目的:探讨Guided Care护理模式在不孕症体外受精-胚胎移植(In vitro fertilization and embryo transfer,IVFET)助孕患者中的应用效果。方法:选取2022年12月至2024年12月于本院接受IVF-ET助孕治疗的92例不孕症患者作为研究对象,采用随...目的:探讨Guided Care护理模式在不孕症体外受精-胚胎移植(In vitro fertilization and embryo transfer,IVFET)助孕患者中的应用效果。方法:选取2022年12月至2024年12月于本院接受IVF-ET助孕治疗的92例不孕症患者作为研究对象,采用随机数字表法分为对照组和观察组,各46例。对照组患者接受常规护理,观察组患者接受Guided Care护理模式,两组均持续护理2 m。比较两组心理状态、治疗依从性、生活质量以及护理满意度。结果:护理后,观察组抑郁-焦虑-压力量表(Depression Anxiety Stress Scales,DASS)各项评分均较对照组低,Morisky改良版服药依从性量表(Morisky Medication Adherence Scale,MMAS-8)评分、(The Mos 36-item Short Form Health Survey,SF-36)评分及护理满意度均高于对照组(P<0.05)。结论:Guided Care护理模式能够有效改善不孕症患者接受IVF-ET治疗期间的焦虑、抑郁情绪,增强其治疗依从性,对于顺利妊娠具有积极意义,从而获得更高的护理满意度。展开更多
Objectives This study aimed to evaluate the effectiveness of the stepped self-care program on the self-care,self-efficacy,and quality of life of stroke survivors.Methods This quasi-experimental study allocated 110 str...Objectives This study aimed to evaluate the effectiveness of the stepped self-care program on the self-care,self-efficacy,and quality of life of stroke survivors.Methods This quasi-experimental study allocated 110 stroke survivors from two neurology wards into an intervention group(n=55)who received the stepped self-care program and a control group(n=55)who received usual care from June to December 2023.The Self-Care of Stroke Inventory,Stroke Self-Efficacy Questionnaire,and the short version of the Stroke Specific Quality of Life Scale were administered at baseline(T0),immediately post-intervention(T_(1)),and at 1-month(T_(2))and 3-month(T_(3))follow-ups.Data were analyzed using repeated measures analyses of variance,and generalized estimating equations.Results A total of 48 participants in the intervention group and 50 participants in the control group completed the study.No statistically significant differences were observed at T0 in any of the measured indicators(all P>0.05).The study showed significant group,time,and group×time interaction effects across the assessed outcomes(all P<0.05).Follow-up between-group comparisons at T_(1),T_(2),and T_(3) indicated that the intervention group had significantly higher scores in self-care maintenance,self-care monitoring,self-care management,self-efficacy,and quality of life than the control group(all P<0.001).Conclusions The stepped self-care program significantly improved self-care behaviors,self-efficacy,and quality of life among stroke survivors.These findings support the broader implementation of this approach in post-discharge home self-care.展开更多
Objectives This study aimed to explore and clarify the concept of reflective supervision as a professional self-care strategy to create a positive Intensive Care Unit(ICU)practice environment.Methods Walker and Avant...Objectives This study aimed to explore and clarify the concept of reflective supervision as a professional self-care strategy to create a positive Intensive Care Unit(ICU)practice environment.Methods Walker and Avant’s eight-step concept analysis approach was utilized to identify and define the attributes,antecedents,and consequences of reflective supervision in the ICU.An extensive literature search was conducted across various databases,including Google Scholar,CINAHL,PubMed.Articles published from 2005 to 2025 were identified.We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)2020 statement to indicate the included articles and extract related data based on relevance.Results Forty articles were included in the analysis.The identified attributes included the supervisor-supervisee relationship,effective communication,teamwork,collaborations,reflection,competencies,feedback,continuous support,and autonomous choice.The identified antecedents included participation,supportive supervision,flexibility,open-door policy,training,and motivation.Consequences impacting the success of reflective supervision were identified as promotion of resiliency,autonomy,work-life balance,self-awareness,increased self-esteem,professional development,critical thinking,increased job satisfaction,and enhanced commitment.Conclusions Reflective supervision is a complex professional self-care strategy that enhances ICU practice,by promoting nurses’well-being,self-awareness,therapeutic skills,and professional development.展开更多
This paper summarizes the nursing experience of a child with acute fulminant myocarditis.Key nursing measures include establishing a multidisciplinary team to jointly formulate diagnosis and treatment plans;implementi...This paper summarizes the nursing experience of a child with acute fulminant myocarditis.Key nursing measures include establishing a multidisciplinary team to jointly formulate diagnosis and treatment plans;implementing refined volume management,anticoagulation management,and ventilator management during extracorporeal membrane oxygenation;providing personalized nutritional support for the child;and strengthening the prevention and management of complications.After active treatment and nursing care,the child recovered well and was successfully transferred out of the intensive care unit.展开更多
