Purpose:To examine variations in Chinese nurses’Actual Scope of Practice(ASCOP)by educational qualifications and professional titles,and to identify regulatory gaps in competency-based role assignments within China’...Purpose:To examine variations in Chinese nurses’Actual Scope of Practice(ASCOP)by educational qualifications and professional titles,and to identify regulatory gaps in competency-based role assignments within China’s evolving healthcare system.Method:A nationwide cross-sectional study using the validated Chinese Nurses’ASCOP Questionnaire is used.Data from 1,540 nurses were analyzed through descriptive statistics,independent t-tests,one-way ANOVA,and Bonferroni correction.ASCOP scores(1–5 scale)were compared across education levels(diploma,bachelor’s,postgraduate)and titles(junior/senior).Results:The overall ASCOP score was 3.95,with significant disparities in high-complexity tasks:postgraduate nurses(4.25)and senior nurses outperformed diploma holders(3.71)and juniors(p<0.01).Low-complexity tasks showed no educational differences(p>0.05),though bachelor’s or postgraduate nurses reported higher frequencies(4.12 vs.3.89).Alarmingly,37.6%of junior nurses routinely performed high-risk procedures beyond their competency.Conclusion:A systemic mismatch exists between nurses’qualifications and assigned responsibilities,reflecting inadequate regulatory oversight.To address this,this study recommends:(1)competency-based tiered authorization systems,(2)legal framework updates aligning with China’s healthcare reforms,and(3)dynamic monitoring mechanisms.These measures could standardize practice boundaries,mitigate occupational risks,and optimize nursing workforce utilization,particularly in resource-constrained settings.展开更多
The understanding of the scope of protection for the right to health should not be limited to fragmented descriptions in departmental laws,such as those focusing on rights,interests,or legal benefits.Instead,it should...The understanding of the scope of protection for the right to health should not be limited to fragmented descriptions in departmental laws,such as those focusing on rights,interests,or legal benefits.Instead,it should be analyzed holistically within the constitutional framework of fundamental rights.From the perspective of defense right function,the right to health addresses physiological harm that progresses through stages of“risk-danger-infringement,”psychological harm that targets inner distress,and minor harm arising from challenges in social adaptation,to clarify the negative defensive obligations of the state to prevent health-related harm.From the perspectives of the beneficiary right function and the objective value order function,the right to health requires a minimum level of constitutional protection and delineating the positive obligations of the state to ensure it through the fulfillment of basic obligations in healthcare and health promotion.展开更多
Objective:To review the current status of research on kinesiophobia,assessment tools,influencing factors,and intervention strategies in patients with chronic obstructive pulmonary disease,aiming to provide a reference...Objective:To review the current status of research on kinesiophobia,assessment tools,influencing factors,and intervention strategies in patients with chronic obstructive pulmonary disease,aiming to provide a reference for promoting pulmonary rehabilitation in these patients.Methods:A scoping review framework was employed to search databases including CNKI,Wanfang,VIP,China Biology Medicine(CBM),PubMed,Web of Science,and Wiley Online Library.The search time frame spanned from the database inception to May 20,2024.Two researchers independently screened the literature,summarized,and analyzed the data.Results:A total of 18 articles were included.Commonly used assessment tools included the Tampa Scale for kinesiophobia and the dyspnea beliefs questionnaire.Influencing factors encompassed demographic,disease-related,psychosocial,and BMI-related factors.Intervention methods included inspiratory muscle training,narrative nursing,and cognitive interventions combined with active cycle of breathing techniques.Conclusion:The incidence of kinesiophobia in COPD patients is relatively high and varies among individuals,influenced by multiple factors.There is a need to develop localized assessment tools to identify kinesiophobia in a timely and accurate manner and to further refine intervention strategies.展开更多
