BACKGROUND Global tumor incidence rises and therapies advance,driving oncology nursing specialization.Granting nurses prescriptive authority optimizes care but polarizes nurses'attitudes due to factors like risk a...BACKGROUND Global tumor incidence rises and therapies advance,driving oncology nursing specialization.Granting nurses prescriptive authority optimizes care but polarizes nurses'attitudes due to factors like risk and competence,hindering policy implementation.AIM To investigate the current status of the attitudes of oncology specialist nurses toward having prescribing authority,specifically concerning symptom management and supportive care in oncology practice,and we conducted a path analysis of their influencing factors.METHODS As participants in the survey,oncology specialist nurses working in hospitals of different grades in Jiangsu Province were selected from March 2025 to May 2025 using a stratified sampling method.The questionnaires were administered using the general information questionnaire,the beliefs and attitudes about nurses'prescriptive authority scale,the nurses'professional identity scale,and the selfefficacy scale.Pearson’s method was used to analyze the correlation between beliefs and attitudes about the prescriptive authority,professional identity,and self-efficacy of nurses.Multiple linear regression was performed to analyze the factors influencing the beliefs and attitudes of nurses’prescriptive authority.The Amos plug-in was used to construct structural equation models to analyze the influencing pathways.RESULTS A total of 329 questionnaires were distributed,and 328 valid questionnaires were returned(effective recovery rate:99.70%).The total score of the 328 oncology nurses on the beliefs and attitudes about nurses'prescriptive authority scale was 101.88±15.13,indicating a moderately high level.Univariate analysis revealed that gender and hospital grade were associated with this score(P<0.05).The Pearson correlation analysis revealed that self-efficacy was positively correlated with the scores of the beliefs and attitudes about nurses’prescriptive authority scale and the nurses’professional identity scale(r=0.4999,P<0.0001 and r=0.7048,P<0.05,respectively),whereas occupational identity was positively correlated only with the former(r=0.6209,P<0.05).Multiple linear regression analysis revealed occupational identity and self-efficacy as the factors influencing the scores of the beliefs and attitudes about nurses’prescriptive authority scale(P<0.05).The results of the path analysis revealed that selfefficacy significantly positively affected nurses’occupational identity and their beliefs and attitudes about having prescriptive authority;occupational identity played a mediating role between the two,with a mediating effect accounting for 54.46% of the total effect,and the structural equation model was well-fitted.CONCLUSION Oncology nurses have more positive attitudes toward prescriptive authority.In addition,self-efficacy positively and indirectly affects nurses’attitudes toward prescriptive authority through the mediating effect of occupational identity.This can be used as a basis for clinical practice to take targeted measures to improve nurses’self-efficacy and occupational identity,thus creating favorable conditions for effectively implementing the policy of prescriptive authority.展开更多
The objective of the article is identification of similarities in behavior and work attitude toward remote working in times of COVID-19 pandemic.Evaluation is concerned on employees of creative employees from differen...The objective of the article is identification of similarities in behavior and work attitude toward remote working in times of COVID-19 pandemic.Evaluation is concerned on employees of creative employees from different countries and business sectors.The author conducted research on Polish and American creative specialists,including software developers.Research conducted for this article in the first stage was qualitative,and in the second stage is based on quantitative methodology and secondary data from American research.The qualitative research conducted in Poland and was based on unstructured interviews with open-ended questions in the form of self-report concerning workflows during remote working.The first stage can be used as the starting point to next research of creative specialists from other countries.The quantitative research is based on secondary data from a study conducted among American employees of Microsoft Corporation.It was research made in the form of survey during COVID-19 pandemic(March-May 2020).The conclusions from each of the stages of research were used to create universal conclusions in the form of gathered key similarities and differences in behavior and wellbeing of creative specialist from different countries during remote working.The analysis included Industry 4.0 perspective-like market needs(e.g.building innovation which require a combination of creativity and technical skills)or condition of constant change.The research and analysis also reveals the potential for future research in the other countries and business sectors.展开更多
Cholangiocarcinoma refers to malignant tumors that develop in epithelial lining of biliary system, and it is divided into two categories according to tumor location, intrahepatic cholangiocarcinoma （ICC） and extrahe...Cholangiocarcinoma refers to malignant tumors that develop in epithelial lining of biliary system, and it is divided into two categories according to tumor location, intrahepatic cholangiocarcinoma （ICC） and extrahepatic cholangiocarcinoma （ECC）. ICC occurs from the epithelial cells of the intrahepatic bile duct, its branches and interlobular biliary tree; and ECC is divided into hilar cholangiocarcinoma and distal cholangiocarcinoma by the circumscription at the confluence of cystic duct and the common hepatic duct.展开更多
Since domestic corporations firstly introduced into and implemented the Advanced Manufacturing Technology (AMT),how to scientifically evaluate the implementation effects of AMT has been an urgent problem.Through the r...Since domestic corporations firstly introduced into and implemented the Advanced Manufacturing Technology (AMT),how to scientifically evaluate the implementation effects of AMT has been an urgent problem.Through the review of for- eign relative studies,this paper constructs an indicator system used to evaluate the implementation effects of AMT.Operational performance,Organizational or managerial performance,Satisfactory performance,and Competitive performance are indicators of first level in the system,and 19 indicators of second level have been selected to estimate the implementation effects of AMT.In this study,a model based on Minkowski distance discriminance to select the specialists’ opinion was designed to evaluate the indica- tor system,and the measure’s validity and practicability was proved by a case study to a diesel engine factory.展开更多
