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Background: Currently, there are few scales used to assess the stressors experienced by undergraduate nursing interns during clinical practice, and the assessment of stressors during clinical practice is not comprehensive; the scale includes some unique stressors during training that is not available in the existing instruments used to assess nursing student practice stress in China. Aim: The study aimed to explore the structure of the Chinese revision of the Student Nurse Stressor-14 Scale(SNS-14-CHI)and investigate the psychometric properties it among Chinese undergraduate nursing interns. Methods: The original scale was culturally adjusted and revised after expert correspondence on the entries, and 414 undergraduate nursing interns were recruited from three cities in China to administer the questionnaire. Reliability was measured by internal consistency, fold-half reliability, and stability. Content validity was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to assess the validity of the SNS-14-CHI. Results: The SNS-14-CHI retained 14 items, the EFA supported a 2-factor structure, and the items' factor attribution differed from the original scale. The CFA results showed a good model fit. The Cronbach coefficient of the scale was 0.934, and the coefficient values of the two factors were 0.890 and 0.898. The content validity index of the scale was 0.964.The cumulative variance contribution of the 2-factor structure was 60.445%. The split-half reliability and stability were 0.869,0.762, respectively. Conclusion: The SNS-14-CHI has excellent reliability and validity among undergraduate nursing trainees. The evaluation results of the scale can provide a reference for nursing managers to develop educational programs and interventions to quantify nursing student stress. [ABSTRACT FROM AUTHOR]

Hospice care is to improve the quality of life and help patients die comfortably, peacefully and dignified by controlling pain and discomfort symptoms and providing physical, psychological and spiritual care and humanistic care in the final stage of the patient's life. Hospice care clients were primarily cancer patients at first and then slowly extended to other critically patients. Hospice care can alleviate the physical, psychosocial and mental problems of patients with advanced cancer, meet the diversified and multi-level health service needs of patients, improve the quality of life of patients and their families, and also save medical expenditure and improve the efficiency of medical resources. At present, there were few studies on hospice care for Chinese patients with advanced cancer. In this study, the needs of hospice care for patients with advanced cancer were reviewed from physical comfort and pain reduction, dignity maintenance, social support, and help calm death, and specific screening and evaluation tools for hospice care for patients with advanced cancer. And this study was summarized to review the influencing factors of hospice care in order to provide a reference for clinical hospice care practice for patients with advanced cancer in China. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to identify the association of chronic polypharmacy and potentially inappropriate medications (PIMs) with adverse health outcomes (AHOs) in community-dwelling older adults with diabetes in China. Methods: A 2-year retrospective cohort study was conducted using 11,829 community-followed older adults with diabetes and medical records from 83 hospitals and 702 primary care centers in Shenzhen, China. Chronic polypharmacy and PIMs were identified from prescription records using Beers' criteria, and their associated AHO was analyzed using multivariable logistic regression analysis. Results: The prevalence of chronic polypharmacy and at least one PIM exposure was 46.37% and 55.09%, respectively. The top five PIMs were diuretics, benzodiazepines, first-generation antihistamines, sulfonylureas, and insulin (sliding scale). Chronic polypharmacy was positively associated with all-cause hospital admission, admission for coronary heart disease, admission for stroke, admission for dementia, and emergency department visits. Exposure to PIMs was positively associated with all-cause hospital admission, admission for heart failure (PIMs ≥2), admission for stroke (PIMs ≥3), emergency department visits, bone fracture, constipation, and diarrhea. Conclusion: Chronic polypharmacy and PIMs were prevalent in older adults with diabetes in Chinese communities. Iatrogenic exposure to chronic polypharmacy and PIMs is associated with a higher incidence of different AHOs. This observational evidence highlights the necessity of patient-centered medication reviews for chronic polypharmacy and PIMs use in older patients with diabetes in primary care facilities in China and draws attention to the caution of polypharmacy, especially PIM use in older adults with diabetes in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Extensive subcutaneous emphysema may lead to a significantly prolonged hospital stay, cosmetic problems, and even death without timely treatment. However, the risk factors for it have been poorly studied. Aim: To clarify the prevalence and risk factors of extensive subcutaneous emphysema after pulmonary resection by video-assisted thoracoscopic surgery. Material and methods: This is a retrospective matched case-control study. A sample of 86 cases and 258 matched controls was recruited from among 4339 patients admitted to the thoracic surgery department from October 2018 to October 2020 in a tertiary teaching hospital in China. Cases were patients who were diagnosed with extensive subcutaneous emphysema after pulmonary resection through video-assisted thoracoscopic surgery. Controls were matched in a ratio of 3: 1 to the cases based on age and sex. Results: In this study, the incidence rate of extensive subcutaneous emphysema was 2.05%, and approximately 75.58% of the cases occurred within 1 to 4 days postoperatively. In univariate analysis, patients with extensive subcutaneous emphysema were also likely to have a significant lower body mass index, worse pulmonary function, greater intraoperative blood loss, longer time of operation, history of lung surgery, wider scope of surgery, and more extensive pleural adhesion. The results of multivariate logistic regression showed that segmentectomy (OR = 3.130, 95% CI: 1.055-9.283, p = 0.040), lobectomy (OR = 4.487, 95% CI: 1.704-11.812, p = 0.002), and extensive pleural adhesion (OR = 4.514, 95% CI: 1.763-11.556, p = 0.002) were independent risk factors. Conclusions: Segmentectomy, lobectomy, and extensive pleural adhesions were identified as independent risk factors for extensive subcutaneous emphysema after video-assisted thoracoscopic surgery. [ABSTRACT FROM AUTHOR]

Background: The field of early rehabilitation has developed slowly in mainland China and there are limited data on the implementation of early mobilisation (EM) practice in intensive care unit (ICUs) in China. Aims: To investigate the implementation of EM in ICUs in mainland China and to analyse its influencing factors. Study design: A cross‐sectional electronic survey was conducted in 444 ICUs across 11 provinces in China. Head nurses provided data on institutional characteristics and EM practice in ICUs. Logistic regression models were used to identify factors associated with the implementation of EM. Results: In all, 56.98% (253/444) of ICUs implemented EM with comprehensive or complete implementation in 86 ICUs. Of the 191 ICUs that did not use EM, 136 planned to implement EM in the near future. Of the 253 ICUs that used EM, 21.34% of ICUs implemented EM for all eligible patients, while 24.90% would evaluate and carry out EM within 48 h after ICU admission, 39.13% had collaborative EM teams, 34.39% reported the use of EM protocols, 14.63% reported multidisciplinary rounds and 17.39% had medical orders and charging standards for all EM activities. Only 18.18% of ICUs conducted frequent professional training for EM, and abnormal events occurred in 15.41% of ICUs during EM practice. Multivariate logistic regression analysis revealed that an economically strong province, the presence of a dedicated therapist team, more ICU beds and a higher staff‐to‐bed ratio favoured the implementation of EM. Furthermore, multidisciplinary rounds, well‐established medical orders and charging standards, and a high frequency of professional training can lead to the comprehensive promotion and development of EM practice in ICUs. Conclusions: Both the implementation rate and quality of EM practice for critically ill patients require improvement. EM practice in Chinese ICUs is still nascent and requires development in a variety of domains. Relevance to clinical practice: To facilitate the implementation of EM in ICUs, more human resources, especially the involvement of a professional therapist team, should be deployed. In addition, health providers should actively organize multidisciplinary rounds and professional training and formulate appropriate EM medical orders and charging standards. [ABSTRACT FROM AUTHOR]