【目的】检验SCOPE(Soil Canopy Observation of Photosynthesis and Energy fluxes)模型用于模拟樟子松人工林的日光诱导叶绿素荧光(sun-induced chlorophyll fluorescence,SIF)和植被总初级生产力(gross primary productivity,GPP)动...【目的】检验SCOPE(Soil Canopy Observation of Photosynthesis and Energy fluxes)模型用于模拟樟子松人工林的日光诱导叶绿素荧光(sun-induced chlorophyll fluorescence,SIF)和植被总初级生产力(gross primary productivity,GPP)动态变化的可能性。【方法】对科尔沁沙地南缘樟子松人工林,基于样地SIF、GPP及气象协同观测数据,利用SCOPE模型模拟SIF与GPP的日变化与季节变化,评估了SCOPE模型在典型晴天、典型多云日、整个观测期的模拟效果。【结果】结果显示,利用气象观测数据及冠层参数(入射短波辐射、气温、大气实际水汽压、CO_(2)浓度及叶面积指数),可驱动SCOPE模型模拟樟子松人工林的SIF与GPP。典型晴天日与多云日的SIF模拟值和实测值的R^(2)分别为0.42与0.52,RMSE分别为0.19与0.18 W·m^(-2)·μm^(-1)·sr^(-1);GPP模拟值和观测值的R^(2)分别为0.78与0.89,RMSE分别为1.87与2.57μmol·m^(-2)·s^(-1)。在季节尺度上,SIF和GPP模拟值和观测值的R^(2)分别为0.50、0.72,RMSE分别为0.19 W·m^(-2)·μm^(-1)·sr^(-1)和2.64μmol·m^(-2)·s^(-1)。在整个观测期,多云日的SIF(R^(2)=0.31,RMSE=0.22 W·m^(-2)·μm^(-1)·sr^(-1))与GPP(R^(2)=0.80,RMSE=2.42μmol·m^(-2)·s^(-1))的模拟效果优于晴天日(SIF:R^(2)=0.30,RMSE=0.26 W·m^(-2)·μm^(-1)·sr^(-1),GPP:R^(2)=0.64,RMSE=3.64μmol·m^(-2)·s^(-1))。SIF模拟值总体高于观测值,当SIF强度较低时易对SIF高估,反之则易低估。GPP的模拟精度较高,模型对较低与较高GPP有所低估,对中间值有所高估。【结论】SCOPE模型可用于日尺度与季节尺度的SIF与GPP模拟,且多云日的模拟精度更高。SCOPE模型对樟子松人工林的GPP模拟结果优于SIF,推测SIF模拟精度较低的原因可能是模型对SIF的模拟是基于阔叶植物的辐射传输过程。未来应发展针对针叶植物的SIF辐射传输模型,为针叶林的辐射传输与荧光遥感监测提供模型基础。展开更多
Data is a key asset for digital platforms,and mergers and acquisitions(M&As)are an important way for platform enterprises to acquire it.The types of data obtained from intra-industry and cross-sector M&As diff...Data is a key asset for digital platforms,and mergers and acquisitions(M&As)are an important way for platform enterprises to acquire it.The types of data obtained from intra-industry and cross-sector M&As differ,as does the extent to which they interact within or between platforms.The impact of such data on corporate market performance is an important question to consider when selecting strategies for digital platform M&As.Based on our research on advertising-driven platforms,we developed a two-stage Hotelling game model for comparing the market performance effects of intra-industry M&As and cross-sector M&As for digital platforms.We carried out an empirical test using relevant data from advertising-driven digital platforms between 2009 and 2021,as well as a case study on Baidu’s M&A activities.Our research discovered that intra-industry M&As driven by“data economies of scale”and cross-sector M&As driven by“data economies of scope”are both beneficial to the market performance of platform enterprises.Intra-industry M&As have a more significant positive effect on the market performance of platform enterprises because the same types of data are easier to integrate and develop the“network effect of data scale”.From a data factor perspective,this paper reveals the inherent economic logic by which different types of M&As influence the market performance of digital platforms,as well as policymaking recommendations for all digital platforms to select M&A strategies based on data scale,data scope,and the network effect of data.展开更多
AIM： To compare dgid proctoscope and flexible endoscope for elastic band ligation of internal hemorrhoids. METHODS： Patients between 18 and 80 years old, with chronic complaints （blood loss, pain, itching or prola...AIM： To compare dgid proctoscope and flexible endoscope for elastic band ligation of internal hemorrhoids. METHODS： Patients between 18 and 80 years old, with chronic complaints （blood loss, pain, itching or prolapse） of internal hemorrhoids of grade 1-91, were randomized to elastic band ligation by rigid proctoscope or flexible endoscope （preloaded with 7 bands）. Patients were retreated every 6 wk until the cessation of complaints. Evaluation by three-dimensional anal endosonography was performed. RESULTS： Forty-one patients were included （median age 52.0, range 27-79 years, 20 men）. Nineteen patients were treated with a rigid proctoscope and twenty two with a flexible endoscope. Twenty-nine patients had grade I hemorrhoids, 9 patients had grade 11 hemorrhoids and 3 patients had grade 91 hemorrhoids. All patients needed a minimum of 1 treatment and a maximum of 3 treatments. A median of 4.0 bands was used in the rigid proctoscope group and a median of 6.0 bands was used in the flexible endoscope group （P 〈 0.05）. Pain after ligation tended to be more frequent in patients treated with the flexible endoscope （first treatment： 3 vs 20 patients, P 〈 0.05）. Three- dimensional endosonography showed no sphincter defects or alterations in submucosal thickness. CONCLUSION： Both techniques are easy to perform, well tolerated and have a good and fast effect. It is easier to perform more ligations with the flexible endoscope. Additional advantages of the flexible scope are the maneuverability and photographic documentation. However, treatment with the flexible endoscope might be more painful and is more expensive.展开更多
