Biliary complications are still the main complications for liver transplantation recipients. Biliary strictures comprise the major part of all biliary complications after deceased-donor liver transplantation (LT). Bil...Biliary complications are still the main complications for liver transplantation recipients. Biliary strictures comprise the major part of all biliary complications after deceased-donor liver transplantation (LT). Biliary strictures following LT are divided into anastomotic strictures (AS) and non-anastomotic strictures (NAS). A Limitation of current published researches is that most studies aren’t based on clinical practice. The aim of this review is to summarize risk factors, clinical presentation, diagnosis and management in post-LT biliary strictures.展开更多
Background: The aim of this study is to gain a better understanding of the true importance of trust in clinical practice by looking at how it is formed, how it affects clinical practice, and how to improve it. Methods...Background: The aim of this study is to gain a better understanding of the true importance of trust in clinical practice by looking at how it is formed, how it affects clinical practice, and how to improve it. Methods: Using the PRISMA-ScR checklist, a review of the literature was performed to identify research evaluating the importance of trust in the doctor-patient relationship. After thorough screening and removal of duplicates, 21 articles were used in the literature review. Results: The classifying themes that emerged in the selected articles were What Makes Trust and Effects of Trust. The theme of What Makes Trust garnered two subthemes as well: Impact of Doctor-Patient Relationship on Trust and Impact of Shared Decision-Making on Trust. Further to that, the overarching themes found were slightly more specific. They were Traits of Trust, Mistrust and Barriers to Trust, Positive Effects of Trust and the Effects of a Lack of Trust. We found that the best way to improve trust was to improve communication between the patient and the doctor. Additionally, we found that the biggest barrier to a trusting doctor patient relationship was a stigmatised condition, followed by a perception of a financially-motivated doctor. Finally, we found that a lack of trust can prevent patients from seeking and receiving proper treatment. Conclusions: With a better understanding of how trust is built and the extent of the role it plays in clinical practice, we hope that this growing knowledge can improve the practice of many doctors in the future. It is certain that more research needs to be done in this area, especially focusing on vulnerable and stigmatised populations such as chronic pain patients.展开更多
Dental pulp stem/stromal cells(DPSCs)are fibroblast-like,neural crest-derived,and multipotent cells that can differentiate into several lineages.They are relatively easy to isolate from healthy and inflamed pulps,with...Dental pulp stem/stromal cells(DPSCs)are fibroblast-like,neural crest-derived,and multipotent cells that can differentiate into several lineages.They are relatively easy to isolate from healthy and inflamed pulps,with little ethical concerns and can be successfully cryopreserved and thawed.The therapeutic effects of DPSCs derived from animal or human sources have been extensively studied through in-vitro and in-vivo animal experiments and the findings indicated that DPSCs are effective not only for dental diseases but also for systemic diseases.Understanding that translational research is a critical step through which the fundamental scientific discoveries could be translated into applicable diagnostics and therapeutics that directly benefit humans,several clinical studies were carried out to generate evidence for the efficacy and safety of autogenous or allogeneic human DPSCs(hDPSCs)as a treatment modality for use in cell-based therapy,regenerative medicine/dentistry and tissue engineering.In clinical medicine,hDPSCs were effective for treating acute ischemic stroke and human exfoliated deciduous teeth-conditioned medium(SHED-CM)repaired vascular damage of the corpus cavernous,which is the main cause of erectile dysfunction.Whereas in clinical dentistry,autologous SHED was able to rege-nerate necrotic dental pulp after implantation into injured teeth,and micrografts enriched with autologous hDPSCs and collagen sponge were considered a treatment option for human intrabony defects.In contrast,hDPSCs did not add a significant regenerative effect when they were used for the treatment of post-extraction sockets.Large-scale clinical studies across diverse populations are still lacking to provide robust evidence on the safety and efficacy of hDPSCs as a new treatment option for various human diseases including dental-related problems.展开更多
AIM:To investigate the practice patterns of optometrists in Saudi Arabia regarding myopia management.METHODS:An internet-based survey was distributed to all practicing optometrists in Saudi Arabia(n=1886).The survey c...AIM:To investigate the practice patterns of optometrists in Saudi Arabia regarding myopia management.METHODS:An internet-based survey was distributed to all practicing optometrists in Saudi Arabia(n=1886).The survey contained questions related to 1)demographics,2)knowledge about myopia and its associated complications,3)current clinical care,4)type and frequency of myopia treatment prescribed,and 5)potential barriers limiting treatment adoption.RESULTS:The completed surveys were collected from 171 optometrists(9.06%response rate,60%male).Knowledge regarding myopia-associated complications was prevalent but somewhat inaccurate among the respondents.Cycloplegic refraction at initial visit was used by 59%of the respondents.The cover test was the most reported binocular vision test(83%),and 38%of optometrists did not perform any ocular biometrics.Twothirds prescribed single-vision spectacles for children with myopia.Increased time spent outdoors was selected by 80%of the practitioners who prescribed myopia control treatment as the primary approach.Insufficient support and lack of clinical experience in providing myopia treatment were reported as the most important factors limiting the adoption of myopia management strategies.CONCLUSION:The current optometric practices in Saudi Arabia require further investigation.Optometrists appear to be somewhat aware of myopia and the associated risks.However,most evidence-based myopia treatments are not being locally adopted,primarily because of lack of support,lack of experience,and limited availability.展开更多