Aim: To investigate the levels of subjective well‐being in graduate nursing students, explore the impact of academic stress and resilience on subjective well‐being, and examine the mediation effect of resilience on the relationship between academic stress and subjective well‐being among graduate nursing students. Background: Few studies explore the impact of academic stress and resilience on subjective well‐being among graduate nursing students. Understanding the status of subjective well‐being and associated factors in graduate nursing students will enable the development of tailored interventions to improve their well‐being and academic achievements during graduation education. Design: A cross‐sectional design. Methods: Graduate nursing students were recruited by social media between April 2021 and October 2021, in China. Subjective well‐being was measured using the General Well‐Being Schedule, resilience by the Connor‐Davidson Resilience Scale, and academic stress through the Questionnaire of Assessing Academic Stress for graduate nursing students. Structural equation modelling was used to test the relationship among academic stress, resilience and subjective well‐being. Findings: The mean score of subjective well‐being for graduate nursing students was 76.37. The proposed model revealed a satisfied fit with the data. Academic stress and resilience were significantly related to subjective well‐being in graduate nursing students. Resilience partially mediated the relationship between academic stress and subjective well‐being, and the mediation effect accounted for 20.9% of the total effect of academic stress on the subjective well‐being. Conclusion: Academic stress and resilience affected subjective well‐being in graduate nursing students, while resilience partially mediated the relationship between academic stress and the subjective well‐being. No Patient or Public Contribution: This study did not involve patients, service users, caregivers or members of the public. [ABSTRACT FROM AUTHOR]

Lung cancer is the malignant tumor with the highest morbidity and mortality in China. Non-small cell lung cancer (NSCLC) is the main pathological subtype of lung cancer. On April 13, 2023, the National Comprehensive Cancer Network (NCCN) released the third edition of the 2023 NCCN Oncology Clinical Practice Guidelines: Non-small Cell Lung Cancer, which reflects the latest advances in international lung cancer research. This article will interpret the main updated contents of the new edition of the guidelines, and compare it with the third edition of the NCCN guidelines in 2022, so as to provide references about the diagnosis and treatment of NSCLC for clinical medical personnel in China. [ABSTRACT FROM AUTHOR]

Nonpharmacologic interventions are recommended to improve outcomes in dementia. Little is known about their prescription in practice, especially in non-Western populations. We investigated individual- and institution-level characteristics associated with nonpharmacologic interventions prescription in China. A multicenter observational study. This study used cross-sectional data from 889 community-dwelling outpatients living with dementia aged ≥45 years from a multicenter registry of 28 memory clinics in China. Prescription records of nonpharmacologic interventions, carer and clinic characteristics, and reasons for declining interventions were collected. Multilevel logistic regression was used to identify factors associated with the prescription. Nonpharmacologic interventions were prescribed in 323 people (36.3%) with mild cognitive impairment or dementia. Cognitive activities and carer training/support were the most prescribed interventions. Multilevel logistic regression showed that 73% of the variance in prescription was attributed to institutional characteristics of the memory clinic. Greater caregiving gain [odds ratio (OR), 1.05; 95% CI, 1.02-1.09], lower burden (OR, 0.97; 95% CI, 0.95-1.00), worse carer-perceived dyad relationship (OR, 0.83; 95% CI, 0.70-0.99), and family history of dementia (OR, 2.08; 95% CI, 1.19-3.65) were individual-level factors associated with prescription. Among 440 people considered having a need but received no prescription, declined by user/carer was the main reason for not prescribing (70.7%). Skepticism about effectiveness by physicians/carers and carers being unable or lacking resources to use the interventions were the common reasons given. A relatively low prescription rate of nonpharmacologic interventions is related to both individual- and institution-level factors. Carer support and education, instrumental support, and prescription guidelines across specialties and sites are possible strategies to improve access to nonpharmacologic interventions in dementia care. [ABSTRACT FROM AUTHOR]

Aim: Unsafe medication behaviour was the direct cause of medication error, while the current status of unsafe medication behaviour among Chinese clinical nurses remains uncertain. To investigate unsafe medication behaviour among Chinese nurses and to analyse its associated factors. Design: A cross‐sectional online study was conducted in 31 provinces and municipalities of mainland China. Methods: The electronic self‐administered questionnaire was used to collect data from July–August 2020, including demographic information (age, gender, initial degree, ultimate education degree, hospital levels, unit nature, professional position, duty, departments, working years and working regions) and an adapted nurse unsafe medication behaviour scale measuring self‐reported nurse unsafe medication behaviour (SR‐NUMB). A generalized linear mixed model was applied to determine the influencing factors. Results: A total of 10,153 Chinese nurses responded online, and 7,873 responses that met the time control requirements were included finally. It turned out that 80.49% of Chinese nurses had SR‐NUMB. Specifically, 72.81% of them had unsafe medication behaviours in the process of medication administration, followed by medication monitoring (53.09%), medication preservation and dispensing (47.42%), and medical order processing (44.53%). A generalized linear mixed model demonstrated that male nurses and nurses who work in secondary hospitals or general hospitals, those who have higher professional positions or duties, those who have been working for 5–10 years, and those who are working in emergency and intensive critical units may have higher level of SR‐NUMB compared to other nurses. Conclusion: Suboptimal SR‐NUMB among Chinese nurses was identified in our findings. Associated factors, such as gender, hospital levels, unit nature, professional position, duty, working years and departments, should be targeted in future prevention and intervention efforts for safe medication management among Chinese nurses. [ABSTRACT FROM AUTHOR]

Background: Migraine is a prevalent and debilitating neurological disorder which presents a major public health burden globally. Research on characteristics, disease burden, and treatment patterns in EM patients in China is limited. Methods: Data were drawn from an existing data set Adelphi Migraine DSP, a point-in-time survey conducted in China (January-June 2014). Internists/neurologists completed patient record forms for the next 9 patients who consulted them in clinical practice; these same patients completed the 'patient self-completion questionnaires'. Descriptive analyses were used to assess key variables: patient demographics, treatment patterns (current acute and preventive medication [AM/PM]), effectiveness, issues with existing treatment, Migraine Disability Assessment (MIDAS) scores, and Work Productivity and Activity Impairment scores. Results: Total of 125 internists/neurologists provided data on 1113 patients with EM (headache days/month < 15). Mean (standard deviation [SD]) age was 43.8 (13.1) years; mean (SD) number of migraine days/month was 3.2 (1.7). AM was prescribed in 86.1% of patients (non-steroid anti-inflammatory drugs [NSAIDs]: 62.7%; triptans: 7.7%), PM in 38.5%, and both in 24.9% of patients. Approximately 55% of patients experienced ≥ 1 issue with their current AM or PM. Migraine-related symptoms (including nausea, photophobia, and phonophobia) were fully controlled in < 50% of patients receiving NSAIDs (21.7– 38.4%) or triptans (32.4– 43.5%). Insufficient response to current AM (migraine headache fully resolved within 2 hours in ≤ 3/5 attacks) was reported by 42.5% of patients. Mild-to-severe disability was reported by 36.8% of patients with a mean (SD) MIDAS score of 5.8 (7.3). Overall, 58.0% of work time was impaired (including time missed and impairment while working). Conclusion: This analysis suggests, despite existing treatment options, disease burden and unmet medical needs remain substantial in Chinese patients with EM. [ABSTRACT FROM AUTHOR]

