Objective： To analyze the importance and constraints of "Internet + nursing" among nurses in tertiary， secondary and primary hospitals in Shanghai，and to provide countermeasures and suggestions for promoting Internet + nursing services. Methods： A total of 36 clinical nurses or managers from 2 third⁃level general hospitals，2 third⁃level specialized hospitals， 2 second⁃level general hospitals and 3 first⁃level hospitals （community health service centers） in Shanghai were selected for semi⁃structured interviews.The content of interview data was analyzed by using the three⁃level coding method and the project map and matrix coding analysis of NVivo 12 Plus software. Results： A total of 3 level 1 nodes， which were importance， constraints and countermeasures，13 level 2 nodes and 11 level 3 nodes were derived from the analysis.According to the number of reference points， the importance was reflected in the well⁃being of the service object， the value of nurses and the development of the hospital.The main constraints are security，manpower，policy and platform.The order of countermeasures and suggestions is mainly service pricing，service item， service security，service standard，service platform and service object. Through the comparison and analysis of the framework matrix， the constraints of "Internet + nursing" services in hospitals of different levels and the focus of countermeasures and suggestions are different. Conclusion： The constraints for nurses at different levels of hospitals to carry out "Internet + nursing" services are different.It is recommended to increase policy support，clarify management systems and service standards， optimize human resource allocation，reasonable service pricing， continuously improve "Internet + nursing" service projects，accelerate the construction of information platforms，and take multiple measures to promote the co⁃construction and sharing of high⁃quality nursing services：.

Objective： To compare the value of risk assessment models based on Logistic regression， decision tree and random forest machine learning algorithms in predicting frailty risk among maintenance hemodialysis patients. Methods： From October 2021 to March 2022，a total of 485 patients receiving maintenance hemodialysis treatment in two tertiary grade-A hospitals in Hangzhou were selected and treated according to 7∶3 ratio was randomly divided into training set（=341） and test set（=144）. Logistic regression， decision tree and random forest were used to establish frailty risk prediction models for maintenance hemodialysis patients.Accuracy，sensitivity，specificity， positive predictive value， negative predictive value，Kappa and AUC value were used to compare the predictive performance of the three models. Results： In the training set，the accuracy of Logistic regression，CART，and random forest were 91.79%，91.50% and 97.95%，the specificity was 96.84%，92.11%，and 96.91%，and the sensitivity was 85.43%，90.73%，and 99.32%，respectively.The positive predictive value was 95.56%，90.13%，96.05%，the negative predictive value was 89.32%，92.59%，99.47%，the Kappa value was 0.832，0.828，0.958，and the AUC value was 0.971，0.954，0.998.The AUC values of the three models were tested， and the results showed that the random forest model was significantly different from the other two models （<0.05）.Age，gender，Charlson Comorbidity Index and nutritional risk screening score were common predictors of the three prediction models. Conclusion： Random forest model is the best model in predicting frailty risk among maintenance hemodialysis patients.

Objective： To investigate the results of respiratory pathogenetic surveillance of patients after novel coronavirus pandemic infection （2023） and to compare them with the pre⁃epidemic （2018—2019） and intra⁃epidemic （2020—2022） results， and to analyze the changes in the trend of respiratory viral infections and the clinical characteristics of influenza A virus （IFVA） and mixed infections. Methods： The peripheral blood pathogen IgM test results of 2 902 patients with respiratory diseases who attended the First Hospital of Shanxi Medical University from February to March 2023 and those who attended the same period of time before （=1 216） and during the epidemic（=3 113） were collected and analyzed，and the positive patients were classified into the IFVA group according to the infection status，IFVA+Mycoplasma pneumoniae （MP），IFVA+Respiratory Syncytial Virus （RSV），and IFVA+Influenza B Virus （IFVB） groups，and the clinical characteristics and blood routine of the mixed infection groups were compared with those of the simple infection groups. Results： In the serum of 2 902 respiratory infection patients in 2023，the number of positive cases for pathogen IgM detection was 1 207，among which IFVA⁃ IgM had the highest positive rate，with a total of 393 cases detected with a combination of two or more antibodies；During the epidemic，the serum IgM test results of 3 113 respiratory infection patients showed a positive number of 794 cases，among which IFVA ⁃ IgM had the highest positive rate，with a total of 194 cases detected by a combination of two or more antibodies；before the epidemic，the serum IgM test results of 1 216 respiratory infection patients showed a positive number of 393 cases，of which IFVA⁃IgM had the highest positive rate，and a total of 63 cases were detected with two or more antibody combinations.The results of Logistic regression analysis showed that age is an independent influencing factor of IFVA+MP，while age and platelet count （PLT） are independent influencing factors of IFVA+RSV； Elevated PLT，shortness of breath and chest tightness，and the presence of underlying diseases are independent influencing factors of IFVA+IFBV.In the receiver operating characteristic （ROC） curve，the area under the ROC curve for age predicted IFVA+MP is 0.715（95%CI 0.657⁃0.773）.The area under the ROC curve for age prediction of IFVA+RSV is 0.742 （95%CI 0.690⁃0.794）. Conclusion： Strict precautionary measures during novel coronavirus infection can curb the spread of respiratory pathogens. Control measures can contain the spread of respiratory pathogens. After the widespread infection of novel coronavirus，people's immunity level generally decreases，which makes them more susceptible to viral infections and mixed infections. Clinicians can predict the occurrence of mixed infections based on patients' clinical symptoms，signs and laboratory tests，and provide symptomatic treatment in a timely manner.