Gastric emptying(GE)exhibits a wide inter-individual variation and is a major determinant of postprandial glycaemia in health and diabetes;the rise in blood glucose following oral carbohydrate is greater when GE is re...Gastric emptying(GE)exhibits a wide inter-individual variation and is a major determinant of postprandial glycaemia in health and diabetes;the rise in blood glucose following oral carbohydrate is greater when GE is relatively more rapid and more sustained when glucose tolerance is impaired.Conversely,GE is influenced by the acute glycaemic environment acute hyperglycaemia slows,while acute hypoglycaemia accelerates it.Delayed GE(gastroparesis)occurs frequently in diabetes and critical illness.In diabetes,this poses challenges for management,particularly in hospitalised individuals and/or those using insulin.In critical illness it compromises the delivery of nutrition and increases the risk of regurgitation and aspiration with consequent lung dysfunction and ventilator dependence.Substantial advances in knowledge relating to GE,which is now recognised as a major determinant of the magnitude of the rise in blood glucose after a meal in both health and diabetes and,the impact of acute glycaemic environment on the rate of GE have been made and the use of gut-based therapies such as glucagon-like peptide-1 receptor agonists,which may profoundly impact GE,in the management of type 2 diabetes,has become commonplace.This necessitates an increased understanding of the complex inter-relationships of GE with glycaemia,its implications in hospitalised patients and the relevance of dysglycaemia and its management,particularly in critical illness.Current approaches to management of gastroparesis to achieve more personalised diabetes care,relevant to clinical practice,is detailed.Further studies focusing on the interactions of medications affecting GE and the glycaemic environment in hospitalised patients,are required.展开更多
BACKGROUND Good clinical practice(GCP)is put in place to protect human participants in clinical trials as well as to ensure the quality of research.Non-adherence to these guidelines can produce research that may not m...BACKGROUND Good clinical practice(GCP)is put in place to protect human participants in clinical trials as well as to ensure the quality of research.Non-adherence to these guidelines can produce research that may not meet the standards set by the scientific community.Therefore,it must be ensured that researchers are wellversed in the GCP.But not much is known about the knowledge and practices of the GCP in the medical colleges of North India.AIM To assess the knowledge and practices of researchers about GCP and analyze these with respect to the demographics of participants.METHODS This is a cross-sectional study.A self-structured questionnaire about GCP,after expert validations,was circulated among researchers,at a tertiary healthcare institute,All India Institute of Medical Sciences(AIIMS),Rishikesh.A total of 59 individuals,who were selected by universal sampling,participated in the study.All healthcare workers who have been investigators of Institutional Ethics Committee-approved research projects,except residents and faculty,and are still a part of the institute have been included in the study.The study was approved by the Institutional Ethics Committee of AIIMS,Rishikesh.We used descriptive analysis and the Chi-squared test to analyze data.P value<0.05 was considered significant.RESULTS Out of 59 participants,only 11(18.6%)were certified for GCP.Most of the participants(64.4%)had“Average”knowledge,33.9%had“Good”knowledge and 1.7%had“Poor”knowledge.Only 49%of participants had satisfactory practices related to GCP.There was a significant difference in the knowledge based on the current academic position for the items assessing knowledge of institutional review board(P=0.010),confidentiality&privacy(P=0.011),and participant safety&adverse events(P<0.001).There was also a significant difference in knowledge of research misconduct(P=0.024)and participant safety&adverse events(P=0.011)based on certification of GCP.There was a notable difference in the practices related to recruitment&retention on the basis of current academic position(P<0.001)and certification of GCP(P=0.023).We also observed a considerable difference between the knowledge and practices of GCP among the participants(P=0.013).CONCLUSION Participants have basic knowledge of GCP but show a lack thereof in certain domains of GCP.This can be addressed by holding training sessions focusing on these particular domains.展开更多
The aim of this study was to explore the perception of male nursing students’ experiences and challenges in maternity clinical practice. A quantitative cross-sectional survey design was used. The self-administered qu...The aim of this study was to explore the perception of male nursing students’ experiences and challenges in maternity clinical practice. A quantitative cross-sectional survey design was used. The self-administered questionnaire included 18 items 5-point Likert scale to identify the challenges experienced by male nursing students in their maternity clinical practice, and 14 items to assess comfort level in performing procedures in maternity clinical areas. Participants were 93 male nursing students who had completed their maternity clinical posting in different maternity clinical areas as a part of their nursing program, at the College of Nursing, Kuwait. Results showed that male nursing students are not very keen on undergoing maternity clinical training (Chi-square analysis χ<sup>2</sup> = 96.939;P χ<sup>2</sup> = 108.638;P χ<sup>2</sup> = 5.297;P = 0.021). In conclusion, this study showed that being treated differently and being refused to provide care to clients were the main challenges faced by male nursing students during their maternity practice. The participants had a strong belief that they will not be accepted by maternity clients because of the gender difference and cultural influence. There is a need to design strategies in both academic and clinical settings to overcome barriers to male nursing students’ engagement in the various maternity care areas. Our findings also indicate the need to embrace gender diversity in maternity clinical practice and call for professionalism, gender and cultural awareness creation, and advocacy.展开更多