Background: The effective transfer of knowledge and skills is the primary goal of nursing education. Despite this, little is known about how knowledge and skills gained through international collaborative nursing educational programs is applied by nurses., Objectives: To describe the experiences of knowledge and skills transfer among nursing graduates from an international collaborative educational program to their clinical practice and ongoing study., Methods: A qualitative design was employed for this study. In 2023, fifteen interviews were conducted with nursing graduates from a Chinese-Swedish collaborative nursing educational program at Lishui University in eastern China. Directed content analysis was utilized to analyze the interview data., Results: Nursing graduates gained both knowledge and skills that surpassed the educational goals of the international collaborative program. Throughout the application and transfer of knowledge and skills, participants reported both positive and negative experiences. Notably, a gap persisted between basic nursing theoretical knowledge and clinical practice. Additionally, deficiencies were identified in the transfer of nursing research knowledge, indicating areas for improvement in future nursing education., Conclusion: The findings suggest that knowledge and skills from an international collaborative nursing educational program can be successfully transferred to clinical nursing practice and postgraduate study. However, addressing the gap between theoretical knowledge and practice, particularly in updated basic nursing knowledge and practice, is essential. Furthermore, there is a need to enhance awareness and attitudes towards nursing research among nurses, emphasizing the importance of continuous learning., Competing Interests: Declaration of competing interest No conflict of interest has been declared by the authors., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Nursing students are one of the most vulnerable groups suffering from workplace violence. This study aimed to investigate the workplace violence incidence of Chinese nursing students during clinical practice, to describe the characteristics of violence and students' responses and to analyse the relationship between the experience of workplace violence and professional identity. Methods: A cross-sectional study was conducted among 954 nursing students in ten universities in China through convenience sampling. Workplace violence was surveyed through Hospital Workplace Violence Questionnaire for Nursing Students. Students' professional identity was measured by Professional Identity Questionnaire for Nursing Students. Statistical methods included descriptive statistics, chi-square test, independent-samples t-test, analysis of variance and linear regression analysis. Results: It was found that the incidence of workplace violence among nursing students was 42.98%. The violent incidents ranking from high to low were: verbal abuse, threat, physical attack, sexual harassment, and gathering disturbance. The majority of the nursing students chose to avoid the conflict during the incident. 86.34% of the students didn't report the incidents. More than half of the victims developed post-traumatic stress disorder after the incidents. Regression analysis results showed that workplace violence experience (β = − 0.076, P < 0.05) was a significantly negative predictor of professional identity. Conclusions: Chinese nursing students were exposed to physical and psychological violence during clinical practice with insufficient coping solutions and psychological adjustment. The professional identity of the nursing students was significantly associated with the experience of workplace violence. [ABSTRACT FROM AUTHOR]

Background: Neonatal survival is a public health concern globally. However, the regional disparity in neonatal mortality between rural counties of western China and urban areas of eastern provinces remains high. Early essential newborn care (EENC), recommended by World Health Organization, refers to a set of cost-effective interventions to improve neonatal health and development outcomes. In this study, we aimed to explore the effectiveness of EENC implementation in four counties of western China.Methods: Pre- and post-intervention investigations were conducted in four selected EENC intervention counties and four control counties of four western provinces of China, from June to August 2017 and from December 2020 to April 2021 respectively. A mixed quantitative and qualitative approach was used for data collection and analysis. Data on the coverage of EENC practices were collected via a post-intervention face-to-face questionnaire survey with postpartum mothers before hospital discharge. Hospital-reported data on neonatal health indicators were obtained through mail surveys in both investigations. We also performed semi-structured interviews with policymakers, health staff and postpartum mothers to understand their perceptions about the usefulness of EENC implementation.Results: Overall, 599 mother-newborn pairs in the intervention group and 699 pairs in the control group participated in the post-intervention survey. Controlling for the confounding factor of province, the proportion of newborns receiving EENC interventions was higher in the intervention group than in the control group (P < 0.05). Intervention groups in four provinces had higher coverage of: any skin-to-skin contact (99.50% vs. 49.07%); early breastfeeding initiation (within 60 min of birth) (90.84% vs. 80.35%); no medicine applied to the umbilical cord (98.50% vs. 9.73%); routine eye care (93.16% vs. 8.73%); and vitamin K1 administration (98.33% vs. 88.98%). EENC implementation was associated with decreased risk of neonatal diarrhea (OR: 0.326, 95% CI: 0.123, 0.865) and eye infection (OR: 0.147, 95% CI: 0.045, 0.483). Policymakers, health staff and postpartum mothers expressed satisfaction with the EENC interventions, noting a willingness among staff and policymakers to implement and sustain these interventions; the promotion of these interventions within hospital policy; the positive emotions experienced by postpartum mothers; perceived improvements in health; and improvements in support for health workers.Conclusion: EENC-recommended core practices (except kangaroo mother care) have been successfully introduced in pilot hospitals. The efficacy of EENC implementation should be highly recognized to accelerate the progress towards its national roll out. [ABSTRACT FROM AUTHOR]

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Background: Machine learning (ML) risk prediction models, although much more accurate than traditional statistical methods, are inconvenient to use in clinical practice due to their nontransparency and requirement of a large number of input variables., Objective: We aimed to develop a precise, explainable, and flexible ML model to predict the risk of in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI)., Methods: This study recruited 18,744 patients enrolled in the 2013 China Acute Myocardial Infarction (CAMI) registry and 12,018 patients from the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE)-Retrospective Acute Myocardial Infarction Study. The Extreme Gradient Boosting (XGBoost) model was derived from 9616 patients in the CAMI registry (2014, 89 variables) with 5-fold cross-validation and validated on both the 9125 patients in the CAMI registry (89 variables) and the independent China PEACE cohort (10 variables). The Shapley Additive Explanations (SHAP) approach was employed to interpret the complex relationships embedded in the proposed model., Results: In the XGBoost model for predicting all-cause in-hospital mortality, the variables with the top 8 most important scores were age, left ventricular ejection fraction, Killip class, heart rate, creatinine, blood glucose, white blood cell count, and use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs). The area under the curve (AUC) on the CAMI validation set was 0.896 (95% CI 0.884-0.909), significantly higher than the previous models. The AUC for the Global Registry of Acute Coronary Events (GRACE) model was 0.809 (95% CI 0.790-0.828), and for the TIMI model, it was 0.782 (95% CI 0.763-0.800). Despite the China PEACE validation set only having 10 available variables, the AUC reached 0.840 (0.829-0.852), showing a substantial improvement to the GRACE (0.762, 95% CI 0.748-0.776) and TIMI (0.789, 95% CI 0.776-0.803) scores. Several novel and nonlinear relationships were discovered between patients' characteristics and in-hospital mortality, including a U-shape pattern of high-density lipoprotein cholesterol (HDL-C)., Conclusions: The proposed ML risk prediction model was highly accurate in predicting in-hospital mortality. Its flexible and explainable characteristics make the model convenient to use in clinical practice and could help guide patient management., Trial Registration: ClinicalTrials.gov NCT01874691; https://clinicaltrials.gov/study/NCT01874691., (©Jingang Yang, Yingxue Li, Xiang Li, Shuiying Tao, Yuan Zhang, Tiange Chen, Guotong Xie, Haiyan Xu, Xiaojin Gao, Yuejin Yang. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 30.07.2024.)

