目的 通过定量适合性测试及主观感受调查，了解适合性测试与主观感受的区别以及对不同口罩的舒适度。方法 在北京市选取不同级别、性质的医院6所，根据呼吸道传染病暴露风险，选取不同风险级别的工作人员，包括医生、护士、医技、工勤人员，对两个品牌四款口罩（即拱形和折叠形）进行适合性测试，同时调查主观感受密合性以及呼吸情况、面部压迫等舒适性感受。结果 共320人参与了测试，4种口罩经过适合性测试通过534人次，主观感受完全密合的为334人次，符合率为62.55%;适合性测试未通过746人次，主观感受有漏气的536人次，符合率为71.85%。四种口罩主观感受不密合的区域均主要为鼻梁区和下巴区。不同品种口罩舒适度之间存在明显差异，折叠形B的主观感受各项指标较好，整体满意程度较高。结论 进行适合性测试不仅为医务人员找到合适的医用防护口罩，还使医务人员了解正确的口罩佩戴方法，并让佩戴者感受密合情况。另外需综合考虑舒适度，为医务人员选择更加合适的口罩。

目的 通过定量适合性测试,描述医用防护口罩的适合现状以及探索适合性测试的影响因素.方法 通过分层抽样选取6所不同级别、性质的医院中不同呼吸道传染病暴露风险部门,即低风险(普通病区)、中风险(如急诊、呼吸科门诊)、高风险(发热门诊、核酸采样点、感控处)的工作人员,包括医生、护士、医技、工勤人员,对两个品牌的拱形和折叠形口罩进行测试,采用环境气溶胶冷凝核计数器法测试医用防护口罩的定量密合性和适合性.结果 6所医院共抽取320名工作人员进行测试,在进行正式适合性测试之前,通过专业人员指导,定量密合性测试通过率较被测试人员自行调整明显提升,整体从27.50％提升至57.73％.不同品种医用防护口罩适合性监测的通过率最低为0.94％,最高为84.06％,差异有统计学意义(χ2=561.51,P<0.001).通过定量密合性测试后,进行标准动作适合性试验时,拱形A、折叠形A、拱形B、折叠形B 4款医用防护口罩通过的比率分别为50.00％、58.25％、66.67％、85.67％.主要是在左右摆头动作之后通过率开始下降.结论 适合性测试是保证呼吸道防护效果的有利工具,应充分利用适合性测试数据为工作人员提供合适的医用防护口罩.

目的 了解耐碳青霉烯类肺炎克雷伯菌(CRKP)医院感染及定植的危险因素.方法 选择北京大学第一医院2020年1月1日—12月31日所有检出肺炎克雷伯菌的住院患者为研究对象,通过回顾性调查明确感染基本情况.采取病例对照研究,将CRKP医院感染和定植患者作为病例组,共59例;碳青霉烯类敏感肺炎克雷伯菌(CSKP)医院感染和定植患者作为对照组,共79例.调查CRKP医院感染及定植的危险因素.结果 感染基本情况:2020年1-12月共86例患者不同部位检出105株CRKP,其中社区感染31株(26例),社区定植1株,医院感染51株(46例),医院定植22株(21例).CRKP医院感染率为0.11例/千住院日,医院定植率为0.35‰.单因素分析:年龄≥65岁、男性、呼吸衰竭、急诊入院、急诊滞留≥48 h、入院前使用碳青霉烯类药物、入院前存在感染、住院期间使用呼吸机+人工气道、留置尿管、住院时长、入住重症监护室(ICU)、使用碳青霉烯类、头孢菌素类(>7 d)、四环素类、氟喹诺酮类、糖肽类抗菌药物以及联合用药可使发生CRKP医院感染/定植风险增加(P<0.05).多因素分析:年龄≥65岁、入院前存在感染、使用碳青霉烯类抗菌药物是发生CRKP医院感染/定植的危险因素(P<0.05).结论 CRKP医院感染及定植的防控需关注高发部位、急诊患者及碳青霉烯类抗菌药物的管理.

