AimTo map the commonly used quantitative blood loss measurement methods in clinical practice and provide a solid foundation for future studies.Design and MethodThis study adhered to the JBI methodology for scoping reviews and preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews. We conducted a literature search using five databases to retrieve articles published between January 2012 and September 2022. The search was repeated on 29 February 2024. Data extraction and verification were carried out by two independent researchers using a self-designed data extraction form.ResultsUltimately, 26 studies published between 2012 and 2024 were considered eligible for inclusion. Six categories of methods were identified from the 26 articles. Among the included studies, only two involved randomized controlled trials, with the majority being observational studies. The World Health Organization (2012) version of the postpartum haemorrhage diagnostic criteria was predominantly used in most studies. Gravimetric and volumetric methods emerged as the most commonly used methods for quantifying postpartum haemorrhages. The timing of blood collection was inconsistent among the included studies. Only 12 studies mentioned measures for the management of amniotic fluid.ConclusionsThis scoping review supports the replacement of the visual estimation of blood loss with quantitative assessment methods. Supporting a specific assessment approach is not feasible due to the variability of the study. Future research should focus on establishing the best practices for specific quantitative methods to standardize the management of postpartum haemorrhage and reduce the incidence of postpartum haemorrhage-related adverse outcomes.Relevance to Clinical PracticeHealthcare professionals need to acknowledge the low accuracy of visual estimation methods and implement quantitative methods to assess postpartum blood loss. Given the limitations inherent in each assessment method, quantification of blood loss should be combined with assessment of maternal vital signs, physiologic indicators and other factors.

AbstractAims and objectivesThis study aimed at evaluating the accuracy of visual estimated blood loss in postpartum haemorrhage by midwives and nurses, as well as exploring its influencing factors.BackgroundTimely recognition of postpartum haemorrhage is critical in saving maternal lives. Yet midwives and nurses can barely distinguish whether the blood loss has reached a life‐threatening amount without precise measurement. Understanding their ability to accurately estimate the amount of blood loss and the influencing factors can help improve this ability with effective measures.DesignThis research was a multicenter cross‐sectional survey with convenient sampling.Material and MethodsUsing a modified online visual estimation questionnaire of blood loss, the QR code of this survey was sent to midwives and obstetrical nurses engaged in clinical practice in secondary and tertiary hospitals in Shanghai. A descriptive analysis was performed with demographics and the responses of visual estimated blood loss of each volume. The difference and consistency of the responses of each volume were evaluated. The relationship between each demographic characteristic and accuracy was explored. STROBE statement checklist was chosen for reporting the study process.ResultsA total of 361 midwives and nurses participated in the survey. The finding showed an overall accuracy of 30.52% (1763/5776), with 25.3% and 18.0% subjects distinguishing postpartum haemorrhage (500 ml) and severe postpartum haemorrhage (1000 ml), respectively. The Kappa coefficients were slight to moderate (0.037–0.590). There were no differences among the categories of gender, age, academic degree, position, title, working experience in years, working department and reported methods of blood loss estimation with regard to accuracy. However, having institutional guidance for blood loss calculation showed a significant relationship with higher accuracy.Relevance to clinical practiceWhile representing a relatively well‐developed area in China, the accuracy of visual estimated blood loss was not satisfactory, as suggested in other developed countries around the world. Training and institutional guidance on blood loss quantification should be provided in midwifery settings, regardless of how the level of medical development is advanced.ConclusionsThe accuracy of VEBL was low even with a visual aid, especially when the volume exceeds 500 ml. To improve accuracy, institutions should make standardadized assessment guidance and provide regular training for blood loss quantification.

