OBJECTIVE:To develop Clinical practice s of Traditional Chinese Medicine(TCM) for acute upper respiratory tract infection(AURI) in children;TCM is usedalone or administered together with antibiotics.METHODS:Under the ...OBJECTIVE:To develop Clinical practice s of Traditional Chinese Medicine(TCM) for acute upper respiratory tract infection(AURI) in children;TCM is usedalone or administered together with antibiotics.METHODS:Under the guidance of evidence-based medicine concept,in strict accordance with the rules of international s development,as well as on the basis of evidence of clinical research of TCM,the s solicited opinions from clinical experts and methodologists in TCM and Western Medicine.GRADE standard was applied to form experts' consensus.RESULTS:The s standardized classification of TCM patterns and TCM treatments in children with AURI,including prescription,Chinese patent medicine,non-drug treatment and prevention.CONCLUSION:Follows the principle of "evidence based,consensus supplemented,and experience referred",these s were formulated,but the quality of evidence of included studies were relatively low.Further refinement of the s should be needed as deeper clinical studies as available in future.展开更多
AIM:To investigate the practice patterns of optometrists in Saudi Arabia regarding myopia management.METHODS:An internet-based survey was distributed to all practicing optometrists in Saudi Arabia(n=1886).The survey c...AIM:To investigate the practice patterns of optometrists in Saudi Arabia regarding myopia management.METHODS:An internet-based survey was distributed to all practicing optometrists in Saudi Arabia(n=1886).The survey contained questions related to 1)demographics,2)knowledge about myopia and its associated complications,3)current clinical care,4)type and frequency of myopia treatment prescribed,and 5)potential barriers limiting treatment adoption.RESULTS:The completed surveys were collected from 171 optometrists(9.06%response rate,60%male).Knowledge regarding myopia-associated complications was prevalent but somewhat inaccurate among the respondents.Cycloplegic refraction at initial visit was used by 59%of the respondents.The cover test was the most reported binocular vision test(83%),and 38%of optometrists did not perform any ocular biometrics.Twothirds prescribed single-vision spectacles for children with myopia.Increased time spent outdoors was selected by 80%of the practitioners who prescribed myopia control treatment as the primary approach.Insufficient support and lack of clinical experience in providing myopia treatment were reported as the most important factors limiting the adoption of myopia management strategies.CONCLUSION:The current optometric practices in Saudi Arabia require further investigation.Optometrists appear to be somewhat aware of myopia and the associated risks.However,most evidence-based myopia treatments are not being locally adopted,primarily because of lack of support,lack of experience,and limited availability.展开更多
BACKGROUND Good clinical practice(GCP)is put in place to protect human participants in clinical trials as well as to ensure the quality of research.Non-adherence to these guidelines can produce research that may not m...BACKGROUND Good clinical practice(GCP)is put in place to protect human participants in clinical trials as well as to ensure the quality of research.Non-adherence to these guidelines can produce research that may not meet the standards set by the scientific community.Therefore,it must be ensured that researchers are wellversed in the GCP.But not much is known about the knowledge and practices of the GCP in the medical colleges of North India.AIM To assess the knowledge and practices of researchers about GCP and analyze these with respect to the demographics of participants.METHODS This is a cross-sectional study.A self-structured questionnaire about GCP,after expert validations,was circulated among researchers,at a tertiary healthcare institute,All India Institute of Medical Sciences(AIIMS),Rishikesh.A total of 59 individuals,who were selected by universal sampling,participated in the study.All healthcare workers who have been investigators of Institutional Ethics Committee-approved research projects,except residents and faculty,and are still a part of the institute have been included in the study.The study was approved by the Institutional Ethics Committee of AIIMS,Rishikesh.We used descriptive analysis and the Chi-squared test to analyze data.P value<0.05 was considered significant.RESULTS Out of 59 participants,only 11(18.6%)were certified for GCP.Most of the participants(64.4%)had“Average”knowledge,33.9%had“Good”knowledge and 1.7%had“Poor”knowledge.Only 49%of participants had satisfactory practices related to GCP.There was a significant difference in the knowledge based on the current academic position for the items assessing knowledge of institutional review board(P=0.010),confidentiality&privacy(P=0.011),and participant safety&adverse events(P<0.001).There was also a significant difference in knowledge of research misconduct(P=0.024)and participant safety&adverse events(P=0.011)based on certification of GCP.There was a notable difference in the practices related to recruitment&retention on the basis of current academic position(P<0.001)and certification of GCP(P=0.023).We also observed a considerable difference between the knowledge and practices of GCP among the participants(P=0.013).CONCLUSION Participants have basic knowledge of GCP but show a lack thereof in certain domains of GCP.This can be addressed by holding training sessions focusing on these particular domains.展开更多
The article"Secondary diabetes due to different etiologies:Four case reports"by Song et al,published in the World Journal of Clinical Cases,delves into the identi-fication of rare causes of secondary diabete...The article"Secondary diabetes due to different etiologies:Four case reports"by Song et al,published in the World Journal of Clinical Cases,delves into the identi-fication of rare causes of secondary diabetes and emphasizes the necessity for healthcare professionals to recognize these conditions.Failure to do so can result in treatment delays and compromised patient outcomes.The article discusses spe-cific types of diabetes,including maturity onset of diabetes in young,pancreas-related diseases,endocrinopathies,drug-induced diabetes,infections,and con-genital genetic syndromes associated with diabetes mellitus.Case summaries highlight how patients with secondary diabetes,stemming from conditions such as Williams-Beuren syndrome and pituitary adenoma,often exhibit distinct characteristics overlooked in clinical practice.The authors stress the importance of a holistic diagnostic approach and advocate for proactive management through early intervention,including genetic tests and antibody detection.Increased awa-reness and education are crucial for timely identification and proper management,ultimately improving patient well-being.These findings prompt a call to action for healthcare professionals to consider rare causes of secondary diabetes,facili-tating better glycemic control and overall patient care.展开更多
Objectives:This study employed evidence mapping to systematically evaluate clinical practice guidelines(CPGs)for neurogenic bladder(NB)care.We aimed to identify research trends,evidence gaps,and consensus patterns to ...Objectives:This study employed evidence mapping to systematically evaluate clinical practice guidelines(CPGs)for neurogenic bladder(NB)care.We aimed to identify research trends,evidence gaps,and consensus patterns to inform evidence-based nursing practices and support the formulation of highquality CPGs.Methods:A systematic search of electronic databases and guideline repositories was conducted,included PubMed,Web of Science,Embase,Guidelines International Network(GIN),ect.Eligible NB guidelines underwent dual-researcher screening and extraction,and methodological and recommendation quality were assessed using the Appraisal of Guidelines for Research and Evaluation II(AGREE II)and Evaluation-Recommendations Excellence(AGREE-REX)instruments.Five researchers independently evaluated recommendation specificity,evidence grading systems,and implementation consistency.Discrepancies were resolved through consensus discussion or third-party arbitration.Results:Analysis of 19 CPGs(2006–2023)from 11 countries/regions revealed that 78.95%(15/19)incorporated evidence grading systems and 68.42%(13/19)specifiedrecommendation strength.The AGREE II evaluation identifiedcritical methodological deficiencies,with three domains scoring below the acceptable thresholds:Rigor of Development(41.70%),Editorial Independence(43.30%),and Applicability(30.00%).The AGREE-REX results showed moderate performance in Clinical Applicability(55.56%)and implantability(41.67%)but severe gaps in Values and Preferences(25.00%).A systematic synthesis identified40 recommendations:90%(36/40)demonstrated consensus and 10%(4/40)contradictions.These studies addressed the following six clinical themes:1)nursing assessment,2)manipulation-assisted voiding,3)behavioral therapy,4)intermittent catheterization,5)indwelling catheterization,and 6)other therapies.Conclusions:The methodologies and recommendations of the CPGs for NB in nursing demonstrated substantial variability.Therefore,there is an urgent need to improve the quality of the NB-related CPGs.More in-depth research and timely updates are required to enhance the practical utility of CPGs and narrow the gap between CPGs and clinical practice.展开更多