AIM：To obtain information on the prevailing practice patterns of glaucoma specialists in India.METHODS：Glaucoma specialists attending the Annual Conference of the Glaucoma Society of India（GSI）were surveyed.This s...AIM：To obtain information on the prevailing practice patterns of glaucoma specialists in India.METHODS：Glaucoma specialists attending the Annual Conference of the Glaucoma Society of India（GSI）were surveyed.This survey,conducted in 2013,was based on an interactive audience response system.RESULTS：The information was obtained from 146 glaucoma specialists.Approximately half（n=83;57%）had≥10y of experience in managing glaucoma and were in institutional practice（n=74,51%）.Goldmann applanation tonometry was preferred by 103（72%）specialists whilst n=25（17.4%）used non-contact tonometer.Indentation gonioscopy was favoured by two-thirds（n=90,66%）whereas stereoscopic optic disc examination and visual fields using Humphrey perimeter was performed by a majority of the specialists surveyed（n=115,86%and n=114;83%respectively）.Nearly three quarter specialists（n=96;72%）preferred optical coherence tomography for imaging.The primary choice for treatment of angle closure disease and primary open angle glaucoma was laser（iridotomy,n=117;93%）and medical management（prostaglandin analogue,n=104;78%）,respectively.Approximately only a third of the specialists surveyed（n=37;28%）were performing both trabeculectomy and implantation of a glaucoma drainage device and about half（n=64;47%）were not operating on congenital glaucoma at all.CONCLUSION：This survey has found conformance with preferred practice patterns in several areas of diagnosisand management of glaucoma,but there was diversity in a few areas.The information is a significant step towards improvement of glaucoma care in India,including planning for future strategies.展开更多
Background: Most countries have a shortage of Primary Care (PC) physicians. Japan has mitigated this problem by specialists making a mid-career change to PC when they go into private practice. This study examines the ...Background: Most countries have a shortage of Primary Care (PC) physicians. Japan has mitigated this problem by specialists making a mid-career change to PC when they go into private practice. This study examines the circumstances under which specialists shift to PC. Methods: Since the division between specialists and PC physicians is blurred in Japan, we focus on Physicians Providing Home Visits (PPHV). The list of PPHV was obtained from the local medical associations in two neighboring medical planning areas in Japan. The methods used were a questionnaire and in-depth interviews. Results: Of the 46 listed as PPHV, 38 responded to the questionnaires. Physicians mainly acquired their knowledge and skills in primary care from post-graduate clinical training and on the job training after becoming PPHV. The specialists who had moved to PC were equally knowledgeable regarding PC as those had taken the PC accreditation exam. The in-depth interviews revealed that the higher income earned in clinics and being able to retain their identity as a specialist were also important factors. Conclusions: The factors that contributed to physicians making a mid-career change from specialists to PC were their experiences after being certified, the higher income in clinics and the ability to retain their professional identity as specialists. These enabling factors might also be applicable for increasing the ratio of PC physicians at the global level although further studies are required.展开更多
The clinical nursing specialist(CNS)is an expert who applies an expanded range of practical,theoretical,and research-based competencies to the care of patients within in a specialty clinical area within the larger dis...The clinical nursing specialist(CNS)is an expert who applies an expanded range of practical,theoretical,and research-based competencies to the care of patients within in a specialty clinical area within the larger discipline of nursing.A large number of studies consistently conclude that the CNS is a valuable healthcare resource that provides highquality clinical and evidence-based nursing practice and improves patient outcome.The CNS has been involved in healthcare practices for many years,with an increasingly diverse role.However,the training for the CNS in China is only in a preliminary developmental stage.The aim of this article is to review the history and development of the CNS role.Furthermore,the epidemiologic status of osteoporosis,as well as the feasibility and necessity of developing training programs in China for the osteoporosis CNS,will be discussed.展开更多
Objective： By constructing a training system of quality evaluation standards for emergency nurse specialist（ENS）, we can ensure smooth operations and quality training for ENS.Methods： First, the frame structure of...Objective： By constructing a training system of quality evaluation standards for emergency nurse specialist（ENS）, we can ensure smooth operations and quality training for ENS.Methods： First, the frame structure of indicators was designed on the basis of system theory and the balanced scorecard method. Meanwhile, corresponding quantitative standard indicators were compiled through literature analysis and a review of training characteristics. Next, screening indicators were collected through consultation with experts and statistical calculations. The indicators weight coefficient was calculated using the analytic hierarchy process（AHP）. Finally, indicators were validated in two groups of nurses in two different training courses.Results：（1） We created a three-level indicator system： level-Ⅰ dimensions have 4 indicators, while level-Ⅱ dimensions and level-Ⅲ dimensions have 13 and 34 indicators, respectively;（2） The coefficient of expert＇s judgment is 0.840, familiarity is 0.914 and authority is 0.877, and the three rounds of coordination coefficient are 0.456, 0.553 and 0.715, respectively;（3） There are at least 56 indicators in alternative quantitative standards; and（4） The alpha reliability value of the indicator system in the two training course had no significant difference（P 〉 0.05）. The same result was observed when examining two groups of nurses in one training course（P 〉 0.05）.Conclusions： This study established a training system of quality evaluation standards for emergency nurse specialists that is objective, reliable, easy to operate and representative according to scientific selection and verification. This system can therefore provide a basis for quality evaluation and targeted improvement for ENS training in addition to promoting health.展开更多
