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ABSTRACTBackground Pseudomonas aeruginosa (P. aeruginosa) is widely distributed in air, soil, and water, human respiratory tract, intestinal tract, and skin. It can induce bloodstream infection, urinary tract infection, gastrointestinal tract infection, respiratory tract infection, etc. Conventional bacterial isolation, culture, and identification are time-consuming, and many false negative results, which cannot meet the needs of precise clinical diagnosis，and proper treatment. This study aims to develop a rapid isothermal amplification assay of Pseudomonas aeruginosa.Methods Specific primers were designed according to the National Center for Biotechnology Information (NCBI) database based on the highly conserved sequence of Pseudomonas aeruginosa virulence factor gene lecA, and a recombinase polymerase amplification (RPA) detection method was established. The sensitivity and specificity were calculated, as well as the collection and processing of clinical samples.Results The thermostatic amplification technique for Pseudomonas aeruginosa established in this paper allows nucleic acid detection within 10 minutes without cross-amplification with other bacterial strains. 27 P. aeruginosa infections were accurately detected in 300 clinical samples.Conclusion The rapid detection system based on thermostatic amplification had shown high sensitivity and specificity in this study, indicated that this method can effectively assist clinical bacterial detection.

AbstractThe World Wide Web and the advancement of computer technology in the 1960s and 1990s respectively set the ground for a substantial and simultaneous change in many facets of our life, including medicine, health care, and medical education. The traditional didactic approach has shifted towards more dynamic and interactive methods, leveraging technologies such as simulation tools, virtual reality, and online platforms. At the forefront is the remarkable evolution that has revolutionized how medical knowledge is accessed, disseminated, and integrated into pedagogical practices. The COVID-19 pandemic also led to rapid and large-scale adoption of e-learning and digital resources in medical education because of widespread lockdowns, social distancing measures, and the closure of medical schools and healthcare training programs. This review paper examines the evolution of medical education from the Flexnerian era to the modern digital age, closely examining the influence of the evolving WWW and its shift from Education 1.0 to Education 4.0. This evolution has been further accentuated by the transition from the static landscapes of Web 2D to the immersive realms of Web 3D, especially considering the growing notion of the metaverse. The application of the metaverse is an interconnected, virtual shared space that includes virtual reality (VR), augmented reality (AR), and mixed reality (MR) to create a fertile ground for simulation-based training, collaborative learning, and experiential skill acquisition for competency development. This review includes the multifaceted applications of the metaverse in medical education, outlining both its benefits and challenges. Through insightful case studies and examples, it highlights the innovative potential of the metaverse as a platform for immersive learning experiences. Moreover, the review addresses the role of emerging technologies in shaping the post-pandemic future of medical education, ultimately culminating in a series of recommendations tailored for medical institutions aiming to successfully capitalize on revolutionary changes.

ABSTRACTBackground Tuberculosis (TB) has a significant treatment burden for patients, requiring at least six months of anti-TB treatment (ATT) with multiple medicines. Ensuring good adherence to ATT is central to global TB strategies, including those in high-income, low-TB incidence (HILI) settings. For adherence interventions to be successful and deliverable, they need to address the personal and environmental factors influencing patient and provider behaviour.Purpose This paper describes the application of theory and research evidence to inform the design process of the IMPACT manualised intervention to support ATT adherence for adults with TB disease in the United Kingdom (UK). It also provides a full description of the resulting intervention.Methods We synthesised findings from our formative research (qualitative and quantitative scoping reviews and patient and carer interviews) and supplemented these with clinic observations, a literature review, and healthcare provider interviews. Findings were mapped to the guiding theoretical framework (Perceptions and Practicalities Approach) which was operationalised to design the intervention components and content. An Intervention Development Group (IDG) of relevant stakeholders were consulted to adapt the intervention to local clinical settings.Results The pragmatic, deliverable components and content for the IMPACT intervention included: (1) an enhanced, structured, risk assessment to systematically identify risk factors for non-adherence plus locally-adapted guidance to mitigate these; and (2) patient educational materials (an animated video and interactive patient booklet) about TB and its treatment, to communicate the need for treatment and address common concerns.Conclusions Using a theory– and evidence– based approach incorporating stakeholder input, we have developed a multi-component, pragmatic, manualised intervention, which addresses patients’ personal barriers to adherence within local service resources to improve adherence to ATT within UK TB services.

Introduction In the new globalized world, noise pollution has started to become a public health problem. We searched for publications about noise pollution in our study. In our study, we examined the noise pollution articles in the Web of Science (WoS) database. Material and Methods A total of 2722 papers were identified which were published between 2001 and 2020, finally, 1815 articles were analyzed. VOSviewer (version 1.6.11) tool used for bibliometric web visualizations. Results When trend analysis was applied to the number of articles by years, a statistically significant increase was detected. The United States contributed the most publications. The countries with the most articles per million population were determined to be Scotland, Singapore, and Ireland, respectively. Most articles on noise pollution were published in the journal Applied Acoustics. The three most used keywords are “noise pollution”, “noise” and “traffic noise”. Conclusions This study showed that there has been a trend of an increasing number of articles on noise pollution in recent years. Also it can be considered that this bibliometric study will help identify gaps in the current research data.