Objective: To assist the prevention and treatment of COVID-19 in Wuhan city, Beijing municipal health commission and Beijing hospitals authority set up a medical team of 138 experts from 13 Beijing municipal hospitals, which was dispatched to Wuhan union hospital west campus to participate in the treatment of severe patients We will give full play to the role of hospital infection prevention and control experts in our work and ensure the strict implementation of hospital infection prevention and control requirements such as the protection of medical staff Methods: After arriving in Wuhan, Beijing aid medical team of Hubei province defined the mission, established the rules and regulations for infection control, and conducted standardized procedures and protection training for all the team members and the medical staff in the west hospital of Wuhan union hospital It took 24hours to complete the transformation of the ward, build a reasonable layout of the demonstration ward of Beijing standard, and start the treatment of COVID-19 confirmed patients While the work was carried out rapidly, the disinfection of the ward and residence was strengthened, which laid the foundation for medical and nursing safety Results: At present, the medical team has been working continuously for 50 days, receiving and treating 341patients including 216 severe patients, 83 critically ill patients and 142 cured At present, the number of patients in the hospital is gradually decreasing, with the utilization rate of beds dropping from 100 00% (150/150) to 70 67% (106/150) The proportion of critically ill patients dropped from a peak of 98 00% (147/150) to 74 67% (112/150), and the number of patients cured and discharged increased significantly Zero infection was achieved for all health care workers Conclusion: This paper summarizes a series of prevention and control measures taken by the infection control team during the work in prevention and control of Novel coronavirus pneumonia in Wuhan union hospital west campus, which provides a reference for the prevention and control of the outbreak of infectious diseases

BACKGROUND:Women with normal fasting glucose (FPG) range (5.1 ≤FPG <6.09 mmol/L) in early pregnancy are at high risk of gestational diabetes mellitus (GDM). The aim of this study was to compare the effectiveness of routine antenatal care with a midwife-managed clinic service in the prevention of GDM in early pregnancy at a hospital in China. MATERIAL AND METHODS:We designed a prospective observational clinical study among pregnancy women with normal fasting glucose (FPG) range (5.1 ≤FPG <6.09 mmol/L) in early pregnancy. Routine antenatal care was compared with a midwife-managed clinic service providing diet and exercise education before week 16. A 75-g OGTT was performed at weeks 24-28 for both groups. Results of OGTT and gestational weight gain were compared between the 2 groups. RESULTS:Of the 592 eligible women, 296 women received the antenatal nursing clinic service and 296 were enrolled in a control group. Thirty-three women were lost to follow-up during the study, leaving 279 in the intervention group and 280 in the control group. Baseline demographic characteristics were similar between the 2 groups. GDM was diagnosed in 115 participants (41.2%) in the intervention group and 141 (50.4%) in the control group. Subgroup analysis showed a significantly lower rate of GDM in the intervention group among the No-IVF population (37.8% vs. 49.0%, P=0.01%). For pre-pregnancy BMI, significant differences were found in the incidence of GDM and maternal hypertension between the different groups, showing that the overweight group benefited most from the midwife-managed antenatal clinic service. CONCLUSIONS:The midwife-managed clinic service was feasible and effective in the prevention of GDM.

AIMS AND OBJECTIVES:This research was conducted to explore the effectiveness of employing the healthcare failure mode and effect analysis method in the management of trial of labour after caesarean, with the aims of increasing vaginal birth after caesarean section rate and reducing potential risks that might cause severe complications. BACKGROUND:Previously high caesarean section rate in China and the "two children" policy leads to the situation where multiparas are faced with the choice of another caesarean or trial of labour after caesarean. Despite evidences showing the benefits of vaginal birth after caesarean, obstetricians and midwives in China tend to be conservative due to limited experience and insufficient clinical routines. Thus, its management needs further optimisation in order to make the practice safe and sound. DESIGN:A prospective quality improvement programme using the healthcare failure mode and effect analysis. METHODS:With the structured methodology of healthcare failure mode and effect analysis, we determined core processes of antepartum and intrapartum management, conducted risk priority numbers and devised remedial protocols for failure modes with high risks. The programme was then implemented as a clinical routine under the agreement of the institutional review board and vaginal birth after caesarean success rates were compared before and after the quality improvement programme, both descriptively and statistically. Standards for Quality Improvement Reporting Excellence 2.0 checklist was chosen on reporting the study process. RESULTS:Seventy failure modes in seven core processes were identified in the management process, with 14 redressed for actions. The 1-year follow-up trial of labour after caesarean and vaginal birth after caesarean rate was increased compared with the previous 3 years, with a vaginal birth after caesarean rate of 86.36%, whereas the incidence of uterine rupture was not compromised. CONCLUSIONS:The application of healthcare failure mode and effect analysis can not only promote trial of labour after caesarean and vaginal birth after caesarean rate, but also maintaining a low risk of uterine rupture. RELEVANCE TO CLINICAL PRACTICE:This modified vaginal birth after caesarean management protocol has been shown effective in increasing its successful rate, which can be continued for further comparison of severe complications to the previous practice.