Herpes simplex virus(HSV)types 1 and 2 pose significant health risks during pregnancy,impacting both maternal and neonatal outcomes.The 2024 joint guideline from the British Association for Sexual Health and HIV(BASHH...Herpes simplex virus(HSV)types 1 and 2 pose significant health risks during pregnancy,impacting both maternal and neonatal outcomes.The 2024 joint guideline from the British Association for Sexual Health and HIV(BASHH)and the Royal College of Obstetricians and Gynaecologists(RCOG)in the United Kingdom introduces updated recommendations to reduce maternal-to-neonatal transmission.Key recommendations include initiating antiviral therapy earlier—at 32 weeks for standard pregnancies or as early as 22 weeks in high-risk cases—to minimize viral shedding.The guideline emphasizes polymerase chain reaction(PCR)testing for accurate diagnosis and advocates a multidisciplinary team(MDT)approach,involving genitourinary medicine(GUM)specialists,obstetricians,and neonatologists for delivery planning and neonatal care.However,the Chinese guidelines offer greater flexibility in the timing of antiviral treatment,tailored to regional resources and specific circumstances.PCR testing is also recommended,particularly in urban hospitals and tertiary care settings.The UK′s MDT model aligns with China′s integrative healthcare approach,presenting opportunities for mutual learning and collaboration.This comparative analysis highlights areas for cross-adaptation in clinical practices,with potential to enhance maternal and neonatal health outcomes globally.展开更多
Background:Non-valvular atrial fibrillation(NVAF),the most prevalent cardiac arrhythmia globally,poses a dual challenge of thromboembolic and bleeding risks,with stroke being the most devastating complication.Despite ...Background:Non-valvular atrial fibrillation(NVAF),the most prevalent cardiac arrhythmia globally,poses a dual challenge of thromboembolic and bleeding risks,with stroke being the most devastating complication.Despite advancements in anticoagulation and rhythm control,patient outcomes remain suboptimal.Aim:This review synthesizes current evidence on the pathophysiological mechanisms,multidimensional management strategies,and emerging innovations in NVAF to inform clinical practice and future research directions.Methods:A systematic literature search was conducted across nine databases(CNKI,Wanfang,SinoMed,VIP,PubMed,Web of Science,Cochrane Library,Embase,and MEDLINE)using combined Medical Subject Headings(MeSH)and free-text terms,including“atrial fibrillation,”“non-valvular atrial fibrillation,”“risk factors,”and“mechanism”(and their Chinese equivalents).Studies on NVAF pathogenesis,therapeutic interventions,and risk stratification tools were analyzed.Results:(1)Risk Factors and Pathophysiology:NVAF progression is driven by hemodynamic stress(e.g.,hypertension),metabolic disorders(e.g.,obesity,diabetes),chronic inflammation,and fibrosis.Biomarkers such as CRP and Galectin-3,along with TGF-β/Smad signaling,are central to atrial remodeling.(2)Anticoagulation Controversies:While NOACs reduce stroke risk compared to warfarin(HR=0.79),challenges persist in extreme body weight populations and drug-drug interactions(e.g.,with P-glycoprotein inhibitors).(3)Left Atrial Appendage Closure(LAAC):LAAC demonstrates non-inferiority to anticoagulation in stroke prevention(HR=0.79)with reduced major bleeding(HR=0.49),though device-related thrombosis(1.8–7%)remains a concern.(4)Precision Medicine:AI-driven models enhance stroke prediction(AUC=0.71;sensitivity 92%),while genotype-guided warfarin dosing shortens INR stabilization by 40%.(5)Lifestyle Interventions:Combined Mediterranean diet and moderate exercise reduce AF burden(HR=0.69)and reverse left atrial enlargement(LAVI reduced by 12%).(6)Multidisciplinary Care:Integrated“heart-brain team”approaches combining LAAC and PFO closure lower annual stroke recurrence from 8.2%to 2.1%,while comprehensive rehabilitation improves functional capacity(6MWD+45 m)and quality of life(SF-36+12 points).Conclusion:NVAF management has evolved from isolated anticoagulation to a multidimensional paradigm integrating genomics,AI,and lifestyle modification.Future priorities include validating long-term outcomes of novel therapies,addressing evidence gaps in special populations,and implementing digitally enabled,cross-disciplinary care models to mitigate the global burden of NVAF-related complications.展开更多
Introduction:Inadequate blood pressure(BP)control is a significant challenge.Therapeutic decisions based on home blood pressure monitoring(HBPM)have been shown to lead to better blood pressure control compared to thos...Introduction:Inadequate blood pressure(BP)control is a significant challenge.Therapeutic decisions based on home blood pressure monitoring(HBPM)have been shown to lead to better blood pressure control compared to those based on office blood pressure(OBP)measurements alone.Objectives:To compare,over a five-year period,the annual BP control rates in hypertensive patients who were treated and monitored by the same cardiologists and who periodically used HBPM.Methodology:This was a multicenter study conducted with five cross-sectional analyses at annual intervals,with the first in 2019 and the last in 2023.OBP and HBPM measurements were performed according to current guidelines.Two cutoff points were considered for the analysis of BP control by OBP:<140/90 mmHg and<130/80 mmHg.For HBPM,the cutoff was<130/80 mmHg.Comparisons of quantitative variables between years were established using the t-test or chi-square test.A p-value<0.05 was considered significant.Results:A total of 8,890 individuals with a mean age of 63.3(±14.9)years were included,of whom 65.8%were women.A reduction in mean OBP values was observed between 2019-2020 and 2021-2022.There was also a reduction in the average number of antihypertensive medications used in 2020,with a mean of 1.99 medications taken that year.Compared to 2020,2022 showed an improvement in control rates for OBP<130/80 mmHg(31.5%vs.35.7%;p=0.008)and OBP<140/90 mmHg(58.7%vs.65.7%;p<0.001).Conclusion:Continuous monitoring by the same physician and the use of home measurement tools can lead to better BP control in hypertensive patients.展开更多
In this letter,we delve into the groundbreaking research by Lorente et al,which sheds light on the intricate relationship between low salivary uric acid levels and periodontitis.The study not only confirms previous ob...In this letter,we delve into the groundbreaking research by Lorente et al,which sheds light on the intricate relationship between low salivary uric acid levels and periodontitis.The study not only confirms previous observations of reduced salivary uric acid concentrations in periodontitis patients but also establishes,for the first time,an independent association between these two factors,even when controlling for traditional risk factors such as age,smoking status,and arterial hypertension.Moreover,the findings reveal a significant negative correlation between salivary uric acid levels and the severity of periodontitis,suggesting that this biomarker may serve as a valuable indicator of disease progression.These discoveries open new avenues for understanding the pathophysiology of period-ontitis and pave the way for innovative diagnostic and therapeutic strategies.The potential clinical applications of salivary uric acid measurement,such as guiding personalized treatment plans and monitoring disease activity,warrant further exploration to enhance patient care and improve outcomes in this prevalent inflammatory condition.展开更多
This study explored the mediating role of moral courage in the relationship between emotional intelligence and perceptions of patient safety competence among nursing students in clinical practice.The study sample comp...This study explored the mediating role of moral courage in the relationship between emotional intelligence and perceptions of patient safety competence among nursing students in clinical practice.The study sample comprised 220 nursing students from a teaching hospital(female=93.6%;mean age=20.64 years,SD=1.78 years).Nursing students completed standardized measures of Emotional Intelligence Scale,the Moral Courage Scale,and the Health Professional Education in Patient Safety Survey.Following hierarchical regression analysis and bootstrap analysis,the results showed that emotional intelligence and moral courage significantly predicted high levels of the perceptions of patient safety competence among nursing students in clinical practice.Moreover,moral courage partially mediated the relationship emotional intelligence and perceptions of patient safety competence.The results indicate measures focused on improving emotional intelligence and moral courage levels among nursing students in clinical practice will be effective at increasing their perceptions of patient safety competence.展开更多
With the iteration and upgrading of medical technology and the continuous growth of public health demands,the quality of nursing services has become a core indicator for measuring the effectiveness of the medical syst...With the iteration and upgrading of medical technology and the continuous growth of public health demands,the quality of nursing services has become a core indicator for measuring the effectiveness of the medical system.The clinical practice ability of nursing staff is directly related to the safety of patient diagnosis and treatment and the rehabilitation process.However,the current clinical nursing talent training model is facing bottlenecks such as limited practical scenarios and fragmented case cognition.This study focuses on the teaching application of augmented reality(AR)technology in hospital Settings and systematically reviews the research progress on the improvement of clinical practice ability of trainee nurses based on the AR immersive teaching model.By constructing a clinical teaching scenario that integrates virtual and real,AR technology can dynamically simulate complex case handling processes and enhance nursing students’three-dimensional cognition of condition assessment,operation norms,and emergency plans.Hospitals,as the core base for practical teaching,can effectively shorten the connection cycle between theoretical teaching and clinical practice by integrating AR technology,improve the clinical practice level of trainee nurses,and provide an innovative model for optimizing the path of clinical nursing talent cultivation.展开更多