Background Low back pain is a common cause of consultation for patients in primary care, however, there is a lack of unified diagnostic and treatment guidelines for the management of patients with low back pain in China. This paper initially establishes a general practice clinical pathway based on patients with low back pain through the preliminary research, and verifies its effectiveness through the adjustment of the management program. Objective To explore the clinical outcomes of general practice clinical pathway for medically unexplained diseases manifested by low back pain. Methods A total of 80 patients with low back pain attending the general practice outpatient clinic of Mishixiang Health Service Center in Gongshu District, Hangzhou City were selected as the study subjects and randomly divided into the control group and experimental group, with 40 cases in each group, by single and double visiting numbers. The experimental group was managed by the general practice clinical pathway for low back pain, and the control group was managed routinely. After six months of intervention, the Roland-Morris dysfunction score, Visual Analogue Pain Scale (VAS) score before and after intervention, and satisfaction of patients were compared between the two groups. Results There was no statistically significant difference in Roland-Morris dysfunction score and VAS pain score between the two groups before the intervention (P>0.05) ; Roland-Morris dysfunction score and VAS score of the experimental group were lower than those of the control group after the intervention (P

Falls are the important causes of morbidity and mortality in older adults. Although clinical staff have paid attention to the management of falls, adherence to fall interventions is not satisfactory, resulting in the high incidence of fall. Understanding the older adults' own perception of fall risk from their perspective may be the key to fall prevention, especially active fall prevention. In this paper, we reviewed the concept of fall risk perception, behavioral consequences and influencing factors of fall risk perception in older adults from the perspective of "the first person responsible for health", and found that there are fewer studies on fall risk perception in older adults at home and abroad, the conceptual connotation still needs to be further explored. Subjective perceptions of fall risk in older adults can lead to different patterns of fall risk coping behaviors that influence fall risk. The influencing factors of fall risk perception mainly focus on the emotional psychology, physiological conditions, social culture, and physical environment, with the influencing process through subjective cognition. Empirical studies can be used to further validate the psychological cognitive mechanisms of fall risk perception in conjunction with the risk perception formation process in the future, in order to provide empirical evidence for proactive fall prevention.

Background Chronic kidney disease has become a major global concern, and the prevalence of kidney disease in China is the highest in the world. About 89.5% of patients require hemodialysis. In recent years, the prevalence of frailty in maintenance hemodialysis (MHD) patients has risen significantly, seriously affecting the quality of life and prognosis of patients. Objective To explore the prevalence of frailty and the influencing factors of maintenance hemodialysis patients in China through Meta-analysis. Methods Cross-sectional and cohort studies on the prevalence and influencing factors of frailty in Chinese MHD patients were systematically searched in CNKI, VIP, CBM, Wanfang Data, Web of Science, PubMed, Cochrane Library, Embase, and CINAHL databases. The search deadline was from the respective databases to July 2023. Literature screening, data extraction and quality assessment were performed independently by two researchers. Stata 15.0 was used for meta-analysis. Results Thirty-two papers were included, and including 6 746 patients, among which 2 566 experienced frailty, involving 37 influencing factors. Meta-analysis showed that the prevalence of frailty in MHD patients in China was 37.4% (95%CI=30.3%-44.5%). Age (OR=1.09, 95%CI=1.06-1.13), age>60 years (OR=3.81, 95%CI=2.31-6.30), female (OR=2.13, 95%CI=1.47-3.08), living alone (OR=2.42, 95%CI=1.22-4.80), sleep (OR=1.28, 95%CI=1.08-1.50), depression (OR=1.97, 95%CI=1.26-3.08), age on dialysis (OR=3.25, 95%CI=1.82-5.79), social support (low level) (OR=1.99, 95%CI=1.39-2.86), comorbidities (OR=1.79, 95%CI=1.40-2.30), malnutrition (OR=1.17, 95%CI=1.07-1.28), Charlson Comorbidity Index (CCI) (OR=1.32, 95%CI=1.01-1.71), C-reactive protein (CRP) (OR=1.15, 95%CI=1.09-1.21), hemoglobin (Hb

Background As the medical service model in China transitions from unidirectional treatment to holistic health, medical social work, aimed at helping individuals help themselves, has gained more opportunities to integrate into the hospital setting. Objective This paper aims to explore the embedding paths, strategies, and outcomes of medical social work in the hospital setting, to categorize the types of integrative development in medical social work, and to provide significant insights for the robust development of medical social work within the healthcare system. Methods Based on Granovetter's embeddedness theory, purposive sampling was employed to conduct in-depth interviews with 33 medical social workers from 15 public hospitals in Shenzhen, where services were purchased by the government. Data analysis was performed using thematic analysis with the aid of Nvivo12.0 software. Results In the context of government-purchased services, the embedding paths of medical social work include structural embedding and relational embedding. The main embedding strategies are "indirect compliance" and "passive compromise" under structural embedding, and "mutual benefit" and "self-empowerment" under relational embedding. The embedding outcomes also led to two different impacts: "administrative" and "professional". Conclusion The study suggests that the integrative development of medical social work can be categorized into four types: "superficial embedding" "administration-led" "mutual development" and "professional inter-construction".

Sepsis is characterized by a dysregulation of immune response to infection, leading to life-threatening organ dysfunction. Sepsis-associated liver injury (SALI) is considered an independent risk factor for predicting death in the intensive care unit (ICU). With the increasing number of studies on the gut-liver axis in recent years, the close linkage of gut microbiota and liver diseases has been gradually revealed. Dysbiosis of gut microbiota has been shown to induce SALI through the mitogen-activated protein kinase/nuclear transcription factorκB (MAPK/NF-κB) signaling pathway and damage to the intestinal barrier. Meanwhile, fecal microbiota transplantation (FMT) and the application of probiotics have great potential in the treatment of SALI. This paper reviews the relevant research progress in recent years both at home and abroad, in order to provide new insights into the pathogenesis and treatment of SALI.

A large number of studies have confirmed that endoplasmic reticulum stress (ERS) is closely related to the development and progression of liver diseases, but the mechanism of the association between ERS and liver disease progression has not been clarified and needs to be further explored. Numerous studies have found that moderate ERS can activate the unfolded protein response (UPR) to protect cells, while severe or persistent ERS can induce apoptosis. Therefore, exploring the role of ERS in the pathogenesis of liver diseases may help to discover new therapeutic strategies. This paper describes the current research status and potential therapeutic strategies of ERS and UPR in various liver diseases.

The African Journal of Emergency Medicine, in partnership with several other regional emergency medicine journals, publishes abstracts from each respective journal. Abstracts are not necessarily linked to open access papers however, all abstracts are accessible without subscription.