Take care of your hair to help it stay clean,strong and healthy.Wash your hair when it gets dirty,but not too often.For most people,that means every two to three days.People with oily hair wash it every one to two day...Take care of your hair to help it stay clean,strong and healthy.Wash your hair when it gets dirty,but not too often.For most people,that means every two to three days.People with oily hair wash it every one to two days.Use a brush or comb to keep your hair neat and smooth.It's also important to be gentle so you don't pull or break your hair.Never go to bed with wet hair.It can break easily when you sleep.Dry it before bed!展开更多
Highlights By conjugating the same anti-N monoclonal antibody(mAb4-mAb1)with colloidal gold or fluorescent microspheres,this study developed two rapid point-of-care antigen immunochromatographic strips for the detecti...Highlights By conjugating the same anti-N monoclonal antibody(mAb4-mAb1)with colloidal gold or fluorescent microspheres,this study developed two rapid point-of-care antigen immunochromatographic strips for the detection of porcine deltacoronavirus.The fluorescent microsphere-based lateral flow test strip demonstrated a sensitivity of 10~(1.7)TCID_(50)/0.1 mL,which is fourfold higher than that of the colloidal gold-based assay.Porcine deltacoronavirus(PDCoV)is a recently identified enteric coronavirus that causes an acute infectious disease in piglets,leading to diarrhea,vomiting,dehydration,and mortality(Hu et al.2015).展开更多
Objective To systematic review and analyze the practices and effects of integrating post-abortion family planning （PAFP） services into existing health system worldwide in order to inform the future interventions to ...Objective To systematic review and analyze the practices and effects of integrating post-abortion family planning （PAFP） services into existing health system worldwide in order to inform the future interventions to deliver PAFP in China. Methods A systematic search for relevant published and unpublished literature was conducted. Based on a set of criteria, citation and full text were screened, related data were extracted. Findings of included studies were reviewed and analyzed using a textual narrative approach to synthesis. Results A total of 28 studies were included in the synthesis. The studies were published between 1995 and 2008 and covered 20 countries. Some countries were in the stage of piloting post-abortion care （PAC）/PAFP intervention, while others were either from piloting to scaling up or examined how well a pilot PAC/PAFP intervention and resulting improvements were able to be maintained over the long term in the same intervention site. Most studies examined initiatives that were implemented at public sectors from tertiary, secondary to primary health facilities, while a few were imple- mented at private sectors. Efforts of integrating PAFP into existing health system from health system perspectives such as funding the programs, training of trainer （TOT） training or on the job training of physicians and mid-level service provider, expan- sion the range of contraceptive methods available including a few free distribution of contraceptives, improving data collection including cost analysis in a few countries,service guidelines provided to health professionals, supportive supervision at program sites to ensure quality of care, and leadership from government to strengthen PAC/ PAFP service by revising or developing a new national policy. Effects of those intervention programs included that 2 studies decreased abortion rates, 7 studies improved modern contraceptive use, 1 study improved women＇s knowledge on sexual ＆ reproductive health, and 5 studies reported women＇s high satisfaction rate with receiving PAC/PAFP services. Conclusion Each study was conducted within a cultural legal social and religious framework. There might be no single set of best practices that can be put forward as a model to integrate PAFP into existing health system in China. These areas should be taken into account in our future intervention including government＇s optimization and complement to the regulations related to abortion, contraception and PAFP, capacity building for service provider, continuous efforts to improve the quality of PAFP service, and accessibility of multiple contraceptive methods for married as well as unmarried youth.展开更多