Colorectal cancer(CRC)is the second most common cancer in China,the morbidity and mortality rates of which are rapidly increasing1,2.Among newly-diagnosed CRC patients,20%have metastatic disease at the time of present...Colorectal cancer(CRC)is the second most common cancer in China,the morbidity and mortality rates of which are rapidly increasing1,2.Among newly-diagnosed CRC patients,20%have metastatic disease at the time of presentation and an additional 25%present with localized disease and will subsequently develop metastases3.The treatment of metastatic colorectal cancer(mCRC)is gradually moving towards the era of precision therapy,which involves guided treatment based on individual genetic characteristics4.Since the first edition of the Chinese Society of Clinical Oncology(CSCO)guidelines was published in 2017,the guidelines have been updated annually according to the latest clinical trial findings5-9.Herein we summarize how the CSCO guidelines enable tailor-made treatments of mCRC with different molecular characteristics(Figure 1).展开更多
Dear editor,We thank Hai Hu’s team for their work in modifying the q SOFA scores.[1]This study has aroused great interest among researchers.[2]As we all know,the advantage of q SOFA score is that it contains bedside ...Dear editor,We thank Hai Hu’s team for their work in modifying the q SOFA scores.[1]This study has aroused great interest among researchers.[2]As we all know,the advantage of q SOFA score is that it contains bedside parameters that can be collected quickly,and it is still helpful in low-and middle-income countries.展开更多
Since 2010,there has been a much greater awareness of the problem of intoxication,which has become the most common form of accidental and intentional death.In 2020,more than 90,000 people died of intoxication in the U...Since 2010,there has been a much greater awareness of the problem of intoxication,which has become the most common form of accidental and intentional death.In 2020,more than 90,000 people died of intoxication in the United States,which surpassed deaths due to motor vehicle accidents and firearms use to become the leading external cause of mortality.展开更多
Objective:The objective of the study is to validate the short version of evidence-based practice(EBP)instruments among nurses in clinical practice.Methods:An institutional-based cross-sectional research design was use...Objective:The objective of the study is to validate the short version of evidence-based practice(EBP)instruments among nurses in clinical practice.Methods:An institutional-based cross-sectional research design was used and a stratified sampling technique to select 285 nurse clinicians.The study utilized a structured questionnaire comprising of demographic data from the participants and three validated scales:the shortened versions of the EBP Beliefs Scale,the EBP Implementation Scale,and the Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice(OCRSIEP)survey.With the use of descriptive statistics,the data were analyzed and presented in frequencies and percentages,while inter-item correlation coefficient(ICC)and the Kaiser-Meyer-Olkin measure of sampling adequacy were used to confirm the validity of using factor analysis.Results:Findings revealed the mean scores of the EBP Beliefs Scale ranged from 1.50 to 1.61,EBP Implementation Scale ranged from 1.84 to 1.94,and the OCRSIEP Scale ranged from 1.93 to 2.19.All the three shortened scales accordingly had good internal reliability,29.30±9.93 out of 80 for the EBP Beliefs Scale,19.56±7.37 out of 72 for the EBP Implementation Scale,and 66.32±20.35 out of 125 for the OCRSIEP Scale.Conclusion:This study has generated a valid Short Version of EBP reliable instrument that is psychometrically robust that can be used by nurses and clinicians to evaluate EBP in clinical settings since the results presented as a whole confirmed the high reliability and factorial validity.展开更多
The concepts of ability, practice ability, and professional practice ability were analyzed using a theoretical research method. Based on the results of the analysis, the concept of clinical practice ability for Master...The concepts of ability, practice ability, and professional practice ability were analyzed using a theoretical research method. Based on the results of the analysis, the concept of clinical practice ability for Master Degree of Nursing(specialty) students was de?ned, and the characteristics were interpreted to provide references for future in-depth studies.展开更多
Clinical practice guidelines(CPGs)contain evidence-based and economically reasonable medical treatment processes.Executable medical treatment processes in healthcare information systems can assist the treatment proces...Clinical practice guidelines(CPGs)contain evidence-based and economically reasonable medical treatment processes.Executable medical treatment processes in healthcare information systems can assist the treatment processes.To this end,business process modeling technologies have been exploited to model medical treatment processes.However,medical treatment processes are usually flexible and knowledge-intensive.To reduce the effort in modeling,we summarize several treatment patterns(i.e.,frequent behaviors in medical treatment processes in CPGs),and represent them by three process modeling languages(i.e.,BPMN,DMN,and CMMN).Based on the summarized treatment patterns,we propose a pattern-based integrated framework for modeling medical treatment processes.A modeling platform is implemented to support the use of treatment patterns,by which the feasibility of our approach is validated.An empirical analysis is discussed based on the coverage rates of treatment patterns.Feedback from interviewed physicians in a Chinese hospital shows that executable medical treatment processes of CPGs provide a convenient way to obtain guidance,thus assisting daily work for medical workers.展开更多