Objective： To establish risk prediction model of postoperative urinary retention using decision tree，logistic regression and support vector machine and compare their performance，in order to provide references for evaluating and preventing urinary retention after radical resection. Methods： The medical history information of 459 patients who underwent radical resection in Shanghai First Maternal and Infant Health Hospital from 2018 to 2021 was collected retrospectively.Three machine learning models，decision tree，logistic regression and support vector machine，were used to construct the risk prediction model of postoperative urinary retention.Accuracy，recall，precision，F1 score and AUC were used to evaluate the performance of the models. Results： A total of eight variables were included， including age， disease stage， body mass index and so on.80% of data sets （367 cases） were selected as training sets and 20%（92 cases） were selected as test sets.The results showed that the accuracy，recall，precision， F1 and AUC of decision tree in the training set and test set were better than those of support vector machine and logistic regression，which indicated that decision tree had higher accuracy and better generalization performance. SVM was better than logistic regression in accuracy， recall， precision， F1 and AUC in the training set. At the same time， in the test sets， the recall and F1 of support vector machine were better than those of logistic regression； but the accuracy， precision and AUC of support vector machine were worse than those of logistic regression， indicating that the generalization ability of support vector machine was worse than that of logistic regression. Conclusion： Decision tree has high performance and generalization ability in constructing the risk prediction model of postoperative urinary retention， which can provide guidance and suggestions for related clinical behaviors.

Objective： To develop and test the reliability and validity of the financial toxicity scale for cancer family caregivers. Methods： Based on the 6⁃factor model of financial toxicity， the initial entry pool of the scale was compiled through literature analysis and semi⁃structured interviews. The initial scale was determined after two rounds of Delphi expert correspondence.Totally 498 family caregivers of cancer patients who were re⁃examined in the outpatient department of Henan Provincial People's Hospital were selected as the subjects for investigation，and the reliability and validity were tested. Results： Exploratory factor analysis produced five common factors， including economic resources，economic expenditure，psychosocial response， treatment and life change， and support seeking， the cumulative variance contribution rate reached 74.885%.Confirmatory factor analysis showed that the 5-factor structure fitted well.The total score of the scale was negatively correlated with the total score of the Chinese version of the Quality of Life of the Family Caregivers of Cancer Patients （=－0.489，<0.001），total monthly family income reported by caregivers（=-0.670，<0.001） and household disposable savings（=－0.577，<0.001）.Total Cronbach's α coefficient， half reliability and retest reliability were 0.841， 0.792 and 0.862 respectively. Conclusion： The financial constructed toxicity scale for cancer family caregivers has good reliability and validity， and it can be used to effectively evaluate the financial toxicity of cancer caregivers.

Objective： To investigate the current status of acute stress disorder in patients with acute myocardial infarction after PCI and to explore its correlation with disease perception and coping mode. Methods： A convenient sample of 205 patients with acute ST⁃segment elevation PCI from January to April 2023 in a tertiary grade A hospital in Shanxi was investigated by general data questionnaire， Stanford Acute Stress Reaction Questionnaire，Medical Coping Modes Questionnaire，Brief Illness Perception Questionnaire. Results： The total score of acute stress disorder of 205 patients with acute ST⁃segment elevation PCI was （42.60±10.22）.The results of regression analysis showed that gender，pain level， disease perception and exposure were the influencing factors of acute stress disorder.Mediation effect analysis showed that disease perception could directly predict acute stress disorder （=0.21，=0.002）.Facing played a mediating role between illness perception and acute stress disorder （=0.05，<0.05），and the mediating effect accounted for 19.23% of the total effect. Conclusion： Patients with acute myocardial infarction after PCI have a high level of acute stress disorder，and medical staff should pay attention to women and patients with high pain level， reduce disease perception and adopt positive response through personalized education to reduce the occurrence of acute stress disorder.