从体全息存储原理出发，列举了体全息存储的技术和主要的几种系统结构，并就同轴式全息存储系统原理、系统结构、编码方式进行了详细的介绍分析。在未有成熟的相位编码方式的情况下，对基于相位调制的同轴全息存储系统的两种相位编码方式进行了分析评价，这两种相位编码方式对全息存储中相位编码的可能实现方式进行了有效补充，其组合式相位编码方式与传统振幅编码相比提高了编码率且降低了误码率。另外，介绍和分析了一种可以有效减少材料消耗并提高存储密度的多阶复振幅调制的同轴全息存储系统，并对其系统表现性能进行评价。综合评价得出，更合理的编码方式、适当的调制手段和抑制噪声仍是现在全息存储研究中亟待解决的问题。

Abstract Objective Postpartum hemorrhage (PPH) is a leading cause of maternal death. Although guidelines have been updated, those with detailed protocols are limited for nursing practice. This study aims at establishing an early assessment and intervention protocol as a toolkit for PPH for midwives and obstetrical nurses. Methods Employing the evidence-based method, a systematic Internet search of guidelines was conducted and appraisal of literatures was conducted with AGREE system and Oxman-Guyatt Overview Quality Assessment Questionnaire (OQAQ), according to which a protocol draft was therefore developed. Then, a two-round modified Delphi method was utilized to reach a consensus of the protocol built on best practices. Selection criteria for each intervention measure included consensus level with a threshold of 70%, mean of importance (M) >3.5, and coefficient of variation (CV) <0.25. Reliability of experts’ opinion was calculated by positive coefficient and authoritative coefficient. Items without consistency were enlisted in the second-round consult. When all items met the selection criteria, the protocol would be finally formulated. Results A 122-measure protocol was established, including prevention, assessment, and intervention of PPH. With a panel of 14 experts participated in the consult, the positivity coefficient was 0.93 and 1.00 for two rounds, respectively, and the authority coefficient was 0.88. After a two-round consult and revision of the draft, the final program was formulated, containing 5 first-level indexes and 14 second-level indexes with a total item of 120. Conclusions The PPH protocol, based on high-quality evidences, was formulated with a two-round Delphi method, which can provide insight for midwives and obstetrical nurses to effectively deal with PPH.

Postpartum Hemorrhage has been recognized as the most fatal factor in maternal death. Yet midwives can barely distinguish whether the blood loss has reached a life-threatening amount without precise measurement, particularly during a slow hemorrhage. Also, understaffed midwives in mainland China adds to the difficulty of timely accurate measurement of blood loss. To evaluate the accuracy of visual estimated blood loss in postpartum hemorrhage by clinical midwives, as well as the reproducibility of the visual estimation and influencing factors on accuracy. With a modified on-line visual estimation questionnaire of blood loss, a cross-sectional multicenter study was conducted among voluntary midwives or obstetrical nurses engaged in clinical practice in secondary and tertiary hospitals in Shanghai. A descriptive analysis was performed with demographic features and the rate of accurate responses. The Kappa coefficient was employed to determine the reproducibility of the agreement of visual estimation. The correlations between demographics and items of the questionnaire were conducted with Chi-square test and Spearman correlation analysis. A total of 281 midwives and nurses participated in the survey. The finding showed relatively low accuracy and reproducibility of visual estimation, with 25.6% and 17.8% subjects in Shanghai hospitals distinguishing the postpartum hemorrhage (500ml) and the severe postpartum hemorrhage (1000ml), respectively. The Kappa coefficients were slight to moderate (0.062~0.450). The institutional routine for blood loss calculation turned out to be relevant to the accuracy of visual estimation. Visual estimation cannot provide sound validity for blood loss evaluation in postpartum hemorrhage in China, especially when the amount exceeds 500ml. Institutions should make routines on how blood loss can be reckoned with the sterile drapes and gauzes they use, and provide regular training for midwives and nurses.