There is a significant unmet need for palliative care globally: of the 58 million people dying annually, it was estimated that at least 60% will have the prolonged advanced illness and dying and would benefit from pal...There is a significant unmet need for palliative care globally: of the 58 million people dying annually, it was estimated that at least 60% will have the prolonged advanced illness and dying and would benefit from palliative care. Zambia has a total population of 15,066,266 people. About 1,150,400 people are living with HIV and 18,900 people were reported to have died of HIV in 2014 alone. The most recent palliative care situational analysis in Zambia highlighted that palliative care remained “an essential absent factor” and revealed that there were gaps in the type of care given in various home based care (HBC) programs. Therefore, this study aimed at exploring the experiences of trained palliative care specialists in implementing palliative care in Lusaka, Zambia. This study was an exploratory qualitative research. The population comprised of the trained palliative care specialists in either degree or diploma in palliative care, working in Lusaka. Purposive sampling was used and the sample totaled 6 (n-6). The data collection was done using a semi-structured interview guide, through face-to-face in-depth interviews. The interviews lasted for an average of 20 minutes. Prompts and probes were used to increase detailed analysis explorations. Eleven themes broadly classified as facilitators or challenges emerged from the study. Among the facilitators: training influence;higher level support;effective team work and delivery models;and personal development and motivation to serve. challenges included: lack of PC knowledge;lack of essential medication for PC;work burden;lack of financial resources;lack of acceptance of PC;lack of PC guidelines;and legal restrictions on the use of opioids. The study provided evidence of the challenges and facilitators that influence palliative care that specialists experience while implementing PC. It is therefore, recommended that more research, education, effective teamwork is promoted as the study revealed that participants needed support for effective implementation of palliative care.展开更多
Background: Although inflammatory bowel disease (IBD) patients have been increasing and new thera-peutic options for IBD have been developed, there are relatively few clinicians who specialize in IBD. Patients treated...Background: Although inflammatory bowel disease (IBD) patients have been increasing and new thera-peutic options for IBD have been developed, there are relatively few clinicians who specialize in IBD. Patients treated by a non-specialist of IBD may not receive appropriate treatment. This study aimed to compare disease and medication status between IBD patients treated by a specialist and those treated by a non-specialist. Methods: Medical charts of ambulating IBD patients in two hospitals were examined. All patients in one hospital were treated by one of the IBD specialists, while in the other hospital, patients were treated by one of the gastroenterologists who was a non-specialist of IBD. Results: The numbers of IBD patients were 255 (hospital with specialists) and 74 (hospital without specialists), respectively. Disease activity of the patients was not well-controlled in the hospital without specialists compared to in the hospi- tal with specialists (ulcerative colitis (UC): p = 0.0006 and Crohn’s disease: p = 0.012, respectively). The proportion of UC patients who received an insufficient dose of mesalazine (Pentasa < 3 g/day or Asacol < 3.6 g/day) was higher in the hospital without specialists (47% vs. 15%, p < 0.0001). In the hospital without specialists, more patients received long-term corticosteroids (UC: 23% vs. 5%, p < 0.0001), while fewer patients received immunomodulators (UC: 8% vs. 46%, p < 0.0001). Conclusions: IBD patients of the hospital without specialists were not well-controlled and were not prescribed appropriately with thera-peutic drugs. Fostering and placement of the specialist of IBD is an urgent problem.展开更多
Our national center of gastroenterology provides highly specialized care, including chronic pancreatitis. Another area of our activities is educational programs, including postgraduate and fellows’ courses. Thereby, ...Our national center of gastroenterology provides highly specialized care, including chronic pancreatitis. Another area of our activities is educational programs, including postgraduate and fellows’ courses. Thereby, we have noted significant gaps in the knowledge of the specialists that involved in the chronic pancreatitis management. The most critical downsides are related to insufficient attention to etiology and risk factors, using outdated classifications, the lack of knowledge in arsenal of diagnostic techniques, polypharmacy or application of low level of evidence treatment methods. Finally, we have made amendments in the National Clinical Protocol in Chronic Pancreatitis [<a href="#ref1">1</a>], updated the State Educational Standard for residents of the gastroenterological profile [<a href="#ref2">2</a>]. The aim of the study was the analysis of the basic knowledge among different specialists in the management of chronic pancreatitis (CP) around the country. This qualitative study consists of two parts, including focus group interviews followed by interviews with the specialists across the country, which was conducted during the period 2015-2018. In this paper, we present results of diagnostic approaches at the different levels of medical care. The general practitioners have noted the absence of modern methods of laboratory and visual diagnostics in their routine practice, therefore explaining the plenty of the complicated forms. Another issue is the low specialist’s adherence to clinical guidelines, poor knowledge of the risk factors and overestimation of the clinical presentation value except malnutrition symptoms. On the other hand, surgeons and other specialists are not ready to implement modern diagnostic tools and methods in their practice. Obviously, in accordance with the results of our study, our educational center should conduct a number of training activities, as well as develop new algorithms for medical care specialists.展开更多
Micro-eukaryotic communities are highly sensitive to environmental changes, and their structure offers crucial insights into the impact of human activities on aquatic habitats. Despite their significance, the assembly...Micro-eukaryotic communities are highly sensitive to environmental changes, and their structure offers crucial insights into the impact of human activities on aquatic habitats. Despite their significance, the assembly mechanisms of micro-eukaryotic communities in lake ecosystems heavily influenced by human activities are not well understood. In this study, we utilized 18S rDNA amplicon sequencing to examine the biodiversity of micro-eukaryotes over a one-year period in Lake Weishan, one of the largest freshwater lakes in northern China. We analyzed the ecological processes governing community assembly among key ecological groups, specifically habitat generalists and specialists. Our findings revealed substantial temporal variation in microbial diversity and community composition, likely driven by water temperature, dissolved oxygen, and the concentrations of several ions (e.g., Ca^(2+) and F^(−)). Notably, community assembly in this canal-disturbed lake was predominantly influenced by stochastic processes (58.18%) rather than deterministic processes (20.46%). Habitat specialists (425 operational taxonomic units, OTUs) exhibited significantly greater diversity compared to habitat generalists (189 OTUs) and were predominantly shaped by stochastic processes (52.47%). In contrast, habitat generalists were less influenced by these processes (17.69%). Altogether, these results suggest that the ecological processes governing micro-eukaryotic community assembly differ markedly between habitat generalists and specialists, primarily due to their varied adaptability to environmental changes.展开更多
