Is Nationwide Special Campaign on Antibiotic Stewardship Program Effective on Ameliorating Irrational Antibiotic Use in China? Study on the Antibiotic Use of Specialized Hospitals in China in 2011–2012

Summary： With dwindling number of new antibiotics and inappropriate use of antibiotics, the emergence and spread of antibiotics resistance occurs commonly in healthcare institutions worldwide. In China, antibiotics are commonly overprescribed and misused. This study is to assess the effect of the nationwide special campaign on antibiotic stewardship program （ASP） at specialized hospitals in China by investigating prescription information from 2011 to 2012. Data on the hospital consumption and prescription of systemic antibiotics were obtained from four specialized hospitals, including maternity, children＇s, stomatological and cancer hospitals. Systematic random sampling was used to select outpatient prescriptions and inpatient cases. A total of 105 specialized hospitals in 2011 and 121 specialized hospitals in 2012 were analysed. The defined daily doses （DDDs） per 100 inpatient days, the percentage of antibiotic use in outpatient prescriptions, and the percentage of antibiotic use in inpatient eases were used as measurements of antibiotic use. The overall antibiotic use density in the selected hospitals decreased between 2011 and 2012 from 39.37 to 26.54 DDD/100 inpatient days （P〈0.001）. The percentage of antibiotic use in outpatient prescriptions （range： 24.12%-18.71%, P=0.109） and inpatient cases （64.85%-60.10%, P=-0.006） also decreased within the two years. Significant changes were observed among regions and different hospitals within the two years. And antibiotic consumption was correlated with the type and size of specialized hospital in 2012, but not with the regions. This analysis of antibiotic consumption of specialized hospitals allows relevant comparisons for benchmarking and shows that national ASP has improved antibiotic rational use in China. The data will assist policymakers in formulating effective strategies to decrease antibiotic overuse and identify areas that require further work.

AGGREGATE SPECIAL FUNCTIONS TO APPROXIMATE PERMUTING TRI-HOMOMORPHISMS AND PERMUTING TRI-DERIVATIONS ASSOCIATED WITH A TRI-ADDITIVEψ-FUNCTIONAL INEQUALITY IN BANACH ALGEBRAS

In this paper,we define a new class of control functions through aggregate special functions.These class of control functions help us to stabilize and approximate a tri-additiveψ-functional inequality to get a better estimation for permuting tri-homomorphisms and permuting tri-derivations in unital C*-algebras and Banach algebras by the vector-valued alternative fixed point theorem.

Theoretical Analysis and Practical Reflection on the Role Conflict of Double-Qualified Teachers in University-Affiliated Hospitals

Taking role conflict as the starting point,this article examines and reflects on the development of clinical teachers.In the process of the occurrence,development,and resolution of role conflicts among clinical teachers,there are many hidden issues related to the development of clinical teachers.The development of clinical teacher teaching and role conflict management contain similar educational philosophies and practical issues.This study draws on classic theories and research achievements in the development of university teachers and conducts theoretical analysis and practical reflection on the development of clinical teachers in medical colleges from the perspective of role conflict in social psychology.Policy recommendations are proposed,including strengthening the construction of teaching systems at the hospital organizational environment level,enhancing the role identity and teacher beliefs of clinical teachers,promoting their teaching development and academic learning,and ensuring their normal teaching investment;promoting leadership support at the level of interpersonal interaction and leveraging the role of colleague support in alleviating role conflicts;enhancing individual teacher beliefs,teacher role learning,and role skills.

Exploration of Teaching Development Strategies for Double-Qualified Teachers in University- Affiliated Hospitals Based on Role Conflict Theory

This study draws on the classic theories and research achievements of university teacher development,and from the perspective of role conflict in social psychology,proposes policy recommendations for the development of clinical teachers in medical colleges,including following different stages of teacher development and designing teaching development strategies at different levels;designing the content and form of teaching development activities to meet the temporal and spatial needs of clinical teachers;and building an academic community for clinical teachers to promote the creation of teaching development behaviors.