目的 基于point-of-care(POC)理念调查某三级甲等综合性教学医院手卫生设施的设置现状.方法 采用横断面方法调查该院各诊疗区域主要供医务人员使用的手卫生设施种类、数量、位置、设施完备程度,以及速干手消毒剂的消耗量.结果 调查102个区域,1165间诊疗用房,手卫生设施配置率为96.48％,洗手池完备率为91.37％％,不同区域完备率比较,差异有统计学意义(P<0.01).80.53％的速干手消毒剂设置符合POC理念,59.51％的普通病区病室速干手消毒剂设置符合POC理念,速干手消毒剂设置符合POC理念比例高的科室手消毒剂消耗量相对较高.结论 手卫生设施的设置和改进应强化POC理念,以提高手卫生依从性和预防医院感染的发生.

Objective:To evaluate the effect of new media among women with gestational diabetes mellitus (GDM) during postpartum period.Methods:The gestational diabetes maternal in the obstetrics department of Peking University First Hospital from May to June, 2017 was selected. We used excel generated random number table to divide the groups, there were 50 cases in the control group and 46 cases in the study group. The control group used routine postpartum routine health education, including informing 2 groups of maternal weight management diet and exercise plans, giving leaflets, and conducting telephone to supervise the quality control; based on these situations, the study group added group WeChat push reminders and Q&A, and "317 Protector" to push the heath education materials after discharge. Then we did comparison of oral glucose tolerance test (OGTT), lipid test results and body mass index (BMI) of the two groups on the 42nd day postpartum.Results:The recovery and control of the study group women were better than those of the control group. In the study group, BMI, fasting blood glucose, triglyceride, total cholesterol, high-density lipoprotein, and low-density lipoprotein were (22.13±2.91) kg/m 2, (5.06±0.39) mmol/L, (0.89±0.27) mmol/L, (5.61±0.68) mmol/L, (1.52±0.27)mmol/L, (3.16±0.71) mmol/L after 42 days of birth. While in the control group, these were (23.66±4.21)kg/m 2, (5.30±0.47) mmol/L, (1.03±0.36) mmol/L, (5.64±0.66) mmol/L, (1.63±0.30) mmol/L, (3.23±0.62) mmol/L. The difference between the two groups was statistically significant ( t value was -3.604-2.059, P<0.05 or 0.01). Conclusion:New media for postpartum follow-up of gestational diabetes can effectively help improve BMI, blood lipids and other indicators, and can also help blood sugar control effect.

对全球新生儿皮肤接触相关研究进展、存在问题进行回顾和整理,为我国新生儿皮肤接触开展提供参考和借鉴.

Objective? To evaluate and summarize the best available evidence of kangaroo mother care for premature infants both in China and abroad, and to provide evidence-based support for clinical practice. Methods? Evidence on kangaroo mother care including evidence-based guidelines, best practices, systematic evaluation and so on were systematically retrieved from databases such as UpToDate, Cochrane Library, Ontario Registered Nurses Association of Canada, National Institute for Health and Care Optimization of the United Kingdom and National Guidelines Network of the United States from the establishment of the database to December 15th, 2018. Four researchers were divided into two groups and evaluated the quality of literature and extracted data. Results? Eight papers were included, including one guideline and seven systematic reviews. The best evidence included suitable population, support system, skin contact (timing, duration, operator), breast feeding support, etc. After evidence extraction, evidence aggregationin combination with localized adjustment in clinical situation, this study has formed eight best evidences. Conclusions? It is necessary to strengthen and support the education of relative knowledge about kangaroo mother care, improve the facilities and promote the development of clinical kangaroo mother care based on the evidence and consider the special humanistic attributes with clinical environment at the same time .

