal care family needs inventory and neonatal nursing competency questionnaire were completed , and the implementation effect of family participation man-agement model was compared.Results:The difference of the general situation and family status of the infants was not statistically significant between the ex-perimental group and the control group.The family needs of the two groups were at a high level.After the implementation of family participation manage-ment model, the medical staff support, the needs of information access and a close relationship with the infants in the experimental group were reduced com-pared with those in the control group.The need of disease assurance was the same between the two groups and the need of comfort in the experimental group was higher than that in the control group.The neonatal nursing ability and satisfaction of the medical team were higher in the experimental group than those in the control group.Conclusion:The implementation of family participation management model can effectively meet the needs of family members of prema-ture infants, and improve nursing ability and satisfaction.

Objective To understand the current situation of high-risk sexual behavior of male clients to STD clinics and its influencing factors to provide a scientific basis for intervention.Methods A cross-sectional survey was conducted with convenience sampling method during June-November 2014.Questionnaires were used to collect data including demographic characteristics,AIDS and STD knowledge,high-risk sexual behavior,sexually transmitted infection status.Results The study enrolled 456 male clients to STD clinics,and the average age of them was 34.06±11.40 years,with 31.84％ having unsafe sex with female sexual workers;53.66％ of clients did not use condoms in the last sex with casual partners;HIV and syphilis infection rates were 3.29％,and 3.95％ respectively.Multivariate logistic regression analysis found that those with younger age (OR=3.768),having received health education (OR=1.790) and high awareness of syphilis knowledge (OR=1.725) tended to use condoms during sex.Conclusion It is necessary to strengthen AIDS knowledge and behavior education among the male clients to STD clinics,especially the adolescents and young singles to raise their awareness of STD and AIDS knowledge and reduce the high-risk sexual behavior.

Background: Syphilis has continuously posed a great challenge to China. However, very little data existed regarding the cost of syphilis. Taking Guangdong Initiative for Comprehensive Control of Syphilis area as the research site, we aimed to comprehensively measure the annual economic burden of syphilis from a societal perspective. Methods: Newly diagnosed and follow-up outpatient cases were investigated by questionnaire. Reported tertiary syphilis cases and medical institutions cost were both collected. The direct economic burden was measured by the bottom-up approach, the productivity cost by the human capital method, and the intangible burden by the contingency valuation method. Results: Three hundred five valid early syphilis cases and 13 valid tertiary syphilis cases were collected in the investigation to estimate the personal average cost. The total economic burden of syphilis was US $729,096.85 in Guangdong Initiative for Comprehensive Control of Syphilis sites in the year of 2014, with medical institutions cost accounting for 73.23% of the total. Household average direct cost of early syphilis was US $23.74. Average hospitalization cost of tertiary syphilis was US $2,749.93. Of the cost to medical institutions, screening and testing comprised the largest proportion (26%), followed by intervention and case management (22%) and operational cost (21%). Household average productivity cost of early syphilis was US $61.19. Household intangible cost of syphilis was US $15,810.54. Conclusions: Syphilis caused a substantial economic burden on patients, their families, and society in Guangdong. Household productivity and intangible costs both shared positive relationships with local economic levels. Strengthening the prevention and effective treatment of early syphilis could greatly help to lower the economic burden of syphilis.

Objective To evaluate the intervention strategies in Guangdong initiative for comprehensive control of syphilis (GICCS) frown the aspect of health economics,and to provide the scientific basis for optimization and formulation of syphilis prevention and control strategy.Methods Two kinds of syphilis intervention strategies were considered:one was 80 percent coverage of syphilis screening (Strategy 1) and the other was 85 percent coverage of syphilis screening (Strategy 2).A Markov model for syphilis screening was applied based on the results of field surveys in GICCS and published literature.Cost-effectiveness analysis and sensitivity analysis were conducted through simulating the total costs and expected health outcomes of 10 000 syphilis high-risk people during the time horizon of 20 years under strategy 1 and Strategy 2 respectively from the societal perspective.Results Compared to strategy 1,strategy 2 would cost 3 998.88 million yuan more but avert 28 primary syphilis,34 secondary syphilis,337 latent syphilis and 8 tertiary syphilis cases and 392 disability adjusted life years (DALYs) at the same time.The incremental cost effectiveness ratio was 101.95 thousand yuan per DALYs.Sensitivity analyses showed that syphilis screening programme would have more cost effectiveness when the incidence of syphilis and the probability of late latent syphilis progressing to tertiary syphilis increased and the treatment rates of secondary syphilis and late latent syphilis decreased.Conclusion The syphilis intervention strategies GICCS adopts have cost effectiveness and can be popularized.

