International Healthcare Review (online)
eISSN: 2795-5567 This Journal is developed in cooperation with The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital (Shandong, China). The International Healthcare Review (online) was established in June 2022. Being a high quality double-blind refereed Journal, IHR provides an international forum for discussion of current trends and dissemination of knowledge to support evidence-based practice and the improvement of the provision of healthcare around the World, with a special emphasis in Nursing Care, Public Health, Social Care and related Healthcare Management topics. 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On Public Health and New Prostate Cancer Screening Strategies
Introduction: Prostate cancer (PCa) is one of the leading causes of death among men worldwide. Early detection is crucial for effective treatment, and several screening strategies have been developed to improve diagnostic accuracy and reduce false positives. This study compares new prostate cancer screening strategies, assessing their effectiveness, accuracy, cost-effectiveness and impact on patients' quality of life. Methodology: This comparative observational study analyzed clinical data from men aged 50 to 75 years without a previous diagnosis of prostate cancer. A literature search was conducted to determine advances in diagnosis and treatment efficacy. Results: The results showed that the combination of PSA and multiparametric MRI increased diagnostic accuracy and reduced false positives. Liquid biopsy was a promising, less invasive tool with potential for early detection. In terms of cost-benefit, the multimodal approach proved to be advantageous, considering the costs of subsequent examinations and treatments, as well as the impacts on patients' quality of life. Conclusion: New prostate cancer screening strategies have distinct advantages and limitations. Combining methods significantly improves clinical outcomes, reducing mortality and promoting a better quality of life for patients. This study highlights the importance of a multimodal approach to prostate cancer screening and the need for continued research to validate these strategies in different populations and clinical settings.
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Challenges in Diagnosis and Risk Factors of Preeclampsia and HELLP Syndrome
Introduction: Preeclampsia and HELLP syndrome are serious complications of pregnancy associated with high rates of maternal and fetal morbidity and mortality. These conditions pose diagnostic challenges due to the variability of their symptoms and the complexity of risk factors, compromising early identification and appropriate management. Methodology: The study used a literature review. Data analysis prioritised identifying gaps in diagnostic protocols and the relevance of identified risk factors. Results: The results indicated that the absence of specific symptoms in the early stages, such as oedema and mild hypertension, makes it difficult to identify preeclampsia. In addition, HELLP syndrome presents nonspecific symptoms, such as epigastric pain and nausea, which are often confused with other conditions. The variability in diagnostic criteria, especially the absence of proteinuria in some cases, aggravates the problem. Regarding risk factors, the most important are family history, pre-existing conditions such as chronic hypertension and obesity, and individual characteristics, such as advanced maternal age and multiple pregnancy. Conclusion: The complexity of these conditions requires a multidisciplinary and ongoing approach. Preventive strategies, such as the use of low-dose aspirin and calcium supplementation, have been shown to be effective in reducing complications. In addition, improvements in access to diagnostic technologies and the implementation of uniform clinical protocols are essential to reduce the impacts of preeclampsia and HELLP syndrome
Prevention and Treatment of Cardiotoxicity in Cancer Patients
Background: Cardiotoxicity is a significant complication in cancer patients resulting from treatments such as chemotherapy (CT) and radiotherapy (RT). This condition can lead to ventricular dysfunction and other cardiac complications, negatively impacting the quality of life and the effectiveness of cancer treatment. Methods: This study reviews the literature on cardiotoxicity in cancer patients, focusing on prevention and treatment methods. Scientific articles, clinical guidelines and case studies were analyzed to identify effective clinical management strategies. The research included data on cardiac monitoring, use of cardioprotective medications and adjustments in cancer therapies. Results: The analysis revealed that continuous monitoring of cardiac function is crucial for early detection of cardiotoxicity. Medications such as beta-blockers and ACE inhibitors are effective in protecting the heart. In addition, modifying chemotherapy doses and using more precise radiotherapy techniques can reduce the risk of cardiac damage. Multidisciplinary collaboration between oncologists and cardiologists is essential for effective management. Conclusion: Prevention and treatment of cardiotoxicity in cancer patients are essential to improve clinical outcomes and quality of life. Strategies such as regular cardiac monitoring, use of cardioprotective agents and adaptation of oncological therapies are effective in mitigating adverse effects. Continuous research and innovation are vital for the development of new therapeutic approaches, ensuring safe and effective cancer treatment.
Breast Cancer in Women Using Breast Implants
Introduction: Breast cancer is one of the most common diseases among women, and early diagnosis is essential for effective treatment. The use of breast implants can introduce additional challenges in the diagnosis and treatment of breast cancer. Methodology: A literature review was conducted to investigate the impact of breast implants on the diagnosis and treatment of breast cancer. Studies on the effectiveness of different imaging methods (mammography, magnetic resonance imaging, and ultrasound) and therapeutic approaches (surgery, radiotherapy, and chemotherapy) in women with breast implants were analyzed, as well as the psychological impact of diagnosis and treatment. Results: The results show that breast implants can make it difficult to visualize the entire breast tissue on mammograms. However, advanced techniques such as MRI and ultrasound can improve diagnostic accuracy. In treatment, the presence of implants can influence surgical approaches and the administration of radiotherapy, requiring careful planning. The psychological impact of diagnosis and treatment on women with implants is significant, highlighting the importance of emotional support. Conclusion: The use of breast implants presents unique challenges in the diagnosis and treatment of breast cancer. With advanced imaging techniques and personalized therapeutic approaches, it is possible to effectively manage these challenges. Collaboration between radiologists, surgeons, oncologists and psychologists is essential to ensure the best possible care for these patients, providing effective and humane treatment.
Efficacy and Applications of Hydrogel Spacers in Prostate Cancer Radiotherapy
Introduction: Radiation therapy (RT) is a common treatment for prostate cancer (PCa), but it can cause significant side effects, especially on the patient's quality of life (QoL). Hydrogel spacers, such as SpaceOAR, have been developed to reduce these side effects by creating a barrier between the prostate and the rectum. Methodology: This clinical study and literature review analyzed the efficacy and applications of hydrogel spacers in PCa RT. Randomized and multicenter clinical trials, as well as systematic reviews and meta-analyses were reviewed. Efficacy was measured by the reduction of side effects, especially rectal ulceration, and by the improvement in patients' CT. Results: The results showed that using hydrogel spacers significantly reduced the incidence of serious side effects, such as rectal ulceration, in patients undergoing RT. In addition, patients who received hydrogel spacers reported improved QT and less discomfort during treatment. Discussion: It is important to minimize the side effects of RT to improve patients' CT. Hydrogel spacers have shown to be a promising approach, with significant benefits in terms of symptom reduction and improvement in CT. However, further studies are needed to confirm long-term results and to assess the long-term safety of hydrogel use. Conclusion: Hydrogel spacers represent an important innovation in PCa RT, offering an effective way to reduce side effects and improve patient outcomes. This study suggests that the use of hydrogel spacers should be considered a best practice in PCa RT treatments
The Influence of Cancer on the Sexual and Emotional Health of Young People
Introduction: Cancer in young people (15-30 years) has a profound impact on sexual and emotional health, due to the critical stage of development they are in. This longitudinal study aims to analyze how cancer affects these aspects, comparing young people with children and adults. Methodology: The study used a longitudinal design with a sample of 200 young people diagnosed with cancer. Data collection was performed at three-time points: at diagnosis, six months and twelve months later. Semi-structured interviews, standardized questionnaires (GHQ for emotional health and IIEF/FSFI for sexual health) and personal diaries were used. Data analysis combined quantitative and qualitative methods. Results: Young people showed a significant increase in anxiety and depression levels immediately after diagnosis, with stabilization after six months and a slight improvement after twelve months. Self-esteem and body image were negatively affected, with gradual improvement over time. Regarding sexual health, men reported erectile dysfunction and women's difficulties with arousal and lubrication. Infertility emerged as a significant concern for both sexes, with 40% of men and 50% of women expressing concern. A strong support network was crucial for emotional and sexual adjustment, while the use of psychological therapies was associated with significant improvements. Conclusion: Cancer significantly impacts the sexual and emotional health of young people, with unique challenges due to their developmental stage. Understanding these differences is essential to providing appropriate support and improving quality of life. Personalized approaches, considering emotional and sexual aspects, are necessary to help young people face the challenges of cancer, promoting a healthier and more fulfilling future.