[Objectives]To explore the effectiveness of integrating ideological and political education based on the Nightingale spirit into the clinical practice curriculum for nursing interns.[Methods]A total of 90 questionnair...[Objectives]To explore the effectiveness of integrating ideological and political education based on the Nightingale spirit into the clinical practice curriculum for nursing interns.[Methods]A total of 90 questionnaires were distributed and analyzed among nursing interns and patients to evaluate multiple dimensions,including the interns satisfaction with the internship,mastery of clinical knowledge,ideological and political literacy,professional ethics,and social responsibility.[Results]The overall internship satisfaction of nursing interns reached 98.9%,indicating that the course design and teaching model were widely recognized by students.Secondly,the interns demonstrated excellent mastery of clinical knowledge,with 94.0%of students stating they had fully grasped the clinical knowledge taught during the internship,an increase of 18.6%compared to the previous cohort.In terms of ideological and political literacy,98%of students had a better understanding and application of the Nightingale spirit,an increase of 16.2%compared to the previous cohort.Additionally,the sense of professional identity was significantly enhanced,with 95.8%of students showing a stronger sense of identity and responsibility towards the nursing profession,an increase of 14.0%compared to the previous cohort.Patients also gave high evaluations of the interns performance,with 98.8%expressing satisfaction with the students attitude and performance in nursing care.[Conclusions]The curriculum model based on the integration of Nightingale spirit has effectively improved the professional quality,ideological and political quality and professional identity of nursing interns,and has been highly recognized by patients.It not only provides strong support for the practice of combining ideological and political work with professional courses in nursing education,but also provides a reference for the optimization of clinical practice teaching mode of nursing interns in the future.展开更多
Objective:To analyze the related factors affecting the professional identity of nursing students before and after clinical practice,hoping to provide reference for the career development and education of nursing stude...Objective:To analyze the related factors affecting the professional identity of nursing students before and after clinical practice,hoping to provide reference for the career development and education of nursing students.Methods:A total of 393 undergraduate nursing students of grade 2020 from the Department of Nursing of a university in Shanxi Province were selected.The professional choice motivation,educational attainment expectation,future career planning,professional practice,and employment prospect expectation of nursing students before clinical practice,and the willingness to upgrade educational attainment,professional experience,career development expectation,and employment planning of nursing students after clinical practice were investigated.Through statistical analysis of the survey data,the related influencing factors affecting the professional identity of nursing students before and after clinical practice were explored.Results:The observation of general data showed that the proportion of female students in the survey sample was higher than that of male students,and the proportion of those whose family residence was in rural areas was slightly higher than that in urban areas.The analysis of students’own situation showed that nursing students chose the nursing major because of the high expected employment rate,but they were generally anxious about the employment prospect before the internship,showing a contradictory mentality.The analysis of students’professional ability showed that nursing students believed that their professional ability was mainly reflected in the vocational adaptability.The analysis of the social environment showed that the educational attainment expectations of nursing students were mainly undergraduate and master’s degrees,and they preferred to engage in clinical nursing work rather than nursing research.The analysis on the selection of internship hospitals shows that nursing students’choice of internship hospitals is mainly influenced by the duration of the internship,and they consider the correlation between the selection of internship hospitals and future employment decisions to be low.The analysis on the surrounding environment such as family and school shows that the professional identity of nursing students is mainly influenced by the opinions of school teachers and parents,but the occupations of most of the family members of nursing students are not related to medicine.Conclusion:Targeted intervention strategies should be formulated based on the relevant influencing factors that affect the professional identity of nursing students before and after clinical internship,to enhance the professional identity and employment confidence of nursing students,and promote the healthy and sustainable development of nursing education and the medical service industry.展开更多
As a core mechanism for training talents in Chinese medicine,a follow-up study has constructed a unique Chinese medicine education model through the in-depth intermingling of teacher-training mode and clinical practic...As a core mechanism for training talents in Chinese medicine,a follow-up study has constructed a unique Chinese medicine education model through the in-depth intermingling of teacher-training mode and clinical practice.In the process of teacher training,the tutor transfers the implicit knowledge such as identification thinking and medication experience in the form of“oral transmission and clinical instruction,”so that the academic postgraduates of Chinese medicine can understand the holistic view of the correspondence between heaven and man,the methodology of identification and treatment,and the internal logic of rationale,methodology,prescription and medicine in the clinical diagnosis and treatment.This kind of transmission not only strengthens the students’basic clinical skills of combining the four diagnoses and analyzing the evidence,but also fosters their academic innovation ability of applying classical theories to solve complex clinical problems through the in-depth analysis of typical medical cases.In this paper,we discuss the significance of teacher-training education in the training of academic postgraduates in Chinese medicine,and propose an optimization path for the reference of higher education in Chinese medicine.展开更多
On the basis of relevant literature and evidence, Clinical Practice Guidelines of Acupuncture-moxibust^on .for Cervical 5pondyloffc Radiculopathy has been formulated according to the quality of evidences and by adopti...On the basis of relevant literature and evidence, Clinical Practice Guidelines of Acupuncture-moxibust^on .for Cervical 5pondyloffc Radiculopathy has been formulated according to the quality of evidences and by adopting the method of Grades of Recommendations Assessment, Development and Evaluation （GRADE）, in which the objective of guidelines formulation, the scope of application of the guidelines, the principle of acupuncture-moxibustion treatment of cervical spondylotic radiculopathy, the time for intervention and different acupuncture-moxibustion regimens, etc. were specified.展开更多
Different newborn screening(NBS) programs have been practiced in many countries since the 1960 s. It is of considerable interest whether next-generation sequencing is applicable in NBS. We have developed a panel of 46...Different newborn screening(NBS) programs have been practiced in many countries since the 1960 s. It is of considerable interest whether next-generation sequencing is applicable in NBS. We have developed a panel of 465 causative genes for 596 early-onset, relatively high incidence, and potentially actionable severe inherited diseases in our Newborn Screening with Targeted Sequencing(NESTS) program to screen 11,484 babies in 8 Women and Children’s hospitals nationwide in China retrospectively. The positive rate from preliminary screening of NESTS was 7.85%(902/11,484). With 45.89%(414/902) follow-up of preliminary positive cases, the overall clinically confirmative diagnosis rate of monogenic disorders was 12.07%(50/414), estimating an average of 0.95%(7.85% × 12.07%) clinical diagnosis rate, suggesting that monogenic disorders account for a considerable proportion of birth defects. The disease/gene spectrum varied in different regions of China. NESTS was implemented in a hospital by screening 3923 newborns to evaluate its clinical application. The turn-around time of a primary report, including the sequencing period of < 7 days, was within 11 days by our automatic interpretation pipeline. Our results suggest that NESTS is feasible and cost-effective as a first-tier NBS program, which will change the status of current clinical practice of NBS in China.展开更多