Advances in endoscopic and surgical techniques have increased the frequency and complexity of these procedures and associated complications such as gastrointestinal perforation. With the advancements in the field of g...Advances in endoscopic and surgical techniques have increased the frequency and complexity of these procedures and associated complications such as gastrointestinal perforation. With the advancements in the field of gastroenterology, the promising use of an over the scope clips(OTSC) has fulfilled the unmet need for a reliable endoscopic devise in approximation of gastrointestinal perforation. This novel approach has raised the level of confidence in endoscopist in dealing with this serious complication during endoscopy. Here we have shared our experience with OTSC to evaluate its efficacy and safety in managing iatrogenic gastrointestinal perforations during endoscopy.展开更多
Gastrointestinal (GI) defects such as fistulas and leaks can be potentially closed endoscopically using hemo-clips and loops. However, hemoclips may not allow for closure of large defects and they do not exert enough ...Gastrointestinal (GI) defects such as fistulas and leaks can be potentially closed endoscopically using hemo-clips and loops. However, hemoclips may not allow for closure of large defects and they do not exert enough tensile force to keep fibrotic defects larger than 5 mm approximated. Herein we present a case of successful endoscopic closure of a gastrocolic fistula in a severely malnourished patient with complex post-surgical upper GI anatomy. We strongly believe that this device is a major breakthrough for the management of various types of discontinuity defects or fistulas. In addition, we show the usefulness of placing a direct jejunostomy using the double balloon enteroscopy (DBE) technique during the same procedure. The concept of providing direct jejunal feedings while allowing for upper gas-trointestinal bowel rest to promote the healing of the minimally invasive endoscopic operation is novel. Thus, our case is unique and exemplifies the utility of mini-mally invasive endoscopic endoluminal surgery.展开更多
Percutaneous endoscopic gastrostomy(PEG) is a common practice for long-term nutrition of patients who are unable to take oral food. We report of an 85-year old man with a history of recurrent larynx carcinoma and hemi...Percutaneous endoscopic gastrostomy(PEG) is a common practice for long-term nutrition of patients who are unable to take oral food. We report of an 85-year old man with a history of recurrent larynx carcinoma and hemicolectomy many years ago due to unknown reason. Laryngectomy was indicated. Preoperatively a PEG was inserted endoscopically after an abdominal ultrasonography without abnormal findings. Few months after PEG insertion, the patient was evaluated for diarrhea and insufficient feeding without signs of infection or peritonism. An upper endoscopy and computed tomography scan confirmed a buried bumper syndrome with migration of the PEG tube into the colon as a rare complication. He underwent successful colonoscopic removal of the internal bumper and closure of the colonic orifice of the fistula with the over-the-scope-clip system(OTSC). OTSC is an endoscopic device for treatment of bleeding, perforation, leak and fistula in the gastrointestinal tract. To the best of our knowledge, this is the first report of the use of OTSC for colonoscopic closure of a gastrocolocutaneous fistula due to a buried bumper syndrome with transcolonic PEG tube migration.展开更多
基金Central Universities Basic Research Fund(Science,Engineering,and Medicine)of Jinan University:“Development of a Nursing Work Time Tracking System Based on the Fourth-Generation Nursing Workload Theory”(Project No.:21619326)。
文摘Purpose:To examine variations in Chinese nurses’Actual Scope of Practice(ASCOP)by educational qualifications and professional titles,and to identify regulatory gaps in competency-based role assignments within China’s evolving healthcare system.Method:A nationwide cross-sectional study using the validated Chinese Nurses’ASCOP Questionnaire is used.Data from 1,540 nurses were analyzed through descriptive statistics,independent t-tests,one-way ANOVA,and Bonferroni correction.ASCOP scores(1–5 scale)were compared across education levels(diploma,bachelor’s,postgraduate)and titles(junior/senior).Results:The overall ASCOP score was 3.95,with significant disparities in high-complexity tasks:postgraduate nurses(4.25)and senior nurses outperformed diploma holders(3.71)and juniors(p<0.01).Low-complexity tasks showed no educational differences(p>0.05),though bachelor’s or postgraduate nurses reported higher frequencies(4.12 vs.3.89).Alarmingly,37.6%of junior nurses routinely performed high-risk procedures beyond their competency.Conclusion:A systemic mismatch exists between nurses’qualifications and assigned responsibilities,reflecting inadequate regulatory oversight.To address this,this study recommends:(1)competency-based tiered authorization systems,(2)legal framework updates aligning with China’s healthcare reforms,and(3)dynamic monitoring mechanisms.These measures could standardize practice boundaries,mitigate occupational risks,and optimize nursing workforce utilization,particularly in resource-constrained settings.