Gender stereotyping on the role of male nurses in the use of intimate care,especially the application of touch,was explored.The barriers for men to provide care were determined.Strategies adopted by male nurses to ove...Gender stereotyping on the role of male nurses in the use of intimate care,especially the application of touch,was explored.The barriers for men to provide care were determined.Strategies adopted by male nurses to overcome these barriers were discussed.The review of literature showed that role stereotyping is still prevalent within nursing.Public media should recognize the diversity of caring and apply positive materials to shape a new image of nursing.The nursing faculty should develop an atmosphere of acceptance and empower male nursing students in the nursing school and clinic.Male nurses themselves should deeply believe that nursing is a profession suitable for both genders.展开更多
Background:Clinical practice guidelines refer to the guidance provided by the expert system to help medical staff and patients decide on appropriate treatments for a specific clinical situation,mainly including guidel...Background:Clinical practice guidelines refer to the guidance provided by the expert system to help medical staff and patients decide on appropriate treatments for a specific clinical situation,mainly including guidelines based on expert consensus and evidence-based guidelines.Since there is no research and clinical application of a specific stoma guidance in China.It is of great significance to understand the application status of the recommended guidelines and the influencing factors in promoting the development of stoma care.Purpose:To investigate the application status of recommended clinical practice guidelines for stoma nursing in China,and to analyse the reasons for the knowledge and application of recommendations.Methods:The Questionnaire on the Application of Recommendations in Clinical Practice Guidelines for Ostomy Nursing was adopted.Results:We collected 195 questionnaires and 183 valid questionnaires were available.(1)The average knowledge rate of a total of 31 recommendations was 73.65%.The main reasons for unknown were insufficient dissemination and lack of training.(2)The average application rate of the 31 recommendations was 58.08%.The overall satisfaction rate of people who used them was high.The main reasons for not applying recommendations were complex.Conclusions:Different levels of recommendations awareness and application are different.There is a lack of evidence-based guidelines for clinical practice in ostomy nursing in the field of stoma care in China,which limits the scientific development of stoma care to a certain extent.However,this study provides reference for the future construction of a guidebook adapted to our country’s localization.展开更多
Pancreatic cancer has become a major disease affecting people’s health because of its insidiousness,rapid progression and poor prognosis.Based on the practical needs of clinical work,combined with domestic multi-cent...Pancreatic cancer has become a major disease affecting people’s health because of its insidiousness,rapid progression and poor prognosis.Based on the practical needs of clinical work,combined with domestic multi-center research and experience,this guideline provides constructive suggestions for the interventional treatment of pancreatic cancer.展开更多
AIM To determine the application of clinical practice guidelines for the current management of diverticulitis and colorectal surgeon specialist consensus in Australia and New Zealand.METHODS A survey was distributed t...AIM To determine the application of clinical practice guidelines for the current management of diverticulitis and colorectal surgeon specialist consensus in Australia and New Zealand.METHODS A survey was distributed to 205 colorectal surgeons in Australia and New Zealand, using 22 hypothetical clinical scenarios.RESULTS The response rate was 102(50%). For 19 guidelinebased scenarios, only 11(58%) reached consensus(defined as > 70% majority opinion) and agreed with guidelines; while 3(16%) reached consensus and did not agree with guidelines. The remaining 5(26%) scenarios showed community equipoise(defined as less than/equal to 70% majority opinion). These included diagnostic imaging where CT scan was contraindicated, management options in the failureof conservative therapy for complicated diverticulitis, surgical management of Hinchey grade 3, proximal extent of resection in sigmoid diverticulitis and use of oral mechanical bowel preparation and antibiotics for an elective colectomy. The consensus areas not agreeing with guidelines were management of simple diverticulitis, management following the failure of conservative therapy in uncomplicated diverticulitis and follow-up after an episode of complicated diverticulitis. Fifty-percent of rural/regional based surgeons would perform an urgent sigmoid colectomy in failed conservative therapy of diverticulitis compared to only 8% of surgeons city-based(Fisher's exact test P = 0.016). In right-sided complicated diverticulitis, a greater number of those in practice for more than ten years would perform an ileocecal resection and ileocolic anastomosis(79% vs 41%, P < 0.0001).CONCLUSION While there are areas of consensus in diverticulitis management, there are areas of community equipoise for future research, potentially in the form of RCTs.展开更多
1.Introduction Eating disorders(ED)are the most common psychiatric disorders afflicting young women^1 and contribute to great detriments in psychological,social,and physical health.^(2,3)Unfortunately,ED treatments te...1.Introduction Eating disorders(ED)are the most common psychiatric disorders afflicting young women^1 and contribute to great detriments in psychological,social,and physical health.^(2,3)Unfortunately,ED treatments tend to be long lasting,intensive,and expensive.~4Additionally,individuals with ED seeking treatment use healthcare services more frequently than non-ED individu-展开更多