Oxygen supplementation is a widely used treatment for ICU patients. However, it can lead to hyperoxia, which in turn can result in oxidative stress, cardiac remodeling, and even mortality. This paper expands upon previous research conducted by our lab to establish time-dependent cardiac changes under hyperoxia. In this study, both young and aged mice (male and female) underwent 72 h of hyperoxia exposure and were monitored at 24-hour intervals for cardiac electrophysiological and functional parameters using ECG and electrocardiogram data. Our analysis showed that young male mice experienced significant weight loss as well as significant lung edema by 48 h. Although young male mice were highly susceptible to physical changes, they were resistant to early cardiac functional and electrophysiological changes compared to the other groups. Both young and aged female and aged males developed functional impairments by 24 h of hyperoxia exposure. Furthermore, sex and age differences were noted in the onset of electrophysiological changes. While some groups could resist early cardiac remodeling, our data suggests that 72 h of hyperoxia exposure is sufficient to induce significant cardiac remodeling across all age and sex groups. Our data establishes that time-dependent cardiac changes due to oxygen supplementation can have devastating consequences even with short exposure periods. These findings can aid in developing clinical practices for individuals admitted to the ICU by elucidating the impact of aging, sex, and length of stay under mechanical ventilation to limit hyperoxia-induced cardiac remodeling.

During the last years, the COVID-19 pandemic determined different clinical and radiological scenarios, sometimes difficult to manage, in particular in breast units. On these bases, we tried to understand what we have learned and how to improve the management of breast cancer screening and breast cancer patients.We included a total number of 16 studies. Most published papers about managing breast units during the spread of COVID-19 were editorial, followed by original articles and reviews. Even if the COVID spread followed a bimodal distribution, most papers were published during the first wave, without significant improvement in 2021 and 2022, and were published in journals belonging to general speciality, followed by surgical and radiological journals.One of the most common topics reported in the final included studies is prioritizing patients in the clinical setting according to individual characteristics (first of all, age), risk factors, and time since the last imaging examination. For biopsies, prioritization has been suggested according to the risk of malignant lesions. In the screening setting, this was suspended in most reported studies, also for BRCA+ patients, and then resumed with different modalities according to different centres. Moreover, some proposed the establishment of mobile units for screening or the decentralization of more screening mammograms to smaller clinics or hospital admittance for screening patients via telemedicine.The majority of analyzed papers underlined that all patients, before admittance into the diagnostic rooms, should be screened for suspicious symptoms directly on-site or by asking by phone. In the case of patients with a high suspicion of COVID-19 infection, some papers proposed to delay all breast imaging studies and others to use dedicated departments or areas of the cancer center. In this setting, telemedicine for radiologists has also been suggested. Moreover, other suggestions should be considered: reducing patients' time in the hospital, increasing the distance between patients in the waiting room, and creating additional waiting areas.

The study evaluated the current state and accessibility of tertiary healthcare services in rural Australia. A systematic literature review from 2010 to 2022 was undertaken, utilising databases such as PubMed, MEDLINE, Cochrane Library, ProQuest, and Google Scholar. The PRISMA method was employed to retrieve an initial total of 4768 papers. Upon removal of 2806 duplicates and 1587 irrelevant records, 1962 articles were screened. From these, 375 were assessed for eligibility, leading to the inclusion of eleven studies in the systematic review. Criteria for exclusion included a focus on primary and secondary healthcare, absence of peer review, and unclear methodology.A collective survey of 230,339 individuals, focusing on access to tertiary healthcare in rural and remote areas of Australia, was reported in the chosen studies. Several barriers to healthcare access for rural populations were identified, including lack of informed leadership, inadequate clinical governance, limited awareness of modern care models, suboptimal workforce planning and resource utilisation, incorrect risk perception, and insufficient community engagement.In conclusion, there is an urgent need to address healthcare disparities and improve service accessibility in Australia's rural and remote areas.

This paper systematically reviewed the process of primary health care development of China over the past 45 years, and summarized the achievements of primary health care based on data related to primary health care draw from 2010-2012 China Health Statistics Year book, 2013-2017 China Health and Family Planning Statistical Yearbook and 2018-2022 China Health Statistics Year book. Data of the infant mortality rate, maternal mortality rate, and average life expectancy were from the World Bank in China and upper middle income countries in 2023. The development of primary health care of China was summarized into four phases, and the achievements included the improvement of the primary health care network, coverage expansion of basic health insurance, the increase of funding and coverage of basic public health services, the steady improvement of family doctor contracts, and the continuous improvement of women's and children's health, with major health indicators ranking among the top upper middle-income countries. The current challenges include the unbalanced development of infrastructure construction in the primary medical and health system, the decline in the proportion of medical insurance funds, the lack of vitality of the management system, the low level of remuneration and imperfect incentive system. This paper summarizes the enlightenment of international experience for China's primary health care, and puts forward the future development directions and strategies.

With the continuous deepening of the reform of the primary care and health system, the standardization of primary health information has received more and more attention. As an important part of the construction of primary health information, primary care diagnostic coding plays an important role in improving the efficiency of primary care management, promoting the quality control of primary care, and effectively collecting primary care data. However, China has used the disease classification of general hospitals as the primary care diagnostic code for a long time, which not only leads to the chaotic state of non-standard and non-standardized primary care diagnosis, but also causes loss and error in the data collection, record and analysis in primary care. By summarizing the historical development of primary care diagnostic coding at home and abroad, this paper points out five main problems faced by China's primary care diagnostic coding: the lack of attention to primary care diagnostic coding, the lack of unified primary care diagnostic coding leads to the limited development of primary care function and quality in China, the disagreements about which international primary care classifications match the primary care diagnostic codes in China, the various challenges faced by the localization of primary care diagnostic coding, and the lack of talents and tools to evaluate and optimize primary care diagnostic coding in China. On this basis, combined with the development process of foreign primary care diagnostic coding, it is proposed that all parties in China should pay attention to the development of primary care diagnostic coding. While further promoting the construction of primary care information in line with international standards, the national unified primary care diagnostic coding standard should be formulated based on the current trial ICD-11 and ICPC-3 classification as soon as possible, and the sound training system for primary care diagnostic coding talents should be established to further implement and optimize primary care diagnostic coding in China.