BACKGROUND The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) (US) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults expanded the definition of hypertension and now considers atherosclerotic cardiovascular disease (ASCVD) risk in determining treatment for people with hypertension. US guidelines are influential around the world and it is therefore justified to study their impact in other settings. Our study determined the impact of adopting the 2017 ACC/AHA guideline in China. METHODS We analyzed the population impact of the 2017 ACC/AHA guideline using the 2011–2012 year of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative sample of Chinese adults 45–74 years of age (n = 11,822). Our analysis was unique because for the first time it used a population-appropriate equation to calculate ASCVD risk instead of the US Pooled Cohort Equation (the latter misrepresents risk in non-US populations). RESULTS Adopting the 2017 ACC/AHA guideline in China would increase the prevalence of hypertension from 44.1% to 56.4% (12.3 percentage points) and increase the number of adults recommended for antihypertensive medication from 41.6% to 49.1% (7.5 percentage points) in the 45–74-year age range. According to Chinese (but not US) risk calculations, the 2017 ACC/AHA guideline more selectively assigns antihypertensive medication to patients at higher risk for ASCVD. CONCLUSIONS The 2017 ACC/AHA guideline brings potential for risk reduction in China and selectively recommends medication for those who would benefit most. Realizing such benefits would ultimately depend on the acceptance, adherence, and feasibility of adopting this guideline. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has altered clinical practice and education in manual therapy globally. Social distancing has limited in-person care and changed health-care provision. Education in manual therapy has moved to online platforms with in-person instruction restricted. The global impact on the clinical practice of manual therapy and education has to date not been explored. a questionnaire survey methodology was used. A sample of convenience of global leaders in manual therapy practice and education received an electronic link to two surveys: one on clinical practice and one on education. Contributors could complete one or both surveys. Twenty-five surveys were received on clinical practice and 23 on education in manual therapy, representing the six major continents. Global themes in clinical practice demonstrated a sudden and dramatic shift away from patient contact, with limited modifications to manual therapy in patient care currently adopted. Themes in education were of a major shift to online learning, development of new modes of student instruction including video-based assessment and virtual case-based instruction. The international perspectives provided demonstrate a major change in manual therapy practice and education globally. Various approaches have been taken in practice and education without a uniform approach being demonstrated. [ABSTRACT FROM AUTHOR]

Background: Compassion has long been advocated as a fundamental element in nursing practice and education. However, defining and translating compassion into caring practice by nursing students who are new to the clinical practice environment as part of their educational journey remain unclear. Objectives: The aim of this study was to explore how Chinese baccalaureate nursing students define and characterize compassionate care as they participate in their clinical practice. Methods: A descriptive qualitative study design was used involving a semi-structured in-depth interview method and qualitative content analysis. Twenty senior year baccalaureate nursing students were interviewed during their clinical practicum experience at four teaching hospitals. Ethical considerations: Permission to conduct the study was received from the Institutional Review Boards and the participating hospitals. Results: Baccalaureate nursing students defined and characterized compassionate care as a union of "empathy" related to a nurse's desire to "alleviate patients' suffering," "address individualized care needs," "use therapeutic communication," and "promote mutual benefits with patients." Students recognized that the "practice environment" was characterized by nurse leaders' interpersonal relations, role modeling by nurses and workloads which influenced the practice of compassionate care by nursing personnel. Conclusion: Compassionate care is crucial for patients, nurses, and students in their professional development as well as the development of the nursing profession. In order to provide compassionate care, a positive practice environment promoted by hospital administrators is needed. This also includes having an adequate workforce of nurses who can role model compassionate care to students in their preceptor role while meeting the needs of their patients. [ABSTRACT FROM AUTHOR]

Clinical cure (herein referred to as functional cure) is currently recognized as the ideal therapeutic goal by the guidelines for the prevention and treatment of chronic hepatitis B (CHB) at home and abroad. China has achieved significant results in research and exploration based on pegylated interferon alpha therapeutic strategies to promote the effectiveness of CHB clinical cure rates in clinical practice. The summary and optimization of clinical cure strategies in different clinical type classifications, as well as the exploration of clinical cure continuity and long-term outcomes, are of great significance for solving the current bottleneck problem and our future efforts in the developmental directions of clinical cure in CHB populations.

Background: Ventricular tachycardia (VT) diagnosis is challenging due to the similarity between VT and some forms of supraventricular tachycardia, complexity of clinical manifestations, heterogeneity of underlying diseases, and potential for life-threatening hemodynamic instability. Clinical decision support systems (CDSSs) have emerged as promising tools to augment the diagnostic capabilities of cardiologists. However, a requirements analysis is acknowledged to be vital for the success of a CDSS, especially for complex clinical tasks such as VT diagnosis., Objective: The aims of this study were to analyze the requirements for a VT diagnosis CDSS within the frameworks of knowledge and practice and to determine the clinical decision support (CDS) needs., Methods: Our multidisciplinary team first conducted semistructured interviews with seven cardiologists related to the clinical challenges of VT and expected decision support. A questionnaire was designed by the multidisciplinary team based on the results of interviews. The questionnaire was divided into four sections: demographic information, knowledge assessment, practice assessment, and CDS needs. The practice section consisted of two simulated cases for a total score of 10 marks. Online questionnaires were disseminated to registered cardiologists across China from December 2022 to February 2023. The scores for the practice section were summarized as continuous variables, using the mean, median, and range. The knowledge and CDS needs sections were assessed using a 4-point Likert scale without a neutral option. Kruskal-Wallis tests were performed to investigate the relationship between scores and practice years or specialty., Results: Of the 687 cardiologists who completed the questionnaire, 567 responses were eligible for further analysis. The results of the knowledge assessment showed that 383 cardiologists (68%) lacked knowledge in diagnostic evaluation. The overall average score of the practice assessment was 6.11 (SD 0.55); the etiological diagnosis section had the highest overall scores (mean 6.74, SD 1.75), whereas the diagnostic evaluation section had the lowest scores (mean 5.78, SD 1.19). A majority of cardiologists (344/567, 60.7%) reported the need for a CDSS. There was a significant difference in practice competency scores between general cardiologists and arrhythmia specialists (P=.02)., Conclusions: There was a notable deficiency in the knowledge and practice of VT among Chinese cardiologists. Specific knowledge and practice support requirements were identified, which provide a foundation for further development and optimization of a CDSS. Moreover, it is important to consider clinicians' specialization levels and years of practice for effective and personalized support., (©Zhao Hu, Min Wang, Si Zheng, Xiaowei Xu, Zhuxin Zhang, Qiaoyue Ge, Jiao Li, Yan Yao. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 26.03.2024.)

Background: Before tyrosine kinase inhibitor (TKI) therapy can be administered in patients with advanced non‐small cell lung cancer (NSCLC), EGFR mutation testing is required. However, few studies have evaluated the extent of EGFR testing in real‐world practice in China. Methods: A multicenter, observational study of EGFR testing in NSCLC patients in North China was conducted. Treatment‐naïve patients or those with postoperative recurrent stage IIIB/IV NSCLC were enrolled. The primary objective was EGFR testing rate. Secondary objectives included EGFR mutation status, EGFR testing methods and specimens, factors associated with EGFR testing, and overall survival with or without EGFR testing. Results: Overall, 2809 patients with stage IIIB/IV NSCLC were enrolled; 90.78% had adenocarcinoma. The EGFR screening rate was 42.54%. EGFR testing rates were higher in tumor samples obtained by lymph node puncture, and in patients with urban medical insurance, adenocarcinoma, non‐smokers, or those located in developed cities (all P < 0.001). The EGFR mutation rate was 46.44%. The most commonly used specimens for EGFR testing were biopsy tumor samples (67.53%). PCR‐based methods (72.05%), Sanger sequencing (5.36%), and Luminex liquid chip (5.10%) were the most frequently used testing platforms. Similar positive EGFR mutation rates were achieved with different platforms. TKI therapy was the first‐line treatment administered to most EGFR‐positive patients (56.22%), and chemotherapy in EGFR‐negative patients (84.88%). Overall survival was higher in EGFR‐tested than in untested patients (27.50 vs. 19.73 months; P = 0.007). Conclusion: Real‐world EGFR testing rates for NSCLC in North China were relatively low because of clinical and social factors, including medical insurance coverage. [ABSTRACT FROM AUTHOR]