[目的]分析广东省2005-2014年梅毒流行趋势和疾病负担,为全面认识梅毒的危害性、合理制定卫生政策提供参考.[方法]利用广东省2005-2014年梅毒病例报告数据和广东省人口数据,分别以发病率和伤残调整寿命年(DALY)为分析指标,对广东省不同年份、不同性别、不同年龄组的梅毒疫情和疾病负担进行分析比较.[结果]梅毒报告发病率从2005年的21.08/10万,增长到2014年的52.55/10万,梅毒疾病负担强度从2005年的2.00 DALYs/1O万,增长到2014年的3.16 DALYs/10万.一期和二期梅毒在全部梅毒病例所占的构成比不断减少,而隐性梅毒的构成比不断增加.虽然三期和胎传梅毒的发病率很低,但其所致疾病负担却远远高于其他分期梅毒.隐性梅毒女性发病率高于男性,但各分期梅毒所致疾病负担均是男性高于女性.一期和二期梅毒的发病高峰为20～35岁,隐性梅毒有两个发病高峰,一个是20 ～ 35岁,另一个是60岁及以上年龄人群.[结论]广东省梅毒疫情形势严峻,梅毒疾病谱已经发生改变,隐性梅毒病例占大多数,三期和胎传梅毒发病率处于较低水平,但其所致疾病负担巨大.本研究提示要把各分期梅毒的防控工作放在同等重要的位置上.

Objective Transgender individuals are at increased risk for HIV infection around the world, yet few studies have focused on transgender individuals in China. We conducted an online cross-sectional survey of men who have sex with men (MSM) and transgender individuals to examine sociodemographics, intimate partner violence (IPV) and sexual behaviours in China. Methods We recruited participants (born biologically male, ≥16 years old, ever engaged in anal sex with men and agreed to provide cell phone number) from three web platforms in 2014. Data on sociodemographics, IPV and sexual behaviours were collected. Logistic regressions were performed to compare the differences between transgender individuals and non-transgender MSM. Results Overall, 1424 eligible participants completed our online survey. Of these participants, 61 (4.3%) were transgender individuals, including 28 (2.0%) identifying as women and 33 (2.3%) identifying as transgender. Compared with MSM, transgender individuals were more likely to have experienced IPV and sexual violence (economic abuse, physical abuse, threat to harm loved ones, threat to ‘out’, forced sex). In addition, transgender individuals were more likely to have engaged in commercial sex (21.3% vs 5.1%, aOR 4.80, 95% CI 2.43 to 9.51) and group sex (26.2% vs 9.2%, aOR 3.47, 95% CI 1.58 to 6.48) in the last 12 months. Conclusions Our study is consistent with the emerging literature demonstrating increased sexual risk behaviours and high levels of IPV among transgender individuals. Future research should further investigate transgender individuals' experiences of IPV and explore ways to promote disclosure of gender identity to healthcare providers. Furthermore, transgender research in China should be expanded independently of MSM research.

Objective:To understand the status of sexually transmitted infections among male STD clinic attenders and the influencing factors of AIDS knowledge , and to provide targeted inter-ventions for future work .Methods: Data was collected through questionnaires , the questionnaire included demographic characteristics , knowledge about AIDS , sexually transmitted infection et al . Results:456 patients were enrolled in the study , the average age was 34.06 ±11.40 years.The HIV infection rate was 3.29%, and the infection rate of genital wart , genital herpes , genital chlamydia trachomatis infection , gonorrhea and syphilis was 16.23%, 6.80%, 5.48%, 4.17%and 3.95%, respectively .26.75% patients only have one STI , while 2.41% have two STIs , 0.44%have four STIs , 0.66%have five STIs .AIDS awareness rate was only 37.94%, and lower among patients who had low levels of education , were older , married, had low monthly income and have not received health education .Conclusions: STI screening among male STD clinic at-tenders should be strengthened , and standardized clinical service should be provided accordingly .&nbsp;Meanwhile , targeted health education program to prevent STD and AIDS should be implemented .