Background In standardized residency training for general practice trainees, the rotation time in various clinical specialties is short, and there is a wide range of learning content, requiring enhanced learning autonomy. General practice faculty would be dealing with trainees from a variety of backgrounds, including 5+3, transfer, professional masters, or 3+2 assistant general practitioners, interns, public health trainees. It was necessary to study how to enable different training targets to get what they need and achieve the desired training effect in training needed to be carefully studied. Objective The objective of this study was to explore a training method that addresses structural problems, enhances trainees' learning initiative, and cultivates their ability for deeper thinking. Methods At the end of each learning activity, immediate discussions were organized to address the following questions: "1. What have you learned through the study? 2. What other questions do you have? 3. What are the same or similar experiences that you can share with others? 4. What inspirations do you have for future work?" The paper conducted theoretical analyses of the four questions to elucidate the method's internal logic and trainees' thinking process. Corresponding questionnaires were designed for validation studies conducted in the General Practice Backbone Teachers' Training Class and the Grassroots Talent Class. Results The training method received strong agreement from the trainees, with the composite score ranging between "strongly agreed" and "agreed". After conducting parameter tests, no statistical differences were found in the answers concerning gender, age, title, position, and working experience. However, statistical differences were observed in academic qualifications, work units, and participated training programs (P

Background Community health service institutions play an important role in the protection of people's health, the application of community traditional Chinese medicine services can significantly improve the quality of life for the patients, and alleviate the problems of the accessibility and affordability for the health care. The bliometric analysis on traditional Chinese medicine services in community health service institutions can provide a basis and direction for further improving the capacity of community traditional Chinese medicine services. Objective To explore the development process, research hotspots and frontiers of traditional Chinese medicine services provided by community health service institutions in China based on the bibliometric analysis and scientific knowledge mapping analysis. Methods On January 1, 2023, CNKI, Wanfang Data and VIP were searched for relevant literature from inception to 2022-12-31. Excel software was used for the statistical analysis of annual publication volume, source journals and source institutions, CiteSpace 6.1.R6 software was used for the research collaborative network of institutions, clustering analysis and burst analysis of keywords. Frequency analysis and co-occurrence network analysis of authors and keywords were carried out with VOSviewer software. Results A total of 920 papers were included, as for their sources, 270 journals and 38 universities were involved, represented by Journal of Traditional Chinese Medicine (80 articles), Beijing University of Chinese Medicine and Guangzhou University of Chinese Medicine (14 articles) with the highest number of articles. A total of 449 research institutions were involved, and the institution with the highest number of articles was Beijing University of Chinese Medicine (23 articles). SHI Yongxing (27 articles) and BAO Yong (18 articles) were the top 2 authors. Twelve clusters could be formed by the co-occurrence analysis of authors, and there was close collaboration among authors within the same cluster, but a wide collaborative network had not been formed yet. A total of 1 252 keywords were involved in this study, forming 13 clusters labeled with "Traditional Chinese Medicine" and "Community", etc. Researches on "constitution of traditional Chinese medicine" and "diabetes mellitus" are expected to become frontiers in this field. Conclusion Traditional Chinese medicine services in community health service institutions in China is in a period of stable development, however, there are still deficiencies in the richness of research methods, formation of collaborative networks with greater influence and scale. It is necessary to strengthen cooperation among community health service institutions, as well as the cooperation between universities and community health service institutions, by combining multidisciplinary research methods.

Introduction A prototype lateral flow device detecting cytokine biomarkers interleukin (IL)-1α and IL-1β has been developed as a point-of-care test—called the Genital InFlammation Test (GIFT)—for detecting genital inflammation associated with sexually transmitted infections (STIs) and/or bacterial vaginosis (BV) in women. In this paper, we describe the rationale and design for studies that will be conducted in South Africa, Zimbabwe and Madagascar to evaluate the performance of GIFT and how it could be integrated into routine care.Methods and analysis We will conduct a prospective, multidisciplinary, multicentre, cross-sectional and observational clinical study comprising two distinct components: a biomedical (‘diagnostic study’) and a qualitative, modelling and economic (‘an integration into care study’) part. The diagnostic study aims to evaluate GIFT’s performance in identifying asymptomatic women with discharge-causing STIs (Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG)) and BV. Study participants will be recruited from women attending research sites and family planning services. Several vaginal swabs will be collected for the evaluation of cytokine concentrations (ELISA), STIs (nucleic acid amplification tests), BV (Nugent score) and vaginal microbiome characteristics (16S rRNA gene sequencing). The first collected vaginal swab will be used for the GIFT assay which will be performed in parallel by a healthcare worker in the clinic near the participant, and by a technician in the laboratory. The integration into care study aims to explore how GIFT could be integrated into routine care. Four activities will be conducted: user experiences and/or perceptions of the GIFT device involving qualitative focus group discussions and in-depth interviews with key stakeholders; discrete choice experiments; development of a decision tree classification algorithm; and economic evaluation of defined management algorithms.Ethics and dissemination Findings will be reported to participants, collaborators and local government for the three sites, presented at national and international conferences, and disseminated in peer-reviewed publications.The protocol and all study documents such as informed consent forms were reviewed and approved by the University of Cape Town Human Research Ethics Committee (HREC reference 366/2022), Medical Research Council of Zimbabwe (MRCZ/A/2966), Comité d’Ethique pour la Recherche Biomédicale de Madagascar (N° 143 MNSAP/SG/AMM/CERBM) and the London School of Hygiene and Tropical Medicine ethics committee (LSHTM reference 28046).Before the start, this study was submitted to the Clinicaltrials.gov public registry (NCT05723484).Trial registration number NCT05723484.