Microorganisms are essential contributors to the forest ecosystems of the Qinghai-Xizang Plateau,encompassing generalists,intermediates,and specialists.Investigating the characteristics and drivers of these microbial ...Microorganisms are essential contributors to the forest ecosystems of the Qinghai-Xizang Plateau,encompassing generalists,intermediates,and specialists.Investigating the characteristics and drivers of these microbial sub-communities across varying elevations is essential for understanding their ecological functions in high-altitude forest soils.This study examines the diversity patterns,assembly processes,environmental adaptations,and potential functions of bacterial and fungal subcommunities along an elevation gradient from 3900 m to the timberline on Shergyla Mountain,China.The findings revealed notable differences between low and high elevations in the diversity and composition of microbial sub-communities.According to neutral and null models,generalists,characterized by the widest niche width and highest migration rates,were primarily influenced by stochastic processes(71.9%).In contrast,deterministic factors,including homogeneous and variable selection,exerted a stronger effect on the assembly of specialists(51.0%).Elevation and nutrient availability emerged as key environmental drivers shaping microbial sub-communities,particularly for specialists,while generalists experienced fewer constraints from environmental factors.Network analysis further demonstrated that habitat specialists occupy central positions within microbial networks,playing a pivotal role in maintaining network stability.Additionally,nitrogen cycling genes—specifically nifH,amoA,nirS and nosZ—exhibited a U-shaped distribution across the elevation gradient and showed a substantial correlation(p<0.05)with the Chao1 and Shannon indices of bacterial specialists.The results enhance our knowledge of microbial community dynamics and underscore the crucial ecological role of microbial specialists in the ecosystems of high-altitude forests.展开更多
INTRODUCTION Resistant hypertension has become a challenge in the treatment of hypertension.As the population continues to age and obesity,sleep apnea hypopnea syndrome,and chronic kidney disease increase in incidence...INTRODUCTION Resistant hypertension has become a challenge in the treatment of hypertension.As the population continues to age and obesity,sleep apnea hypopnea syndrome,and chronic kidney disease increase in incidence,resistant hypertension has become an increasingly common issue in clinical practice.Failure to control blood pressure can impair target organs such as the heart,brain,and kidney,facilitating the occurrence of clinical cardiovascular events.展开更多
To help improve the physical conditions of the people in the Hui ethnic minority areas of Yunnan Province, from December 6 to 11,2005, a 10-member medical team of specialists from the Capital went to the Weishan Yi an...To help improve the physical conditions of the people in the Hui ethnic minority areas of Yunnan Province, from December 6 to 11,2005, a 10-member medical team of specialists from the Capital went to the Weishan Yi and Hui Ethnic Minority Autonomous County of Dali Prefecture and Xundian Hui and Yi Ethnic Minority Autonomous County of Kunming City to give free medical treatment for 6 days. This activity展开更多
New opportunities ahead for print media in advertis-ing-talks among experts promote cooperation a-mong partners:agencies,printers and suppliers"Print media in advertising have a promising fu-ture;accuracy of reac...New opportunities ahead for print media in advertis-ing-talks among experts promote cooperation a-mong partners:agencies,printers and suppliers"Print media in advertising have a promising fu-ture;accuracy of reaching target groups and specificadvertising effectiveness are important advantageswhich will remain assets in the competition betweenprinting and electronic media."This opinion展开更多
The current modes of experience inheritance from famous specialists in traditional Chinese medicine （TCM） include master and disciple, literature review, clinical-epidemiology-based clinical research observation, an...The current modes of experience inheritance from famous specialists in traditional Chinese medicine （TCM） include master and disciple, literature review, clinical-epidemiology-based clinical research observation, and analysis and data mining via computer and database technologies. Each mode has its advantages and disadvantages. However, a scientific and instructive experience inheritance mode has not been developed. The advent of the big data era as well as the formation and practice accumulation of the TCM clinical research paradigm in the real world have provided new perspectives, techniques, and methods for inheriting experience from famous TCM specialists. Through continuous exploration and practice, the research group proposes the innovation research mode based on the real-world TCM clinical research paradigm, which involves the inheritance and innovation of the existing modes. This mode is formulated in line with its own development regularity of TCM and is expected to become the main mode of experience inheritance in the clinical field.展开更多
William Checkley,professor of medicine and a pulmonary and critical care specialist at Johns Hopkins University(Baltimore,MD,USA)has seen kitchens with stalactites.But not the kind found in caves.“You walk in,and the...William Checkley,professor of medicine and a pulmonary and critical care specialist at Johns Hopkins University(Baltimore,MD,USA)has seen kitchens with stalactites.But not the kind found in caves.“You walk in,and the smoke is everywhere,”said Checkley.“It is difficult to breathe—you cough,your eyes burn.”Layers of soot from cookfires cover the walls and,in some extreme cases,form stalactites that hang from the ceiling.展开更多
Objective:To assess the teaching efficacy of clinical instructors for MNS postgraduates,this study aims to gather insights into clinical educators’perceptions concerning MNS postgraduate training and identify key com...Objective:To assess the teaching efficacy of clinical instructors for MNS postgraduates,this study aims to gather insights into clinical educators’perceptions concerning MNS postgraduate training and identify key competencies required for effective teaching.Methods:This study utilized a cross-sectional design.An online questionnaire survey was distributed among clinical faculty members engaged in the education of MNS postgraduates.The survey addressed 4 areas:general teaching conditions,perceptions regarding training for MNS postgraduates,core competencies expected from clinical teachers,and implementation strategies for delivering clinical instruction tailored to these graduates.Results:A total of 143 clinical teachers supervising MNS postgraduates completed the questionnaire.Of these respondents,101(70.62%)held a bachelor’s degree while 42(29.37%)possessed a master’s