Impact of Mutations in DNA Repair Genes in Lynch Syndrome: A Systematic Literature Review
Introduction: Lynch syndrome (LS), also known as hereditary nonpolyposis colorectal cancer, is a genetic condition that significantly increases the risk of developing colorectal cancer and other types of cancer. This syndrome is caused by mutations in DNA repair (MMR) genes, which are responsible for correcting errors that occur during DNA replication. Methodology: Scientific databases such as PubMed, Scopus, and Web of Science were consulted for this systematic review. Studies that addressed mutations in MMR genes (MLH1, MSH2, MSH6, PMS2 and EPCAM) and their association with Lynch syndrome were included. Studies that did not present relevant clinical data or that were not systematic reviews were excluded. Results: The results showed that mutations in MMR genes are responsible for approximately 1-7% of all cases of colorectal cancer. The most common mutations are found in the MLH1 (50%) and MSH2 (40%) genes, while MSH6, PMS2 and EPCAM represent a smaller proportion1. These mutations lead to genomic instability, resulting in a high rate of mutations in tumour cells, which contributes to the development of cancer. Conclusion: The systematic review demonstrated that mutations in DNA repair genes have a significant impact on Lynch Syndrome, increasing the risk of colorectal cancer and other types of cancer. Identifying these mutations is crucial for early diagnosis and implementation of screening and prevention programs. Furthermore, understanding the molecular basis of the syndrome may lead to the development of new targeted therapies.
SBRT for Uncomplicated Bone Metastases in the Spine from Lung Cancer
Introduction: Bone metastases (BM) are common in several types of cancer, especially breast, prostate, lung, kidney and thyroid. Radiotherapy (RT) is a standard treatment for symptomatic BM, providing pain relief with minimal toxicity. Stereotactic body RT (SBRT) has emerged as an advanced technique to treat uncomplicated spinal bone metastases (UNSM) in patients with lung cancer. Methodology: A review of the scientific literature on the use of SBRT for UNSM was performed. The review included randomized controlled trials and meta-analyses, focusing on patient selection, treatment techniques and clinical outcomes. Inclusion criteria were defined, excluding imminent pathological fractures or spinal cord compression. Results: SBRT showed high rates of local control of metastases, reaching up to 90% in one year. There was significant pain relief and improvement in the quality of life of patients. Toxicities were minimal, with rare serious complications reported. Studies indicate that SBRT offers additional benefits, allowing dose escalation and minimizing toxicity compared to conventional RT. Discussion: SBRT is a promising approach to treat MONC, especially in patients with oligometastatic disease. Early detection and planned treatment of asymptomatic bone metastases can prevent serious complications, such as pathological fractures and spinal cord compression, improving pain-free survival. Current evidence supports the efficacy of SBRT, but prospective clinical trials are needed to optimize treatment protocols and patient selection. Multidisciplinary collaboration is essential for successful patient management. Conclusion: SBRT represents a significant advance in RT for uncomplicated spinal bone metastases in lung cancer, combining clinical efficacy and safety, with a positive impact on patients' quality of life. This innovative technique offers new therapeutic possibilities that should be considered in selected patients.
Leptospirosis has been known to affect both man and numerous mammalian species resulting in morbidity and mortality. Leptospira interrogans is a pathogenic species that cause leptospirosis while L. biflexa is nonpathogenic. Leptospirosis has worldwide distribution due to the large spectrum of mammalian hosts that harbor and excrete the agent from their renal tubules. The central point on the epidemiology of leptospirosis is the state of the renal carrier, the animal that has its renal tubules colonized by leptospirae, which in turn are excreted in the urine infecting the environment. Infection in domestic animals and wildlife can lead to economic loss and pose a potential spread to the communities. The disease can be directly transmitted through contact with secretions, blood or urine of infected animals, or indirectly through water contaminated mainly with urine of reservoir animals. Leptospirae penetrate intact mucous membrane of the mouth, nose or eyes or abraded, scratched or water softened skin and multiply rapidly after entering the vascular system, spread and further replicate in many tissues including kidney, liver, spleen, central nervous system, eye and genital tract. In Ethiopia leptospirosis is a relatively unknown disease although already reported to occur in domestic animals. The disease is characterized by a broad range of clinical signs which can be presented as acute, sub-acute or chronic. Leptospirosis can be treated by antibiotics such as tetracycline, penicillin, doxycycline, streptomycin and erythromycin, while prevention is characterized by sanitary control and decrease in the risk of infection occurring due to contact with contaminated environments, infected wild animals as well as with synanthropic animals and rodents. Elimination of the carrier state, control of rodents in kennels, maintenance of environmental condition to discourage bacterial survival and isolation of infected animal need to be under taken in order to prevent the disease. Leptospirosis has been recognized as a re-emerging global public health problem due to the increased incidence in both developing and developed countries.