Traditional Chinese medicine(TCM)clinical efficacy evaluation runs through the development of TCM and has been progressing so far.With the introduction of evidence-based medicine(EBM)in recent 20 years,TCM clinical ef...Traditional Chinese medicine(TCM)clinical efficacy evaluation runs through the development of TCM and has been progressing so far.With the introduction of evidence-based medicine(EBM)in recent 20 years,TCM clinical efficacy evaluation has developed rapidly,accumulated research and experience,improved the quality and standardization of research,but also gradually found deep-seated deficiencies.In 2019,the China Center for Evidence-based Traditional Chinese Medicine(CCEBTCM)was established,and TCM was included in the 11th revision of the International Statistical Classification of Diseases(ICD-11).In above opportunities for TCM clinical efficacy evaluation,it is necessary to face up to the previous deficiencies,so that the TCM clinical efficacy evaluation can truly reflect the actual clinical practice characteristics,including TCM clinical problems,TCM thinking and TCM diagnosis&treatment mode.Based on the summary and analysis of past research,development concepts are proposed in this article.On the one hand,original concepts of TCM should be confidently paid more attention to the design and implementation of TCM clinical efficacy evaluation to be close to TCM clinical practice.On the other hand,it is necessary to consolidate the foundation of TCM clinical practice before evaluating efficacy.Evaluated object built on TCM ontology knowledge should be demonstrated based on clinical practice,and unknown evaluated object combined with new methods,technologies and concepts should be maturely integrated in clinical practice firstly.展开更多
Clinical practice teaching is an important part of medical education.For medical students in colleges and universities,the teaching method is mostly single before the teaching reform.Innovative clinical practice teach...Clinical practice teaching is an important part of medical education.For medical students in colleges and universities,the teaching method is mostly single before the teaching reform.Innovative clinical practice teaching methods have been implemented in colleges and universities with the deepening of the teaching reform in recent years.展开更多
文摘Biliary complications are still the main complications for liver transplantation recipients. Biliary strictures comprise the major part of all biliary complications after deceased-donor liver transplantation (LT). Biliary strictures following LT are divided into anastomotic strictures (AS) and non-anastomotic strictures (NAS). A Limitation of current published researches is that most studies aren’t based on clinical practice. The aim of this review is to summarize risk factors, clinical presentation, diagnosis and management in post-LT biliary strictures.
文摘Background: The aim of this study is to gain a better understanding of the true importance of trust in clinical practice by looking at how it is formed, how it affects clinical practice, and how to improve it. Methods: Using the PRISMA-ScR checklist, a review of the literature was performed to identify research evaluating the importance of trust in the doctor-patient relationship. After thorough screening and removal of duplicates, 21 articles were used in the literature review. Results: The classifying themes that emerged in the selected articles were What Makes Trust and Effects of Trust. The theme of What Makes Trust garnered two subthemes as well: Impact of Doctor-Patient Relationship on Trust and Impact of Shared Decision-Making on Trust. Further to that, the overarching themes found were slightly more specific. They were Traits of Trust, Mistrust and Barriers to Trust, Positive Effects of Trust and the Effects of a Lack of Trust. We found that the best way to improve trust was to improve communication between the patient and the doctor. Additionally, we found that the biggest barrier to a trusting doctor patient relationship was a stigmatised condition, followed by a perception of a financially-motivated doctor. Finally, we found that a lack of trust can prevent patients from seeking and receiving proper treatment. Conclusions: With a better understanding of how trust is built and the extent of the role it plays in clinical practice, we hope that this growing knowledge can improve the practice of many doctors in the future. It is certain that more research needs to be done in this area, especially focusing on vulnerable and stigmatised populations such as chronic pain patients.
文摘Dental pulp stem/stromal cells(DPSCs)are fibroblast-like,neural crest-derived,and multipotent cells that can differentiate into several lineages.They are relatively easy to isolate from healthy and inflamed pulps,with little ethical concerns and can be successfully cryopreserved and thawed.The therapeutic effects of DPSCs derived from animal or human sources have been extensively studied through in-vitro and in-vivo animal experiments and the findings indicated that DPSCs are effective not only for dental diseases but also for systemic diseases.Understanding that translational research is a critical step through which the fundamental scientific discoveries could be translated into applicable diagnostics and therapeutics that directly benefit humans,several clinical studies were carried out to generate evidence for the efficacy and safety of autogenous or allogeneic human DPSCs(hDPSCs)as a treatment modality for use in cell-based therapy,regenerative medicine/dentistry and tissue engineering.In clinical medicine,hDPSCs were effective for treating acute ischemic stroke and human exfoliated deciduous teeth-conditioned medium(SHED-CM)repaired vascular damage of the corpus cavernous,which is the main cause of erectile dysfunction.Whereas in clinical dentistry,autologous SHED was able to rege-nerate necrotic dental pulp after implantation into injured teeth,and micrografts enriched with autologous hDPSCs and collagen sponge were considered a treatment option for human intrabony defects.In contrast,hDPSCs did not add a significant regenerative effect when they were used for the treatment of post-extraction sockets.Large-scale clinical studies across diverse populations are still lacking to provide robust evidence on the safety and efficacy of hDPSCs as a new treatment option for various human diseases including dental-related problems.