Objective:Formulating critical clinical questions and outcomes is essential for developing clinical practice guidelines(CPGs).This study aims to formulate the key clinical questions and outcomes for the CPG on acupunc...Objective:Formulating critical clinical questions and outcomes is essential for developing clinical practice guidelines(CPGs).This study aims to formulate the key clinical questions and outcomes for the CPG on acupuncture and moxibustion for allergic rhinitis(AR).Methods:PICO(patient,intervention,comparator,and outcome)question survey,Delphi survey,and consensus conference of the guideline development group(GDG)were employed.PICO questionnaires were used to gather and analyze the target users’key demands and interests.The GDG then selected the critical clinical questions and outcomes via a mixed method of Delphi survey and consensus conference.Results:Fifteen potential clinical questions and ten types of outcomes were formulated based on the analysis of 123 responses from seventeen countries on five continents.After two rounds of the Delphi survey and complete discussions,a consensus was reached by the GDG that all potential questions were included.After three rounds of the Delphi survey and complete debate,the consensus was reached that nine outcomes were considered important.Conclusion:Fifteen key clinical questions and nine important outcomes were formulated for the CPG.These covered issues elicited the most attention from global users in acupuncture therapy and AR.The results will contribute to the CPGs development and future clinical studies.展开更多
AIM： To clarify the prevalence of defensive medicine and the specific defensive medicine practices among gastroenterologists in Japan. METHODS： A survey of gastroenterologists in Hiroshima, Japan, was conducted by m...AIM： To clarify the prevalence of defensive medicine and the specific defensive medicine practices among gastroenterologists in Japan. METHODS： A survey of gastroenterologists in Hiroshima, Japan, was conducted by mail in March 2006. The number of gastroenterologists reporting defensive medicine behaviors or changes in their scope of practice and the reported defensive medicine practices, i.e., assurance and avoidance behaviors, were examined. RESULTS： A total of 131 （77%） out of 171 gastroenterologists completed the survey. Three （2%） respondents were sued, and most respondents （96%） had liability insurance. Nearly all respondents （98%） reported practicing defensive medicine. Avoidance behaviors, such as avoiding certain procedures or interventions and avoiding caring for high-risk patients, were very common （96%）. Seventy-five percent of respondents reported often avoiding certain procedures or interventions. However, seasoned gastroenterologists （those in practice for more than 20 years） adopted avoidance behaviors significantly less often than those in practice for less than 10 years. Assurance behaviors, i.e., supplying additional services of marginal or no medical value, were also widespread （91%）. Sixty-eight percent of respondents reported that they sometimes or often referred patients to other specialists unnecessarily. CONCLUSION： Defensive medicine may be highly prevalent among gastroenterologists throughout 3apan, with potentially serious implications regarding costs, access, and both technical and interpersonal quality of care.展开更多
A systematic review was conducted to identify and qualitatively analyze the methods as well as recommendations of Clinical Practice Guidelines （CPG） and Best Practice Statements （BPS） concerning varicocele in the ...A systematic review was conducted to identify and qualitatively analyze the methods as well as recommendations of Clinical Practice Guidelines （CPG） and Best Practice Statements （BPS） concerning varicocele in the pediatric and adolescent population. An electronic search was performed with the MEDLINE, EMBASE, Science Direct, and Scielo databases, as well as guidelines＇ Web sites until September 2015. Four guidelines were included in the qualitative synthesis. In general, the recommendations provided by the CPG/BPS were consistent despite the existence of some gaps across the studies. The guidelines issued by the American Urological Association （AUA） and American Society for Reproductive Medicine （ASRM） did not provide evidence-based levels for the recommendations given. Most of the recommendations given by the European Association of Urology （EAU） and European Society of Pediatric Urology （ESPU） were derived from nonrandomized clinical trials, retrospective studies, and expert opinion. Among all CPG/BPS, only one was specifically designed for the pediatric population. The studied guidelines did not undertake independent cost-effectiveness and risk-benefit analysis. The main objectives of these guidelines were to translate the best evidence into practice and provide a framework of standardized care while maintaining clinical autonomy and physician judgment. However, the limitations identified in the CPG/BPS for the diagnosis and management of varicocele in children and adolescents indicate ample opportunities for research and future incorporation of higher quality standards in patient care.展开更多
Objective:This study aims to get the medical management of acupuncture and moxibustion in the countries and regions where the society members of World Federation of Acupuncture-Moxibustion Societies(WFAS)are located,i...Objective:This study aims to get the medical management of acupuncture and moxibustion in the countries and regions where the society members of World Federation of Acupuncture-Moxibustion Societies(WFAS)are located,including the educational background of acupuncture and moxibustion practitioners and the local clinical practice of acupuncture and moxibustion,and the demands of the content and evidence types of Clinical Practice Guidelines(CPGs)of acupuncture and moxibustion in accordance with WFAS standards,so as to provide requirements and reference principles for the development of CPGs of acupuncture and moxibustion in accordance with WFAS standards.Methods:The convenient sampling method was used to collect the questionnaires,and the WFAS secretariat distributed the questionnaires to 294 contacts of society members from 70 countries and regions in the form of Questionnaire Star four times in April 2020,July 2020,March 2021,and April 2021 respectively.They were then distributed to individual members of acupuncture-moxibustion societies by the contacts.The study content involved the basic information of respondents,including their nationality,occupation,educational background of acupuncture and moxibustion,their local clinical practice and medical management of acupuncture and moxibustion,as well as their demand for CPGs of acupuncture and moxibustion,etc.After the questionnaires were collected,the data were analyzed and described by quantitative research method.Results:In all,302 respondents from 37 countries of six continents responded.The 302 respondents were members of the WFAS society members.(1)Basic information of respondents.They all had acupuncture and moxibustion learning experience,among which,76.5%(231/302)had the education background of acupuncture and moxibustion professional college training,and 88.4%(267/302)had experience of acupuncture and moxibustion clinical practice.Acupuncturists or traditional Chinese medicine doctors accounted for 63.9%(193/302),western medicine doctors,nurses,and pharmacists accounted for 18.2%(55/302),and researchers and teachers accounted for 6.3%(19/302).(2)Local clinical practice and medical management of acupuncture and moxibustion.The level of clinical practice of acupuncture and moxibustion varies greatly among the regions where the WFAS society members lived.Among them,more countries in Europe have not included acupuncture and moxibustion in medical insurance than those in other continents(x^(2)=26.049,P<0.01),and more countries have not included acupuncture and moxibustion in public hospital treatment system than those in other continents(x^(2)=113.488,P<0.01).(3)Demand for CPGs of acupuncture and moxibustion.A total of 93.0%(281/302)respondents believed that WFAS CPGs of acupuncture and moxibustion would be helpful for their local practice.The order of their demand and concern for WFAS CPGs was:acupuncture manipulation>latest progress of acupuncture treatment>choice of acupuncture therapies>safety of acupuncture and moxibustion>combination of acupuncture and other programs.A total of 87.4%(264/302)respondents believed that ancient classics could guide clinical practice,and the ancient literature should be used as evidence for the development of guidelines.Conclusion:The respondents are those future practitioners of CPGs of acupuncture and moxibustion conforming to WFAS standards.Commonly they have clinical practice experience and professional education background.They believe that guidelines will be of help to the clinical practice of acupuncture and moxibustion,hope that WFAS CPGs would recommend effective guidelines for acupuncture manipulation and provide the latest progress in acupuncture treatment and so on,and they believe that classical ancient books can guide their clinical practice.It indicates the necessity and feasibility of formulating the WFAS CPGs of acupuncture and moxibustion.In view of the results of this study,it is suggested that the formulation process of WFAS CPGs of acupuncture and moxibustion should take into account the clinical practice level of acupuncture and moxibustion in each region,as well as its legislation and management situation of acupuncture and moxibustion,so as to meet the needs of users as much as possible.展开更多
文摘OBJECTIVE:To develop Clinical practice s of Traditional Chinese Medicine(TCM) for acute upper respiratory tract infection(AURI) in children;TCM is usedalone or administered together with antibiotics.METHODS:Under the guidance of evidence-based medicine concept,in strict accordance with the rules of international s development,as well as on the basis of evidence of clinical research of TCM,the s solicited opinions from clinical experts and methodologists in TCM and Western Medicine.GRADE standard was applied to form experts' consensus.RESULTS:The s standardized classification of TCM patterns and TCM treatments in children with AURI,including prescription,Chinese patent medicine,non-drug treatment and prevention.CONCLUSION:Follows the principle of "evidence based,consensus supplemented,and experience referred",these s were formulated,but the quality of evidence of included studies were relatively low.Further refinement of the s should be needed as deeper clinical studies as available in future.