Background and Objective The development of modern palliative care in China began in the 1980s and is currently in an accelerating phase.However,inconsistencies in terminology and concepts have hindered policy-making,...Background and Objective The development of modern palliative care in China began in the 1980s and is currently in an accelerating phase.However,inconsistencies in terminology and concepts have hindered policy-making,clinical practice,and academic research.The Terminology of Clinical Medicine(2023 edition)has determined huan-he-yi-liao(缓和医疗)and an-ning-liao-hu(安宁疗护)as the formal terms of"palliative care"and"hospice care",respectively.To align with these terms,this study aims to establish expert consensus definitions tailored to the Chinese context.Methods We systematically retrieved and collected domestic and international literature and policy documents related to the definition of palliative care,then deconstructed and analyzed the relevant conceptual elements of these definitions.Core expert panel built the initial recommended definition upon the conceptual elements and consensus definition of palliative care by the International Association for Hospice and Palliative Care(IAHPC)through two rounds of online discussions.After nomination and selection,61 professionals in the field of palliative care in China were invited to participate in the consensus expert group.Two rounds of Delphi consultation were conducted among the consensus experts,who were asked to score their agreement using Likert scale to the items in the initial recommended definition and the definition statements of palliative care and hospice care.Agreement rate of over 80%was considered as reaching consensus for each items.The core expert panel revised the items and the statements of recommended definitions based on the results from Delphi surveys.The final recommended definitions were formulated after feedback from patient and public involvement(PPI)group members.Results The response rates for the first and second round of Delphi surveys were 83.6%and 100.0%,respectively.The agreement rates of the items and statements of the recommended definitions exceeded 90%.Accordingly,the definitions based on Chinese expert consensus are recommended.Palliative care is an active holistic approach aimed at patients of all ages suffering from life-threatening illness and their families and caregivers.It seeks to improve their quality of life by preventing,assessing,and relieving physical,psychological,social,and spiritual suffering.Hospice care is an integral part of palliative care,focusing on holistic care for patients at the end of life and their families and caregivers.Its goal is to help patients to maintain dignity and achieve a good death by alleviating physical,psychological,social,and spiritual distress without intentionally hastening or postponing death,meanwhile improve the quality of life for families and caregivers.Conclusions This study has established the Chinese expert consensus definitions of palliative care and hospice care in China,as well as the relationship between the two.The definitions highlight the holistic nature of palliative care,providing a foundation for discipline development,clinical practice,and public communication.展开更多
Management of patients with acute hemorrhage requires addressing the source of bleeding,replenishing blood volume,and addressing any coagulopathy that may be present.Assessing coagulopathy and predicting blood require...Management of patients with acute hemorrhage requires addressing the source of bleeding,replenishing blood volume,and addressing any coagulopathy that may be present.Assessing coagulopathy and predicting blood requirements in real-time in patients experiencing ongoing bleeding can pose substantial challenges.In these patients,transfusion concepts based on ratios do not effectively address coagulopathy or reduce mortality.Moreover,ratio-based concepts do not stop bleeding;instead,they just give physicians more time to identify the bleeding source and plan management strategies.In clinical practice,standard laboratory coagulation tests(SLCT)are frequently used to assess various aspects of blood clotting.However,these tests may not always offer a comprehensive under-standing of clinically significant coagulopathy and the severity of blood loss.Furthermore,the SLCT have a considerable turnaround time,which may not be ideal for making prompt clinical decisions.In recent years,there has been a growing interest in point-of-care viscoelastic assays like rotational thromboelast-ometry,which provide real-time,dynamic information about clot formation and dissolution.展开更多
BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU ad...BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.展开更多
Objective:To clarify the concept of in-home respite care in dementia care and identify changes in the service content over time to help providers and users better understand this sustainable service.Method:A literatur...Objective:To clarify the concept of in-home respite care in dementia care and identify changes in the service content over time to help providers and users better understand this sustainable service.Method:A literature search was conducted through Chinese databases China National Knowledge Infrastructure(CNKI),Wanfang,VIP,and SinoMed,as well as English databases PubMed,the Cochrane Library,Web of Sciences,and Embase.Articles published from January 1980 to December 2024 were identified.Rogers’conceptual analysis of evolution was used for this concept analysis,including