The Role of PTEN Tumor Suppressor Genes in Endometrial Cancer
Introduction: The PTEN gene is one of the main tumour suppressors, which is essential in regulating cell growth and preventing carcinogenesis. In endometrial cancer, mutations or loss of function of PTEN are frequently associated with disease progression, making this gene a relevant target for studies on molecular mechanisms and potential therapeutic approaches. Uncontrolled activation of the PI3K/AKT pathway, resulting from PTEN inactivation, favours cell proliferation and resistance to apoptosis, contributing to tumour aggressiveness. Methology: This study is based on a systematic review of the scientific literature, analysing articles published between 2010 and 2025 in databases such as PubMed, Scopus and Web of Science. Studies that investigate the relationship between PTEN mutations and the development of endometrial cancer, considering molecular, clinical and therapeutic aspects, were included. The selection of articles followed strict inclusion and exclusion criteria, prioritising research with significant samples and well-established methodologies. Results: The data analysed indicate that PTEN mutations are present in approximately 50% of endometrial cancer cases, being more frequent in high-grade tumours. These mutations compromise the function of the PTEN protein, allowing cells with DNA damage to avoid apoptosis and continue to proliferate. In addition, tumours with PTEN mutations are more resistant to conventional treatments, such as chemotherapy and radiotherapy. Recent studies suggest that inhibition of the PI3K/AKT pathway may be a promising strategy to contain tumour progression in patients with PTEN mutations. Discussion: The presence of PTEN mutations in endometrial cancer reinforces its importance as a prognostic and therapeutic biomarker. Uncontrolled activation of the PI3K/AKT pathway contributes to exacerbated cell proliferation, resistance to apoptosis, and tumour angiogenesis, favouring cancer dissemination. Therapeutic strategies aimed at modulating this pathway are being investigated, including specific PI3K inhibitors and targeted therapies. However, challenges such as heterogeneity of mutations and the interaction of PTEN with other molecular pathways require more personalised approaches for the treatment of the disease. Conclusion: The PTEN gene plays an essential role in regulating cell growth and preventing endometrial cancer. Its mutation or loss of function is directly related to tumour progression, therapeutic resistance, and poor prognosis of the disease. Understanding these mechanisms paves the way for the development of new therapeutic strategies, including targeted therapies and PI3K/AKT pathway inhibitors, which may improve clinical outcomes for patients. Future studies should focus on identifying biomarkers associated with PTEN and improving targeted therapies to optimise the management of endometrial cancer
Personalisation of treatments and regenerative therapy in aesthetic dermatology
Introduction: Aesthetic dermatology has revolutionised in recent years, driven by technological advances and the growing demand for more effective and personalised treatments. Personalising skin care allows procedures to be tailored to the individual characteristics of each patient, taking into account factors such as skin type, age, health history and lifestyle. In addition, regenerative therapy has emerged as an innovative approach, promoting cell renewal and improving skin quality in a natural and lasting way. Methodology: This study is based on a systematic review of the scientific literature, analysing articles published between 2015 and 2025 in databases such as PubMed, Scopus and Web of Science. Studies that investigate the effectiveness of personalised dermatological treatments and regenerative therapies, considering clinical, technological and biological aspects, were included. The selection of articles followed strict criteria, prioritising research with significant samples and well-established methodologies. Results: The data analysed indicate that personalising dermatological treatments significantly improves clinical results, reducing adverse effects and increasing patient satisfaction. Technologies such as artificial intelligence, 3d bioprinting and nanotechnology have enabled more accurate diagnoses and highly individualised treatments. In addition, regenerative therapy, based on exosomes, stem cells and growth factors, has shown great potential in skin restoration, promoting rejuvenation and repair of damaged tissues.. Discussion: The personalisation of dermatological treatments represents a significant advance in modern aesthetics, allowing for more effective and safer approaches. Integrating artificial intelligence into skin analysis enables more accurate diagnoses and personalised recommendations, while nanotechnology improves the absorption of active ingredients and enhances the effects of treatments. Regenerative medicine, in turn, has revolutionised dermatology by stimulating cell regeneration and reducing the need for invasive procedures. However, challenges such as accessibility, cost and regulation still need to be overcome for these innovations to be widely adopted. Conclusion: Personalised dermatological treatments and regenerative therapy represent a new paradigm in aesthetics, offering more effective solutions tailored to the individual needs of patients. The combination of advanced technology and biotechnology has enabled more natural and long-lasting results, promoting not only aesthetic improvements but also skin health. Future studies should focus on expanding access to these technologies, ensuring that more people can benefit from these innovations
Impact of Lifestyle on the Incidence of Heart Disease
Introduction: Cardiovascular diseases (CVDs) represent one of the main causes of morbidity and mortality globally. Several lifestyle factors, such as diet, physical activity, alcohol consumption and smoking, have been widely studied for their impact on the incidence of heart disease. This systematic review seeks to analyse the relationship between lifestyle habits and the risk of developing CVD, consolidating scientific evidence on the influence of healthy behaviours in preventing these conditions. Methodology: A systematic review of prospective studies published up to February 2023 was carried out, using databases such as PubMed, EMBASE and Web of Science. Studies that investigated the association between multiple lifestyle habits and the incidence of CVD were included. Statistical analysis involved estimates of relative risk (RR) and 95% confidence intervals (CI), using fixed and random effects models. In addition, subgroup analyses and meta-regression were conducted to assess the robustness of the findings. Results: The results indicated that individuals who adopt a set of healthy habits have a significant reduction of 58% in the risk of CVD and 55% in mortality from CVD. Among those already diagnosed with cardiovascular disease, adherence to a healthy lifestyle reduced the risk of disease recurrence by 62% and mortality from all causes by 67%. The dose-response analysis revealed that each increase in a healthy habit was associated with a 17% decrease in the risk of CVD and 19% in cardiovascular mortality. Discussion: The findings reinforce the importance of adopting multiple healthy habits in the prevention and management of CVD. Public health strategies should focus on promoting behavioural changes, encouraging the practice of physical activity, a balanced diet and smoking cessation. In addition, prevention policies should consider integrated approaches that combine multiple lifestyle factors to maximise health benefits. Conclusion: The systematic review confirms that the adoption of healthy habits is strongly associated with the reduction of CVD risk and improvement of prognosis in individuals already diagnosed. Rather than focusing on just one behaviour, it is recommended to promote multiple healthy habits as an effective strategy in preventing and controlling cardiovascular diseases.
Thayssa Thayssa Vitoria Oliveira Sousa Holanda
On Understanding Urban and Rural healthcare services
Introduction: China is facing a rapid and profound aging process, and the comprehensive demand of the older adults population for medical care, healthcare and living care will continue to rise. This trend not only has an impact on the family's old-age function, but also poses a serious challenge to the social security system and the allocation of medical resources. By exploring the difficulties faced by China's urban-rural integrated medical and care service system, this paper explores the impact of the dual structural dilemma of system and resources on the integrated development of medical and care. Methods: Compared to standard systematic reviews, rapid literature reviews are a kind of evidence synthesis that can provide timely information for decision-making and evidence-based practice. This review uses Web of Science and CNKI (China National Knowledge Infrastructure) as the database source. The search keywords include "medical and healthcare integration", "structural dilemma", "institutional barriers", "resource misapplication" and "digital governance." The search scope is restricted to articles published between January 2024 and December 2024 in order to identify the most up-to-date literature. Results: The development speed of the combination of urban and rural medical care is different. The dual structure of urban and rural areas leads to the uneven distribution of medical resources, and it is difficult for the rural older adults to obtain long-term healthcare and chronic disease management services that are the same as urban ones. Conclusion: The key to solving the structural dilemma is to build an elastic governance framework with Chinese characteristics. The future institutional design needs to enhance adaptability, pay more attention to the complementary relationship between the informal care system and the formal system, and learn from the global experience of aging social governance. Main Contribution to Evidence-Based Practice: This paper shows the dilemma of China's urban and rural medical and rural integrated service system, and mainly analyzes the structural contradictions caused by the system and resources. Therefore, it can provide a reference for the government's medical policy.