Lung cancer is the malignant tumor with the highest morbidity and mortality in China. Non-small cell lung cancer (NSCLC) is the main pathological subtype of lung cancer. On April 13, 2023, the National Comprehensive Cancer Network (NCCN) released the third edition of the 2023 NCCN Oncology Clinical Practice Guidelines: Non-small Cell Lung Cancer, which reflects the latest advances in international lung cancer research. This article will interpret the main updated contents of the new edition of the guidelines, and compare it with the third edition of the NCCN guidelines in 2022, so as to provide references about the diagnosis and treatment of NSCLC for clinical medical personnel in China.
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Fracture is one of the common diseases in the department of orthopaedics and traumatology. Jiegu Qili Tablets(Capsules) are a Chinese patent medicine commonly used to treat fractures in clinical practice, which has been included in the Class A drugs of the catalog of medicines covered by the National Medical Insurance System. However, no consensus or guideline has yet been developed to guide clinicians based on an evidence-based approach in detail, which has severely limited the clinical value of this drug. According to the guiding principle of evidence as the key, consensus as the supplement, and experience as the reference, a consensus was developed in strict accordance with the steps stipulated in the expert consensus on clinical applications of proprietary Chinese medicines. Based on literature review and questionnaire survey, the consensus was a timely summary of the existing clinical evidence on the treatment of fractures with Jiegu Qili Tablets(Capsules), and incorporated the treatment experience of a number of clinical experts. The preparation process took more than a year and the consensus(GS/CACM 293-2021) was officially released by the China Association of Chinese Medicine in September 2021, with the participation of multidisciplinary experts from 27 organizations of Chinese and Western medicine and research institutions. This article introduces the background and objectives of the consensus in detail, and describes the main process of proposal, drafting, expert consensus, and consultation. In particular, 5 consensus recommendations and 12 consensus suggestions are formed with regard to the key issues of indications, treatment timing, dose, duration, and safety in the clinical application of Jiegu Qili Tablets(Capsules) for the treatment of fractures, which guide and standardize the rational use by clinicians and improve the accuracy and safety of drugs.

This work aims to evaluate the stressful effects of clinical learning environments on nursing students and to better understand the importance of reducing anxiety. Ninety-two female nursing students were randomly recruited. State Anxiety Inventory ( SAI), General Self- Efficacy scale ( GSES), Social Support Rating Scale ( SSRS), General Maladjustment Scale ( GM), Pittsburgh Sleep Quality Index, the personal information questionnaire were administered along with an immune-endocrine profile, red blood cells and plasma cortisol. The nursing students' state and trait anxiety scores were significantly higher in clinic than in school. With one-way ANOVA, nursing students from rural areas, not liking nurse work and being pessimistic to employment prospects, and not being assigned in an ideal teaching hospital had higher scores of SAI. High levels of anxiety were associated with low scores of GSES, objective support of SSRS and high scores of GM. Additionally, the subjects' anxiety related to poor sleep quality, and students with high levels of anxiety showed a significantly lower percentage of CD3 and CD4. In conclusion, clinical practice can raise nursing students' State- Trait Anxiety Inventory scores. The level of anxiety is related to some internal and external factors. Severe anxiety not only affects student's physical and mental health and successful practice, but also reduces T lymphocyte immune functions. [ABSTRACT FROM AUTHOR]

Most of the neuroendocrine tumors(NETs) overexpress the somatostatin receptor(SSTR),which provides a reliable target for SSTR-targeted peptide receptor radionuclide therapy(PRRT).Compared with drug therapy,PRRT has high objective response rate and significantly prolongs patients' survival.Moreover,the patients have good tolerance to this therapy.Considering that PRRT is in clinical trial phase in China,this article elaborates on the selection and preparation of patients,pre-treatment medications,administration methods,treatment cycles,side effects,follow-up plan,and the combination of PRRT with other drugs based on the published international guidelines in this field and our experience from clinical practice.Hoping that relevant professionals can well understand the principle of PRRT and apply it in clinical practice,we write this article to provide a basis for serving real-world patients and carrying out clinical trials.

Adherence to antihypertensive medications represents a crucial success factor for optimal blood pressure (BP) control in clinical practice. This study evaluated whether an additional pharmacist-led medication counseling could achieve better optimal BP control and enhance compliance. In a designated family clinic in a region with similar resident characteristics to Hong Kong, patients taking ≥ one antihypertensive agent with suboptimal compliance were randomly allocated to a brief 3-minute drug advice (control; n = 161) or pharmacist counseling (intervention; n = 113). The two groups were compared by repeated measure ANOVA at 3-months and 6-months with BP control and medication compliance as outcome variables, respectively. The proportions of patients having optimal compliance increased from 0% to 41.1% at 3 months and 61.9% at 6 months ( P < 0.001). The proportion of patients having optimal BP control improved from 64.1% at baseline to 74.0% at 3 months and 74.5% at 6 months ( P = 0.023). There were no significant differences between the two groups in the changes of BP control and compliance levels. This study implied that even a brief 3-minute drug advice might lead to improved BP levels among patients on antihypertensive medications in general practice, but did not demonstrate additional effects by pharmacist counseling. [ABSTRACT FROM AUTHOR]

The article presents a study which aims to establish a back propagation artificial neural network for screening community Alzheimer's disease in China. The use of scores of activities of adaily living (ADLs), creatinine and dopamine as input variables is highlighted. According to the study, the diagnostic method is satisfactory for screening Alzheimer's disease.

Background Stroke is a major health issue in China. Aims We aimed to describe the management of patients admitted to hospitals in China with acute ischaemic stroke, and to determine whether there were any differences by age and gender. Methods Using a multicentre prospective hospital register across all eight major economic (geographic) regions in China, data on the socioeconomic characteristics, medical history, clinical features, and in-hospital investigations, management, and outcomes were collected on consecutive patients with acute stroke due to cerebral ischaemia during a 5-month period in 2006. Results Overall, traditional Chinese medicine and neuroprotectant use were remarkably high, with nearly 80% of patients receiving the former and >70% receiving the latter in hospital. Length of hospital stay was also long (median duration 16-days). Multivariate analyses revealed no clinically important differences in management between the genders. For the age-specific analyses, there were significant trends of decreasing use of thrombolysis ( P=0·04), warfarin ( P=0·01), corticosteroids ( P=0·03), and lipid-lowering therapy ( P=0·001); however, more assisted feeding ( P=0·004) and rising rates of disability and in-hospital complications occurred with increasing age. Conclusions New information is provided regarding the current state of ischaemic stroke management in China. Notably, there is high use of traditional Chinese medicine and neuroprotectants and long lengths of hospital stay. Similar to many other countries, differences in stroke care and management by age and gender also exist to a small extent in China. [ABSTRACT FROM AUTHOR]

Over the past 20 years, emergency medicine (EM) in China has been through a period of rapid development. This included the formal establishment of professional association of EM in 1986 and the establishment of ED in all county-level hospitals across the country in the late 1990s. In line with the rapid economic development of China, ED have been equipped with appropriate ‘hardware’ equipment, but the ‘software’ part of the ED system remains underdeveloped. Doctors do not usually work exclusively in ED, but on a rotational basis, while also working as specialists in their own departments, such as medicine and surgery. EM in China remains underdeveloped, at least partly, for two main reasons: the current financial status of the health-care system and lack of sufficient numbers of qualified EM specialists. Chinese education and training systems are now beginning to produce high-quality emergency specialists, although there is not yet consistency across all courses. In Australia, the specialty of EM is well developed and, as such, this country is well placed to contribute to the development of ED in China. [ABSTRACT FROM AUTHOR]