six steps:identifying the concept and its context,selecting appropriate databases,determining relevant literature,identifying the concept’s attributes,antecedents,and consequences,choosing a concept exemplar if appropriate,and defininghypotheses and implications for further concept development.Results:Thirty-one articles were included.This conceptual analysis revealed the evolution of in-home respite care service content over time and summarized three key attributes.The antecedents included factors related to people with dementia,family caregivers,and the social environment(aging society,government support).The consequences of in-home respite services include delayed institutional placement and reduced security risk events for people with dementia.For family caregivers,consequences include reduced caregiving stress,improved quality of life,and perceived benefitsfrom rest periods.Conclusion:In-home respite care can be interpreted as family-centered home care that provides temporary relief from family caregivers’responsibilities in caring for people with dementia to reduce caregiver burden.The trend of service specialization and attention on dementia families’needs in service provision are future research focus.展开更多
The integration of the digital economy with the traditional sales industry has prompted the robust growth of e-commerce.Live-streaming e-commerce,as a novel business model,has gained immense popularity.However,is⁃sues...The integration of the digital economy with the traditional sales industry has prompted the robust growth of e-commerce.Live-streaming e-commerce,as a novel business model,has gained immense popularity.However,is⁃sues of regulatory loopholes and inefficacy continue to surface.In live-streaming e-commerce,the head anchor,as host of the live-streaming rooms,wields significant influence in determining the goods to be showcased and marketed.Such influence expands risks such as infringement of intellectual property rights.Yet the uncertainty in law concerning the identity of head anchors results in a lack of accountability.Current norms are inadequate in constraining the group of head anchors.Drawing on the principles of risk control,the alignment between benefit and risk,and the theory of so⁃cial cost control,this paper argues that it is both justifiable and feasible to impose a duty to exercise reasonable care on head anchors.To effectively enshrine this duty in law,it is of great importance to redefine the mechanism of identifying the duty of care of head anchors in live-streaming e-commerce.In particular,the contents of the duty of care under⁃taken by head anchors and the consequences of breaching such a duty of care should be clarified.展开更多
This letter responds to Wang et al's recent publication on endoscopic biliary stenting for malignant obstructive jaundice(MOJ)by offering constructive feedback and suggestions for future research.We commend the au...This letter responds to Wang et al's recent publication on endoscopic biliary stenting for malignant obstructive jaundice(MOJ)by offering constructive feedback and suggestions for future research.We commend the authors for their comprehensive study design and execution,which included a clear delineation of study groups and a robust set of outcome measures.We suggest that future studies incorporate additional biomarkers,such as serum levels of liver enzymes and bilirubin,to provide a more nuanced understanding of liver function changes post-intervention.The study's focus on short-term survival rates is appreciated,but we recommend exploring longer-term follow-up periods to capture the full spectrum of survival outcomes.Additionally,the inclusion of quality of life assessments using validated instruments could offer a more holistic view of patient outcomes.From a critical care perspective,we advocate for the integration of advanced imaging techniques to better characterize biliary anatomy and potentially predict treatment response or complications.We believe that incor-porating these suggestions could enhance the understanding of endoscopic biliary stenting's role in MOJ management and its impact on patient outcomes,influ-encing future clinical guidelines and practice.展开更多
Deep learning algorithms have been rapidly incorporated into many different applications due to the increase in computational power and the availability of massive amounts of data.Recently,both deep learning and ensem...Deep learning algorithms have been rapidly incorporated into many different applications due to the increase in computational power and the availability of massive amounts of data.Recently,both deep learning and ensemble learning have been used to recognize underlying structures and patterns from high-level features to make predictions/decisions.With the growth in popularity of deep learning and ensemble learning algorithms,they have received significant attention from both scientists and the industrial community due to their superior ability to learn features from big data.Ensemble