基金Deanship of Scientific Research,College of Applied Medical Sciences Research Center at King Saud University,for funding this work。
文摘AIM:To investigate the practice patterns of optometrists in Saudi Arabia regarding myopia management.METHODS:An internet-based survey was distributed to all practicing optometrists in Saudi Arabia(n=1886).The survey contained questions related to 1)demographics,2)knowledge about myopia and its associated complications,3)current clinical care,4)type and frequency of myopia treatment prescribed,and 5)potential barriers limiting treatment adoption.RESULTS:The completed surveys were collected from 171 optometrists(9.06%response rate,60%male).Knowledge regarding myopia-associated complications was prevalent but somewhat inaccurate among the respondents.Cycloplegic refraction at initial visit was used by 59%of the respondents.The cover test was the most reported binocular vision test(83%),and 38%of optometrists did not perform any ocular biometrics.Twothirds prescribed single-vision spectacles for children with myopia.Increased time spent outdoors was selected by 80%of the practitioners who prescribed myopia control treatment as the primary approach.Insufficient support and lack of clinical experience in providing myopia treatment were reported as the most important factors limiting the adoption of myopia management strategies.CONCLUSION:The current optometric practices in Saudi Arabia require further investigation.Optometrists appear to be somewhat aware of myopia and the associated risks.However,most evidence-based myopia treatments are not being locally adopted,primarily because of lack of support,lack of experience,and limited availability.
文摘BACKGROUND Good clinical practice(GCP)is put in place to protect human participants in clinical trials as well as to ensure the quality of research.Non-adherence to these guidelines can produce research that may not meet the standards set by the scientific community.Therefore,it must be ensured that researchers are wellversed in the GCP.But not much is known about the knowledge and practices of the GCP in the medical colleges of North India.AIM To assess the knowledge and practices of researchers about GCP and analyze these with respect to the demographics of participants.METHODS This is a cross-sectional study.A self-structured questionnaire about GCP,after expert validations,was circulated among researchers,at a tertiary healthcare institute,All India Institute of Medical Sciences(AIIMS),Rishikesh.A total of 59 individuals,who were selected by universal sampling,participated in the study.All healthcare workers who have been investigators of Institutional Ethics Committee-approved research projects,except residents and faculty,and are still a part of the institute have been included in the study.The study was approved by the Institutional Ethics Committee of AIIMS,Rishikesh.We used descriptive analysis and the Chi-squared test to analyze data.P value<0.05 was considered significant.RESULTS Out of 59 participants,only 11(18.6%)were certified for GCP.Most of the participants(64.4%)had“Average”knowledge,33.9%had“Good”knowledge and 1.7%had“Poor”knowledge.Only 49%of participants had satisfactory practices related to GCP.There was a significant difference in the knowledge based on the current academic position for the items assessing knowledge of institutional review board(P=0.010),confidentiality&privacy(P=0.011),and participant safety&adverse events(P<0.001).There was also a significant difference in knowledge of research misconduct(P=0.024)and participant safety&adverse events(P=0.011)based on certification of GCP.There was a notable difference in the practices related to recruitment&retention on the basis of current academic position(P<0.001)and certification of GCP(P=0.023).We also observed a considerable difference between the knowledge and practices of GCP among the participants(P=0.013).CONCLUSION Participants have basic knowledge of GCP but show a lack thereof in certain domains of GCP.This can be addressed by holding training sessions focusing on these particular domains.
文摘The article"Secondary diabetes due to different etiologies:Four case reports"by Song et al,published in the World Journal of Clinical Cases,delves into the identi-fication of rare causes of secondary diabetes and emphasizes the necessity for healthcare professionals to recognize these conditions.Failure to do so can result in treatment delays and compromised patient outcomes.The article discusses spe-cific types of diabetes,including maturity onset of diabetes in young,pancreas-related diseases,endocrinopathies,drug-induced diabetes,infections,and con-genital genetic syndromes associated with diabetes mellitus.Case summaries highlight how patients with secondary diabetes,stemming from conditions such as Williams-Beuren syndrome and pituitary adenoma,often exhibit distinct characteristics overlooked in clinical practice.The authors stress the importance of a holistic diagnostic approach and advocate for proactive management through early intervention,including genetic tests and antibody detection.Increased awa-reness and education are crucial for timely identification and proper management,ultimately improving patient well-being.These findings prompt a call to action for healthcare professionals to consider rare causes of secondary diabetes,facili-tating better glycemic control and overall patient care.
文摘Objectives:This study employed evidence mapping to systematically evaluate clinical practice guidelines(CPGs)for neurogenic bladder(NB)care.We aimed to identify research trends,evidence gaps,and consensus patterns to inform evidence-based nursing practices and support the formulation of highquality CPGs.Methods:A systematic search of electronic databases and guideline repositories was conducted,included PubMed,Web of Science,Embase,Guidelines International Network(GIN),ect.Eligible NB guidelines underwent dual-researcher screening and extraction,and methodological and recommendation quality were assessed using the Appraisal of Guidelines for Research and Evaluation II(AGREE II)and Evaluation-Recommendations Excellence(AGREE-REX)instruments.Five researchers independently evaluated recommendation specificity,evidence grading systems,and implementation consistency.Discrepancies were resolved through consensus discussion or third-party arbitration.Results:Analysis of 19 CPGs(2006–2023)from 11 countries/regions revealed that 78.95%(15/19)incorporated evidence grading systems and 68.42%(13/19)specifiedrecommendation strength.The AGREE II evaluation identifiedcritical methodological deficiencies,with three domains scoring below the acceptable thresholds:Rigor of Development(41.70%),Editorial Independence(43.30%),and Applicability(30.00%).The AGREE-REX results showed moderate performance in Clinical Applicability(55.56%)and implantability(41.67%)but severe gaps in Values and Preferences(25.00%).A systematic synthesis identified40 recommendations:90%(36/40)demonstrated consensus and 10%(4/40)contradictions.These studies addressed the following six clinical themes:1)nursing assessment,2)manipulation-assisted voiding,3)behavioral therapy,4)intermittent catheterization,5)indwelling catheterization,and 6)other therapies.Conclusions:The methodologies and recommendations of the CPGs for NB in nursing demonstrated substantial variability.Therefore,there is an urgent need to improve the quality of the NB-related CPGs.More in-depth research and timely updates are required to enhance the practical utility of CPGs and narrow the gap between CPGs and clinical practice.