Chatbots and AI Systems for Pre-Hospital Care
Introduction: Using chatbots and artificial intelligence (AI) systems in pre-hospital care has transformed patient triage, initial support and emergency logistics. These technologies offer speed and effectiveness in critical situations and are promising tools for improving health outcomes. Methods: This study was based on a literature review in PubMed, Scopus and IEEE Xplore databases, between 2015 and 2023. Articles that explored the use of chatbots and AI in emergency triage, first aid and logistics management were selected. Qualitative analysis synthesized the practical and theoretical contributions of these systems. Results: Chatbots and AI have proven effective in automated triage, reducing response times and improving diagnostic accuracy in medical emergencies. AI systems have optimized ambulance logistics and resources, while chatbots have provided practical guidance on first aid, such as CPR. However, challenges such as unequal access to technology, cultural resistance, and ethical issues related to privacy have been identified. Discussion: These technologies have a positive impact on pre-hospital care by providing rapid and effective support, especially in remote areas. However, technological and ethical barriers limit their adoption. Cultural acceptance and user trust, combined with appropriate regulations and training, are essential to overcome these obstacles. More accessible and integrated systems represent a promising prospect. Conclusion: Chatbots and AI are revolutionizing emergency care, offering accuracy, speed, and accessibility. While challenges remain, coordinated efforts in research, infrastructure, and regulation can ensure their ethical and efficient implementation, enhancing their ability to save lives and transform pre-hospital care.
On The Impact of the New Rural Social Pension Insurance on the Happiness of Rural Residents in the Context of Population Aging
Background The accelerating process of urbanization has led to an increasingly serious aging of the population. In this context, “happy old age” has become a hot issue of social concern. Objectives This study aims to examine the impact of the New Rural Social Pension on the well-being of rural residents in China. Specifically, it seeks to understand how the implementation of this policy affects life satisfaction, confidence in the future, and overall sense of well-being among rural residents. Methods Based on the 2018 and 2020 China Family Panel Studies (CFPS) data, empirical analysis was conducted using Ordinary Least Squares (OLS) and Ordered Probit models. The study also conducted heterogeneity analysis to explore the variability of the impact across different demographic groups. Results The findings show that the implementation of the New Rural Social Pension significantly increases rural residents' life satisfaction and level of confidence in the future, thus enhancing their sense of well-being. Additionally, the heterogeneity analysis reveals that younger residents, females, those from eastern and western regions, and married groups benefit more from the New Rural Social Pension. Conclusion This study provides empirical evidence for understanding the actual effects of the New Rural Social Security policy. It also offers policy recommendations for further optimizing the rural social security system in China.
Operational Efficiency in Teaching Hospitals
Background: Improving the efficiency of teaching hospitals is a growing concern in health systems worldwide. These institutions face unique challenges due to their dual role in delivering care and training professionals. This review synthesizes recent international evidence on strategies to improve teaching hospital efficiency. Methods: A structured literature search was conducted in the PubMed, EMBASE, and Cochrane Library databases for English-language articles published between 2015 and 2024. Articles were selected based on predefined inclusion and exclusion criteria. Eligible studies were analysed and thematically synthesized. Results: Five studies met the inclusion criteria. The most common analytical method was Data Envelopment Analysis (DEA) (n=3), with one study each using DEA combined with PROMETHEE, DEA with propensity score matching, and stochastic frontier analysis. Key efficiency drivers identified included fixed-price payment systems, hospital closures, centralized bed and waitlist management, outpatient service prioritization, and resource optimization. Teaching hospitals were generally found to be less efficient than non-teaching ones, largely due to greater operational complexity. Conclusion: A variety of strategies and hybrid analytical methods are being used internationally to enhance efficiency in teaching hospitals. Structural reforms and operational innovations, particularly those related to centralized management and financial incentives, appear to be most effective. Partnerships between public and academic hospitals may improve efficiency through better resource sharing. However, findings are limited to a small number of countries. Further research is needed to assess the long-term impacts of these strategies across diverse healthcare contexts.
Philosophical Reflections on Chinese Naturopathy against Malignant Tumours
How to recognize the pathogenesis of cancer and how to treat cancer? This involves the "epistemology" and "methodology" of medical philosophy. With the arrival of the global aging society, and after the Covid-19 Pandemic, cancer has become a common and frequent disease. Western medicine mainly adopts surgery, radiotherapy, chemotherapy, targeted therapy and other "allopathic therapies" for the treatment of lung, stomach and breast cancers; however, such traumatic therapies will lead to a further decline in the immune function of the patients, and at the same time of surgery, radiotherapy and chemotherapy, a new ecological environment for the metastasis and recurrence of the cancer cells has already been created. These represent main reasons why it has been difficult to improve the survival rate of cancer patients with more than 5 years in middle and late stage lung cancer, stomach cancer and other cancers. However, patients and the financing institutions, like national health insurance systems, have to bear expensive healthcare expenses for this purpose. Especially in developing countries, many cancer patients "become poor because of cancer", and most of the middle- and late-stage cancer patients end up with "two empty pockets". Thus, the prevention, treatment and rehabilitation of cancer has become a public health issue of global concern and a serious social issue. This is the purpose of writing this article after analyzing the pros and cons of the current "allopathic" cancer treatment model - how to analyze the pathogenesis of cancer applying the philosophical concept of Chinese naturopathy and put forward the Chinese naturopathic "Trinity" cancer treatment model. This approach is in line with the "bio-psycho-social" healthcare model advocated by the World Health Organization, so that more cancer patients can benefit from a holistic treatment process.
Predictive Factors and Outcomes in the Management of Stage IB Endometrial Cancer
Introduction: Endometrial cancer is one of the most common gynaecological malignancies, especially in postmenopausal women. This case study analyzes the clinical course of a 52-year-old female patient diagnosed in April 2020 with low-grade endometrioid adenocarcinoma, stage IB by the FIGO system. After total hysterectomy with bilateral salpingo-oophorectomy, the patient underwent adjuvant radiotherapy due to the presence of risk factors, such as obesity and limited myometrial invasion. Despite the favourable prognosis associated with the ultra mutated POLE molecular profile, the patient presented metastatic recurrence three years after the initial treatment. Methodology: This was a retrospective analysis of the patient's clinical data, including medical history, therapeutic interventions, and outcomes. Management of recurrence included systemic chemotherapy with carboplatin and paclitaxel, associated with palliative radiotherapy for local control. The investigation detailed the factors that contributed to clinical failure, such as obesity, characteristics of the occupational environment, and limitations of the therapeutic strategies adopted. Results: Partial control of metastatic disease, with reduced symptoms and improved quality of life during treatment of recurrence. However, the disease progressed systemically approximately 18 months after intervention, leading to death in a comprehensive palliative care setting. This case highlights the importance of integrative approaches in managing endometrial cancer, considering the interaction between clinical, molecular and psychosocial factors. Clinical failure in the presence of a favourable molecular profile reinforces the need for more personalized therapeutic strategies, including the use of immunotherapy in specific scenarios. Conclusion: The integration of innovative therapies, improved monitoring protocols, and psychosocial support are critical to optimizing outcomes in patients with gynecologic cancer. This case highlights the relevance of additional studies exploring the combination of technological advances and patient-centred care to address the challenges of this condition.