Study on the Changes of Medical Income Structure in Governmentrun Hospitals of Traditional Chinese Medicine from 2012 to 2021

Objective To study the changing characteristics and trend of medical income structure in the government-run hospitals of traditional Chinese medicine(TCM),evaluate the effects of relevant reform measures,and to put forward corresponding suggestions for further optimizing their income structure.Methods The data related to the average medical income of government-run hospitals of TCM from 2012 to 2021 were sorted out.Then,descriptive analysis method was used to analyze the changes of related indicators.Besides,structural change method was applied to investigate the changes of outpatient income and inpatient income.Results and Conclusion From 2012 to 2021,the growth of medical income in government-run hospitals of TCM tended to be stable,and the proportion of medical service income increased from 22.62%(2012)to 29.38%(2021),but the average annual growth rate was only 0.68%.The main items that caused the change of outpatient income structure were medicine revenue,laboratory tests,diagnosis and treatment,and the cumulative contribution rate was 89.15%.The main items that caused the change of inpatient income structure were medicine revenue,sanitary materials,and auxiliary examinations income,with a cumulative contribution rate of 80.04%.However,the contribution rate of registration,diagnosis,treatment,surgery and nursing income reflecting the value of medical personnel’s technical labor was relatively small.The medical income structure of government-run hospitals of TCM underwent great changes and gradually became reasonable,but the medical service income increased slowly,and not all indicators achieved the expectations.To promote the sustainable development of public hospitals of TCM and enable them to provide high-quality and efficient TCM medical and health services,it is necessary to further improve the relevant policy mechanism.

Attributes of Specialized Households'Resilience and Its Impact on Rural Industrial Advancement:A Case Study of National Musical Instrument Production Specialized Households in Lankao County,Henan,China

Specialized households serve as the primary units within specialized villages in China,and their capacity to withstand risks and external influences significantly shapes the future trajectory of specialized villages and the overall vitality of the rural economy.In this study,we established a measurement indicator system based on the definition of specialized households’resilience,elucidating the logical connection between specialized households’resilience and rural industrial development in China.The musical instrument industry in Lankao County,Henan Province of China,was employed as a case;survey data,the entropy method,and an obstacle diagnosis model were used to examine how instrument production specialized households responded to the challenges posed by Corona Virus Disease 2019(COVID-19)and the tightening of national environmental protection policies,yielding the following key findings:1)there exists substantial variation in the comprehensive resilience levels among different specialized households;2)the ability to learn and adapt is the most significant contributor to the overall resilience level of specialized households;3)technological proficiency and access to skilled talent emerge as pivotal factors influencing specialized households’resilience;4)the positioning of specialized households within the industrial supply chain and the stability of their income have a direct bearing on their resilience level.The influence of specialized households’resilience on industrial development primarily manifests in the following ways:stronger resilience correlates with increased stability in production and sales,fostering a more proactive approach to future actions.However,heightened exposure to the external macroeconomic environment can lead to a higher rate of export reduction.To enhance the development resilience of entities like specialized households and family farms,and to invigorate rural economic development,escalating investments in rural science and technology and prioritizing the training of technical talent become imperative.

The Oral Health Status of Person with Special Needs in Kumasi

Background: The most prevalent non-communicable disease worldwide is oral health-related disease, with dental caries and periodontal conditions being common. Oral health status significantly impacts overall health and quality of life. Barriers to dental care affect children with special needs. This study evaluates the oral health status and treatment requirements of people with special needs. Methodology: This descriptive cross-sectional study in Kumasi, Ghana examined oral health status among people, 121 children with special needs over two months, in June-July 2022. Dental caries, periodontal changes, malocclusion, and trauma were assessed. The data was analyzed using SPSS 20.0. Results: The oral health status among people with special needs in this study was generally moderate, with a range from very good to very poor. The prevalence of dental caries was 37%, with a mean DMFT score of 2.82. Periodontal health showed unsatisfactory indicators such as mobile teeth, poor gingival health, high plaque scores, and the presence of halitosis. Conclusion: This descriptive study aimed to provide baseline data on the oral health status of special needs students in Kumasi, addressing the lack of knowledge in this area. It highlighted the importance of dental care in maintaining good oral health and overall well-being in individuals with special needs. Coordinated efforts by dental professionals are needed to provide dental health education and preventive interventions for these children.