Reframing can be an effective tool in enhancing a clinical practice that is based on a holistic understanding of the client's meaning systems, and the strengths and resilience exemplified in the client's life experience. Immigrant clients, who are often marginalized in society due to their markedly different sociocultural backgrounds and the pernicious effects of racism, tend to struggle with belief systems that are subjugated by those of the host country and internalize their losses and setbacks as personal deficits and failures. Two case vignettes of Chinese immigrants will be used to discuss how reframing can offer positive yet culturally relevant options for clients to create new meanings and adaptive behavior in their life situations. [ABSTRACT FROM PUBLISHER]

thompson d.r., lopez v., lee d. & twinn s. (2004) Journal of Clinical Nursing 13, 131–135 SARS – a perspective from a school of nursing in Hong Kong Severe acute respiratory syndrome (SARS) is a new infectious disease with significant morbidity and mortality that has had a major impact on health and health care services worldwide. Hong Kong has had a significant number of cases and deaths. Nurses, at the vanguard of the clinical health care team, have been particularly affected by it. The outbreak prompted the health authorities to implement a series of public health measures and hospital policies, including a guideline for the diagnosis and management of patients with SARS. This paper aims at providing an overview of what is known about SARS and the impact it has had in Hong Kong and to highlight from the perspective of a school of nursing the major clinical, educational and public health implications. The lack of understanding and uncertainty about the disease led to significant variation in the provision of information, contributing to the confusion and anxiety in the community. Therefore, there is a need to revise the nursing curriculum, to provide continuing education to all health care professionals, particularly with regard to infection control measures, and to revisit the range of public health policies to ensure the health of the community is protected by these policies. There also has been a reaffirmation of the importance of health promotion that highlights the importance of the partnership between nurses, health policy makers and public health personnel. It is evident that the organization and delivery of clinical practice, teaching and health promotion have to be flexible and responsive to a changing health scenario. Nurses must play a crucial role in the prevention, detection and containment of SARS. They will need to implement and ensure strict adherence to infection control measures and, in some circumstances, isolation and quarantine may be warranted. Attention to the psychological state of patients and family members should not be overlooked. Paramount is education of patients, families and members of the public at large. [ABSTRACT FROM AUTHOR]

Different newborn screening (NBS) programs have been practiced in many countries since the 1960s. It is of considerable interest whether next-generation sequencing is applicable in NBS. We have developed a panel of 465 causative genes for 596 early-onset, relatively high incidence, and potentially actionable severe inherited diseases in our Newborn Screening with Targeted Sequencing (NESTS) program to screen 11,484 babies in 8 Women and Children's hospitals nationwide in China retrospectively. The positive rate from preliminary screening of NESTS was 7.85% (902/11,484). With 45.89% (414/902) follow-up of preliminary positive cases, the overall clinically confirmative diagnosis rate of monogenic disorders was 12.07% (50/414), estimating an average of 0.95% (7.85% × 12.07%) clinical diagnosis rate, suggesting that monogenic disorders account for a considerable proportion of birth defects. The disease/gene spectrum varied in different regions of China. NESTS was implemented in a hospital by screening 3923 newborns to evaluate its clinical application. The turn-around time of a primary report, including the sequencing period of < 7 days, was within 11 days by our automatic interpretation pipeline. Our results suggest that NESTS is feasible and cost-effective as a first-tier NBS program, which will change the status of current clinical practice of NBS in China., Competing Interests: Conflict of interest The authors declare no competing financial interest., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The cognitive attitudes and behaviors of medical post-graduates may be influenced by the coronavirus disease 2019 (COVID-19) pandemic. A cross-sectional study was used from a questionnaire survey in hospitals affiliated with the Zhejiang University School of Medicine. Questionnaire was distributed online including demographic information, cognitive attitudes, and personal protective behaviors. Moreover, personal protective behaviors such as wearing protective equipment were compared between different academic major and gender, respectively. A total of 176 valid questionnaires were obtained. Of the medical post-graduates in this study, (1) 89.67% believed that the COVID-19 pandemic had an impact on their clinical internships, and 40.34% expressed concerns about their infection on inadequate personal protection; (2) 91.48% took personal protection in hospital and 86.36% enhanced personal hygiene; (3) There were no statistically differences in the personal protection by academic major and gender ( p > 0.05). This study suggests that the COVID-19 pandemic had an impact on the medical post-graduates' clinical practice, and affected their cognitive attitudes and behaviors. As such, universities and hospitals should increase pandemic prevention training and investment, provide more psychological counseling to their medical post-graduates to reduce their psychological burden, and take measures to reduce the influence of the COVID-19 pandemic on their medical post-graduates' clinical practice., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Feng, Xie and Shen.)

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in the gastrointestinal tract. At present, many professional academic groups and associations at home and abroad have released guidelines for the diagnosis and treatment of GIST. In 2020, Gastrointestinal Stromal Tumor Expert Committee of China Society of Clinical Oncology (CSCO) issued the first "CSCO gastrointestinal stromal tumor diagnosis and treatment guidelines" in China. In the same year, NCCN also released the first "NCCN guideline for the diagnosis and treatment of gastrointestinal stromal tumors (first edition in 2021)" by separating GIST-related content from the guideline for soft tissue sarcoma. However, there are many inconsistencies between the guidelines' recommendation and clinical practice in China. For example, in the aspect of diagnosis, the emphasis on and implementation of molecular detection are variable, the format of molecular detection report is not unified or standardized, the selection of detection methods is inappropriate, the diagnosis of wild-type GIST is not standardized, the risk assessment is improper, and the use of EUS-FNA is relatively seldom; in the aspect of drug therapy, there are some problems, such as the lack of standardization in dose and course of targeted drugs, and off-label medication such as cross line therapy; in terms of surgical treatment, there are also some problems, such as the clinical application scenarios of laparoscopic surgery exceed the recommendations of the guidelines, and the general description of surgical intervention of advanced GIST in the guidelines cannot well guide specific clinical practice. In this context, on the one hand, clinicians need to understand the academic frontier and standardize their medical behavior with the latest guidelines; on the other hand, clinicians need to consider the scientific rationale and accessibility of treatment on some clinical problems that are not clear in the guidelines, and take whether patients can benefit the most as the criteria.

This study aimed to investigate the hypertension management abilities of rural physicians in a high-altitude Tibetan area. A cross-sectional survey was conducted in the Ganzi Tibetan Autonomous Prefecture, China, in October 2020. Information about healthcare resources in local medical institutions, along with the knowledge, attitudes, practices, and training status of primary care physicians, was collected. Limited resources were observed in terms of equipment, drugs, and personnel in the 18 township hospitals included. A total of 132 physicians participated in this survey. The scores for hypertension-related knowledge, attitudes toward hypertension management, routine practice ability, priority given to hypertension, and confidence in performing certain tasks were 32.60%, 67.40%, 18.90%, 65.15%, and 35.60%, respectively. The most concerning issues lay in the ignorance of the healthy lifestyle, undervaluation of cardiovascular risks, and lack of confidence in optimally performing management activities. Only 9.85% of the physicians received more than 24 days of training per year; 28.79% preferred a longer training time. While training was generally provided in conference sessions (63.64% of current training programs), physicians preferred remote education (55.30%), and on-site guidance (46.21%) from professionals. The current training was centered around clinical skills (61.36%) and was identified as a major training requirement by the physicians surveyed (80.30%). This survey suggests that the medical resources may not be effective, with deficiencies present in the knowledge and practices of primary care physicians in the Sichuan Tibetan area. Hypertension education and skill-development courses based on the specific issues identified should be provided to these physicians in the future., (© 2021 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

Objective: This study aimed to systematically analyze the effectiveness and safety of the local application of vancomycin powder to prevent surgical site infection (SSI) after spinal surgeries and provide guidance for clinical practice., Methods: Two researchers independently searched PubMed, Web of Science, Elsevier, and China National Knowledge Infrastructure using the MeSH terms "spinal surgery," "vancomycin," "local," "topical," "prophylactic," "surgical site infection," and "SSI" to identify studies published between January 2010 and January 2020 on the local application of vancomycin powder for preventing SSI after spinal surgeries. The outcome assessment indicators were analyzed using RevMan 5.3 software., Results: Three randomized controlled trials, two prospective studies, and 26 retrospective studies were included in the current research. The results of the meta-analysis revealed significant differences between the vancomycin and control groups (non-vancomycin group) concerning the incidence of SSI (risk ratio = 0.39, 95% confidence interval = 0.28-0.55, Z  = 5.46), indicating that local application of vancomycin powder can significantly reduce the incidence of SSI., Conclusion: Local application of vancomycin powder is an effective and safe method to prevent SSI after spinal surgeries.