Identification and prevention of long-term care risks for disabled elderly in rural areas of China
Background: With the continuous deepening of population aging, the trend of core family size, and the intensification of social phenomena such as aging before becoming rich, the long-term care risks of disabled elderly are becoming increasingly prominent. Objectives: This study aims to deeply analyze the connotation, characteristics, and causes of long-term care risks for disabled elderly in China, systematically identify their specific manifestations at different levels, and explore how to construct effective risk warning mechanisms and prevention systems. Methods: This study adopts a literature analysis method to systematically clarify the connotation of risk, analyze the specific manifestations of nursing risks faced by disabled elderly people, and examine the influence of factors such as population, family, and labor force, providing theoretical support for the construction of risk warning mechanisms. Results: Research shows that the long-term care risks faced by disabled elderly people in China are mainly reflected in three aspects: financial, caregiving, and poverty risks, and are influenced by factors such as the aging population structure, the prevalence of nuclear families, labor migration, and the increasing burden of elderly care. Conclusion: The long-term care risks faced by disabled elderly people are a key constraint in the development of China's elderly care security system, requiring coordinated responses from the government, society, and families. Establishing a whole-life-cycle risk early warning mechanism, improving the elderly care security system, and optimizing fertility policies are necessary to address these challenges.
Neonatal Hypoglycemia: exploring incidence and risk factors
Introduction: Neonatal hypoglycemia is one of the most common metabolic problems in newborns, which can lead to brain damage and increase the risk of developmental delay. Objectives: The aim of this study was to determine the incidence of neonatal hypoglycemia in neonates and to identify associated risk factors using data from one major hospital in one Province of China. The application of this study in clinical settings can help professionals early identify high risk newborn and give individualized prevention and intervention measures, which may in turn help reduce the incidence rate of neonatal hypoglycemia and reduce complications caused by hypoglycemia. Methodology: Case control study was used on newborns who gave birth between 2016 and 2021 in China. Authors developed a case-control study at a tertiary hospital database between Jan 1, 2016 and Jan 2021. The Cases were identified on the basis of having an outcome of hypoglycemia. Four controls per case (1:4) were randomly selected. Then, multivariable logistic regression analysis was used to analyze risk factors related to the incidence of neonatal hypoglycemia. Results: 16.8% (255) newborns in the cohort had hypoglycemia within 24 hours of birth. Besides, logistic regression analyses showed that cesarean section(OR:3.800,95%CI:8.223-23.158), maternal diabetes(OR:7.416,95%CI:4.287-12.828), maternal hypertension(OR:8.019,95%CI:3.933-16.348), small for gestational age(OR:3.894,95%CI:1.428-10.622), neonatal hypothermia(OR:17.130,95%CI:10.899-26.925) and neonatal infection(OR:17.038,95%CI:5.520-52.590) were risk factors for neonatal hypoglycemia. Conclusion: In a contemporary cohort, the incidence of neonatal hypoglycemia is relatively high, and the incidence of neonatal hypoglycemia is significantly correlated with various clinical factors. Monitoring these risk factors is one of the important measures to reduce the adverse consequences caused by neonatal hypoglycemia.
Copyright (c) 2024 The Publisher https://creativecommons.org/licenses/by/4.0
The CRISPR therapy: A revolutionary breakthrough in genetic medicine
Gene editing with CRISPR-Cas9 technology revolutionizes modern medicine by enabling precise DNA modifications. Initially discovered as a bacterial defense mechanism, the Cas9 enzyme, guided by RNA, can target and cut specific DNA sites, allowing for gene editing. Applications include genetic engineering, functional studies, and potential treatments for genetic diseases like cancer. Notably, in 2023, CRISPR-Cas9 was approved for treating sickle cell anaemia with significant results, despite challenges like long-term security and high costs. CRISPR-Cas9 technology allows for correcting genetic defects, treating diseases, and improving agricultural crops. It can regulate gene transcription through the CRISPRi system, using an inactive Cas9 to interfere with gene expression without permanently altering DNA. This gene-editing tool shows promise in gene therapy, potentially curing diseases like HIV-1, sickle cell disease, and haemophilia B. However, challenges include off-target mutations and efficient delivery of CRISPR/Cas9. Precise target site selection and dosage control are crucial, with tools like CasOT helping identify and prevent unwanted mutations. CRISPR-Cas9 requires a PAM sequence to function, narrowing its targets in the genome but increasing specificity. Production of gRNA faces challenges due to mRNA processing, with alternatives like the artificial gene RGR showing promise. Efficient delivery methods are still needed, with current techniques involving DNA and RNA injection. Future applications include treating genetic diseases and agricultural improvements, with ongoing research essential for overcoming challenges and ensuring safety and accuracy. Global collaboration is vital for the ethical use of this technology. Contribution to evidence-based healthcare: CRISPR therapy represents an exciting frontier in genetic medicine, allowing for precise gene editing and opening up new possibilities for treating incurable diseases.
Social work supervision is an important mechanism for social work personnel training. Through the binary analysis framework of "leadership-subjectivity", it can be found that the effectiveness of social work supervision in accomplishing the supervision tasks within a given time depends on the effectiveness of accompanying supervision characterized by co-situationality. Only by giving full play to the leadership of the social work supervisor and the subjectivity of the social worker and the shaping of the synergy between the two can the ideal effectiveness of accompanied supervision be realized. From the point of view of the working mechanism of accompanying supervision, only by means of the integration mechanism, guidance mechanism, participation mechanism and cultivation mechanism can the supervisor accomplish the goal of supervising and cultivating social work effectively by fully activating and cultivating the subjectivity of the social workers while accomplishing the transformation from embeddedness to integration.