Nondestructive and active interrogation system for special nuclear material:proof of principle and initial results

Herein,we employ the threshold energy neutron analysis(TENA)technique to introduce the world's first active interrogation system to detect special nuclear materials(SNMs),including U-235 and Pu-239.The system utilizes a DD neutron generator based on inertial electrostatic confinement(IEC)to interrogate suspicious objects.To detect secondary neutrons produced during fission reactions induced in SNMs,a tensioned metastable fluid detector(TMFD)is employed.The current status of the system's development is reported in this paper,accompanied by the results from experiments conducted to detect 10 g of highly enriched uranium(HEU).Notably,the experimental findings demonstrate a distinct difference in the count rates of measurements with and without HEU.This difference in count rates surpasses two times the standard deviation,indicating a confidence level of more than 96% for identifying the presence of HEU.The paper presents and extensively discusses the proof-of-principle experimental results,along with the system's planned trajectory.

Predictors of Fatal Outcome in Hospitalised Adult Patients with Acute Kidney Injury at Two Tertiary Hospitals in Sub-Saharan Africa

Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.

Empowering Rice Farmers in Nueva Ecija, Philippines: A Strategic Approach to Boosting Income through Special Purpose Rice Production

Low income is the main problem of millions of farmers who are cultivating 4.81 million hectares in the Philippines. This problem is attributed to challenges specifically low yield, low quality of produce, and significant post-harvest losses, particularly in a resource-scarce setting. This study aimed to help increase the farmers’ income in selected towns of Nueva Ecija through the promotion and use of special purpose rice production technology. Twenty (20) farmer-cooperators in three towns of Nueva Ecija were selected to demonstrate the production technology covering a total area of 4.75 hectares during the dry season, and 3.3 hectares during the wet season, both in 2023. Extension modalities such as training, techno-demo establishment, information material and technical assistance provision, and market linkage were undertaken to enhance their knowledge, attitude, and skills on special rice production and enterprise. The study utilized the descriptive quantitative method wherein the data were gathered through surveys, specifically personal interviews. Results showed that 70% of the farmer-cooperators were male and 60% were living below the poverty threshold. The farmers were 53 years old on average and engaged in farming as their primary source of income. The average yield of special purpose rice particularly the CLS-2 variety was higher (6.46 MT/ha and 6.22 MT/ha during dry and wet seasons, respectively) than that of inbred or non-special rice. The income per hectare from special purpose rice production per hectare was Php 75,420.00, which is higher than that of regular rice at Php 29,389.00, giving a higher benefit of Php 46,031.00. The technology adopters and area planted increased (from 6 to 9 and from 1.4 hectares to 2.75 hectares, respectively) in Licab, Nueva Ecija. The opposite was true in Sto. Domingo and Guimba, Nueva Ecija where farmers were discouraged by the marketing issues that arose.

Effect of special types of bread with select herbal components on postprandial glucose levels in diabetic patients

BACKGROUND Nutrition recommendations in patients with type 2 diabetes mellitus(T2DM)are to consume rye or integral bread instead of white bread.A positive effect on glucoregulation has been achieved by enriching food with various biologically active substances of herbal origin,so we formulated an herbal mixture that can be used as a supplement for a special type of bread(STB)to achieve better effects on postprandial glucose and insulin levels in patients with T2DM.AIM To compare organoleptic characteristics and effects of two types of bread on postprandial glucose and insulin levels in T2DM patients.METHODS This trial included 97 patients with T2DM.A parallel group of 16 healthy subjects was also investigated.All participants were given 50 g of rye bread and the same amount of a STB with an herbal mixture on 2 consecutive days.Postprandial blood glucose and insulin levels were compared at the 30^(th),60^(th),90^(th) and 120th min.A questionnaire was used for subjective estimation of the organoleptic and satiety features of the two types of bread.RESULTS Compared to patients who consumed rye bread,significantly lower postprandial blood glucose and insulin concentrations were found in T2DM patients who consumed STB.No relevant differences were found among the healthy subjects.Subjectively estimated organoleptic and satiety characteristics are better for STB than for rye bread.CONCLUSION STB have better effects than rye bread on postprandial glucoregulation in T2DM patients.Subjectively estimated organoleptic and satiety characteristics are better for STB than for rye bread.Therefore,STB can be recommended for nutrition in T2DM patients.