In this paper,we introduced the concept of core competency of midwives,the evaluation criteria of midwives'core competency and the current status of midwives qualification accreditation and education in various countries.We also explained curriculum provision and cultivation objectives based on midwives' core competency,so as to provide reference and new perspectives for the development of higher midwifery education in China.

Objective : This study aims to outline the progress of midwifery-related policies in contemporary and modern China as well as the obstacles in this process, and to provide recommendations for policy makers in the establishment of Chinese midwifery policies, ultimately promoting the development of midwifery in China. Background and introduction: Policy plays an increasingly important role in midwifery development, particularly needed in modern China. A review of policies of midwifery could help policy makers develop effective strategies to address current problems in China, including the insufficient numbers of midwives, the shrinking of responsibility and the degradation of midwives' competency. Methods: The Policy Triangle was used to examine through literature the laws and regulations regarding midwifery from 1928 in China and was conducted from April to September in 2013. This was followed by insider interviews with two senior policy makers from the National Health Commission to explain nursing policy progress, thereby identifying the reasons why midwifery has developed more slowly than nursing. Results: The development of midwifery in China could be classified into four stages: (1) the beginning period (1928-1949), beginning with the first midwifery rules; (2) the development period (1949-1979), in which the quality and quantity of midwives were significant; (3) the unclear positioning period (1979-2008), without clear midwifery policy; and (4) the subordination to nursing period (2008-present), with the Nurse Byelaw 2008 stating that midwives must apply for nursing licenses. Discussion: The main factors influencing midwifery policies are: (1) social background, such as the changes of different governments and health care reform, and (2) the powers of the actors. Currently, it is an appropriate time to develop strategies for policy makers to facilitate midwifery development in China. Conclusions and Implications for Health Policy: Midwifery policy should be independently included in the frame of national medical industry reform because midwives are an indispensable part of the health care workforce. In-depth research should be conducted to confirm the position of midwifery in China to ensure its sustainable development.

目的 探讨助产专业大专毕业生的核心胜任力状况,并分析影响因素、为提高助产教育质量提供参考.方法 选取已完成毕业实习的助产专业大专毕业生642人,采用一般资料调查表、助产士核心胜任力量表、中文版自我导向学习评定量表进行问卷调查.结果 助产专业大专毕业生的助产士核心胜任力得分为196.64±30.14;自我导向学习能力中的人际关系技能、学习行为及生源地、工作意愿是核心胜任力的影响因素(调整R2 =0.283).结论 助产专业大专毕业生助产士核心胜任力呈中等偏上水平,主体因素和环境因素影响其核心胜任力;实习过程中应给予其更多的助产实践机会,并提高自我导向学习能力,以促进其核心胜任力的发展.

Objective To review the midwifery legislation history in the world,and explore the effective strategies for midwifery legislation in China.Methods Literature review and focus group interview were employed to summarize the development process of midwifery legislation home and abroad and the strategies for midwifery legislation in China.Results Many developed countries had developed legal system in midwifery field,however,the legislation related to midwifery access,examination and management was inadequate in China. Midwifery legislation in China should choose reasonable positioning and level,and begin from the definition of midwifery,right and obligation,admission and management system.Conclusions The construction of midwifery legislation system is necessary in China. Legislators should construct and improve the midwifery legislation based on the existing law,and provide good environment for the harmonious development of midwifery and its related industry.

Objective:To investigate the attitudes and opinions of the midwives and related groups and propose the needs of midwifery legislative in China. Method:Totally 5470 midwives and related groups were recruited and investigated by Midwifery Legislation Questionnaire and in-depth interview was conducted among midwives. Results:About 94.70%of the respondents thought that midwifery legislation is necessary. Legislative needs focused on the rights of midwives, scope of practice, responsibility and obligations, etc. Conclusion:There are urgent needs for midwifery legislation in China. We should perfect midwifery legislation from access of midwives, scope of practice , and the system of professional title and promotion.