Abstract: Background: Colorectal cancer (CRC) is one of the most common cancers in the Western world, with approximately 1.2 million people diagnosed worldwide each year. Most CRCs are sporadic, resulting from chromosome instability and dysplasia of adenomas to carcinomas. At the same time, the hereditary syndromes of familial adenomatous polyposis (FAP) and hereditary nonpolyposis colpos (HNPCC) arise due to germline mutations in the APC gene and the microsatellite instability pathway. Dysbiosis and associated chronic inflammation have previously been implicated in inflammatory bowel disease, irritable bowel syndrome, and type 2 diabetes mellitus. They are now known to facilitate carcinogenesis in CRC through genetic and epigenetic mechanisms. The dysbiotic bacterium primarily implicated in CRC is Fusobacterium nucleatum, associated with microsatellite instability and lymph node metastasis in clinical trials. Recent clinical studies have also suggested that they may affect prognosis, which, if established, could potentially signal a new frontier in the diagnosis, evaluation and therapeutic management of CRC. Objectives: To systematically review the literature to gather evidence investigating the associations between gut microbiota and CRC, colorectal adenomas, CRC tumour site, CRC stage, prognosis and survival, and the effect of current therapy performed for the treatment of CRC. Methodology: A systematic review of the published literature. Results: 53 studies were considered relevant for inclusion, covering a total of 5167 CRC patients, of which 3754 were tested through mucosal tissue samples, 1072 through stool samples and 341 through a combination. Conclusion: There is a significant association between gut microbiome and CRC, with emphasis on Fusobacterium (genus) and F. nucleatum (species). This association appears to exist more in advanced stages of the tumour and/or adenoma and is often associated with worse prognosis and shorter survival. Keywords: Colorectal cancer, familial adenomatous polyposis, Fusobacterium nucleatum, intestinal microbiota
On The Role of Artificial Intelligence in the Development of Health Tourism
Introduction: Health tourism is one of the rapidly growing industries worldwide, driven by the increasing demand for high-quality medical services at lower costs. In this context, artificial intelligence (AI), as an emerging technology, plays a crucial role in improving service quality, enhancing efficiency, and reducing costs associated with this field. Objective: The aim of this research is to identify opportunities, challenges, and future trends in the application of AI in health tourism, providing a comprehensive perspective for policymakers, healthcare service providers, and professionals in this sector. Methodology: This study is a systematic review conducted in accordance with PRISMA guidelines. A literature search was performed in reputable databases, including PubMed, Scopus, Web of Science, and Google Scholar, using keywords related to "artificial intelligence" and "health tourism." Studies published between 2010-2025 were reviewed. Results: The findings of this study indicate that artificial intelligence has a significant impact on the development of health tourism. The most important applications of AI in this field include optimizing appointment scheduling and booking systems, intelligent diagnosis and treatment, personalized medical services, efficient management of international patients, and enhancing the patient experience. Additionally, the use of AI can lead to cost reduction, increased diagnostic accuracy, and improved quality of healthcare services for health tourists. Conclusion: Artificial intelligence plays a significant role in improving and developing health tourism, leading to increased efficiency, cost reduction, and enhanced service quality. However, challenges such as implementation costs and ethical issues need to be addressed. The development of supportive policies and technological infrastructure can help effectively leverage this technology in health tourism.
Impact of Adjuvant Radiotherapy on Survival of Patients with Stage I-II Endometrial Cancer
Introduction: Endometrial cancer is the most common gynecological neoplasm in developed countries. Most cases are diagnosed early, and surgical treatment is usually curative. The role of adjuvant radiotherapy is controversial, especially for patients with intermediate or high-risk factors. The increasing variety of therapies and emphasis on personalized treatment underscore the need to critically assess the impact of radiotherapy on patient outcomes. Therefore, this study aims to evaluate the impact of adjuvant radiotherapy on clinical outcomes in patients with endometrial cancer who have intermediate or high-risk factors. Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol was registered on the PROSPERO platform. A literature search was conducted in PubMed/MEDLINE, Embase, Scopus, Web of Science, Lilacs, and SciELO. The search covered publications up to August 2025. Controlled descriptors (MeSH) and free keywords were used, combined with Boolean operators. Original studies with clinical data on patients undergoing adjuvant radiotherapy, published in Portuguese, English, or Spanish, were included. Results: After screening and evaluating the full texts, 12 studies were included, totaling 18,975 patients. The studies analyzed different radiotherapy modalities, such as external beam radiotherapy, vaginal brachytherapy, and combination therapy with chemotherapy. The results demonstrated that adjuvant radiotherapy significantly contributes to reducing locoregional recurrence and improving disease-free survival, especially in patients with risk factors such as high tumor grade, lymphovascular invasion, or malignant peritoneal cytology. Vaginal brachytherapy showed similar efficacy to external beam radiotherapy in many cases, with less toxicity. Recent studies propose selective treatment deintensification and the use of molecular profiles to guide radiotherapy indications, as evidenced in the PORTEC-4a clinical trial. Conclusions: Adjuvant radiotherapy plays a relevant role in the management of early-stage endometrial cancer and should be indicated selectively based on clinical, histological, and molecular criteria.
Copyright (c) 2026 The Authors https://creativecommons.org/licenses/by/4.0
Nursing performance management under the reform of health insurance payment in China
Introduction: In recent years, China's medical insurance payment reform has shifted from “project-based payment” to composite payment modes such as Diagnosis-Related-Group/Big Data Diagnosis-Intervention Pocket (DRG/DIP) payment and total prepayment, aiming to control medical costs and improve service efficiency. Nursing, as the core process of health services, its performance management directly affects the quality of nursing and the effectiveness of medical insurance fund utilization. At present, the reform of medical insurance payment modes has posed new requirements for nursing staffing, service processes, cost control, etc. However, the problems of single evaluation indicators and insufficient connection with medical insurance policies in traditional nursing performance management urgently need to be solved. Methods: This review analyzed the correlation between medical insurance payment reform and nursing performance management and sorted out the current practice status, challenges, and optimization paths of nursing performance system under the background of existing policies. Results: In response to the impact brought about by the new healthcare payment reform, it is necessary to establish a healthcare-nursing linkage indicator system, formulate detailed nursing cost accounting and budget management, and innovate the performance distribution mechanism. Conclusions: The article provides reference for building a nursing performance management model that conforms to the orientation of health insurance reform.
Copyright (c) 2025 The Authors https://creativecommons.org/licenses/by/4.0
Factors in Genetic Alterations in DNA Repair Pathways and Their Effects on Endometrial Cancer
Introduction: Endometrial cancer is the most common gynecological neoplasm, with its origins closely linked to genetic alterations. This study highlights mutations in genes involved in DNA repair, especially the mismatch repair system and the BRCA1/2 genes, as central elements in the development of the disease, its molecular profile, and response to treatments. Understanding these genetic impacts is crucial to improving diagnostic methods and driving the development of personalized therapeutic approaches. Methodology: A literature review was conducted, searching for articles in the PubMed and Scopus databases. Inclusion criteria included molecular, clinical, and epidemiological studies that established a correlation between mutations in DNA repair genes and endometrial cancer, published in the last ten years. The selected studies were analyzed to gather information on the prevalence of mutations in the mismatch repair system and BRCA1/2 genes, the frequency of microsatellite instability, the clinical and molecular profiles of the tumors, and the impact of these alterations on the response to therapies, especially immunotherapy. Results: The results of the review indicate that mismatch repair deficiency, caused by germline mutations or epigenetic methylation, represents a relevant molecular event in approximately 20 to 30% of endometrial cancer cases. This deficiency is associated with microsatellite instability and a hypermutated phenotype, characterized by a high mutational burden. This condition makes the tumor more immunogenic, favoring a positive response to immunotherapy with immune checkpoint inhibitors. Furthermore, germline mutations in the MMR genes are linked to Lynch Syndrome, which significantly increases the risk of developing endometrial cancer in young women. Mutations in the BRCA1/2 genes have also been identified, especially in the more aggressive serous subtype, suggesting a role in homologous recombination deficiency and tumor progression. Conclusion: Genetic alterations in genes responsible for DNA repair play a key role in the molecular biology of endometrial cancer. They not only determine specific molecular subtypes of the disease but also serve as valuable indicators for diagnosis, prognostic assessment, and patient selection for targeted therapies.