Objectives The expansion of gay sex-seeking application (gay app) use among men who have sex with men (MSM) may create new virtual risk environments that facilitate STI transmission. The goals of this study were to compare sexual behaviours between gay app users and non-users, and to describe sexual behaviours among gay app users in China.Methods In October 2014, we recruited MSM from three Chinese gay websites. Data on sociodemographics, sexual behaviours and gay app use were collected. Logistic regressions were used to compare gay app users with non-app users and to identify factors associated with condomless sex among gay app users.Results Of the 1424 participants, most were <30 years old (77.5%), single (83.8%) and self-identified as gay (72.9%). Overall, 824 (57.9%) had used gay apps for partner-seeking in the last 6 months. Among gay app users, 36.4% met their last partner within 24 hours of first message exchange through gay apps, and 59.0% negotiated condom use before in-person meeting. Compared with non-users, gay app users reported engaging in more condomless sex in the last 6 months (adjusted OR (aOR) = 1.52, 95% CI 1.19 to 1.94) and more group sex (aOR = 1.49, 95% CI 1.02 to 2.18). Negotiating condom use before in-person meeting was positively associated with condom use with partners met through gay apps (aOR = 1.83, 95% CI 1.29 to 2.60).Conclusions Gay apps are linked to risky sexual behaviours and may foster a virtual risk environment for STI transmission among Chinese MSM. App-based interventions could target young gay man and facilitate condom negotiation.

BACKGROUNDCrowdsourcing, the process of shifting individual tasks to a large group, may enhance human immunodeficiency virus (HIV) testing interventions. We conducted a noninferiority, randomized controlled trial to compare first-time HIV testing rates among men who have sex with men (MSM) and transgender individuals who received a crowdsourced or a health marketing HIV test promotion video.METHODSSeven hundred twenty-one MSM and transgender participants (≥16 years old, never before tested for HIV) were recruited through 3 Chinese MSM Web portals and randomly assigned to 1 of 2 videos. The crowdsourced video was developed using an open contest and formal transparent judging while the evidence-based health marketing video was designed by experts. Study objectives were to measure HIV test uptake within 3 weeks of watching either HIV test promotion video and cost per new HIV test and diagnosis.RESULTSOverall, 624 of 721 (87%) participants from 31 provinces in 217 Chinese cities completed the study. HIV test uptake was similar between the crowdsourced arm (37% [114/307]) and the health marketing arm (35% [111/317]). The estimated difference between the interventions was 2.1% (95% confidence interval, -5.4% to 9.7%). Among those tested, 31% (69/225) reported a new HIV diagnosis. The crowdsourced intervention cost substantially less than the health marketing intervention per first-time HIV test (US$131 vs US$238 per person) and per new HIV diagnosis (US$415 vs US$799 per person).CONCLUSIONSOur nationwide study demonstrates that crowdsourcing may be an effective tool for improving HIV testing messaging campaigns and could increase community engagement in health campaigns.CLINICAL TRIALS REGISTRATIONNCT02248558.

Background. Our study aimed to assess the burden of depression and evaluate factors associated with depression and status of HIV risk behaviors among female sex workers (FSWs) in Guangdong, China. Method. We recruited FSWs from massage parlors, saunas, restaurants, hotels, hair salons, and streets in Guangdong, China, in 2014. Information on demographic characteristics, HIV testing history, and sexual behaviors was collected using a questionnaire. A blood sample was collected to test for HIV, syphilis, and HCV. A participant was defined as being depressed if she obtained 6 points or above using the 12-item General Health Questionnaire. Results. Among the 653 participants, 41.7% were 21-30 years old and 43.6% married. Overall, 52.4% were found to be depressed. FSWs who had correct syphilis related knowledge [aOR = 1.45; 95% CI: 1.04-2.03] and had primary sex partner (1.63, 1.14-2.33) were more likely to be depressed. FSWs who did not use a condom during their last sex with the primary sex partner were less likely to be depressed (0.47, 0.31-0.71). Conclusion. Our study observed high level of depression and HIV risk behaviors among Chinese FSWs. Future interventions should integrate mental health services in comprehensive interventions to prevent depression among Chinese FSWs.