deep learning has exhibited significant performance in enhancing learning generalization through the use of multiple deep learning algorithms.Although ensemble deep learning has large quantities of training parameters,which results in time and space overheads,it performs much better than traditional ensemble learning.Ensemble deep learning has been successfully used in several areas,such as bioinformatics,finance,and health care.In this paper,we review and investigate recent ensemble deep learning algorithms and techniques in health care domains,medical imaging,health care data analytics,genomics,diagnosis,disease prevention,and drug discovery.We cover several widely used deep learning algorithms along with their architectures,including deep neural networks(DNNs),convolutional neural networks(CNNs),recurrent neural networks(RNNs),and generative adversarial networks(GANs).Common healthcare tasks,such as medical imaging,electronic health records,and genomics,are also demonstrated.Furthermore,in this review,the challenges inherent in reducing the burden on the healthcare system are discussed and explored.Finally,future directions and opportunities for enhancing healthcare model performance are discussed.展开更多
文摘目的:探讨Guided Care护理模式在不孕症体外受精-胚胎移植(In vitro fertilization and embryo transfer,IVFET)助孕患者中的应用效果。方法:选取2022年12月至2024年12月于本院接受IVF-ET助孕治疗的92例不孕症患者作为研究对象,采用随机数字表法分为对照组和观察组,各46例。对照组患者接受常规护理,观察组患者接受Guided Care护理模式,两组均持续护理2 m。比较两组心理状态、治疗依从性、生活质量以及护理满意度。结果:护理后,观察组抑郁-焦虑-压力量表(Depression Anxiety Stress Scales,DASS)各项评分均较对照组低,Morisky改良版服药依从性量表(Morisky Medication Adherence Scale,MMAS-8)评分、(The Mos 36-item Short Form Health Survey,SF-36)评分及护理满意度均高于对照组(P<0.05)。结论:Guided Care护理模式能够有效改善不孕症患者接受IVF-ET治疗期间的焦虑、抑郁情绪,增强其治疗依从性,对于顺利妊娠具有积极意义,从而获得更高的护理满意度。
基金The National Natural Science Foundation of China[72174184]provided policy and financialsupport for this research.
文摘Objectives This study aimed to evaluate the effectiveness of the stepped self-care program on the self-care,self-efficacy,and quality of life of stroke survivors.Methods This quasi-experimental study allocated 110 stroke survivors from two neurology wards into an intervention group(n=55)who received the stepped self-care program and a control group(n=55)who received usual care from June to December 2023.The Self-Care of Stroke Inventory,Stroke Self-Efficacy Questionnaire,and the short version of the Stroke Specific Quality of Life Scale were administered at baseline(T0),immediately post-intervention(T_(1)),and at 1-month(T_(2))and 3-month(T_(3))follow-ups.Data were analyzed using repeated measures analyses of variance,and generalized estimating equations.Results A total of 48 participants in the intervention group and 50 participants in the control group completed the study.No statistically significant differences were observed at T0 in any of the measured indicators(all P>0.05).The study showed significant group,time,and group×time interaction effects across the assessed outcomes(all P<0.05).Follow-up between-group comparisons at T_(1),T_(2),and T_(3) indicated that the intervention group had significantly higher scores in self-care maintenance,self-care monitoring,self-care management,self-efficacy,and quality of life than the control group(all P<0.001).Conclusions The stepped self-care program significantly improved self-care behaviors,self-efficacy,and quality of life among stroke survivors.These findings support the broader implementation of this approach in post-discharge home self-care.
文摘Objectives This study aimed to explore and clarify the concept of reflective supervision as a professional self-care strategy to create a positive Intensive Care Unit(ICU)practice environment.Methods Walker and Avant’s eight-step concept analysis approach was utilized to identify and define the attributes,antecedents,and consequences of reflective supervision in the ICU.An extensive literature search was conducted across various databases,including Google Scholar,CINAHL,PubMed.Articles published from 2005 to 2025 were identified.We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)2020 statement to indicate the included articles and extract related data based on relevance.Results Forty articles were included in the analysis.The identified attributes included the supervisor-supervisee relationship,effective communication,teamwork,collaborations,reflection,competencies,feedback,continuous support,and autonomous choice.The identified antecedents included participation,supportive supervision,flexibility,open-door policy,training,and motivation.Consequences impacting the success of reflective supervision were identified as promotion of resiliency,autonomy,work-life balance,self-awareness,increased self-esteem,professional development,critical thinking,increased job satisfaction,and enhanced commitment.Conclusions Reflective supervision is a complex professional self-care strategy that enhances ICU practice,by promoting nurses’well-being,self-awareness,therapeutic skills,and professional development.