基金Deanship of Scientific Research,College of Applied Medical Sciences Research Center at King Saud University,for funding this work。
文摘AIM:To investigate the practice patterns of optometrists in Saudi Arabia regarding myopia management.METHODS:An internet-based survey was distributed to all practicing optometrists in Saudi Arabia(n=1886).The survey contained questions related to 1)demographics,2)knowledge about myopia and its associated complications,3)current clinical care,4)type and frequency of myopia treatment prescribed,and 5)potential barriers limiting treatment adoption.RESULTS:The completed surveys were collected from 171 optometrists(9.06%response rate,60%male).Knowledge regarding myopia-associated complications was prevalent but somewhat inaccurate among the respondents.Cycloplegic refraction at initial visit was used by 59%of the respondents.The cover test was the most reported binocular vision test(83%),and 38%of optometrists did not perform any ocular biometrics.Twothirds prescribed single-vision spectacles for children with myopia.Increased time spent outdoors was selected by 80%of the practitioners who prescribed myopia control treatment as the primary approach.Insufficient support and lack of clinical experience in providing myopia treatment were reported as the most important factors limiting the adoption of myopia management strategies.CONCLUSION:The current optometric practices in Saudi Arabia require further investigation.Optometrists appear to be somewhat aware of myopia and the associated risks.However,most evidence-based myopia treatments are not being locally adopted,primarily because of lack of support,lack of experience,and limited availability.
文摘Gastric emptying(GE)exhibits a wide inter-individual variation and is a major determinant of postprandial glycaemia in health and diabetes;the rise in blood glucose following oral carbohydrate is greater when GE is relatively more rapid and more sustained when glucose tolerance is impaired.Conversely,GE is influenced by the acute glycaemic environment acute hyperglycaemia slows,while acute hypoglycaemia accelerates it.Delayed GE(gastroparesis)occurs frequently in diabetes and critical illness.In diabetes,this poses challenges for management,particularly in hospitalised individuals and/or those using insulin.In critical illness it compromises the delivery of nutrition and increases the risk of regurgitation and aspiration with consequent lung dysfunction and ventilator dependence.Substantial advances in knowledge relating to GE,which is now recognised as a major determinant of the magnitude of the rise in blood glucose after a meal in both health and diabetes and,the impact of acute glycaemic environment on the rate of GE have been made and the use of gut-based therapies such as glucagon-like peptide-1 receptor agonists,which may profoundly impact GE,in the management of type 2 diabetes,has become commonplace.This necessitates an increased understanding of the complex inter-relationships of GE with glycaemia,its implications in hospitalised patients and the relevance of dysglycaemia and its management,particularly in critical illness.Current approaches to management of gastroparesis to achieve more personalised diabetes care,relevant to clinical practice,is detailed.Further studies focusing on the interactions of medications affecting GE and the glycaemic environment in hospitalised patients,are required.
文摘BACKGROUND Good clinical practice(GCP)is put in place to protect human participants in clinical trials as well as to ensure the quality of research.Non-adherence to these guidelines can produce research that may not meet the standards set by the scientific community.Therefore,it must be ensured that researchers are wellversed in the GCP.But not much is known about the knowledge and practices of the GCP in the medical colleges of North India.AIM To assess the knowledge and practices of researchers about GCP and analyze these with respect to the demographics of participants.METHODS This is a cross-sectional study.A self-structured questionnaire about GCP,after expert validations,was circulated among researchers,at a tertiary healthcare institute,All India Institute of Medical Sciences(AIIMS),Rishikesh.A total of 59 individuals,who were selected by universal sampling,participated in the study.All healthcare workers who have been investigators of Institutional Ethics Committee-approved research projects,except residents and faculty,and are still a part of the institute have been included in the study.The study was approved by the Institutional Ethics Committee of AIIMS,Rishikesh.We used descriptive analysis and the Chi-squared test to analyze data.P value<0.05 was considered significant.RESULTS Out of 59 participants,only 11(18.6%)were certified for GCP.Most of the participants(64.4%)had“Average”knowledge,33.9%had“Good”knowledge and 1.7%had“Poor”knowledge.Only 49%of participants had satisfactory practices related to GCP.There was a significant difference in the knowledge based on the current academic position for the items assessing knowledge of institutional review board(P=0.010),confidentiality&privacy(P=0.011),and participant safety&adverse events(P<0.001).There was also a significant difference in knowledge of research misconduct(P=0.024)and participant safety&adverse events(P=0.011)based on certification of GCP.There was a notable difference in the practices related to recruitment&retention on the basis of current academic position(P<0.001)and certification of GCP(P=0.023).We also observed a considerable difference between the knowledge and practices of GCP among the participants(P=0.013).CONCLUSION Participants have basic knowledge of GCP but show a lack thereof in certain domains of GCP.This can be addressed by holding training sessions focusing on these particular domains.
文摘The aim of this study was to explore the perception of male nursing students’ experiences and challenges in maternity clinical practice. A quantitative cross-sectional survey design was used. The self-administered questionnaire included 18 items 5-point Likert scale to identify the challenges experienced by male nursing students in their maternity clinical practice, and 14 items to assess comfort level in performing procedures in maternity clinical areas. Participants were 93 male nursing students who had completed their maternity clinical posting in different maternity clinical areas as a part of their nursing program, at the College of Nursing, Kuwait. Results showed that male nursing students are not very keen on undergoing maternity clinical training (Chi-square analysis χ<sup>2</sup> = 96.939;P χ<sup>2</sup> = 108.638;P χ<sup>2</sup> = 5.297;P = 0.021). In conclusion, this study showed that being treated differently and being refused to provide care to clients were the main challenges faced by male nursing students during their maternity practice. The participants had a strong belief that they will not be accepted by maternity clients because of the gender difference and cultural influence. There is a need to design strategies in both academic and clinical settings to overcome barriers to male nursing students’ engagement in the various maternity care areas. Our findings also indicate the need to embrace gender diversity in maternity clinical practice and call for professionalism, gender and cultural awareness creation, and advocacy.