Introduction: Identifying mutations in the POLE gene in endometrial cancer has direct implications for therapeutic management, potentially allowing clinicians to avoid aggressive adjuvant treatments in patients with a favorable molecular profile. Endometrial cancer is the most common gynecological neoplasm in developed countries, with a predominance of the endometrioid subtype. Recently, the molecular classification proposed by The Cancer Genome Atlas identified four distinct subtypes, including the group with POLE gene mutations, characterized by ultramutation, excellent prognosis, and low recurrence rates. Methods: A clinical case study involved a 58-year-old with high-grade endometrioid adenocarcinoma, stage IB. The patient underwent total hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. Genetic sequencing of the tumor confirmed the POLE mutation. The therapeutic approach was discussed at a multidisciplinary meeting, considering clinical, histopathological, and molecular data. The team decided to proceed with observation without adjuvant therapy. The patient experienced a favorable outcome post-operatively, with no evidence of disease recurrence at follow-up. Results: The POLE mutation is associated with a robust tumor immune response and excellent overall survival, even in high-grade tumors. Several studies, including ESGO/ESTRO/ESMO guidelines, recommend that patients with this molecular profile be treated with surgery alone, without the need for radiotherapy or adjuvant chemotherapy, provided there are no high-risk clinical factors. In the case analyzed, the patient had a satisfactory surgical recovery without complications. Conclusions: The molecular characterization of endometrial cancer, especially the identification of the POLE mutation, represents a significant advance in personalized treatment. In patients with this profile, such as the 58-year-old woman analyzed, a surgical approach alone may be sufficient, avoiding unnecessary toxicities and maintaining an excellent prognosis. The incorporation of genomics into clinical practice reinforces the importance of precision medicine in gynecological oncology.
Introduction: Case study of woman 55-year-old, single, retired female patient who presented with a painless, slowly growing swelling in the right submandibular region for approximately 8 months, accompanied by mild dysphagia for the last two months. The absence of systemic symptoms, such as pain, fever, or weight loss, initially made the presentation clinically nonspecific. Still, the persistent swelling and its characteristics on physical examination and imaging raised strong suspicion of salivary gland neoplasia. Methods: The diagnostic process included a detailed clinical evaluation and sequential complementary exams. Initially, basic laboratory tests were performed, showing results within normal limits, except for a mild, nonspecific elevation of C-reactive protein. Imaging investigation began with an ultrasound of the cervical region, which revealed a hypoechoic, solid, and vascularized nodular mass in the right submandibular gland. A contrast-enhanced CT scan of the neck confirmed the mass, with no signs of invasion of adjacent structures or lymph node enlargement. Ultrasound-guided fine-needle aspiration biopsy was suggestive of salivary gland neoplasia, but not definitive. Results: Histopathological examination of the surgical specimen confirmed the diagnosis of adenoid cystic carcinoma of the submandibular gland, classified as low/intermediate grade. The surgical margins were considered clear, but focal perineural invasion was identified, a crucial finding due to its prognostic impact. Based on the perineural invasion, the patient was referred for adjuvant radiotherapy with the Intensity Modulated Radiation Therapy technique. Acute side effects were observed and managed during radiotherapy. Conclusion: This case of adenoid cystic carcinoma of the submandibular gland demonstrates the importance of early diagnosis and a multimodal approach in the treatment of salivary gland tumours, especially those with risk factors such as perineural invasion. The patient was successfully treated with surgery and adjuvant radiotherapy. Still, the aggressive nature and propensity of adenoid cystic carcinoma to late recurrence and distant metastases require rigorous and continuous long-term follow-up, with periodic clinical examinations and serial imaging studies (neck and chest CT scans), to monitor disease recurrence and optimise the patient's survival and quality of life.
Multimodal Safeguards Against Oncological Relapse and Therapy-Induced Cardiotoxicity
Introduction: A 65-year-old woman had been cured of breast cancer 15 years earlier (2010) with a regimen that included doxorubicin, and despite prolonged survival, cardiac evaluation revealed preexisting subclinical myocardial dysfunction. The central challenge arose with the diagnosis of locally advanced non-small cell lung cancer in 2024, requiring thoracic radiotherapy, which presented a significant risk of worsening her previous cardiac impairment. Methods: The investigation of the patient's new condition began with respiratory symptoms, and the diagnosis of NSCLC was confirmed by chest X-ray, contrast-enhanced computed tomography, and CT-guided lung biopsy with pathological examination and immunohistochemistry. A whole-body PET/CT scan was used for staging, revealing no distant metastases. A detailed cardiac evaluation before treatment revealed borderline left ventricular ejection fraction and decreased global longitudinal strain, confirming preexisting type I cardiotoxicity. Given the diagnosis of NSCLC, a multidisciplinary treatment plan focused on cardio-protection was defined, with early introduction of an angiotensin-converting enzyme inhibitor and a beta-blocker before starting radiotherapy. The article followed the CARE protocol for Case Studies. Conclusion: The patient completed radiotherapy for NSCLC without experiencing severe acute cardiac toxicity during treatment. The lung tumour demonstrated a good therapeutic response.
Research on the optimization path for digital health promotion in the context of healthcare integration
As the population ages and the prevalence of chronic diseases rises, the conventional passive healthcare service paradigm is unable to provide health requirements. digital health promotion facilitate health monitoring, risk assessment, and intervention advice through the utilization of Internet of Things, big data, artificial intelligence, and other technologies, offering an innovative solution for healthcare integration. We examine the conceptual implications and developmental status of digital health promotion, addresses the practical challenges encountered in their development, and proposes recommendations for advancement through multifaceted approaches including policy enhancement, technological integration, and talent development, aiming to offer insights for the execution of healthy aging strategy.
Racial and Ethnic Disparities in Cancer Care among People with HIV in the USA
Background: People with HIV (PwH) are at heightened cancer risk, but racial/ethnic disparities across the cancer care are not well understood. Our systematic review examined racial/ethnic differences in cancer risk, screening, treatment, and survival/mortality among PwH. Methods: We searched PubMed, Web of Science, Cochrane Library, ProQuest, and EMBASE for studies published in English (01/01/1980-05/30/2023), using key words and MeSH terms “race/ethnicity”, “cancer”, and “HIV”. Paired reviewers screened studies and extracted data. Study quality was assessed using the National Institutes of Health Study Quality Assessment Tool. All eligible studies were included, regardless of quality, to identify research gaps. Results: Of the 26 eligible studies, 11 assessed cancer risk only, 4 screening, 5 treatment, and 3 survival/mortality only, while 3 assessed both cancer risk and mortality. Risk studies focused on human papilloma virus-related (4), Kaposi sarcoma (4), urogenital (3), and lung (1) cancers. Among men who have sex with men (MSM), Kaposi sarcoma risk appeared higher among Black men than white, but lower in HHV-8 seropositive MSM. Screening studies on cervical (3), breast (3), and colorectal (2) cancers showed no evidence of disparity. Treatment studies on lymphoma (3) and multiple cancers combined (3) found Black individuals were less likely to receive treatment than their White counterparts. Most studies were rated fair (14) or poor (12). Conclusions: Our findings suggest that there are racial/ethnic disparities of cancer risk, treatment, and mortality/survival outcomes but no observable disparities related to cancer screening among PwH. Additional research on distinct cancer types to expand the breadth of evidence will address existing gaps in knowledge on racial/ethnic disparities among individuals with PwH at risk or living with cancer. Contributions to Evidence-Based Practice: Racial/ethnic disparities of cancer risk, treatment, and mortality/survival outcomes but no observable disparities related to cancer screening among PwH. Additional research on distinct cancer types to expand the breadth of evidence will address existing gaps in knowledge to allow for the planning of tailored interventions to provide a more equitable healthcare for individuals at risk or living with cancer in PwH.