文摘This paper summarizes the nursing experience of a child with acute fulminant myocarditis.Key nursing measures include establishing a multidisciplinary team to jointly formulate diagnosis and treatment plans;implementing refined volume management,anticoagulation management,and ventilator management during extracorporeal membrane oxygenation;providing personalized nutritional support for the child;and strengthening the prevention and management of complications.After active treatment and nursing care,the child recovered well and was successfully transferred out of the intensive care unit.
文摘Take care of your hair to help it stay clean,strong and healthy.Wash your hair when it gets dirty,but not too often.For most people,that means every two to three days.People with oily hair wash it every one to two days.Use a brush or comb to keep your hair neat and smooth.It's also important to be gentle so you don't pull or break your hair.Never go to bed with wet hair.It can break easily when you sleep.Dry it before bed!
基金financially supported by the National Key Research and Development Program of China(2021YFF0703600)。
文摘Highlights By conjugating the same anti-N monoclonal antibody(mAb4-mAb1)with colloidal gold or fluorescent microspheres,this study developed two rapid point-of-care antigen immunochromatographic strips for the detection of porcine deltacoronavirus.The fluorescent microsphere-based lateral flow test strip demonstrated a sensitivity of 10~(1.7)TCID_(50)/0.1 mL,which is fourfold higher than that of the colloidal gold-based assay.Porcine deltacoronavirus(PDCoV)is a recently identified enteric coronavirus that causes an acute infectious disease in piglets,leading to diarrhea,vomiting,dehydration,and mortality(Hu et al.2015).
基金funded by the European Commission’s Seventh Framework Program[FP7/2007-2013]under grant agreement No.282490
文摘Objective To systematic review and analyze the practices and effects of integrating post-abortion family planning （PAFP） services into existing health system worldwide in order to inform the future interventions to deliver PAFP in China. Methods A systematic search for relevant published and unpublished literature was conducted. Based on a set of criteria, citation and full text were screened, related data were extracted. Findings of included studies were reviewed and analyzed using a textual narrative approach to synthesis. Results A total of 28 studies were included in the synthesis. The studies were published between 1995 and 2008 and covered 20 countries. Some countries were in the stage of piloting post-abortion care （PAC）/PAFP intervention, while others were either from piloting to scaling up or examined how well a pilot PAC/PAFP intervention and resulting improvements were able to be maintained over the long term in the same intervention site. Most studies examined initiatives that were implemented at public sectors from tertiary, secondary to primary health facilities, while a few were imple- mented at private sectors. Efforts of integrating PAFP into existing health system from health system perspectives such as funding the programs, training of trainer （TOT） training or on the job training of physicians and mid-level service provider, expan- sion the range of contraceptive methods available including a few free distribution of contraceptives, improving data collection including cost analysis in a few countries,service guidelines provided to health professionals, supportive supervision at program sites to ensure quality of care, and leadership from government to strengthen PAC/ PAFP service by revising or developing a new national policy. Effects of those intervention programs included that 2 studies decreased abortion rates, 7 studies improved modern contraceptive use, 1 study improved women＇s knowledge on sexual ＆ reproductive health, and 5 studies reported women＇s high satisfaction rate with receiving PAC/PAFP services. Conclusion Each study was conducted within a cultural legal social and religious framework. There might be no single set of best practices that can be put forward as a model to integrate PAFP into existing health system in China. These areas should be taken into account in our future intervention including government＇s optimization and complement to the regulations related to abortion, contraception and PAFP, capacity building for service provider, continuous efforts to improve the quality of PAFP service, and accessibility of multiple contraceptive methods for married as well as unmarried youth.