Impact of specialized nursing outpatient case management on postcoronary artery bypass grafting patients

BACKGROUND Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events(MACE)and require readmission after Coronary Artery Bypass Grafting(CABG)surgery.This is often attributed to patients'unhealthy lifestyles and dietary habits,inadequate understanding of the disease,and poor disease management compliance.Thus,searching for more targeted nursing intervention models that can enhance patients'self-management abilities and reduce the risk of readmission after CABG surgery is significant.AIM To observe the impact of specialized nursing outpatient case management on patients after CABG surgery.METHODS A total of 103 patients who underwent CABG surgery in our hospital between April 2021 and April 2022 comprised the study sample.The patients were divided into two groups using an odd-even number grouping method.The control group received routine nursing care,while the case management group received specialized nursing outpatient case management.The differences in psychological status,adherence to medical treatment,self-care ability,knowledge mastery,quality of life scores,and the occurrence rate of MACE were compared between the two groups.RESULTS After the intervention,the case management group had lower scores on the selfrating depression scale and self-rating anxiety scale and lower MACE rate,as well as higher scores for adherence to a healthy diet,medication adherence,good lifestyle habits,regular exercise,and timely follow-up,higher scores on the Coronary Heart Disease Self-Management Scale,higher scores for managing adverse habits,symptoms,emotional cognition,emergency response,disease knowledge,general lifestyle,and treatment adherence,higher scores for understanding coronary heart disease,recognizing the importance of medication adherence,understanding selfcare points after CABG surgery,and being aware of post-CABG precautions,higher scores for physical well-being,disease condition,general health,social-psychological well-being,and work-related aspects(P<0.05).CONCLUSION Specialized nursing outpatient case management can enhance patient adherence to medical treatment,knowledge mastery,psychological well-being,and overall quality of life in patients after CABG surgery.

Hyperprolactinemia in Hospitals in Lomé: Diagnostic and Therapeutic Aspects

Introduction. Hyperprolactinemia represents a supraphysiological secretion of prolactin. In clinical practice, it is the most frequently encountered anterior pituitary disorder. However, its real prevalence is little known in Africa. The purpose of this study is to list all cases of hyperprolactinemia over the past four years and to make an inventory of the various etiologies found and their management. Methodology. This is a cross-sectional descriptive study on the files of patients who came for consultation in the internal medicine and endocrinology department with hyperprolactinemia retrospectively collected from January 2017 to December 2020. Included were patients followed or whose the diagnosis of hyperprolactinemia was established in endocrinological consultation during the study period. Results. This study recorded 26 cases of hyperprolactinemia. The female sex represented 73.08% (sex ratio M/F 0.37) and the average age was 33.92 years. The 40 - 50 age group was the most represented with 30.77%. In women, galactorrhea accounted for 73.07%, amenorrhea 57.69% of clinical pictures and infertility 23.08%. In men, infertility accounted for 7.69% of presentations, gynecomastia 11.54% and erectile dysfunction 15.38%. The duration of evolution of the signs was 4 months in 23.08% of the patients. The mean prolactinemia was 702.58 ng/ml. CT was performed in 80.85% of patients. The main etiologies were pituitary adenomas (77%). All our patients were treated with dopaminergic agonists. Cabergoline was prescribed in 77% of patients. The evolution was favorable in 96.25% of patients. Conclusion. Hyperprolactinemia is a pathology that exists in our regions. The main etiology remains pituitary adenomas and treatment with cabergoline.