Background: Several studies on clinical practice for Duchenne muscular dystrophy (DMD) have been conducted in Western countries. However, there have been only a few similar studies in Asia and Oceania. Here, we investigate the steroid therapy-related clinical practice for DMD among the local experts. In 2015, we conducted a DMD expert survey in Asia and Oceania to acquire information regarding patients with DMD and to assess current clinical practice with the cooperation of Asian and Oceanian Myology Centre, a neuromuscular disease research network., Results: We obtained survey responses from 87 out of 148 clinicians (62%) from 13 countries and regions. In China, 1385 DMD patients were followed-up by 5 respondent neurologists, and 84% were between 0 and 9 years of age (15% were 10-19 years, 1% > 19 years). While in Japan, 1032 patients were followed-up by 20 clinicians, and the age distribution was similar between the 3 groups (27% were 0-9 years, 35% were 10-19 years, 38% were >19 years). Most respondent clinicians (91%) were aware of DMD standard of care recommendations. Daily prednisolone/prednisone administration was used most frequently at initiation (N = 45, 64%). Inconsistent opinion on steroid therapy after loss of ambulation and medication for bone protection was observed., Conclusions: Rare disease research infrastructures have been underdeveloped in many of Asian and Oceanian countries. In this situation, our results show the snapshots of current medical situation and clinical practice in DMD. For further epidemiological studies, expansion of DMD registries is necessary., (Copyright © 2020 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)

Background: The prevalence of depressive disorder in Shenzhen is higher than for any other city in China. Despite national health system reform to integrate mental health into primary care, the majority of depression cases continue to go unrecognized and untreated. Qualitative research was conducted with primary care medical leaders to describe the current clinical practice of depressive disorder in community healthcare centres (CHC) in Shenzhen and to explore the participants' perceptions of psychological, organizational and societal barriers and enablers to current practice with a view to identifying current needs for the improved care of depressive disorder in the community. Methods: Seventeen semi-structured, audio-recorded interviews (approx. 1 h long) were conducted in Melbourne (n = 7) and Shenzhen (n = 10) with a convenience sample of primary care medical leaders who currently work in community healthcare centres (CHC) in Shenzhen and completed any one of the 3-month long, Melbourne-based, "Monash-Shenzhen Primary Healthcare Leaders Programs" conducted between 2015 and 2017. The interview guide was developed using the Theoretical Domain's Framework (TDF) and a directed content analysis (using Nvivo 11 software) was performed using English translations. Results: Despite primary care medical leaders being aware of a mental health treatment gap and the benefits of early depression care for community wellbeing, depressive disorder was not perceived as a treatment priority in CHCs. Instead, hospital specialists were identified as holding primary responsibility for formal diagnosis and treatment initiation with primary care doctors providing early assessment and basic health education. Current needs for improved depression care included: (i) Improved professional development for primary care doctors with better access to diagnostic guidelines and tools, case-sharing and improved connection with mentors to overcome current low levels of treatment confidence. (ii) An improved consulting environment (e.g. allocated mental health resource; longer and private consultations; developed medical referral system; better access to antidepressants) which embraces mental health initiatives (e.g. development of mental health departments in local hospitals; future use of e-mental health; reimbursement for patients; doctors' incentives). (iii) Improved health literacy to overcome substantive mental health stigma in society and specific stigma directed towards the only public psychiatric hospital. Conclusions: Whilst a multi-faceted approach is needed to improve depression care in community health centres in Shenzhen, this study highlights how appropriate mental health training is central to developing a robust work-force which can act as key agents in national healthcare reform. The cultural adaption of the depression component of the World Health Organisation's mental health gap intervention guide (mhGAP-IG.v2) could provide primary care doctors with a future training tool to develop their assessment skills and treatment confidence. [ABSTRACT FROM AUTHOR]

Suppression of TP53 function is nearly ubiquitous in human cancers, and a significant fraction of cancers have mutations in the TP53 gene itself. Therefore, the wild-type TP53 gene has become an important target gene for transformation research of cancer gene therapy. In 2003, the first anti-tumor gene therapy drug rAd-p53 (recombinant human p53 adenovirus), trade name Gendicine™, was approved by the China Food and Drug Administration (CFDA) for treatment of head and neck squamous cell carcinoma (HNSCC) in combination with radiotherapy. The recombinant human TP53 gene is delivered into cancer cells by an adenovirus vector constructed to express the functional p53 protein. Although the only currently approved used of Gendicine is in combination with radiotherapy for treatment of HNSCC, clinical studies have been carried out for more than 20 other applications of Gendicine in treating cancer, including treatment of advanced lung cancer, advanced liver cancer, malignant gynecological tumors, and soft tissue sarcomas. Currently more than 30,000 patients have been treated with Gendicine. This review provides an overview of the clinical applications of Gendicine in China. We summarize a total of 48 studies with 2,561 patients with solid tumors, including 34 controlled clinical studies and 14 open clinical studies, i.e., clinical studies without a control group. There are 11 studies for head and neck cancer, 10 for liver cancer, 6 for malignant gynecological tumors, 4 for non-small cell lung cancer, 4 for soft tissue sarcoma, 4 for malignant effusion, 2 for gastrointestinal tumors, and 7 for other types of cancer. In all the reported clinical studies, the most common side effect was self-limited fever. Intratumoral injection and intra-arterial infusion were the most common routes of administration. Overall, Gendicine combined with chemotherapy, radiotherapy, or other conventional treatment regimens demonstrated significantly higher response rates compared to standard therapies alone. Some of the published studies also showed that Gendicine combination regimens demonstrated longer progression-free survival times than conventional treatments alone. To date, Gendicine has been clinically used in China for treatment of cancers other than HNSCC for more than ten years, mainly for patients with advanced or unresectable malignant tumors. However, the establishment of standard treatment regimens using TP53 gene therapy is still needed in order to advance its use in clinical practice., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Qilong Capsules is the representative Chinese patent medicine of the theory of &quot; invigorating Qi and activating blood circulation&quot; in traditional Chinese medicine( TCM),with distinct characteristics of TCM in clinical application. Qilong Capsules indication on package insert is ischemic stroke( cerebral infarction),which is a complex disease and has many pathological links. The treatment principles and methods at various stages are different. Inappropriate time of intervention,dosage and course of treatment make it difficult to give full play to the efficacy,but also cause adverse reactions,such as bleeding. In order to promote the rational use of Qilong Capsules,the project team invited frontline clinical experts,pharmaceutical experts and methodologist of evidence-based medicine around China to develop the consensus. The consensus is based on a combination of clinical research evidence and expert experi-ence to give recommendations for clinical problems with evidence support and expert consensus suggestions for clinical problems without evidence support. The consensus recommends the indication,timing of intervention,dosage,course of treatment,combined medication and contraindications of Qilong Capsules in clinical application,and introduced its safety characteristics,in order to guide clinical medical workers( involving Chinese medicine,Western medicine,combining traditional Chinese and Western medicine) to use Qilong Capsules reasonably in the treatment of cerebral infarction.

As a topical plaster developed by modern pharmaceutical technology based on traditional Tibetan medicine,Cheezheng Xiaotong Tiegao has functions of promoting blood circulation,relieving swelling and relieving pain. Since its introduction in 1993,it has been widely used in the treatment of various types of acute and chronic musculoskeletal pain and various types of spinal,joint and soft tissue diseases. In order to better standardize the clinical application and improve the clinical efficacy of Cheezheng Xiaotong Tiegao,the research and development work of the Experts consensus statement on Cheezheng Xiaotong Tiegao in clinical practice was officially launched on October 19,2017,upon approval from China Association of Chinese Medicine. In this paper,main R&D process and related technical links for the experts consensus on Cheezheng Xiaotong Tiegao would be summarized,which will help the various medical workers understand,master and apply more accurately,and also provide reference for the development of experts consensus on clinical application of other topical Chinese medicines.