degree.Although these clinicians demonstrated certain core competencies,they exhibited lower proficiency in understanding trends related to scientific advancements and current research priorities along with limited research capabilities 4.00(3.00,4.00).Notably,>95.8%of teachers recognized differences between the 2 categories of postgraduate students;only 4.2%were completely unaware of such distinctions.There was no statistically significant relationship between the demographic data of clinical educators and their core competencies(P>0.05).Conclusions:This study revealed no significant correlation between the general characteristics of clinical teachers and the core competencies of MNS postgraduates.Additionally,we identified a lack of effective communication and collaboration between MNS postgraduate supervisors and clinical educators.The findings from this research offer valuable insights for further investigation into the factors that influence the core competencies of clinical teachers,as well as strategies to enhance the clinical teaching standards for MNS postgraduates.展开更多
文摘BACKGROUND Global tumor incidence rises and therapies advance,driving oncology nursing specialization.Granting nurses prescriptive authority optimizes care but polarizes nurses'attitudes due to factors like risk and competence,hindering policy implementation.AIM To investigate the current status of the attitudes of oncology specialist nurses toward having prescribing authority,specifically concerning symptom management and supportive care in oncology practice,and we conducted a path analysis of their influencing factors.METHODS As participants in the survey,oncology specialist nurses working in hospitals of different grades in Jiangsu Province were selected from March 2025 to May 2025 using a stratified sampling method.The questionnaires were administered using the general information questionnaire,the beliefs and attitudes about nurses'prescriptive authority scale,the nurses'professional identity scale,and the selfefficacy scale.Pearson’s method was used to analyze the correlation between beliefs and attitudes about the prescriptive authority,professional identity,and self-efficacy of nurses.Multiple linear regression was performed to analyze the factors influencing the beliefs and attitudes of nurses’prescriptive authority.The Amos plug-in was used to construct structural equation models to analyze the influencing pathways.RESULTS A total of 329 questionnaires were distributed,and 328 valid questionnaires were returned(effective recovery rate:99.70%).The total score of the 328 oncology nurses on the beliefs and attitudes about nurses'prescriptive authority scale was 101.88±15.13,indicating a moderately high level.Univariate analysis revealed that gender and hospital grade were associated with this score(P<0.05).The Pearson correlation analysis revealed that self-efficacy was positively correlated with the scores of the beliefs and attitudes about nurses’prescriptive authority scale and the nurses’professional identity scale(r=0.4999,P<0.0001 and r=0.7048,P<0.05,respectively),whereas occupational identity was positively correlated only with the former(r=0.6209,P<0.05).Multiple linear regression analysis revealed occupational identity and self-efficacy as the factors influencing the scores of the beliefs and attitudes about nurses’prescriptive authority scale(P<0.05).The results of the path analysis revealed that selfefficacy significantly positively affected nurses’occupational identity and their beliefs and attitudes about having prescriptive authority;occupational identity played a mediating role between the two,with a mediating effect accounting for 54.46% of the total effect,and the structural equation model was well-fitted.CONCLUSION Oncology nurses have more positive attitudes toward prescriptive authority.In addition,self-efficacy positively and indirectly affects nurses’attitudes toward prescriptive authority through the mediating effect of occupational identity.This can be used as a basis for clinical practice to take targeted measures to improve nurses’self-efficacy and occupational identity,thus creating favorable conditions for effectively implementing the policy of prescriptive authority.
文摘The objective of the article is identification of similarities in behavior and work attitude toward remote working in times of COVID-19 pandemic.Evaluation is concerned on employees of creative employees from different countries and business sectors.The author conducted research on Polish and American creative specialists,including software developers.Research conducted for this article in the first stage was qualitative,and in the second stage is based on quantitative methodology and secondary data from American research.The qualitative research conducted in Poland and was based on unstructured interviews with open-ended questions in the form of self-report concerning workflows during remote working.The first stage can be used as the starting point to next research of creative specialists from other countries.The quantitative research is based on secondary data from a study conducted among American employees of Microsoft Corporation.It was research made in the form of survey during COVID-19 pandemic(March-May 2020).The conclusions from each of the stages of research were used to create universal conclusions in the form of gathered key similarities and differences in behavior and wellbeing of creative specialist from different countries during remote working.The analysis included Industry 4.0 perspective-like market needs(e.g.building innovation which require a combination of creativity and technical skills)or condition of constant change.The research and analysis also reveals the potential for future research in the other countries and business sectors.
文摘Cholangiocarcinoma refers to malignant tumors that develop in epithelial lining of biliary system, and it is divided into two categories according to tumor location, intrahepatic cholangiocarcinoma （ICC） and extrahepatic cholangiocarcinoma （ECC）. ICC occurs from the epithelial cells of the intrahepatic bile duct, its branches and interlobular biliary tree; and ECC is divided into hilar cholangiocarcinoma and distal cholangiocarcinoma by the circumscription at the confluence of cystic duct and the common hepatic duct.
文摘Since domestic corporations firstly introduced into and implemented the Advanced Manufacturing Technology (AMT),how to scientifically evaluate the implementation effects of AMT has been an urgent problem.Through the review of for- eign relative studies,this paper constructs an indicator system used to evaluate the implementation effects of AMT.Operational performance,Organizational or managerial performance,Satisfactory performance,and Competitive performance are indicators of first level in the system,and 19 indicators of second level have been selected to estimate the implementation effects of AMT.In this study,a model based on Minkowski distance discriminance to select the specialists’ opinion was designed to evaluate the indica- tor system,and the measure’s validity and practicability was proved by a case study to a diesel engine factory.