文摘Herpes simplex virus(HSV)types 1 and 2 pose significant health risks during pregnancy,impacting both maternal and neonatal outcomes.The 2024 joint guideline from the British Association for Sexual Health and HIV(BASHH)and the Royal College of Obstetricians and Gynaecologists(RCOG)in the United Kingdom introduces updated recommendations to reduce maternal-to-neonatal transmission.Key recommendations include initiating antiviral therapy earlier—at 32 weeks for standard pregnancies or as early as 22 weeks in high-risk cases—to minimize viral shedding.The guideline emphasizes polymerase chain reaction(PCR)testing for accurate diagnosis and advocates a multidisciplinary team(MDT)approach,involving genitourinary medicine(GUM)specialists,obstetricians,and neonatologists for delivery planning and neonatal care.However,the Chinese guidelines offer greater flexibility in the timing of antiviral treatment,tailored to regional resources and specific circumstances.PCR testing is also recommended,particularly in urban hospitals and tertiary care settings.The UK′s MDT model aligns with China′s integrative healthcare approach,presenting opportunities for mutual learning and collaboration.This comparative analysis highlights areas for cross-adaptation in clinical practices,with potential to enhance maternal and neonatal health outcomes globally.
文摘Background:Non-valvular atrial fibrillation(NVAF),the most prevalent cardiac arrhythmia globally,poses a dual challenge of thromboembolic and bleeding risks,with stroke being the most devastating complication.Despite advancements in anticoagulation and rhythm control,patient outcomes remain suboptimal.Aim:This review synthesizes current evidence on the pathophysiological mechanisms,multidimensional management strategies,and emerging innovations in NVAF to inform clinical practice and future research directions.Methods:A systematic literature search was conducted across nine databases(CNKI,Wanfang,SinoMed,VIP,PubMed,Web of Science,Cochrane Library,Embase,and MEDLINE)using combined Medical Subject Headings(MeSH)and free-text terms,including“atrial fibrillation,”“non-valvular atrial fibrillation,”“risk factors,”and“mechanism”(and their Chinese equivalents).Studies on NVAF pathogenesis,therapeutic interventions,and risk stratification tools were analyzed.Results:(1)Risk Factors and Pathophysiology:NVAF progression is driven by hemodynamic stress(e.g.,hypertension),metabolic disorders(e.g.,obesity,diabetes),chronic inflammation,and fibrosis.Biomarkers such as CRP and Galectin-3,along with TGF-β/Smad signaling,are central to atrial remodeling.(2)Anticoagulation Controversies:While NOACs reduce stroke risk compared to warfarin(HR=0.79),challenges persist in extreme body weight populations and drug-drug interactions(e.g.,with P-glycoprotein inhibitors).(3)Left Atrial Appendage Closure(LAAC):LAAC demonstrates non-inferiority to anticoagulation in stroke prevention(HR=0.79)with reduced major bleeding(HR=0.49),though device-related thrombosis(1.8–7%)remains a concern.(4)Precision Medicine:AI-driven models enhance stroke prediction(AUC=0.71;sensitivity 92%),while genotype-guided warfarin dosing shortens INR stabilization by 40%.(5)Lifestyle Interventions:Combined Mediterranean diet and moderate exercise reduce AF burden(HR=0.69)and reverse left atrial enlargement(LAVI reduced by 12%).(6)Multidisciplinary Care:Integrated“heart-brain team”approaches combining LAAC and PFO closure lower annual stroke recurrence from 8.2%to 2.1%,while comprehensive rehabilitation improves functional capacity(6MWD+45 m)and quality of life(SF-36+12 points).Conclusion:NVAF management has evolved from isolated anticoagulation to a multidimensional paradigm integrating genomics,AI,and lifestyle modification.Future priorities include validating long-term outcomes of novel therapies,addressing evidence gaps in special populations,and implementing digitally enabled,cross-disciplinary care models to mitigate the global burden of NVAF-related complications.
文摘Introduction:Inadequate blood pressure(BP)control is a significant challenge.Therapeutic decisions based on home blood pressure monitoring(HBPM)have been shown to lead to better blood pressure control compared to those based on office blood pressure(OBP)measurements alone.Objectives:To compare,over a five-year period,the annual BP control rates in hypertensive patients who were treated and monitored by the same cardiologists and who periodically used HBPM.Methodology:This was a multicenter study conducted with five cross-sectional analyses at annual intervals,with the first in 2019 and the last in 2023.OBP and HBPM measurements were performed according to current guidelines.Two cutoff points were considered for the analysis of BP control by OBP:<140/90 mmHg and<130/80 mmHg.For HBPM,the cutoff was<130/80 mmHg.Comparisons of quantitative variables between years were established using the t-test or chi-square test.A p-value<0.05 was considered significant.Results:A total of 8,890 individuals with a mean age of 63.3(±14.9)years were included,of whom 65.8%were women.A reduction in mean OBP values was observed between 2019-2020 and 2021-2022.There was also a reduction in the average number of antihypertensive medications used in 2020,with a mean of 1.99 medications taken that year.Compared to 2020,2022 showed an improvement in control rates for OBP<130/80 mmHg(31.5%vs.35.7%;p=0.008)and OBP<140/90 mmHg(58.7%vs.65.7%;p<0.001).Conclusion:Continuous monitoring by the same physician and the use of home measurement tools can lead to better BP control in hypertensive patients.
文摘In this letter,we delve into the groundbreaking research by Lorente et al,which sheds light on the intricate relationship between low salivary uric acid levels and periodontitis.The study not only confirms previous observations of reduced salivary uric acid concentrations in periodontitis patients but also establishes,for the first time,an independent association between these two factors,even when controlling for traditional risk factors such as age,smoking status,and arterial hypertension.Moreover,the findings reveal a significant negative correlation between salivary uric acid levels and the severity of periodontitis,suggesting that this biomarker may serve as a valuable indicator of disease progression.These discoveries open new avenues for understanding the pathophysiology of period-ontitis and pave the way for innovative diagnostic and therapeutic strategies.The potential clinical applications of salivary uric acid measurement,such as guiding personalized treatment plans and monitoring disease activity,warrant further exploration to enhance patient care and improve outcomes in this prevalent inflammatory condition.
基金funded by the Demonstration Project for Consolidating the Scientific and Educational Support for Medical Talents(Scientific Research Team for Improving the Service Quality of“the Elderly and the Young”).
文摘This study explored the mediating role of moral courage in the relationship between emotional intelligence and perceptions of patient safety competence among nursing students in clinical practice.The study sample comprised 220 nursing students from a teaching hospital(female=93.6%;mean age=20.64 years,SD=1.78 years).Nursing students completed standardized measures of Emotional Intelligence Scale,the Moral Courage Scale,and the Health Professional Education in Patient Safety Survey.Following hierarchical regression analysis and bootstrap analysis,the results showed that emotional intelligence and moral courage significantly predicted high levels of the perceptions of patient safety competence among nursing students in clinical practice.Moreover,moral courage partially mediated the relationship emotional intelligence and perceptions of patient safety competence.The results indicate measures focused on improving emotional intelligence and moral courage levels among nursing students in clinical practice will be effective at increasing their perceptions of patient safety competence.