Objective： To explore the independent and combined effects of personality traits on sleep quality in male and female infertile patients， and the moderating effect of mindfulness on the relationship. Methods： Pittsburgh Sleep Quality Index，Five⁃Factor Inventory and Short Inventory of Mindfulness Capability were used to investigate 360 male and 380 female infertility patients. Results： Only neuroticism was correlated with sleep quality in infertile patients （<0.01）.The combination of personality traits， whether high neuroticism or low extraversion or low conscientiousness was associated with poor sleep quality in male infertility patients（<0.05）.While the combination of high neuroticism was associated with poor sleep quality in female patients （<0.05）. Mindfulness moderated the relationship between neuroticism and sleep quality only in female infertility patients （<0.01）. Conclusion： It suggests that neuroticism and its combination of personality traits are associated with sleep quality in infertile patients， and mindfulness moderates the relationship between neuroticism and sleep quality in women.

Objective： To develop a scale to evaluate the medical narrative ability of hospice care personnel， and to test its reliability and validity. Methods： Guided by the theory of narrative medicine and the specific practice of hospice care， combined with literature analysis and qualitative interview results， the item pool of the scale was constructed. The first version of the scale was formed through on⁃site expert Delphi consultation. A questionnaire survey was conducted among 324 persons who carried out hospice care and narrative medicine/nursing services to test the reliability and validity of the scale. Results： The medical narrative ability scale for hospice staff included two dimensions，which were response focus and reflective representation，and 21 items，they could explain 78.626% of the total variance.Cronbach'sαcoefficient of the scale was 0.978，and Cronbach's α coefficientof each dimension were above 0.9，the correlation coefficients of the scale and each dimension were 0.916-0.973，and the dimensions and total scores of the scale were positively correlated with the scores of the Caring Ability Inventory（<0.01）. Conclusion： The structure of medical narrative ability of hospice care personnel formed in this study is reasonable and ti has good reliability and validity.It is suitable for the evaluation of medical narrative ability of hospice care personnel.

Objective： To explore the correlation between cognitive reserve and subjective cognitive decline. Methods： A total of 300 elderly people aged ≥60 in communities and hospitals in Hebei were selected by convenient sampling，and they were investigated by general data questionnaire， self⁃assessment form of subjective cognitive decline（SCD） and cognitive reserve parameter collection table. Results： Among the 300 elderly people，185（61.67%） had subjective cognitive decline.Multiple analysis showed that experienced negative life events in the past two years was a risk factor for SCD in the elderly， and participation in cognitive activities was a protective factor for SCD in the elderly.Cognitive reserve was correlated with cognitive decline（OR=0.984，<0.05）.Among the three sub⁃variables of cognitive reserve， length of full⁃time education， main occupation and cognitive activity，cognitive activity was correlated with SCD（OR=0.869，<0.05）. Conclusion： Experience negative life events is a risk factor for the elderly to have SCD. Participating in cognitive activities has a protective effect on SCD for the elderly. cognitive reserve has an independent protective effect on SCD for the elderly. Improving cognitive reserve for the elderly may delay the SCD process.

Objective： To understand the status quo and influencing factors of the oral health⁃related self⁃efficacy of older individuals in nursing institutions. Methods： A total of 407 elderly people aged 60 and above in 7 nursing institutions in Xingtai city were surveyed by the general data questionnaire，the Geriatric Self⁃Efficacy Scale for Oral Health，Geriatric Oral Health Assessment Index and Fried Frailty Phenotype. Results： The total score of the Geriatric Self⁃Efficacy Scale for Oral Health of the elderly in nursing institutions was （52.44±13.94）.The results of multiple linear regression showed that，pre⁃retirement occupational nature， oral denture condition，frailty，and geriatric oral health assessment index in the elderly entered into regression equation（<0.05），and they could explain 55.1% of the total variation. Conclusion： The oral health⁃related self⁃efficacy of older individuals in nursing institutions was at a medium level.Medical staff should take targeted measures such as oral health knowledge education and helping the elderly develop good hygiene habits to improve the level of oral health⁃related self⁃efficacy of the elderly.

Objective： To investigate the status quo of fatigue in patients with hematopoietic stem cell transplantation （HSCT） and analyze its influencing factors， so as to provide references for formulating targeted intervention measures for fatigue in patients with HSCT. Methods： 217 HSCT patients who were followed up in the inpatient department or outpatient department of 9 tertiary grade A hospitals in Beijing from September 2019 to March 2020 were investigated with Self⁃Designed General Data Questionnaire， Revised Piper Fatigue Scale， Hospital Anxiety and Depression Scale， International Physical Activity Questionnaire， Exercise Self⁃Efficacy Scale and Social Support Rating Scale. Results： Among 217 HSCT patients，131 patients （60.37%） had no fatigue， 27 patients （12.44%） had mild fatigue， 49 patients （22.58%） had moderate fatigue， and 10 patients （4.61%） had severe fatigue. Ordered Logistic regression analysis showed that anxiety， physical activity intensity， exercise self⁃efficacy and transplant times were the influencing factors of fatigue in HSCT patients （<0.05）. Conclusion： Although the fatigue of HSCT patients has been improved， it is still not optimistic. It is suggested that various measures should be implemented according to the influencing factors to reduce the fatigue level of patients and improve their quality of life.