Background: Prader-Willi syndrome (PWS) and Angelman syndrome (AS) are clinically distinct neurodevelopmental disorders caused by absence of paternally or maternally expressed imprinted genes on chromosome 15q11.2-q13.3 region. Methods: 3331 individuals was recruited from June 2013 to December 2016 under an institutional review board-approved protocol of informed consent. The methylation-specific PCR was employed as a first-tier screening test. The multiplex-fluorescent-labeled STR linkage analysis was carried out to define the underlying genetic mechanisms. The chromosomal microarray analysis was employed to identify chromosomal breakpoints in confirmed cases, and to detect other chromosomal abnormalities in undiagnosed cases. Genetic counseling and recurrence risk assessment were provided to families with affected individuals. Results: The methylation-specific PCR identified 36 PWS suspected patients and 13 AS suspected patients. UBE3A sequence analysis identified another 1 patient with AS. The STR linkage analysis define the underlying genetic mechanisms. Thirty PWS patients were with paternal deletions on chromosome region 15q11-q13, 5 with isodisomic uniparental disomy and 1 with mixed segmental isodisomic/ heterodisomic uniparental disomy of maternal chromosome 15. Twelve AS patients were with maternal deletions, 1 with isodisomic uniparental disomy and 1 with UBE3A gene mutation. The chromosomal microarray analysis identified chromosomal breakpoints in confirmed cases, and detected chromosomal abnormalities in another 4 patients with clinically overlapped features but tested negative for PWS/AS. Genetic counseling was offered to all families with affected individuals. Conclusions: Identifying the disorders at early age, establishing the molecular mechanisms, carrying out treatment intervention and close monitoring can significantly improve the prognosis of PWS/AS patients. [ABSTRACT FROM AUTHOR]

Acupuncture anesthesia (AA) is an anesthetic method created by medical workers and researchers in China during medical practice in 1950s. As a paragon of integrated traditional Chinese and Western medicine, AA clinical practice and basic theoretic research have gained continuous improvement and progress, and obtained a series of outstanding achievements in the past 60 years. Consequently, the theory of traditional Chinese medicine was enriched, and the acupuncture therapy was pushed forward to the world. The present paper reviews the course of formation and development of clinical application of AA from the late years of 1950s up to now, including the initial stage (1958-1966), rapid propulsion stage (1967-1979), consolidation period (1980-2004) and newly developing period (2005-now). The AA has experienced flexural pathway from simple acupuncture analgesia, to acupuncture-drug compound anesthesia (or acupuncture-assisted anesthesia), and to the application of whole perioperative period. Nowadays, it keeps unceasing development and innovation from simple analgesia and sedation to organ protection during perioperative period and reduction of post-operative complications. The AA possesses unique prosperous vitality, and also has a plenty room for improvement, being worthy of further popularization and research.

Objective: Kangaroo care (KC), a well-established parent-based intervention in neonatal intensive care units (NICUs), with documented benefits for infants and their parents. However, in China there remains a lack of knowledge and a reluctance to implement KC in hospitals. Therefore, our aim was to investigate the current knowledge, beliefs and practices regarding KC among NICU nurses in China using the 'Kangaroo Care Questionnaire'., Methods: A quantitative descriptive survey was designed. This questionnaire comprised 90 items classified according to four domains: knowledge, practice, barriers and perception. Data were analysed using SPSS V.20.0, and content analysis was used to summarise data derived from open-ended questions., Results: The survey involved 861 neonatal nurses from maternity and general hospitals across China (response rate=95.7%). The findings showed that 47.7% (n=411) of the nurses had participated in the implementation of KC. Neonatal nurses in the 'experienced in KC' group showed an overall better understanding of KC and its benefits with a higher 'correct response' rate than those in the 'not experienced in KC' group. In the 'experienced in KC' group, over 90% considered KC beneficial to the parent-baby relationship and attachment, and over 80% believed that KC positively affected outcomes of preterm infants. The 'not experienced in KC' group perceived more barriers to KC implementation than did the 'experienced in KC' group., Conclusion: Although most nurses working in NICUs in China were aware of the benefits of KC, there remain substantial barriers to its routine use in practice. Education for both staff and parents is necessary, as is the provision of appropriate facilities and policies to support parents in providing this evidence-based intervention., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

It is important for clinical nursing teachers and managers to recognize the importance of nursing students' quality of life (QOL) since they are the source of future nurses. As yet, there is no quality of life evaluation scale (QOLES) specific to them. This study designed a quantitative instrument for evaluating QOL of nursing students. The study design was a descriptive survey with mixed methods including literature review, panel discussion, Delphi method, and statistical analysis. The data were collected from 880 nursing students from four teaching hospitals in Wuhan, China. The reliability and validity of the scale were tested through completion of the QOLES in a cluster sampling method. The total scale included 18 items in three domains: physical, psychological, and social functional. The cumulative contributing rate of the three common factors was 65.23%. Cronbach's alpha coefficient of the scale was 0.82. This scale had good reliability and validity to evaluate nursing students' QOL., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Comments on the article 'Should surgeons send all surgical specimens to the pathology laboratory?,' by Shiu et al regarding importance of submitting surgical specimen to pathologists in Hong Kong, China. Reason for surgeons to submit to pathologists organ and tissue from a human; Advantage of surgical pathologists to surgeons; Need for the Hong Kong College of Surgeons and the Hong Kong College of Pathologists to set up guidelines for the practice.

Rates of renal cell carcinoma (RCC) morbidity and mortality vary widely by geography, with increasing incidence in most countries. Interestingly, RCC incidence is significantly lower in Asian countries relative to other regions, which is attributed to environmental and genetic influences. Additionally, it has been demonstrated that different ethnic groups differ in their RCC characteristics which might lead to varied responses to therapy. In this review, physicians drawn from countries across the Asia-Pacific region--China, Japan, Taiwan, Republic of Korea, and Australia--take all available data into consideration to develop the first opinion statement on treatment of advanced RCC in the region. We have sought to determine what factors influence treatment patterns and availability of therapeutic agents in our respective countries, discussed whether these factors are fully justified or should be modified, and considered what additional efforts should be undertaken to optimize treatment outcomes in RCC. Additionally, we have addressed the limitations on treatment of RCC in the region, capturing the restrictive situations of targeted therapy use in the Asia-Pacific region, mainly because of drug availability and treatment reimbursement. Often this illustrates the gap between Western and regional or even among local guidelines, the opinions of leading physicians regarding the treatment, and the realistic access to agents for most patients. Proposals made in this document are based on clinical experience and data from clinical trials of RCC therapies in which Asian patients have been included., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The Society of Dental Education, Chinese Stomatological Association has formulated the Standards of Clinical Practice for Chinese Undergraduate Students Majoring in Stomatology, on the basis of extensively soliciting the views of experts in various fields. The aim of this standard is to guide clinical teaching and improve teaching quality in schools of stomatology in China. The standards include eight parts: the standard of clinical practice for oral and maxillofacial surgery, for cariology and endodontics, for periodontics, for the oral mucosa diseases, for preventive dentistry, for pedodontology, for prosthodontics and for oral imageology. Each part includes introduction to subjects, the clinical practice time period, the purpose and requirements of practice, the disease types of practice and items of clinical operation, the index of the lowest workload of practice and the major methods of assessment. These standards are not only the basic requirements and guiding principles for clinical teaching, but also the major criteria for assessing the clinical teaching quality of stomatological colleges/schools of China., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)