文摘With the iteration and upgrading of medical technology and the continuous growth of public health demands,the quality of nursing services has become a core indicator for measuring the effectiveness of the medical system.The clinical practice ability of nursing staff is directly related to the safety of patient diagnosis and treatment and the rehabilitation process.However,the current clinical nursing talent training model is facing bottlenecks such as limited practical scenarios and fragmented case cognition.This study focuses on the teaching application of augmented reality(AR)technology in hospital Settings and systematically reviews the research progress on the improvement of clinical practice ability of trainee nurses based on the AR immersive teaching model.By constructing a clinical teaching scenario that integrates virtual and real,AR technology can dynamically simulate complex case handling processes and enhance nursing students’three-dimensional cognition of condition assessment,operation norms,and emergency plans.Hospitals,as the core base for practical teaching,can effectively shorten the connection cycle between theoretical teaching and clinical practice by integrating AR technology,improve the clinical practice level of trainee nurses,and provide an innovative model for optimizing the path of clinical nursing talent cultivation.
基金Supported by 2024 Basic Research and Applied Basic Research Project in Neijiang City(2024 NJJCYJZZXR001)。
文摘[Objectives]To explore the effectiveness of integrating ideological and political education based on the Nightingale spirit into the clinical practice curriculum for nursing interns.[Methods]A total of 90 questionnaires were distributed and analyzed among nursing interns and patients to evaluate multiple dimensions,including the interns satisfaction with the internship,mastery of clinical knowledge,ideological and political literacy,professional ethics,and social responsibility.[Results]The overall internship satisfaction of nursing interns reached 98.9%,indicating that the course design and teaching model were widely recognized by students.Secondly,the interns demonstrated excellent mastery of clinical knowledge,with 94.0%of students stating they had fully grasped the clinical knowledge taught during the internship,an increase of 18.6%compared to the previous cohort.In terms of ideological and political literacy,98%of students had a better understanding and application of the Nightingale spirit,an increase of 16.2%compared to the previous cohort.Additionally,the sense of professional identity was significantly enhanced,with 95.8%of students showing a stronger sense of identity and responsibility towards the nursing profession,an increase of 14.0%compared to the previous cohort.Patients also gave high evaluations of the interns performance,with 98.8%expressing satisfaction with the students attitude and performance in nursing care.[Conclusions]The curriculum model based on the integration of Nightingale spirit has effectively improved the professional quality,ideological and political quality and professional identity of nursing interns,and has been highly recognized by patients.It not only provides strong support for the practice of combining ideological and political work with professional courses in nursing education,but also provides a reference for the optimization of clinical practice teaching mode of nursing interns in the future.
基金Project foundation information:2023 Shanxi Provincial College Student Innovation and Entrepreneurship Training Project(Project No.:20231789)。
文摘Objective:To analyze the related factors affecting the professional identity of nursing students before and after clinical practice,hoping to provide reference for the career development and education of nursing students.Methods:A total of 393 undergraduate nursing students of grade 2020 from the Department of Nursing of a university in Shanxi Province were selected.The professional choice motivation,educational attainment expectation,future career planning,professional practice,and employment prospect expectation of nursing students before clinical practice,and the willingness to upgrade educational attainment,professional experience,career development expectation,and employment planning of nursing students after clinical practice were investigated.Through statistical analysis of the survey data,the related influencing factors affecting the professional identity of nursing students before and after clinical practice were explored.Results:The observation of general data showed that the proportion of female students in the survey sample was higher than that of male students,and the proportion of those whose family residence was in rural areas was slightly higher than that in urban areas.The analysis of students’own situation showed that nursing students chose the nursing major because of the high expected employment rate,but they were generally anxious about the employment prospect before the internship,showing a contradictory mentality.The analysis of students’professional ability showed that nursing students believed that their professional ability was mainly reflected in the vocational adaptability.The analysis of the social environment showed that the educational attainment expectations of nursing students were mainly undergraduate and master’s degrees,and they preferred to engage in clinical nursing work rather than nursing research.The analysis on the selection of internship hospitals shows that nursing students’choice of internship hospitals is mainly influenced by the duration of the internship,and they consider the correlation between the selection of internship hospitals and future employment decisions to be low.The analysis on the surrounding environment such as family and school shows that the professional identity of nursing students is mainly influenced by the opinions of school teachers and parents,but the occupations of most of the family members of nursing students are not related to medicine.Conclusion:Targeted intervention strategies should be formulated based on the relevant influencing factors that affect the professional identity of nursing students before and after clinical internship,to enhance the professional identity and employment confidence of nursing students,and promote the healthy and sustainable development of nursing education and the medical service industry.
文摘As a core mechanism for training talents in Chinese medicine,a follow-up study has constructed a unique Chinese medicine education model through the in-depth intermingling of teacher-training mode and clinical practice.In the process of teacher training,the tutor transfers the implicit knowledge such as identification thinking and medication experience in the form of“oral transmission and clinical instruction,”so that the academic postgraduates of Chinese medicine can understand the holistic view of the correspondence between heaven and man,the methodology of identification and treatment,and the internal logic of rationale,methodology,prescription and medicine in the clinical diagnosis and treatment.This kind of transmission not only strengthens the students’basic clinical skills of combining the four diagnoses and analyzing the evidence,but also fosters their academic innovation ability of applying classical theories to solve complex clinical problems through the in-depth analysis of typical medical cases.In this paper,we discuss the significance of teacher-training education in the training of academic postgraduates in Chinese medicine,and propose an optimization path for the reference of higher education in Chinese medicine.
文摘On the basis of relevant literature and evidence, Clinical Practice Guidelines of Acupuncture-moxibust^on .for Cervical 5pondyloffc Radiculopathy has been formulated according to the quality of evidences and by adopting the method of Grades of Recommendations Assessment, Development and Evaluation （GRADE）, in which the objective of guidelines formulation, the scope of application of the guidelines, the principle of acupuncture-moxibustion treatment of cervical spondylotic radiculopathy, the time for intervention and different acupuncture-moxibustion regimens, etc. were specified.
基金partially supported by grants from the Ministry of Science and Technology of China(2016YFC1000306)the Beijing Municipal Science and Technology Commission Foundation(Z181100001918003)+1 种基金the Beijing Municipal Commission of Health and Family Planning Foundation(2018-21141,2020-4-1144)Beihang University&Capital Medical University Advanced Innovation Center for Big Data-Based Precision Medicine Plan(BHME-201905)。
文摘Different newborn screening(NBS) programs have been practiced in many countries since the 1960 s. It is of considerable interest whether next-generation sequencing is applicable in NBS. We have developed a panel of 465 causative genes for 596 early-onset, relatively high incidence, and potentially actionable severe inherited diseases in our Newborn Screening with Targeted Sequencing(NESTS) program to screen 11,484 babies in 8 Women and Children’s hospitals nationwide in China retrospectively. The positive rate from preliminary screening of NESTS was 7.85%(902/11,484). With 45.89%(414/902) follow-up of preliminary positive cases, the overall clinically confirmative diagnosis rate of monogenic disorders was 12.07%(50/414), estimating an average of 0.95%(7.85% × 12.07%) clinical diagnosis rate, suggesting that monogenic disorders account for a considerable proportion of birth defects. The disease/gene spectrum varied in different regions of China. NESTS was implemented in a hospital by screening 3923 newborns to evaluate its clinical application. The turn-around time of a primary report, including the sequencing period of < 7 days, was within 11 days by our automatic interpretation pipeline. Our results suggest that NESTS is feasible and cost-effective as a first-tier NBS program, which will change the status of current clinical practice of NBS in China.