Breast cancer is an illness that affects many women and can cause even death; this is a case of not being detected on time, which could be due to a human error during the analysis of radiographic images or not going on time in a health center. For this, using machine learning (ML) to analyze radiographic images is proposed as a support tool for radiologists aiming to reduce false diagnostic rates. While researching information, it was detected that this technology has many benefits in the health area; however, it also has limitations or disadvantages. The importance of this paper is to demonstrate that there are not enough clinical tests nor details about the methodologies that were used; there should be more to assert that ML is defined at the moment of making a diagnosis, which generates no conclusive results regarding effectiveness and therefore creates mistrust in doctors, and some people might rather use deep learning (DL) for its application in the detection of breast cancer because DL has more practical tests and fewer limitations than machine learning. [ABSTRACT FROM AUTHOR]

Cross-sectional study is one of the classic research design methods, which is widely used in clinical research. Cross-sectional study designs are used to answer a large number of scientific questions in general practice research. This includes not only the investigation of population health characteristics, disease characteristics or health service status, but also a variety of research scenarios such as the construction of disease screening and diagnosis methods for community people. Therefore, this paper will sort out and summarize the key points of cross-sectional research in the field of general medicine, and provide reference for future research work. In the field of general practice, cross-sectional studies can be used for status description, comparative analysis, correlation factor analysis and exploration of community screening diagnostic methods. The clinical development of cross-sectional studies should include two stages, study design and study implementation. The design stage includes accurate extraction of study objectives, defining clinical factors such as study population, study factors and outcome indicators, and determining the method of sample acquisition, determining the basis for sample size and rational statistical analysis strategies. In the implementation stage, complete research plan and case report form should be used to present research design ideas, and data collection should be carried out under the premise of ethical approval. Meanwhile, quality of data management and statistical analysis methods in the plan should be strictly implem.

Background Trauma is a highly prevalent and costly global health problem. Prevention and control of infection is a major challenge in the management of traumatic wounds, while prolonged absence of skin washing after trauma will increase the incidence of wound infection, as well as the discomfort. Although many patients are willing to take a bath after trauma, the timing and method of bathing remains unclear. Therefore, it is necessary to build an appropriate scheme of bathing with wounds to keep the skin and wounds clean. Objective To construct a bathing with wounds at home scheme suitable for patients with traumatic wounds in China, and to provide a feasible care scheme for keeping the skin of trauma patients clean and improving the outcome of wound healing. Methods Database at home and abroad were searched to obtain original literature, the first draft of the items of bathing with wounds at home scheme for patients with traumatic wounds was formulated through evidence-based analysis, generalization, group discussion. Fifteen wound care experts with associate or higher titles were included, and Delphi consultation was used to modify and improve the bathing with wounds scheme, with an interval of one week for each round of correspondences, the reliability of the consultation results was evaluated by the expert positive and authority coefficients. The consistency of the consultation results was evaluated by the coefficient of variation, a revised draft was formulated with terminated consultation when the coefficient of variation less than 0.25, which means that the expert opinions tend to be consistent. Thirty patients with traumatic wounds were enrolled in the pre-test, Likert 5-point scale was used to verify the convenience, safety and patient compliance of the bathing with wounds scheme, and the final scheme was developed after discussion and modification. Results After the inclusion of 23 related papers, the first draft of bathing with wounds scheme was developed through evidence-based analysis and discussion, involving three first-level items (including preparation befor bathing, bathing operation and treatment after bathing), seven second-level items, nine third-level items and four fourth-level items. The opinions of the 15 experts converged after 2 rounds of correspondence, with recall rates of 93.75% and 100.00%, with authority coefficients of 0.947 and 0.957, respectively. The variation coefficients of importance and maneuverability of each item in the first round were 0-0.25 and 0-0.23, and those in the second round were 0.09-0.18 and 0.07-0.14, respectively, a total of 2 items were deleted, 5 items were modified and 2 items were added, resulting in a revised draft. The 30 enrolled patients with traumatic wounds took baths (2.70±0.47) times per week according to the bathing scheme, with the average bath time of 10-15min, convenience and compliance scores of (4.67±0.48) and (4.70±0.47), and no bathing-related adverse events and wound infection occurred.The pre-test proved that the bathing plan was safe、reliable、simple and have good patient compliance. The final draft of the bathing with wounds scheme for traumatic wound patients included three first-level items, eight second-level items, nine third-level items and three fourth-level items. Conclusion In the construction process of the bathing with wounds scheme for traumatic wound patients, the positive and authority coefficients of experts are high, which has been unanimously approved by corresponding experts. The compliance of 30 patients with traumatic wounds in the pre-test was high, suggesting that the bathing with wounds scheme is safe and convenient, which can be applied to bathing with wounds at home for patients with traumatic wounds in China.

Background Acute ischemic stroke (AIS) is a serious cerebrovascular disease, which causes a heavy burden on society and patients. Ligustrazine injection has been widely used in the treatment of AIS with significant efficacy, but there is still a lack of direct or indirect comparison between ligustrazine injections. Objective To systematically evaluate the efficacy and safety of ligustrazine injection in the adjuvant treatment of AIS within 72 hours. Methods CNKI, Wanfang Data Knowledge Service Platform, VIP, PubMed, Cochrane Library, Embase, and Web of Science databases were searched for randomized controlled trials (RCTs) about the efficacy and safety of ligustrazine injection in the treatment of AIS from inception to April 2023. Literature was independently screened, extracted and quality assessed by 2 investigators using the Cochrane Evaluation Tool. RevMan 5.3, Stata 17, Addis and RStudio software were used to statistically compare and rank the efficacy and safety of different types of ligustrazine injection. Results A total of 71 papers involving 7 304 cases were included, and the interventions included Salvia Miltiorrhiza Ligustrazine Injection (DSCXQ), Shenxiong Glucose Injection (SXPTT), Xingxiong Sodium Chloride Injection (XXLHN), Ligustrazine Phosphate Injection (LSCXQ) and Ligustrazine Hydrochloride Injection (YSCXQ) combined with conventional western medical therapy (CT), respectively, and CT alone. Direct Meta-analysis results showed that in improving all the outcome indicators of AIS, the total effective rate, NIHSS score, fibrinogen level, and incidence of adverse reactions of ligustrazine injection combined with CT were better than those of CT alone (PYSCXQ+CT (0.20) >LSCXQ+CT (0.15) >DSCXQ+CT (0.03) >XXLHN+CT (0.02) >CT (0) ; the order of cumulative probability in improving NIHSS score was SXPTT+CT (0.55) >XXLHN+CT (0.26) >YSCXQ+CT (0.12) >DSCXQ+CT (0.07) >CT (0) ; the order of cumulative probability in reducing fibrinogen level was XXLHN+CT (0.32) >LSCXQ+CT (0.22) >DSCXQ+CT (0.17) >SXPTT+CT (0.15) >YSCXQ+CT (0.14) >CT (0) ; the order of cumulative probability in safety was SXPTT+CT (0.79) >XXLHN+CT (0.13) >CT (0.04) >DSCXQ+CT (0.03) >YSCXQ+CT (0.01) . Conclusion Ligustrazine injection is effective and safe in adjuvant treatment of AIS, among which Shenxiong glucose injection was the best in total effective rate and improving NIHSS scores, with the least adverse reactions; Xingxiong sodium chloride injection has the most advantages in fibrinogen level.