ObjectiveThe assessment indicators of postpartum hemorrhage (PPH) were systematically reviewed to explore their relationship with blood loss as an early warning sign to identify potential PPH for prompt intervention.MethodsA systematic literature search of 9 databases was conducted according to inclusion and exclusion criteria using a comprehensive strategy. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) strategy was chosen as the tool for quality assessment of included studies, and data concerning the basic study characteristics and assessment indicators were extracted.ResultsEleven studies were included in this review. The assessment indicators in different reports covered heart rate, blood pressure, placental and birth canal check, hemoglobin (Hb), hematocrit (HCT), coagulation function tests, hemodynamic parameters and arterial blood gas, but no data on the assessment of postpartum uterine contraction were found. The relationship between indicators and blood loss varies. The overall quality of 9 manuscripts was comparatively high or moderate, and 2 were rated as low.ConclusionsThe association between blood loss and clinical symptoms is not conclusive based on the present studies, and specific cut-off points could not be formulated to determine the approximate amount of blood loss. However, some cut-off points can be considered warning signs for the need of advanced interventions, such as heart rate, prothrombin time, and placental implantation. Further research on comprehensive assessment and cut-off points should be performed such that birth attendants can distinguish PPH as early as possible.

新《环境保护法》实施对于项目建设和投资并未提出新的要求,但程序更加规范、执法愈发严格,对项目建设周期及投资产生了一定的影响。对油气管道项目而言,主要体现在:生态红线划定、环评技术要求高等对项目建设周期的影响;环境应急预案备案要求对项目竣工环保验收的影响;长输管道压气站氮氧化物排放控制、应急物资储备要求增加了项目建设投资。针对新《环境保护法》实施后项目建设存在的问题,提出开展项目前置环境影响评价、公开生态红线信息、制定油气管道环境影响评价导则、编制油气管道应急物资配备行业标准或规范等建议。

有人说：人生就像一场旅行，不必在乎目的地，在乎的是沿途的风景．以及看风景的心情。恍惚间一年又过去，还有很多没来得及做的事情，还有很多没看到的风景，所以我们要一直在路上。无论是早上匆忙赶去上班．还是辛苦了一天下班回家，《大武汉》想要在路上一直陪伴你。

建筑工程行业作为国民经济的主导产业之一，对国家经济的平稳有序运行有着十分重要的影响。在营改增全面的推开下，建筑工程行业作为改革的重点行业之一，鉴于建筑工程行业自身的特殊性，营改增把面临诸多的问题。基于此，本文分析了建筑工程行业的营改增对工·程造价的影响进行阐述，希望可供相关从业者的参考借鉴。

“1998年，我和芭田开始合作，那个时候国产肥的厂家很少i化肥的产量也少，我们也是抱着试试看的心理去推广芭田肥，结果非常满意。施用芭田肥的经济作物的口感和外观会有质的改善，比施用其他肥料的效果显著，芭田一经推出就受到经销商和农民的欢迎。”谈及与芭田的合作之初，广东开平德信农资李德新如是说。

四月中的三亚,最高温度已超过30℃。距离三亚市中心10余公里的凤凰镇,100余亩的芒果园里,4979棵芒果树上的30多万颗芒果再等一周就要开始采摘了。年近七旬的老人王关德就是这片芒果园的主人。从退休到走种植之路,王关德已坚持了十一年。在与芒果相处的十一年里,王关德已扎根农业，他专注于芒果种埴，从一名芒果生手到成为一名芒果种植匠，他一直坚持着“做良心人，种良心果”的理念，他坚守着保证芒果高品质的要求，坚持使用有机肥，最大可能地减少芒果使用化肥和农药，他坚决拒绝为了让芒果增产施加药州的做法。

1月 价格四平八稳 静等“春风来” 冬储价虽然推迟，但是厂家采取了各种促销方式来刺激经销商，可惜的是去年的冬储销量较往年来讲缩水很多，厂商只能寄望于春耕市场，这种期待表现在复合肥方面就是价格相对稳定。在本月，尿素的价格一直都是震荡运行的，基层的情绪比较凝重，山东送皖北到站价为1380元／吨，这也是多年来最低的价格；一铵价格同时也在下行，估计在2000元／吨上下或趋稳。

树大招风,老大难做。今年农民用肥需求弱,单质肥、低端肥争抢市场,假冒充斥市场,一线品牌化肥日子究竟过得怎样？近日,《中国农资》记者针对这一问题进行了采访调查。据了解,业内普遍反映,在农资市场低迷的大环境下,一线化肥品牌正在遭遇腹背受敌的困境,今年复合肥、磷肥销量减少20%左右,市场销售产品以尿素、碳铵居多,其中一二线品牌的中坚砥柱——中高端化肥销量受影响最为明显,且多方面因素时刻考验着一线化肥品牌背后的各条＂大船＂。