基金Supported by the National Key R&D Program of China:2019YFC1712200。
文摘Objective:Formulating critical clinical questions and outcomes is essential for developing clinical practice guidelines(CPGs).This study aims to formulate the key clinical questions and outcomes for the CPG on acupuncture and moxibustion for allergic rhinitis(AR).Methods:PICO(patient,intervention,comparator,and outcome)question survey,Delphi survey,and consensus conference of the guideline development group(GDG)were employed.PICO questionnaires were used to gather and analyze the target users’key demands and interests.The GDG then selected the critical clinical questions and outcomes via a mixed method of Delphi survey and consensus conference.Results:Fifteen potential clinical questions and ten types of outcomes were formulated based on the analysis of 123 responses from seventeen countries on five continents.After two rounds of the Delphi survey and complete discussions,a consensus was reached by the GDG that all potential questions were included.After three rounds of the Delphi survey and complete debate,the consensus was reached that nine outcomes were considered important.Conclusion:Fifteen key clinical questions and nine important outcomes were formulated for the CPG.These covered issues elicited the most attention from global users in acupuncture therapy and AR.The results will contribute to the CPGs development and future clinical studies.
文摘AIM： To clarify the prevalence of defensive medicine and the specific defensive medicine practices among gastroenterologists in Japan. METHODS： A survey of gastroenterologists in Hiroshima, Japan, was conducted by mail in March 2006. The number of gastroenterologists reporting defensive medicine behaviors or changes in their scope of practice and the reported defensive medicine practices, i.e., assurance and avoidance behaviors, were examined. RESULTS： A total of 131 （77%） out of 171 gastroenterologists completed the survey. Three （2%） respondents were sued, and most respondents （96%） had liability insurance. Nearly all respondents （98%） reported practicing defensive medicine. Avoidance behaviors, such as avoiding certain procedures or interventions and avoiding caring for high-risk patients, were very common （96%）. Seventy-five percent of respondents reported often avoiding certain procedures or interventions. However, seasoned gastroenterologists （those in practice for more than 20 years） adopted avoidance behaviors significantly less often than those in practice for less than 10 years. Assurance behaviors, i.e., supplying additional services of marginal or no medical value, were also widespread （91%）. Sixty-eight percent of respondents reported that they sometimes or often referred patients to other specialists unnecessarily. CONCLUSION： Defensive medicine may be highly prevalent among gastroenterologists throughout 3apan, with potentially serious implications regarding costs, access, and both technical and interpersonal quality of care.
文摘A systematic review was conducted to identify and qualitatively analyze the methods as well as recommendations of Clinical Practice Guidelines （CPG） and Best Practice Statements （BPS） concerning varicocele in the pediatric and adolescent population. An electronic search was performed with the MEDLINE, EMBASE, Science Direct, and Scielo databases, as well as guidelines＇ Web sites until September 2015. Four guidelines were included in the qualitative synthesis. In general, the recommendations provided by the CPG/BPS were consistent despite the existence of some gaps across the studies. The guidelines issued by the American Urological Association （AUA） and American Society for Reproductive Medicine （ASRM） did not provide evidence-based levels for the recommendations given. Most of the recommendations given by the European Association of Urology （EAU） and European Society of Pediatric Urology （ESPU） were derived from nonrandomized clinical trials, retrospective studies, and expert opinion. Among all CPG/BPS, only one was specifically designed for the pediatric population. The studied guidelines did not undertake independent cost-effectiveness and risk-benefit analysis. The main objectives of these guidelines were to translate the best evidence into practice and provide a framework of standardized care while maintaining clinical autonomy and physician judgment. However, the limitations identified in the CPG/BPS for the diagnosis and management of varicocele in children and adolescents indicate ample opportunities for research and future incorporation of higher quality standards in patient care.
基金Supported by National Key R&D Program of China:No.2019YFC1712200,No.2019YFC1712201。
文摘Objective:This study aims to get the medical management of acupuncture and moxibustion in the countries and regions where the society members of World Federation of Acupuncture-Moxibustion Societies(WFAS)are located,including the educational background of acupuncture and moxibustion practitioners and the local clinical practice of acupuncture and moxibustion,and the demands of the content and evidence types of Clinical Practice Guidelines(CPGs)of acupuncture and moxibustion in accordance with WFAS standards,so as to provide requirements and reference principles for the development of CPGs of acupuncture and moxibustion in accordance with WFAS standards.Methods:The convenient sampling method was used to collect the questionnaires,and the WFAS secretariat distributed the questionnaires to 294 contacts of society members from 70 countries and regions in the form of Questionnaire Star four times in April 2020,July 2020,March 2021,and April 2021 respectively.They were then distributed to individual members of acupuncture-moxibustion societies by the contacts.The study content involved the basic information of respondents,including their nationality,occupation,educational background of acupuncture and moxibustion,their local clinical practice and medical management of acupuncture and moxibustion,as well as their demand for CPGs of acupuncture and moxibustion,etc.After the questionnaires were collected,the data were analyzed and described by quantitative research method.Results:In all,302 respondents from 37 countries of six continents responded.The 302 respondents were members of the WFAS society members.(1)Basic information of respondents.They all had acupuncture and moxibustion learning experience,among which,76.5%(231/302)had the education background of acupuncture and moxibustion professional college training,and 88.4%(267/302)had experience of acupuncture and moxibustion clinical practice.Acupuncturists or traditional Chinese medicine doctors accounted for 63.9%(193/302),western medicine doctors,nurses,and pharmacists accounted for 18.2%(55/302),and researchers and teachers accounted for 6.3%(19/302).(2)Local clinical practice and medical management of acupuncture and moxibustion.The level of clinical practice of acupuncture and moxibustion varies greatly among the regions where the WFAS society members lived.Among them,more countries in Europe have not included acupuncture and moxibustion in medical insurance than those in other continents(x^(2)=26.049,P<0.01),and more countries have not included acupuncture and moxibustion in public hospital treatment system than those in other continents(x^(2)=113.488,P<0.01).(3)Demand for CPGs of acupuncture and moxibustion.A total of 93.0%(281/302)respondents believed that WFAS CPGs of acupuncture and moxibustion would be helpful for their local practice.The order of their demand and concern for WFAS CPGs was:acupuncture manipulation>latest progress of acupuncture treatment>choice of acupuncture therapies>safety of acupuncture and moxibustion>combination of acupuncture and other programs.A total of 87.4%(264/302)respondents believed that ancient classics could guide clinical practice,and the ancient literature should be used as evidence for the development of guidelines.Conclusion:The respondents are those future practitioners of CPGs of acupuncture and moxibustion conforming to WFAS standards.Commonly they have clinical practice experience and professional education background.They believe that guidelines will be of help to the clinical practice of acupuncture and moxibustion,hope that WFAS CPGs would recommend effective guidelines for acupuncture manipulation and provide the latest progress in acupuncture treatment and so on,and they believe that classical ancient books can guide their clinical practice.It indicates the necessity and feasibility of formulating the WFAS CPGs of acupuncture and moxibustion.In view of the results of this study,it is suggested that the formulation process of WFAS CPGs of acupuncture and moxibustion should take into account the clinical practice level of acupuncture and moxibustion in each region,as well as its legislation and management situation of acupuncture and moxibustion,so as to meet the needs of users as much as possible.