Research on Disciplines in China’s Local Universities from the Perspective of Special Zones

China's local colleges and universities are the main force of China's higher education.Due to the limited construction funds,weak discipline foundation and other reasons,China's local colleges and universities generally face the embarrassment of weak discipline.How to break the constraints of the traditional management system,concentrate and efficiently allocate limited resources to achieve the overall improvement of the discipline construction level,the successful experience of China's special economic zones provides model reference and construction guidance for Chinese local universities.This study takes the subject special zones of local universities in China as the research object,chooses the theoretical system of economics and institutional theory as the logical starting point of the research,constructs the research framework of three dimensions of idea value,system design and action strategy,takes the reform of special economic zones as the institutional model and practice reference,and carries out the research from five dimensions of reform subject,logic,path,idea and strategy.Explore the effective development path of the rise of discipline construction.

Motion and Special Relativity in Complex Spaces

A natural extension of the Lorentz transformation to its complex version was constructed together with a parallel extension of the Minkowski M4 model for special relativity (SR) to complex C4 space-time. As the [signed] absolute values of complex coordinates of the underlying motion’s characterization in C4 one obtains a Newtonian-like type of motion whereas as the real parts of the complex motion’s description and of the complex Lorentz transformation, all the SR theory as modeled by M4 real space-time can be recovered. This means all the SR theory is preserved in the real subspace M4 of the space-time C4 while becoming simpler and clearer in the new complex model’s framework. Since velocities in the complex model can be determined geometrically, with no primary use of time, time turns out to be definable within the equivalent theory of the reduced complex C4 model to the C3 “para-space” model. That procedure allows us to separate time from the (para)space and consider all the SR theory as a theory of C3 alone. On the other hand, the complex time defined within the C3 theory is interpreted and modeled by the single separate C1 complex plane. The possibility for application of the C3 model to quantum mechanics is suggested. As such, the model C3 seems to have unifying abilities for application to different physical theories.

Design a Special Fixture for Tractor Lever

Aiming at the problems of long time and poor machining precision in processing the tractor lever workpiece,a special fixture suitable for the tractor lever workpiece is designed by analyzing the processing technology of the lever workpiece,and the workpiece is accurately positioned and tightened under the action of the special fixture.Efficient machining of the workpiece can be achieved by using a drill template.The fixture not only has the advantages of high production efficiency,low cost and high life,but also effectively improves the processing technology of the workpiece,and has certain reference value for the subsequent fixture improvement design.

Application of Specialized Group Management in the Quality Control of Perioperative Nursing

Objective:To explore the role of specialized group management in the quality control of perioperative nursing.Methods:45 surgical nurses from our hospital were selected as the research subjects.Traditional operating room management was adopted from July 2019 to June 2020,and specialized group management was adopted from July 2020 to June 2021.The surgeon’s satisfaction,surgical nurses’core professional competence,and surgical patients’satisfaction were obtained through surveys and the results were analyzed.Results:Surgeon satisfaction before the implementation of specialized group management was significantly lower than after its implementation(P<0.05).Besides,surgical nurses’core professional competency scores before the implementation of specialized group management were significantly lower than after its implementation(P<0.05).Lastly,surgical patients’satisfaction before the implementation of specialized group management was significantly lower than after its implementation(P<0.05).Conclusion:Specialized group management helps to improve the quality of perioperative care and should be applied in clinical practice.

Research misconduct in hospitals is spreading:A bibliometric analysis of retracted papers from Chinese university-affiliated hospitals

Purpose: The number of retracted papers from Chinese university-affiliated hospitals is increasing, which has raised much concern. The aim of this study is to analyze the retracted papers from university-affiliated hospitals in China’s mainland from 2000 to 2021. Design/methodology/approach: Data for 1,031 retracted papers were identified from the Web of Science Core collection database. The information of the hospitals involved was obtained from their official websites. We analyzed the chronological changes, journal distribution, discipline distribution and retraction reasons for the retracted papers. The grade and geographic locations of the hospitals involved were explored as well.Findings: We found a rapid increase in the number of retracted papers, while the retraction time interval is decreasing. The main reasons for retraction are plagiarism/self-plagiarism(n=255), invalid data/images/conclusions(n=212), fake peer review(n=175) and honesty error(n=163). The disciplines are mainly distributed in oncology(n=320), pharmacology & pharmacy(n=198) and research & experimental medicine(n=166). About 43.8% of the retracted papers were from hospitals affiliated with prestigious universities. Research limitations: This study fails to differentiate between retractions due to honest error and retractions due to research misconduct. We believe that there is a fundamental difference between honest error retractions and misconduct retractions. Another limitation is that authors of the retracted papers have not been analyzed in this study.Practical implications: This study provides a reference for addressing research misconduct in Chinese university-affiliated hospitals. It is our recommendation that universities and hospitals should educate all their staff about the basic norms of research integrity, punish authors of scientific misconduct retracted papers, and reform the unreasonable evaluation system.Originality/value: Based on the analysis of retracted papers, this study further analyzes the characteristics of institutions of retracted papers, which may deepen the research on retracted papers and provide a new perspective to understand the retraction phenomenon.