文摘Background and Objective The development of modern palliative care in China began in the 1980s and is currently in an accelerating phase.However,inconsistencies in terminology and concepts have hindered policy-making,clinical practice,and academic research.The Terminology of Clinical Medicine(2023 edition)has determined huan-he-yi-liao(缓和医疗)and an-ning-liao-hu(安宁疗护)as the formal terms of"palliative care"and"hospice care",respectively.To align with these terms,this study aims to establish expert consensus definitions tailored to the Chinese context.Methods We systematically retrieved and collected domestic and international literature and policy documents related to the definition of palliative care,then deconstructed and analyzed the relevant conceptual elements of these definitions.Core expert panel built the initial recommended definition upon the conceptual elements and consensus definition of palliative care by the International Association for Hospice and Palliative Care(IAHPC)through two rounds of online discussions.After nomination and selection,61 professionals in the field of palliative care in China were invited to participate in the consensus expert group.Two rounds of Delphi consultation were conducted among the consensus experts,who were asked to score their agreement using Likert scale to the items in the initial recommended definition and the definition statements of palliative care and hospice care.Agreement rate of over 80%was considered as reaching consensus for each items.The core expert panel revised the items and the statements of recommended definitions based on the results from Delphi surveys.The final recommended definitions were formulated after feedback from patient and public involvement(PPI)group members.Results The response rates for the first and second round of Delphi surveys were 83.6%and 100.0%,respectively.The agreement rates of the items and statements of the recommended definitions exceeded 90%.Accordingly,the definitions based on Chinese expert consensus are recommended.Palliative care is an active holistic approach aimed at patients of all ages suffering from life-threatening illness and their families and caregivers.It seeks to improve their quality of life by preventing,assessing,and relieving physical,psychological,social,and spiritual suffering.Hospice care is an integral part of palliative care,focusing on holistic care for patients at the end of life and their families and caregivers.Its goal is to help patients to maintain dignity and achieve a good death by alleviating physical,psychological,social,and spiritual distress without intentionally hastening or postponing death,meanwhile improve the quality of life for families and caregivers.Conclusions This study has established the Chinese expert consensus definitions of palliative care and hospice care in China,as well as the relationship between the two.The definitions highlight the holistic nature of palliative care,providing a foundation for discipline development,clinical practice,and public communication.
文摘Management of patients with acute hemorrhage requires addressing the source of bleeding,replenishing blood volume,and addressing any coagulopathy that may be present.Assessing coagulopathy and predicting blood requirements in real-time in patients experiencing ongoing bleeding can pose substantial challenges.In these patients,transfusion concepts based on ratios do not effectively address coagulopathy or reduce mortality.Moreover,ratio-based concepts do not stop bleeding;instead,they just give physicians more time to identify the bleeding source and plan management strategies.In clinical practice,standard laboratory coagulation tests(SLCT)are frequently used to assess various aspects of blood clotting.However,these tests may not always offer a comprehensive under-standing of clinically significant coagulopathy and the severity of blood loss.Furthermore,the SLCT have a considerable turnaround time,which may not be ideal for making prompt clinical decisions.In recent years,there has been a growing interest in point-of-care viscoelastic assays like rotational thromboelast-ometry,which provide real-time,dynamic information about clot formation and dissolution.
文摘BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.
基金supported by the Fundamental Research Funds for the Central Universities(lzujbky-2022-it36)。
文摘Objective:To clarify the concept of in-home respite care in dementia care and identify changes in the service content over time to help providers and users better understand this sustainable service.Method:A literature search was conducted through Chinese databases China National Knowledge Infrastructure(CNKI),Wanfang,VIP,and SinoMed,as well as English databases PubMed,the Cochrane Library,Web of Sciences,and Embase.Articles published from January 1980 to December 2024 were identified.Rogers’conceptual analysis of evolution was used for this concept analysis,including six steps:identifying the concept and its context,selecting appropriate databases,determining relevant literature,identifying the concept’s attributes,antecedents,and consequences,choosing a concept exemplar if appropriate,and defininghypotheses and implications for further concept development.Results:Thirty-one articles were included.This conceptual analysis revealed the evolution of in-home respite care service content over time and summarized three key attributes.The antecedents included factors related to people with dementia,family caregivers,and the social environment(aging society,government support).The consequences of in-home respite services include delayed institutional placement and reduced security risk events for people with dementia.For family caregivers,consequences include reduced caregiving stress,improved quality of life,and perceived benefitsfrom rest periods.Conclusion:In-home respite care can be interpreted as family-centered home care that provides temporary relief from family caregivers’responsibilities in caring for people with dementia to reduce caregiver burden.The trend of service specialization and attention on dementia families’needs in service provision are future research focus.