文摘AIM：To obtain information on the prevailing practice patterns of glaucoma specialists in India.METHODS：Glaucoma specialists attending the Annual Conference of the Glaucoma Society of India（GSI）were surveyed.This survey,conducted in 2013,was based on an interactive audience response system.RESULTS：The information was obtained from 146 glaucoma specialists.Approximately half（n=83;57%）had≥10y of experience in managing glaucoma and were in institutional practice（n=74,51%）.Goldmann applanation tonometry was preferred by 103（72%）specialists whilst n=25（17.4%）used non-contact tonometer.Indentation gonioscopy was favoured by two-thirds（n=90,66%）whereas stereoscopic optic disc examination and visual fields using Humphrey perimeter was performed by a majority of the specialists surveyed（n=115,86%and n=114;83%respectively）.Nearly three quarter specialists（n=96;72%）preferred optical coherence tomography for imaging.The primary choice for treatment of angle closure disease and primary open angle glaucoma was laser（iridotomy,n=117;93%）and medical management（prostaglandin analogue,n=104;78%）,respectively.Approximately only a third of the specialists surveyed（n=37;28%）were performing both trabeculectomy and implantation of a glaucoma drainage device and about half（n=64;47%）were not operating on congenital glaucoma at all.CONCLUSION：This survey has found conformance with preferred practice patterns in several areas of diagnosisand management of glaucoma,but there was diversity in a few areas.The information is a significant step towards improvement of glaucoma care in India,including planning for future strategies.
文摘Background: Most countries have a shortage of Primary Care (PC) physicians. Japan has mitigated this problem by specialists making a mid-career change to PC when they go into private practice. This study examines the circumstances under which specialists shift to PC. Methods: Since the division between specialists and PC physicians is blurred in Japan, we focus on Physicians Providing Home Visits (PPHV). The list of PPHV was obtained from the local medical associations in two neighboring medical planning areas in Japan. The methods used were a questionnaire and in-depth interviews. Results: Of the 46 listed as PPHV, 38 responded to the questionnaires. Physicians mainly acquired their knowledge and skills in primary care from post-graduate clinical training and on the job training after becoming PPHV. The specialists who had moved to PC were equally knowledgeable regarding PC as those had taken the PC accreditation exam. The in-depth interviews revealed that the higher income earned in clinics and being able to retain their identity as a specialist were also important factors. Conclusions: The factors that contributed to physicians making a mid-career change from specialists to PC were their experiences after being certified, the higher income in clinics and the ability to retain their professional identity as specialists. These enabling factors might also be applicable for increasing the ratio of PC physicians at the global level although further studies are required.
基金The work was supported by the Comprehensive investment strategic emerging industries related construction projects in“twelfth five-year”for Tianjin(Tianjin Education Committee[2011]no.61).
文摘The clinical nursing specialist(CNS)is an expert who applies an expanded range of practical,theoretical,and research-based competencies to the care of patients within in a specialty clinical area within the larger discipline of nursing.A large number of studies consistently conclude that the CNS is a valuable healthcare resource that provides highquality clinical and evidence-based nursing practice and improves patient outcome.The CNS has been involved in healthcare practices for many years,with an increasingly diverse role.However,the training for the CNS in China is only in a preliminary developmental stage.The aim of this article is to review the history and development of the CNS role.Furthermore,the epidemiologic status of osteoporosis,as well as the feasibility and necessity of developing training programs in China for the osteoporosis CNS,will be discussed.
基金supported by the nursing special items of Health and Family Planning Commission Research Fund in Hubei province(No.HL2012-15)
文摘Objective： By constructing a training system of quality evaluation standards for emergency nurse specialist（ENS）, we can ensure smooth operations and quality training for ENS.Methods： First, the frame structure of indicators was designed on the basis of system theory and the balanced scorecard method. Meanwhile, corresponding quantitative standard indicators were compiled through literature analysis and a review of training characteristics. Next, screening indicators were collected through consultation with experts and statistical calculations. The indicators weight coefficient was calculated using the analytic hierarchy process（AHP）. Finally, indicators were validated in two groups of nurses in two different training courses.Results：（1） We created a three-level indicator system： level-Ⅰ dimensions have 4 indicators, while level-Ⅱ dimensions and level-Ⅲ dimensions have 13 and 34 indicators, respectively;（2） The coefficient of expert＇s judgment is 0.840, familiarity is 0.914 and authority is 0.877, and the three rounds of coordination coefficient are 0.456, 0.553 and 0.715, respectively;（3） There are at least 56 indicators in alternative quantitative standards; and（4） The alpha reliability value of the indicator system in the two training course had no significant difference（P 〉 0.05）. The same result was observed when examining two groups of nurses in one training course（P 〉 0.05）.Conclusions： This study established a training system of quality evaluation standards for emergency nurse specialists that is objective, reliable, easy to operate and representative according to scientific selection and verification. This system can therefore provide a basis for quality evaluation and targeted improvement for ENS training in addition to promoting health.