文摘The understanding of the scope of protection for the right to health should not be limited to fragmented descriptions in departmental laws,such as those focusing on rights,interests,or legal benefits.Instead,it should be analyzed holistically within the constitutional framework of fundamental rights.From the perspective of defense right function,the right to health addresses physiological harm that progresses through stages of“risk-danger-infringement,”psychological harm that targets inner distress,and minor harm arising from challenges in social adaptation,to clarify the negative defensive obligations of the state to prevent health-related harm.From the perspectives of the beneficiary right function and the objective value order function,the right to health requires a minimum level of constitutional protection and delineating the positive obligations of the state to ensure it through the fulfillment of basic obligations in healthcare and health promotion.
文摘Objective:To review the current status of research on kinesiophobia,assessment tools,influencing factors,and intervention strategies in patients with chronic obstructive pulmonary disease,aiming to provide a reference for promoting pulmonary rehabilitation in these patients.Methods:A scoping review framework was employed to search databases including CNKI,Wanfang,VIP,China Biology Medicine(CBM),PubMed,Web of Science,and Wiley Online Library.The search time frame spanned from the database inception to May 20,2024.Two researchers independently screened the literature,summarized,and analyzed the data.Results:A total of 18 articles were included.Commonly used assessment tools included the Tampa Scale for kinesiophobia and the dyspnea beliefs questionnaire.Influencing factors encompassed demographic,disease-related,psychosocial,and BMI-related factors.Intervention methods included inspiratory muscle training,narrative nursing,and cognitive interventions combined with active cycle of breathing techniques.Conclusion:The incidence of kinesiophobia in COPD patients is relatively high and varies among individuals,influenced by multiple factors.There is a need to develop localized assessment tools to identify kinesiophobia in a timely and accurate manner and to further refine intervention strategies.
基金supported by the National Natural Science Foundation of China“Research on Cross-sector Competition Effect and Regulatory Policy of Digital Platforms Based on Inter-platform Network Externalities”(Grant No.72103085).
文摘Data is a key asset for digital platforms,and mergers and acquisitions(M&As)are an important way for platform enterprises to acquire it.The types of data obtained from intra-industry and cross-sector M&As differ,as does the extent to which they interact within or between platforms.The impact of such data on corporate market performance is an important question to consider when selecting strategies for digital platform M&As.Based on our research on advertising-driven platforms,we developed a two-stage Hotelling game model for comparing the market performance effects of intra-industry M&As and cross-sector M&As for digital platforms.We carried out an empirical test using relevant data from advertising-driven digital platforms between 2009 and 2021,as well as a case study on Baidu’s M&A activities.Our research discovered that intra-industry M&As driven by“data economies of scale”and cross-sector M&As driven by“data economies of scope”are both beneficial to the market performance of platform enterprises.Intra-industry M&As have a more significant positive effect on the market performance of platform enterprises because the same types of data are easier to integrate and develop the“network effect of data scale”.From a data factor perspective,this paper reveals the inherent economic logic by which different types of M&As influence the market performance of digital platforms,as well as policymaking recommendations for all digital platforms to select M&A strategies based on data scale,data scope,and the network effect of data.