文摘The integration of the digital economy with the traditional sales industry has prompted the robust growth of e-commerce.Live-streaming e-commerce,as a novel business model,has gained immense popularity.However,is⁃sues of regulatory loopholes and inefficacy continue to surface.In live-streaming e-commerce,the head anchor,as host of the live-streaming rooms,wields significant influence in determining the goods to be showcased and marketed.Such influence expands risks such as infringement of intellectual property rights.Yet the uncertainty in law concerning the identity of head anchors results in a lack of accountability.Current norms are inadequate in constraining the group of head anchors.Drawing on the principles of risk control,the alignment between benefit and risk,and the theory of so⁃cial cost control,this paper argues that it is both justifiable and feasible to impose a duty to exercise reasonable care on head anchors.To effectively enshrine this duty in law,it is of great importance to redefine the mechanism of identifying the duty of care of head anchors in live-streaming e-commerce.In particular,the contents of the duty of care under⁃taken by head anchors and the consequences of breaching such a duty of care should be clarified.
文摘This letter responds to Wang et al's recent publication on endoscopic biliary stenting for malignant obstructive jaundice(MOJ)by offering constructive feedback and suggestions for future research.We commend the authors for their comprehensive study design and execution,which included a clear delineation of study groups and a robust set of outcome measures.We suggest that future studies incorporate additional biomarkers,such as serum levels of liver enzymes and bilirubin,to provide a more nuanced understanding of liver function changes post-intervention.The study's focus on short-term survival rates is appreciated,but we recommend exploring longer-term follow-up periods to capture the full spectrum of survival outcomes.Additionally,the inclusion of quality of life assessments using validated instruments could offer a more holistic view of patient outcomes.From a critical care perspective,we advocate for the integration of advanced imaging techniques to better characterize biliary anatomy and potentially predict treatment response or complications.We believe that incor-porating these suggestions could enhance the understanding of endoscopic biliary stenting's role in MOJ management and its impact on patient outcomes,influ-encing future clinical guidelines and practice.
基金funded by Taif University,Saudi Arabia,project No.(TU-DSPP-2024-263).
文摘Deep learning algorithms have been rapidly incorporated into many different applications due to the increase in computational power and the availability of massive amounts of data.Recently,both deep learning and ensemble learning have been used to recognize underlying structures and patterns from high-level features to make predictions/decisions.With the growth in popularity of deep learning and ensemble learning algorithms,they have received significant attention from both scientists and the industrial community due to their superior ability to learn features from big data.Ensemble deep learning has exhibited significant performance in enhancing learning generalization through the use of multiple deep learning algorithms.Although ensemble deep learning has large quantities of training parameters,which results in time and space overheads,it performs much better than traditional ensemble learning.Ensemble deep learning has been successfully used in several areas,such as bioinformatics,finance,and health care.In this paper,we review and investigate recent ensemble deep learning algorithms and techniques in health care domains,medical imaging,health care data analytics,genomics,diagnosis,disease prevention,and drug discovery.We cover several widely used deep learning algorithms along with their architectures,including deep neural networks(DNNs),convolutional neural networks(CNNs),recurrent neural networks(RNNs),and generative adversarial networks(GANs).Common healthcare tasks,such as medical imaging,electronic health records,and genomics,are also demonstrated.Furthermore,in this review,the challenges inherent in reducing the burden on the healthcare system are discussed and explored.Finally,future directions and opportunities for enhancing healthcare model performance are discussed.