文摘There is a significant unmet need for palliative care globally: of the 58 million people dying annually, it was estimated that at least 60% will have the prolonged advanced illness and dying and would benefit from palliative care. Zambia has a total population of 15,066,266 people. About 1,150,400 people are living with HIV and 18,900 people were reported to have died of HIV in 2014 alone. The most recent palliative care situational analysis in Zambia highlighted that palliative care remained “an essential absent factor” and revealed that there were gaps in the type of care given in various home based care (HBC) programs. Therefore, this study aimed at exploring the experiences of trained palliative care specialists in implementing palliative care in Lusaka, Zambia. This study was an exploratory qualitative research. The population comprised of the trained palliative care specialists in either degree or diploma in palliative care, working in Lusaka. Purposive sampling was used and the sample totaled 6 (n-6). The data collection was done using a semi-structured interview guide, through face-to-face in-depth interviews. The interviews lasted for an average of 20 minutes. Prompts and probes were used to increase detailed analysis explorations. Eleven themes broadly classified as facilitators or challenges emerged from the study. Among the facilitators: training influence;higher level support;effective team work and delivery models;and personal development and motivation to serve. challenges included: lack of PC knowledge;lack of essential medication for PC;work burden;lack of financial resources;lack of acceptance of PC;lack of PC guidelines;and legal restrictions on the use of opioids. The study provided evidence of the challenges and facilitators that influence palliative care that specialists experience while implementing PC. It is therefore, recommended that more research, education, effective teamwork is promoted as the study revealed that participants needed support for effective implementation of palliative care.
文摘Background: Although inflammatory bowel disease (IBD) patients have been increasing and new thera-peutic options for IBD have been developed, there are relatively few clinicians who specialize in IBD. Patients treated by a non-specialist of IBD may not receive appropriate treatment. This study aimed to compare disease and medication status between IBD patients treated by a specialist and those treated by a non-specialist. Methods: Medical charts of ambulating IBD patients in two hospitals were examined. All patients in one hospital were treated by one of the IBD specialists, while in the other hospital, patients were treated by one of the gastroenterologists who was a non-specialist of IBD. Results: The numbers of IBD patients were 255 (hospital with specialists) and 74 (hospital without specialists), respectively. Disease activity of the patients was not well-controlled in the hospital without specialists compared to in the hospi- tal with specialists (ulcerative colitis (UC): p = 0.0006 and Crohn’s disease: p = 0.012, respectively). The proportion of UC patients who received an insufficient dose of mesalazine (Pentasa < 3 g/day or Asacol < 3.6 g/day) was higher in the hospital without specialists (47% vs. 15%, p < 0.0001). In the hospital without specialists, more patients received long-term corticosteroids (UC: 23% vs. 5%, p < 0.0001), while fewer patients received immunomodulators (UC: 8% vs. 46%, p < 0.0001). Conclusions: IBD patients of the hospital without specialists were not well-controlled and were not prescribed appropriately with thera-peutic drugs. Fostering and placement of the specialist of IBD is an urgent problem.
文摘Our national center of gastroenterology provides highly specialized care, including chronic pancreatitis. Another area of our activities is educational programs, including postgraduate and fellows’ courses. Thereby, we have noted significant gaps in the knowledge of the specialists that involved in the chronic pancreatitis management. The most critical downsides are related to insufficient attention to etiology and risk factors, using outdated classifications, the lack of knowledge in arsenal of diagnostic techniques, polypharmacy or application of low level of evidence treatment methods. Finally, we have made amendments in the National Clinical Protocol in Chronic Pancreatitis [<a href="#ref1">1</a>], updated the State Educational Standard for residents of the gastroenterological profile [<a href="#ref2">2</a>]. The aim of the study was the analysis of the basic knowledge among different specialists in the management of chronic pancreatitis (CP) around the country. This qualitative study consists of two parts, including focus group interviews followed by interviews with the specialists across the country, which was conducted during the period 2015-2018. In this paper, we present results of diagnostic approaches at the different levels of medical care. The general practitioners have noted the absence of modern methods of laboratory and visual diagnostics in their routine practice, therefore explaining the plenty of the complicated forms. Another issue is the low specialist’s adherence to clinical guidelines, poor knowledge of the risk factors and overestimation of the clinical presentation value except malnutrition symptoms. On the other hand, surgeons and other specialists are not ready to implement modern diagnostic tools and methods in their practice. Obviously, in accordance with the results of our study, our educational center should conduct a number of training activities, as well as develop new algorithms for medical care specialists.
基金supported by the National Natural Science Foundation of China(No.32030015,32470545)Science&Technology Fundamental Resources Investigation Program(Grant No.2022FY100400)+1 种基金the Key Projects of Science and Technology Research from the Education Department of Hubei Province(D20221002)the Project(No:RSP2025R7)of the King Saud University,Saudi Arabia.
文摘Micro-eukaryotic communities are highly sensitive to environmental changes, and their structure offers crucial insights into the impact of human activities on aquatic habitats. Despite their significance, the assembly mechanisms of micro-eukaryotic communities in lake ecosystems heavily influenced by human activities are not well understood. In this study, we utilized 18S rDNA amplicon sequencing to examine the biodiversity of micro-eukaryotes over a one-year period in Lake Weishan, one of the largest freshwater lakes in northern China. We analyzed the ecological processes governing community assembly among key ecological groups, specifically habitat generalists and specialists. Our findings revealed substantial temporal variation in microbial diversity and community composition, likely driven by water temperature, dissolved oxygen, and the concentrations of several ions (e.g., Ca^(2+) and F^(−)). Notably, community assembly in this canal-disturbed lake was predominantly influenced by stochastic processes (58.18%) rather than deterministic processes (20.46%). Habitat specialists (425 operational taxonomic units, OTUs) exhibited significantly greater diversity compared to habitat generalists (189 OTUs) and were predominantly shaped by stochastic processes (52.47%). In contrast, habitat generalists were less influenced by these processes (17.69%). Altogether, these results suggest that the ecological processes governing micro-eukaryotic community assembly differ markedly between habitat generalists and specialists, primarily due to their varied adaptability to environmental changes.