Traumatic central nervous system injury can cause imbalance in intestinal microenvironmental homeostasis by disrupting intestinal barrier function, while the disturbed intestinal microenvironment can react on the central nervous system and aggravate the secondary injury of it. A large number of studies suggest that the intestinal barrier plays an important role in the pathophysiological process of traumatic central nervous system injury and can be an important target for the action of central nervous system injury. This paper reviews the structural and functional changes of intestinal microbial, chemical, mechanical and immune barriers after traumatic central nervous system injury and their bidirectional interaction with the central nervous system, summarizes the possible mechanisms leading to the disruption of intestinal barrier, including malnutrition, ischemia-reperfusion injury, inflammatory response and the release of neurotransmitters and hormones, to provide theoretical basis and new ideas for the development of research on the intestinal microenvironment after traumatic central nervous injury.

Background Accessory breast plasma cell mastitis (PCM) is uncommon in clinical practice with rare reports. Objective To investigate the clinical characteristics, diagnostic methods and the traditional Chinese medicine (TCM) clinical efficacy of accessory breast PCM. Methods The clinical diagnosis and treatment data of 15 patients with accessory breast PCM admitted to Beijing Hospital of Traditional Chinese Medicine, Capital Medical University from January 2017 to December 2021 were analyzed retrospectively, the general information, diagnostic methods, treatment methods and outcomes of 15 cases with accessory breast PCM were summarized. Results A total of 15 female patients of childbearing age with accessory breast PCM were included in this paper, with onset within 2-5 years after pregnancy. The etiology was complex and the course of accessory breast PCM was protracted, which was similar to breast PCM in pathogenetic characteristics, using pathological examination results as gold standard for diagnosis. After the combination of internal and external treatment of TCM, the symptoms of 15 patients were relieved, local lesions disappeared, and there was no recurrence after six months of follow-up. Conclusion Accessory breast PCM is rare in clinical practice, which is easy to be misdiagnosed or missed, and difficult to be treated clinically. The combination of internal and external treatment of TCM has a significant effect on accessory breast PCM.

Chronic kidney disease-mineral and bone disorder (CKD-MBD) has a direct impact on patients' quality of life, hospitalization rates and fracture risk. In recent years, osteoblasts and osteoclasts have become central to the pathophysiology of CKD-MBD. Osteoblasts interact with other organs by synthesizing fibroblast growth factor-23 (FGF-23) and sclerostin (SOST), making the skeleton an endocrine organ. Therefore, dysregulation of osteoblast differentiation is an important early event in the pathogenesis of CKD. In this paper, we systematically discuss the metabolic pathways of osteoblasts and the mechanisms related to the altered metabolic reprogramming of osteoblasts in the early CKD-MBD pathology. This paper shows that abnormalities in signaling pathways and metabolites such as Wnt/β-catenin, FGF-23, uremic toxins, metabolic acidosis, can alter the metabolic activity of osteoblasts, causing impaired maturation of the osteogenic spectrum, which in turn affects bone remodeling, which will provide a new way of thinking for explaining the pathological changes in renal bone disease and developing clinical treatment options.

24-hour movement behaviors include physical activity, sedentary behavior and sleep. Domestic and foreign studies have found that the elderly generally have problems of low physical activity, sedentary behavior and insufficient sleep. Rational allocation of 24-hour movement behaviors has been demonstrated to be an important measure to improve adverse health outcomes in older adults, but the relevant research on 24-hour movement behaviors of the elderly is still in the exploratory stage. This paper reviews the concept, theoretical development and analytical methods of 24-hour movement behaviors and its relationship with adverse health outcomes in the elderly. In the future, relevant studies should be actively carried out to deeply explore and quantify the impact of 24-hour movement behaviors on health, develop a combination of 24-hour movement behaviors that can exert the maximum health benefits of the elderly, and develop accurate assessment tools, so as to promote active and healthy aging.

The standardized workflow of computer-aided static guided implant surgery includes preoperative examination, data acquisition, guide design, guide fabrication and surgery. Errors may occur at each step, leading to irreversible cumulative effects and thus impacting the accuracy of implant placement. However, clinicians tend to focus on factors causing errors in surgical operations, ignoring the possibility of irreversible errors in nonstandard guided surgery. Based on the clinical practice of domestic experts and research progress at home and abroad, this paper summarizes the sources of errors in guided implant surgery from the perspectives of preoperative inspection, data collection, guide designing and manufacturing and describes strategies to resolve errors so as to gain expert consensus. Consensus recommendation: 1. Preoperative considerations: the appropriate implant guide type should be selected according to the patient's oral condition before surgery, and a retaining screw-assisted support guide should be selected if necessary. 2. Data acquisition should be standardized as much as possible, including beam CT and extraoral scanning. CBCT performed with the patient’s head fixed and with a small field of view is recommended. For patients with metal prostheses inside the mouth, a registration marker guide should be used, and the ambient temperature and light of the external oral scanner should be reasonably controlled. 3. Optimization of computer-aided design: it is recommended to select a handle-guided planting system and a closed metal sleeve and to register images by overlapping markers. Properly designing the retaining screws, extending the support structure of the guide plate and increasing the length of the guide section are methods to feasibly reduce the incidence of surgical errors. 4. Improving computer-aided production: it is also crucial to set the best printing parameters according to different printing technologies and to choose the most appropriate postprocessing procedures.