基金supported by the Provincial Key R&D Program of Zhejiang Province(Grant No.2021C03125)the Beijing Xisike Clinical Oncology Research Foundation(Grant No.Y-tongshu2021/ms-0003).
文摘Colorectal cancer(CRC)is the second most common cancer in China,the morbidity and mortality rates of which are rapidly increasing1,2.Among newly-diagnosed CRC patients,20%have metastatic disease at the time of presentation and an additional 25%present with localized disease and will subsequently develop metastases3.The treatment of metastatic colorectal cancer(mCRC)is gradually moving towards the era of precision therapy,which involves guided treatment based on individual genetic characteristics4.Since the first edition of the Chinese Society of Clinical Oncology(CSCO)guidelines was published in 2017,the guidelines have been updated annually according to the latest clinical trial findings5-9.Herein we summarize how the CSCO guidelines enable tailor-made treatments of mCRC with different molecular characteristics(Figure 1).
文摘Dear editor,We thank Hai Hu’s team for their work in modifying the q SOFA scores.[1]This study has aroused great interest among researchers.[2]As we all know,the advantage of q SOFA score is that it contains bedside parameters that can be collected quickly,and it is still helpful in low-and middle-income countries.
基金This work was financially supported by the National Natural Science Foundation of China(nos.52273158 and 52022095)the Science and Technology Development Program of Jilin Province(no.20210509005RQ)the Youth Innovation Promotion Association of Chinese Academy of Sciences(no.2019230).
文摘Since 2010,there has been a much greater awareness of the problem of intoxication,which has become the most common form of accidental and intentional death.In 2020,more than 90,000 people died of intoxication in the United States,which surpassed deaths due to motor vehicle accidents and firearms use to become the leading external cause of mortality.
文摘Objective:The objective of the study is to validate the short version of evidence-based practice(EBP)instruments among nurses in clinical practice.Methods:An institutional-based cross-sectional research design was used and a stratified sampling technique to select 285 nurse clinicians.The study utilized a structured questionnaire comprising of demographic data from the participants and three validated scales:the shortened versions of the EBP Beliefs Scale,the EBP Implementation Scale,and the Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice(OCRSIEP)survey.With the use of descriptive statistics,the data were analyzed and presented in frequencies and percentages,while inter-item correlation coefficient(ICC)and the Kaiser-Meyer-Olkin measure of sampling adequacy were used to confirm the validity of using factor analysis.Results:Findings revealed the mean scores of the EBP Beliefs Scale ranged from 1.50 to 1.61,EBP Implementation Scale ranged from 1.84 to 1.94,and the OCRSIEP Scale ranged from 1.93 to 2.19.All the three shortened scales accordingly had good internal reliability,29.30±9.93 out of 80 for the EBP Beliefs Scale,19.56±7.37 out of 72 for the EBP Implementation Scale,and 66.32±20.35 out of 125 for the OCRSIEP Scale.Conclusion:This study has generated a valid Short Version of EBP reliable instrument that is psychometrically robust that can be used by nurses and clinicians to evaluate EBP in clinical settings since the results presented as a whole confirmed the high reliability and factorial validity.
基金supported by planning project of “12th Five-Year” in philosophy and social sciences of Sichuan province(No.SC13B081)
文摘The concepts of ability, practice ability, and professional practice ability were analyzed using a theoretical research method. Based on the results of the analysis, the concept of clinical practice ability for Master Degree of Nursing(specialty) students was de?ned, and the characteristics were interpreted to provide references for future in-depth studies.
基金supported by Chinese National Key Research and Development Program(No.2017YFB1400604).
文摘Clinical practice guidelines(CPGs)contain evidence-based and economically reasonable medical treatment processes.Executable medical treatment processes in healthcare information systems can assist the treatment processes.To this end,business process modeling technologies have been exploited to model medical treatment processes.However,medical treatment processes are usually flexible and knowledge-intensive.To reduce the effort in modeling,we summarize several treatment patterns(i.e.,frequent behaviors in medical treatment processes in CPGs),and represent them by three process modeling languages(i.e.,BPMN,DMN,and CMMN).Based on the summarized treatment patterns,we propose a pattern-based integrated framework for modeling medical treatment processes.A modeling platform is implemented to support the use of treatment patterns,by which the feasibility of our approach is validated.An empirical analysis is discussed based on the coverage rates of treatment patterns.Feedback from interviewed physicians in a Chinese hospital shows that executable medical treatment processes of CPGs provide a convenient way to obtain guidance,thus assisting daily work for medical workers.
文摘Gender stereotyping on the role of male nurses in the use of intimate care,especially the application of touch,was explored.The barriers for men to provide care were determined.Strategies adopted by male nurses to overcome these barriers were discussed.The review of literature showed that role stereotyping is still prevalent within nursing.Public media should recognize the diversity of caring and apply positive materials to shape a new image of nursing.The nursing faculty should develop an atmosphere of acceptance and empower male nursing students in the nursing school and clinic.Male nurses themselves should deeply believe that nursing is a profession suitable for both genders.