基金supported by the Fundamental Research Funds for the Central Universities(China)(No.B240201049)the China Postdoctoral Science Foundation(No.376371)the Six Talent Peaks Project in Jiangsu Province(China)(No.2016-JNHB-007).
文摘Microorganisms are essential contributors to the forest ecosystems of the Qinghai-Xizang Plateau,encompassing generalists,intermediates,and specialists.Investigating the characteristics and drivers of these microbial sub-communities across varying elevations is essential for understanding their ecological functions in high-altitude forest soils.This study examines the diversity patterns,assembly processes,environmental adaptations,and potential functions of bacterial and fungal subcommunities along an elevation gradient from 3900 m to the timberline on Shergyla Mountain,China.The findings revealed notable differences between low and high elevations in the diversity and composition of microbial sub-communities.According to neutral and null models,generalists,characterized by the widest niche width and highest migration rates,were primarily influenced by stochastic processes(71.9%).In contrast,deterministic factors,including homogeneous and variable selection,exerted a stronger effect on the assembly of specialists(51.0%).Elevation and nutrient availability emerged as key environmental drivers shaping microbial sub-communities,particularly for specialists,while generalists experienced fewer constraints from environmental factors.Network analysis further demonstrated that habitat specialists occupy central positions within microbial networks,playing a pivotal role in maintaining network stability.Additionally,nitrogen cycling genes—specifically nifH,amoA,nirS and nosZ—exhibited a U-shaped distribution across the elevation gradient and showed a substantial correlation(p<0.05)with the Chao1 and Shannon indices of bacterial specialists.The results enhance our knowledge of microbial community dynamics and underscore the crucial ecological role of microbial specialists in the ecosystems of high-altitude forests.
文摘INTRODUCTION Resistant hypertension has become a challenge in the treatment of hypertension.As the population continues to age and obesity,sleep apnea hypopnea syndrome,and chronic kidney disease increase in incidence,resistant hypertension has become an increasingly common issue in clinical practice.Failure to control blood pressure can impair target organs such as the heart,brain,and kidney,facilitating the occurrence of clinical cardiovascular events.
文摘To help improve the physical conditions of the people in the Hui ethnic minority areas of Yunnan Province, from December 6 to 11,2005, a 10-member medical team of specialists from the Capital went to the Weishan Yi and Hui Ethnic Minority Autonomous County of Dali Prefecture and Xundian Hui and Yi Ethnic Minority Autonomous County of Kunming City to give free medical treatment for 6 days. This activity
文摘New opportunities ahead for print media in advertis-ing-talks among experts promote cooperation a-mong partners:agencies,printers and suppliers"Print media in advertising have a promising fu-ture;accuracy of reaching target groups and specificadvertising effectiveness are important advantageswhich will remain assets in the competition betweenprinting and electronic media."This opinion
文摘The current modes of experience inheritance from famous specialists in traditional Chinese medicine （TCM） include master and disciple, literature review, clinical-epidemiology-based clinical research observation, and analysis and data mining via computer and database technologies. Each mode has its advantages and disadvantages. However, a scientific and instructive experience inheritance mode has not been developed. The advent of the big data era as well as the formation and practice accumulation of the TCM clinical research paradigm in the real world have provided new perspectives, techniques, and methods for inheriting experience from famous TCM specialists. Through continuous exploration and practice, the research group proposes the innovation research mode based on the real-world TCM clinical research paradigm, which involves the inheritance and innovation of the existing modes. This mode is formulated in line with its own development regularity of TCM and is expected to become the main mode of experience inheritance in the clinical field.
文摘William Checkley,professor of medicine and a pulmonary and critical care specialist at Johns Hopkins University(Baltimore,MD,USA)has seen kitchens with stalactites.But not the kind found in caves.“You walk in,and the smoke is everywhere,”said Checkley.“It is difficult to breathe—you cough,your eyes burn.”Layers of soot from cookfires cover the walls and,in some extreme cases,form stalactites that hang from the ceiling.
基金supported by the Medical Education Research Initiative of Henan Province,grant funded by the Henan Provincial Health Commission(No.Wjlx2022186).
文摘Objective:To assess the teaching efficacy of clinical instructors for MNS postgraduates,this study aims to gather insights into clinical educators’perceptions concerning MNS postgraduate training and identify key competencies required for effective teaching.Methods:This study utilized a cross-sectional design.An online questionnaire survey was distributed among clinical faculty members engaged in the education of MNS postgraduates.The survey addressed 4 areas:general teaching conditions,perceptions regarding training for MNS postgraduates,core competencies expected from clinical teachers,and implementation strategies for delivering clinical instruction tailored to these graduates.Results:A total of 143 clinical teachers supervising MNS postgraduates completed the questionnaire.Of these respondents,101(70.62%)held a bachelor’s degree while 42(29.37%)possessed a master’s degree.Although these clinicians demonstrated certain core competencies,they exhibited lower proficiency in understanding trends related to scientific advancements and current research priorities along with limited research capabilities 4.00(3.00,4.00).Notably,>95.8%of teachers recognized differences between the 2 categories of postgraduate students;only 4.2%were completely unaware of such distinctions.There was no statistically significant relationship between the demographic data of clinical educators and their core competencies(P>0.05).Conclusions:This study revealed no significant correlation between the general characteristics of clinical teachers and the core competencies of MNS postgraduates.Additionally,we identified a lack of effective communication and collaboration between MNS postgraduate supervisors and clinical educators.The findings from this research offer valuable insights for further investigation into the factors that influence the core competencies of clinical teachers,as well as strategies to enhance the clinical teaching standards for MNS postgraduates.