Aspects of hypnosis and its application in psychotherapy, psychosomatics and medicine are examined and contextualized in the 250-year history of hypnosis. Imagination as an essential element of hypnotic treatments appeared as early as 1784 as an argument rejecting the theory of animal magnetism of Franz Anton Mesmer. In somnambulism of German romanticism, another proto-form of hypnosis after 1800, concepts of the mind–body problem were dealt with, which still characterize the understanding of unconscious mental processes today. Hypnosis was at the beginning of psychoanalysis, but was not pursued further by Sigmund Freud from 1900 onwards. Nevertheless, there were some hypnoanalytical approaches in the 20th century, as well as attempts to integrate hypnosis into behavior therapy. Techniques of imagination and relaxation combine both; in particular findings from cognitive psychology explain processes of both hypnosis and cognitive behavioral therapy. The influence of social psychology brought a new perspective to the debate about the nature of hypnosis, which continues to this day: is hypnosis to be understood as a special state of consciousness or is it a completely normal, mundane interaction? The experiments that were carried out to support one side or the other were also dependent on the hypnotizability of the subjects involved, as the more difficult hypnotic phenomena such as paralysis, hallucinations or identity delusions can only be demonstrated by highly hypnotizable subjects. The fact that these are not mere compliance reactions has now been proven by many studies using imaging techniques. But even those who are moderately hypnotizable benefit from hypnosis rituals. Variables postulated by socio-cognitive hypnosis researchers, such as motivation and expectation, are relevant, as is a good “hypnotic rapport.” Practical application of hypnotherapy today is characterized by the innovative techniques and strategies developed by Milton H. Erickson. Research into the effectiveness of hypnosis in the field of psychotherapy and psychosomatics still leaves much to be done. The situation is different in the field of medical hypnosis, where there are considerably more studies with a satisfactory design and verifiable effects. However, the impact in practical application in everyday medical practice is still low. Newer developments such as virtual reality and artificial intelligence are being looked at with critical interest. [ABSTRACT FROM AUTHOR]

Adherence is vital for medicine to have an effect, yet adherence is considered to be low, with approximately half of the patients not fully adherent. However, research into adherence tends to focus on quantitative analysis of performance, which fails to perceive how people are adherent in their many different environments. As a contribution to gaining a deeper understanding, interviews were held with thirty individuals in the UK, Egypt, Kazakhstan, and six countries in sub-Saharan Africa to understand their perceptions on adherence to a range of drugs, and these were compared with an existing well-regarded list. New or undocumented reasons for non-adherence were discovered. Reasons for non-adherence were consistent across both developing and developed worlds. A new viewpoint on adherence is suggested, which considers adherence to be a single act and therefore as an individual opportunity to be adherent, permitting greater focus on the enablers and inhibitors of adherence at any given point in time. [ABSTRACT FROM AUTHOR]

Introduction: The emergence of artificial intelligence (AI) chat programs has opened two distinct paths, one enhancing interaction and another potentially replacing personal understanding. Ethical and legal concerns arise due to the rapid development of these programs. This paper investigates academic discussions on AI in medicine, analyzing the context, frequency, and reasons behind these conversations. Methods: The study collected data from the Web of Science database on articles containing the keyword "ChatGPT" published from January to September 2023, resulting in 786 medically related journal articles. The inclusion criteria were peer-reviewed articles in English related to medicine. Results: The United States led in publications (38.1%), followed by India (15.5%) and China (7.0%). Keywords such as "patient" (16.7%), "research" (12%), and "performance" (10.6%) were prevalent. The Cureus Journal of Medical Science (11.8%) had the most publications, followed by the Annals of Biomedical Engineering (8.3%). August 2023 had the highest number of publications (29.3%), with significant growth between February to March and April to May. Medical General Internal (21.0%) was the most common category, followed by Surgery (15.4%) and Radiology (7.9%). Discussion: The prominence of India in ChatGPT research, despite lower research funding, indicates the platform's popularity and highlights the importance of monitoring its use for potential medical misinformation. China's interest in ChatGPT research suggests a focus on Natural Language Processing (NLP) AI applications, despite public bans on the platform. Cureus' success in publishing ChatGPT articles can be attributed to its open-access, rapid publication model. The study identifies research trends in plastic surgery, radiology, and obstetric gynecology, emphasizing the need for ethical considerations and reliability assessments in the application of ChatGPT in medical practice. Conclusion: ChatGPT's presence in medical literature is growing rapidly across various specialties, but concerns related to safety, privacy, and accuracy persist. More research is needed to assess its suitability for patient care and implications for non-medical use. Skepticism and thorough review of research are essential, as current studies may face retraction as more information emerges. [ABSTRACT FROM AUTHOR]

Objective To develop a computerized visuomotor integration system for assessment and training of visual perception impairments and evaluate its safety and feasibility in patients with a stroke. Visual field defects and spatial neglect lead to substantial poststroke impairment. Most diagnostic assessments are anchored in traditional methods, and clinical effects of rehabilitation treatments are limited. Methods The CoTras Vision system included two evaluations and four training modules. The evaluation modules were based on the Albert’s test and Star cancellation test, and training modules were based on visual tracking, central-peripheral integration, and visuomotor perception techniques. Bland–Altman plots for agreement with the traditional paper-and-pencil test were performed, and the modified Intrinsic Motivation Inventory, Patient Satisfaction Questionnaire, and Simulator Sickness Questionnaire were conducted. Results Ten patients with acute stroke completed the study. Bland–Altman plots revealed good agreements for Albert’s test (mean difference, -0.3±4.5) and Star cancellation test (mean difference, 0.3±0.7). The mean±standard deviation scores of the modified Intrinsic Motivation Inventory, Patient Satisfaction Survey, and Simulator Sickness Questionnaire were 84.7±30.6, 40.5±7.9, and 34.0±34.5 respectively. Conclusion The CoTras Vision system is feasible and safe in patients with stroke. Most patients had a high degree of motivation to use the system and did not experience severe adverse events. Further studies are needed to confirm its usefulness in stroke patients with visual field defects and hemineglect symptoms. Furthermore, a large, well-designed, randomized controlled trial will be needed to confirm the treatment effect of the CoTras Vision system.