文摘Background:Clinical practice guidelines refer to the guidance provided by the expert system to help medical staff and patients decide on appropriate treatments for a specific clinical situation,mainly including guidelines based on expert consensus and evidence-based guidelines.Since there is no research and clinical application of a specific stoma guidance in China.It is of great significance to understand the application status of the recommended guidelines and the influencing factors in promoting the development of stoma care.Purpose:To investigate the application status of recommended clinical practice guidelines for stoma nursing in China,and to analyse the reasons for the knowledge and application of recommendations.Methods:The Questionnaire on the Application of Recommendations in Clinical Practice Guidelines for Ostomy Nursing was adopted.Results:We collected 195 questionnaires and 183 valid questionnaires were available.(1)The average knowledge rate of a total of 31 recommendations was 73.65%.The main reasons for unknown were insufficient dissemination and lack of training.(2)The average application rate of the 31 recommendations was 58.08%.The overall satisfaction rate of people who used them was high.The main reasons for not applying recommendations were complex.Conclusions:Different levels of recommendations awareness and application are different.There is a lack of evidence-based guidelines for clinical practice in ostomy nursing in the field of stoma care in China,which limits the scientific development of stoma care to a certain extent.However,this study provides reference for the future construction of a guidebook adapted to our country’s localization.
文摘Pancreatic cancer has become a major disease affecting people’s health because of its insidiousness,rapid progression and poor prognosis.Based on the practical needs of clinical work,combined with domestic multi-center research and experience,this guideline provides constructive suggestions for the interventional treatment of pancreatic cancer.
文摘AIM To determine the application of clinical practice guidelines for the current management of diverticulitis and colorectal surgeon specialist consensus in Australia and New Zealand.METHODS A survey was distributed to 205 colorectal surgeons in Australia and New Zealand, using 22 hypothetical clinical scenarios.RESULTS The response rate was 102(50%). For 19 guidelinebased scenarios, only 11(58%) reached consensus(defined as > 70% majority opinion) and agreed with guidelines; while 3(16%) reached consensus and did not agree with guidelines. The remaining 5(26%) scenarios showed community equipoise(defined as less than/equal to 70% majority opinion). These included diagnostic imaging where CT scan was contraindicated, management options in the failureof conservative therapy for complicated diverticulitis, surgical management of Hinchey grade 3, proximal extent of resection in sigmoid diverticulitis and use of oral mechanical bowel preparation and antibiotics for an elective colectomy. The consensus areas not agreeing with guidelines were management of simple diverticulitis, management following the failure of conservative therapy in uncomplicated diverticulitis and follow-up after an episode of complicated diverticulitis. Fifty-percent of rural/regional based surgeons would perform an urgent sigmoid colectomy in failed conservative therapy of diverticulitis compared to only 8% of surgeons city-based(Fisher's exact test P = 0.016). In right-sided complicated diverticulitis, a greater number of those in practice for more than ten years would perform an ileocecal resection and ileocolic anastomosis(79% vs 41%, P < 0.0001).CONCLUSION While there are areas of consensus in diverticulitis management, there are areas of community equipoise for future research, potentially in the form of RCTs.
文摘1.Introduction Eating disorders(ED)are the most common psychiatric disorders afflicting young women^1 and contribute to great detriments in psychological,social,and physical health.^(2,3)Unfortunately,ED treatments tend to be long lasting,intensive,and expensive.~4Additionally,individuals with ED seeking treatment use healthcare services more frequently than non-ED individu-
基金the National Natural Science Foundation of China(No.81725024).
文摘Traditional Chinese medicine(TCM)clinical efficacy evaluation runs through the development of TCM and has been progressing so far.With the introduction of evidence-based medicine(EBM)in recent 20 years,TCM clinical efficacy evaluation has developed rapidly,accumulated research and experience,improved the quality and standardization of research,but also gradually found deep-seated deficiencies.In 2019,the China Center for Evidence-based Traditional Chinese Medicine(CCEBTCM)was established,and TCM was included in the 11th revision of the International Statistical Classification of Diseases(ICD-11).In above opportunities for TCM clinical efficacy evaluation,it is necessary to face up to the previous deficiencies,so that the TCM clinical efficacy evaluation can truly reflect the actual clinical practice characteristics,including TCM clinical problems,TCM thinking and TCM diagnosis&treatment mode.Based on the summary and analysis of past research,development concepts are proposed in this article.On the one hand,original concepts of TCM should be confidently paid more attention to the design and implementation of TCM clinical efficacy evaluation to be close to TCM clinical practice.On the other hand,it is necessary to consolidate the foundation of TCM clinical practice before evaluating efficacy.Evaluated object built on TCM ontology knowledge should be demonstrated based on clinical practice,and unknown evaluated object combined with new methods,technologies and concepts should be maturely integrated in clinical practice firstly.
基金This study was supported by Heilongjiang Province Education Science“13th Five-Year Plan”2020 Key Topics Project(Item number:GJB1320365).
文摘Clinical practice teaching is an important part of medical education.For medical students in colleges and universities,the teaching method is mostly single before the teaching reform.Innovative clinical practice teaching methods have been implemented in colleges and universities with the deepening of the teaching reform in recent years.