Hospital Stakeholders’ Perception on Environmental Effects Related to Biomedical Waste in Togo’s University Hospitals (UHC) in 2021

Introduction: Given its effects, hospital waste is an environmental concern and a threat to health personnel, users of health services and neighboring populations. Our objective was to assess the perception of health care stakeholders on the environmental effects related to biomedical waste produced in Teaching Hospitals (CHU) in Togo in 2021. Methods: This was a cross-sectional study held from June 24 to August 28, 2021. It targeted three university hospitals, 340 health care providers and services selected by a probabilistic method with a simple random technique in 25 services, 72 directors, deputy directors, supervisors and heads of services, 27 collection and incineration agents selected by a non-probabilistic method with a reasoned choice technique, 44 patients and attendants and 36 householders of neighboring residents selected by a non-probabilistic method with an accidental choice technique. Variables such as the spreading of disease vectors, soil, air and water contamination, the presence of unpleasant odors and unsightly living conditions were assessed. Results: According to the respondents, biomedical waste causes the proliferation of vectors (55.3%), an unsightly environment inside the hospital (47.1%), and unpleasant odors (61.2%). Incineration operations disturb hospital residents (52.8%), according to the householders of the residents. During observation, we note deposits of waste that have not been destroyed and wastewater flowing in some places. Conclusion: Biomedical waste in Togo’s university hospitals generates environmental effects and therefore potentially high risks for human health. Improving their management should be a concern for all hospital actors.

The Hesitance of Nurses to Apply for Midwifery Specialization: Explorative Qualitative Study

Background: Many countries across the world are facing an ongoing shortage of midwife practitioners due to several reasons such as increased workload, working overtime, poor-quality midwifery care, low staff morale, stress and burnout, lack of opportunity for training, lack of management support, financial issues and lack of recognition and compromised autonomy. Purpose: To explore the reasons behind nurses’ hesitance to apply for midwifery specialization. The objectives of this study were to understand the challenges that lie in front of Omani nurses and the motivational factors to apply for a midwifery programme. Method: Exploratory qualitative study was conducted at the largest tertiary hospital in Oman. Purposive sampling was applied for participant recruitment. Face-to-face interviews and focus group discussions were used as data collection methods. The study included general nurses, nurses in charge working in the maternity unit as well as nurses whose applications were accepted for midwifery education. Qualified midwives were excluded. The data collection process yielded twenty-five nurses. The interview protocol highlighted the impact and perception of the midwifery specialization on nurses’ careers. Thematic analysis was employed for data analysis. Results: Three over-arching major themes were identified. These are 1) nurses’ perceptions about the nature of work in maternity wards, the nurses have positive perception toward working in maternity wards and labor room because of working exclusively with female patients and their babies 2) factors influencing the decision to study midwifery specialization, work overload, stress, lack of support from administration were the most common reason behind the nurses not to apply for midwifery specialization and 3) support and recommendations required for midwives, the nurses mentioned that their identity, promotions and support from the administration will encourage them to apply for midwifery specialization. Conclusion: One of the main reasons that hindered nurses from applying to midwifery specialization is the false belief that midwives cannot work outside the delivery suite (DS). The second reason was the stress that midwives encounter at DS, and this was perceived by general nurses who did not work at DS. These challenges could be mitigated by leadership support, midwifery profession identity, as well as financial recognition for the midwives.