文摘AIM： To compare dgid proctoscope and flexible endoscope for elastic band ligation of internal hemorrhoids. METHODS： Patients between 18 and 80 years old, with chronic complaints （blood loss, pain, itching or prolapse） of internal hemorrhoids of grade 1-91, were randomized to elastic band ligation by rigid proctoscope or flexible endoscope （preloaded with 7 bands）. Patients were retreated every 6 wk until the cessation of complaints. Evaluation by three-dimensional anal endosonography was performed. RESULTS： Forty-one patients were included （median age 52.0, range 27-79 years, 20 men）. Nineteen patients were treated with a rigid proctoscope and twenty two with a flexible endoscope. Twenty-nine patients had grade I hemorrhoids, 9 patients had grade 11 hemorrhoids and 3 patients had grade 91 hemorrhoids. All patients needed a minimum of 1 treatment and a maximum of 3 treatments. A median of 4.0 bands was used in the rigid proctoscope group and a median of 6.0 bands was used in the flexible endoscope group （P 〈 0.05）. Pain after ligation tended to be more frequent in patients treated with the flexible endoscope （first treatment： 3 vs 20 patients, P 〈 0.05）. Three- dimensional endosonography showed no sphincter defects or alterations in submucosal thickness. CONCLUSION： Both techniques are easy to perform, well tolerated and have a good and fast effect. It is easier to perform more ligations with the flexible endoscope. Additional advantages of the flexible scope are the maneuverability and photographic documentation. However, treatment with the flexible endoscope might be more painful and is more expensive.
文摘Advances in endoscopic and surgical techniques have increased the frequency and complexity of these procedures and associated complications such as gastrointestinal perforation. With the advancements in the field of gastroenterology, the promising use of an over the scope clips(OTSC) has fulfilled the unmet need for a reliable endoscopic devise in approximation of gastrointestinal perforation. This novel approach has raised the level of confidence in endoscopist in dealing with this serious complication during endoscopy. Here we have shared our experience with OTSC to evaluate its efficacy and safety in managing iatrogenic gastrointestinal perforations during endoscopy.
文摘Gastrointestinal (GI) defects such as fistulas and leaks can be potentially closed endoscopically using hemo-clips and loops. However, hemoclips may not allow for closure of large defects and they do not exert enough tensile force to keep fibrotic defects larger than 5 mm approximated. Herein we present a case of successful endoscopic closure of a gastrocolic fistula in a severely malnourished patient with complex post-surgical upper GI anatomy. We strongly believe that this device is a major breakthrough for the management of various types of discontinuity defects or fistulas. In addition, we show the usefulness of placing a direct jejunostomy using the double balloon enteroscopy (DBE) technique during the same procedure. The concept of providing direct jejunal feedings while allowing for upper gas-trointestinal bowel rest to promote the healing of the minimally invasive endoscopic operation is novel. Thus, our case is unique and exemplifies the utility of mini-mally invasive endoscopic endoluminal surgery.
文摘Percutaneous endoscopic gastrostomy(PEG) is a common practice for long-term nutrition of patients who are unable to take oral food. We report of an 85-year old man with a history of recurrent larynx carcinoma and hemicolectomy many years ago due to unknown reason. Laryngectomy was indicated. Preoperatively a PEG was inserted endoscopically after an abdominal ultrasonography without abnormal findings. Few months after PEG insertion, the patient was evaluated for diarrhea and insufficient feeding without signs of infection or peritonism. An upper endoscopy and computed tomography scan confirmed a buried bumper syndrome with migration of the PEG tube into the colon as a rare complication. He underwent successful colonoscopic removal of the internal bumper and closure of the colonic orifice of the fistula with the over-the-scope-clip system(OTSC). OTSC is an endoscopic device for treatment of bleeding, perforation, leak and fistula in the gastrointestinal tract. To the best of our knowledge, this is the first report of the use of OTSC for colonoscopic closure of a gastrocolocutaneous fistula due to a buried bumper syndrome with transcolonic PEG tube migration.