目的 了解中国跨性别MSM人群及非跨性别MSM的高危性行为特征及HIV/梅毒检测情况,并比较两个人群的差异,为制定针对性的防治措施提供依据.方法 利用互联网招募跨性别MSM及非跨性别MSM,收集其高危性行为、HIV/梅毒检测史等资料进行分析.结果 本研究共从30个省份招募MSM 1 320例,其中52例(3.94％)为跨性别MSM.跨性别MSM人群及非跨性别MSM自我报告的HIV感染率分别为11.11％,5.67％.多因素分析显示,跨性别MSM人群更可能选择跨性别者作为性伴(调整后OR(aOR) =8.113,95％ CI:2.559 ～25.692),更少与女性伴侣居住(aOR =0.102,95％ CI:0.021 ～0.402);跨性别MSM人群的HIV及梅毒检测率均低于非跨MSM(aORHIV=0.363,95％CI:0.203 ～0.652;aORsyphilis=0.423,95％ CI:0.203 ～ 0.907).结论 跨性别MSM人群HIV感染率较高而检测率较低,需要进一步促进该人群的HIV/梅毒检测,从而控制HIV/梅毒在该人群的进一步传播.

目的 了解广东省梅毒综合防治示范区工作开展前的基线现状,为策略实施和最终评估提供科学依据.方法 采用定性访谈和定量研究相结合的方法收集数据,通过问卷调查收集梅毒预防知识知晓率、梅毒专业人员梅毒知识合格率等资料,采用不同人群筛查收集艾滋病病毒(HIV)和梅毒感染资料.结果 女性性工作者(FSW)、性病门诊就诊者(MSP)、男男性行为者(MSM)的HIV和梅毒阳性率分别为0.6％和5.1％、3.3％和4.6％、10.8％和6.2％;城市居民、农村居民、流动人口、FSW、MSM、MSP的梅毒预防知识知晓率分别为62.8％、54.0％、58.5％、40.0％、57.6％、28.9％.梅毒相关医务人员专业知识合格率,南山区为87.5％,珠海市为75.0％,英德市为50.3％.定性访谈发现部门间梅控工作协调沟通有限,梅毒规范诊疗服务水平较低.结论 各示范区经济社会发展水平差异明显,梅毒防控水平参差不齐,应因地制宜、分类指导,建立梅毒防控长效工作机制,加强高危人群干预,完善监测检测体系及规范化诊疗服务.

Objective:To investigate the incidence and epidemiological characteristics of sexu-ally transmitted diseases (STDs) in Guangdong province in 2014, and to provide scientific evi-dence for prevention and control strategies .Methods:A descriptive epidemiologic study was per-formed on 5 kinds of STDs cases including syphilis , gonorrhea , genital warts , genital herpes , and Chlamydia trachomatis infection which reported from 21 prefecture-level cities in Guangdong prov-ince.Results:The incidence of syphilis, gonorrhea, condyloma acuminatum, genital herpes and Chlamydia trachomatis infection during 2014 was 52.55, 15.74, 22.09, 7.68 and 51.27 per 100,000 population respectively and 149.34/100,000 in total, with an increase or decrease of 4.57%, -19.80%, 2.55%, -3.39%, 2.65% and 0.01% compared with those in 2013 . The epidemic was centralized in Pearl River Delta , and the cases in Shenzhen , Guangzhou , Fos-han and Dongguan were all over 10,000.The male to female ratio of the 5 kinds of STDs was 1.14∶1, 6.62∶1, 0.98∶1, 1.42∶1 and 0.36∶1, respectively.The cases were mostly between 20 and 45 years old, which accounted for 72.17%.Conclusion:STDs were still the most important pub-lic health issue in Guangdong province .Syphilis and Chlamydia trachomatis infection were the pri-mary STDs in 2014 , and latent syphilis was the major stage in syphilis .Targeted prevention as well as control strategy should be developed and implemented toward STDs .