Summary: Many people like to perceive themselves as better than previous generations: more knowledgeable, moral, tolerant and humane. Values associated with these aspects of ourselves may affect how we understand our professional forebears. In the early 20th century, some psychiatrists adopted new biomedical theories, including focal sepsis and eugenics, which resulted in inestimable harm. Detrimental clinical practices arose and were perpetuated in the context of societal values, medical ethics and other forces within and outside the medical profession. Historical understanding of the processes by which these things took place may help inform debate concerning current and future challenges of providing psychiatric care. The methods by which psychiatrists consider their predecessors may also have a bearing on how psychiatrists of the future will perceive us, the psychiatrists of the 2020s. [ABSTRACT FROM AUTHOR]

Abstract Background Diabetes recently has been identified as a growing epidemic. Although insulin’s vital role in both types of diabetes, it is considered one of the harmful medications if used incorrectly. In Egypt, effective usage of insulin remains a challenge due to insufficient knowledge of insulin and diabetes management, leading to errors in insulin therapy. As pharmacists are experts in pharmacological knowledge, they are uniquely situated to assess adherence to treatment regimens, the effect of drug therapy, or potential alterations in drug therapy to meet patient goals. To provide effective patient education and counseling, community pharmacists in Egypt should be efficiently knowledgeable about diabetes and insulin. Objective To identify the knowledge, attitude, and practice of pharmacists and patients about insulin. To identify pharmacists’ educational preparedness and confidence in counseling diabetic patients. Methods A descriptive, cross-sectional study was conducted with two knowledge, attitude, and practice surveys. This study was carried out from September 2016 to February 2023. Face-to-face interviews were conducted with patients, and a paper-based questionnaire was administered to pharmacists. The two questionnaires were adapted from previous studies. Results A total of 492 patients and 465 pharmacists participated in this study. The mean knowledge score of correct answers among patients and pharmacists was 10.67 ± 1.9 and 15 ± 3.6. Most of the patients and pharmacists had a positive attitude regarding insulin’s role in improving health and to better control blood glucose. On the negative side, around half of the patients reported that they believe that regular use of insulin leads to addiction, while only 14.5% of the pharmacists believed that insulin could cause addiction. Self-confidence scores for pharmacists differed statistically with sex, years of experience, and pharmacist’s direct exposure to diabetic patients. Conclusions This study uncovers considerable deficiencies in patients’ and pharmacists’ knowledge about insulin therapy. This study also strongly recommends higher education and a more structured pharmacist training schedule.

Abstract Background This paper investigates the perceptions of medical interns regarding the usefulness of non-mother tongue communication skills taught during the undergraduate curriculum at the University of Cape Town in South Africa. In 2003, the university decided to incorporate Afrikaans and IsiXhosa communication skills into the new MBChB curriculum in order to meet the Faculty of Health Sciences goals to promote quality and equity in healthcare, and to prepare graduating health practitioners for multilingual communities where they would be serving. Despite annual internal evaluations and reviews of the languages courses, the usefulness, if any, of the additional languages in the working clinical environment had not been determined. Methods Data were collected during the second year of medical internship across a five-year period through survey questionnaires, as well as focus group interviews conducted in the Western Cape, South Africa. Surveys were conducted from 2009 to 2013. Results The study shows that the usefulness of each of the probed categories was not consistent across both languages. The interns expressed a need for an overall improvement of the isiXhosa course offering, while the outcomes for the Afrikaans language were more positive across all categories except for cultural understanding. Conclusion The study indicates a positive trend amongst the interns towards developing usefulness in communication skills in Afrikaans and isiXhosa to communicate with their patients.

Abstract Background Feedback processes are crucial for learning, guiding improvement, and enhancing performance. In workplace-based learning settings, diverse teaching and assessment activities are advocated to be designed and implemented, generating feedback that students use, with proper guidance, to close the gap between current and desired performance levels. Since productive feedback processes rely on observed information regarding a student's performance, it is imperative to establish structured feedback activities within undergraduate workplace-based learning settings. However, these settings are characterized by their unpredictable nature, which can either promote learning or present challenges in offering structured learning opportunities for students. This scoping review maps literature on how feedback processes are organised in undergraduate clinical workplace-based learning settings, providing insight into the design and use of feedback. Methods A scoping review was conducted. Studies were identified from seven databases and ten relevant journals in medical education. The screening process was performed independently in duplicate with the support of the StArt program. Data were organized in a data chart and analyzed using thematic analysis. The feedback loop with a sociocultural perspective was used as a theoretical framework. Results The search yielded 4,877 papers, and 61 were included in the review. Two themes were identified in the qualitative analysis: (1) The organization of the feedback processes in workplace-based learning settings, and (2) Sociocultural factors influencing the organization of feedback processes. The literature describes multiple teaching and assessment activities that generate feedback information. Most papers described experiences and perceptions of diverse teaching and assessment feedback activities. Few studies described how feedback processes improve performance. Sociocultural factors such as establishing a feedback culture, enabling stable and trustworthy relationships, and enhancing student feedback agency are crucial for productive feedback processes. Conclusions This review identified concrete ideas regarding how feedback could be organized within the clinical workplace to promote feedback processes. The feedback encounter should be organized to allow follow-up of the feedback, i.e., working on required learning and performance goals at the next occasion. The educational programs should design feedback processes by appropriately planning subsequent tasks and activities. More insight is needed in designing a full-loop feedback process, in which specific attention is needed in effective feedforward practices.