Nursing performance management under the reform of Health Insurance payment in China
Introduction: China's Health Insurance payment reform has shifted to DRG/DIP in recent years. Nursing performance and management under the reform have been research hotspots. This article focuses on analyzing the research trends to help advance research in these fields. Methods: Using CiteSpace, the literature on nursing performance management under the Health Insurance payment reform was visualized and analyzed. Through analyses of annual publication volume, co-occurrence of authors, institutions, and keywords—as well as clustering and burst detection—trend charts of publication volume, collaborative co-occurrence maps, and keyword clustering visualizations were generated. Further exploration of research hotspots and trends followed. Results: The results indicated that research hotspots focused on public hospitals, nursing, and nursing pathways, with future research trends moving toward cost management. Discussion: There is still a need for enhanced research on nursing performance and nursing management under the medical payment reform. Conclusion: Although researchers have focused on keywords related to nursing performance management during the Health Insurance payment reform, more in-depth studies are still needed. What do we already know about this topic? Through CiteSpace's visual analysis, the study clearly identifies and delineates the core research hotspots and evolutionary trends in this field in recent years, such as the specific impact of DRG/DIP payment methods on nursing resource allocation, cost accounting, quality monitoring, and nurse performance appraisal. What is the main contribution to Evidence-Based Practice from this article? By identifying hotspots and trends, the research highlights which nursing management practices and performance improvement measures have received significant attention and (potential) validation of effectiveness in the current reform context, guiding clinical institutions in prioritizing the adoption and implementation of evidence-based nursing management models. What are this research’s implications towards health policy? The identified hotspots, such as linking nursing performance evaluation to payment and the role of nursing management in cost control and quality improvement, emphasize that future economic policies need to more precisely account for the unique value and economic contribution of nursing services, promoting their effective integration into overall healthcare value assessment and reimbursement systems.
On The Digital Transformation of Health Systems
The digital transformation of the primary health and healthcare system is not a process of replacing classical machines and techniques with advanced tools and machines, but rather a process of transformation, programming, and changing concepts, methods, habits, and systems. The human cadre has an effective role in the process of digital transformation among all sectors of the health sector. There is interconnection and understanding in the process of digital transformation of health between individuals, where workers in the health sector exchange and investigate about adequate education for digital transformations. Understanding every detail of digital transformation, investing in it, and working to develop it gives success and a strong boost to the system. Digital transformations will impact traditional healthcare organizations into an advanced digital world with maximum new technology implementation. This Letter to the Editor explores these challenges in international healthcare management.
The Implementation of HFMEA in a Primary Care Emergency Service of the Portuguese National Health System
Background: One of the main priorities for healthcare institutions is to provide better and more advanced services that contribute to prolonging the lives of those who seek their care, as well as improving their quality of life as long as it lasts. Both their patients and the professionals who work in those institutions need to feel protected against adverse effects that may affect them physically, mentally, or socially. As such, both at national and international levels, healthcare governing bodies have made decisions and implemented measures aimed at reducing the risk of adverse effects for the patients who use their services. Objectives: The main objective of this work was to develop and implement a risk management system based on HFMEA in a basic emergency service (primary care), to promote patient safety and the safety of healthcare professionals. Methods: A prospective, explanatory, and descriptive case study was applied to a basic emergency service, using ISO 31000 – risk management in organisations, and the healthcare failure mode and effects analyses (HFMEA) support tool. Results: There were identified 57 possible failures associated with 88 different effects, with risk magnitudes classified as severe (1 cases), very severe (18 cases), and intolerable (38 cases). Failures whose effects impact patients were mentioned 2,6 times more than those primarily affecting professionals. Conclusions: The study allowed the identification of different failures in some of its work processes, for which corrective measures were determined to be carried out by the team and the governing entities of the service, to be implemented as soon as possible, ensuring greater safety in its services.
Objective: Against the backdrop of China's aging population and the "Healthy China Strategy", promoting the reform of the nursing industry is becoming increasingly important. The "Internet + Nursing Service" model is becoming a new trend. This study aims to provide a reference for the high-quality development of "Internet + Nursing Service". Method: Utilize the SWOT analysis method to deeply understand and analyze the advantages and disadvantages, current development status, and existing policy issues of the "Internet + Nursing Service" model in China. And relevant targeted suggestions and proactive countermeasures were put forward. Result: "Internet + Nursing services" has become a new trend in the development of nursing. Conclusion: Currently, the "Internet + Nursing Service" model in China not only has the advantages of breaking the industry barriers of traditional nursing, extending the radius of nursing services, and meeting diverse and multi-level health needs, but also can encourage nurses to utilize their spare time, give full play to their skills, and serve the society more. It not only reflects professional advantages, but also demonstrates the autonomy and flexibility of services. However, there are also deficiencies such as a shortage of nursing human resources and the elderly's lack of access to networks. Only by constantly playing to strengths and making up for weaknesses and improving the management system can "Internet + Nursing services" achieve better development.
The Factors influencing career well-being of clinical laboratory professionals
Background: The healthcare industry experiences a massive occupational burden worldwide due to several emerging factors. Among healthcare workers, medical laboratory professionals undergo immense emotional and financial degrowth over the past decades, diminishing career satisfaction, productivity, and retention. Quality of work life (QWL) acts as a significant parameter to measure job satisfaction. Although carrier satisfaction is governed mainly by financial and emotional factors, the type of working sector of the professionals can also be a vulnerable factor (e.g., private and government). Objectives: The scope of this paper is to magnify the knowledge through available literature on the factors influencing the career well-being of clinical laboratory professionals. Methods: We reviewed articles regarding this topic since 2018 by searching Google Scholar, PubMed, ResearchGate, Web of Science, and ScienceDirect databases. A thorough search of research papers and articles on career satisfaction of medical laboratory professionals globally from 2018 to 2025 in the Web of Science and other mentioned databases. Results: Medical laboratory professionals seek a lot of influences for their career well-being, such as occupational satisfaction, motivation, financial stability, job security, policy framework, benefits, career development, and recognition. Make sure that all these are covered in the literature. The review is divided into four main headings to discuss the core areas of interest, including workplace environment, workload, motivation, and stress, among all other factors. Conclusion: This review emerges from the knowledge to discover the main factors affecting the career well-being of medical laboratory professionals, when it comes to the practical scenario. It can be concluded that the major contributor to job satisfaction as the emotional factor, which changes from one person to another. Motivation, is the key determinant of occupational fulfillment. Main Contribution to Evidence-Based Practice: The article helps to make healthcare professionals aware of the current satisfactory rate of medical laboratory professionals. This research study will contribute a lot of knowledge to the worldwide health sector by raising awareness of job dissatisfaction among clinical laboratory professionals in evidence-based practice.
The Awareness of the Violence Against Healthcare Workers in Pakistan
Background: Workplace violence (WPV) threatens healthcare worker safety and undermines health systems globally. Although progressive legislation, such as the Khyber Pakhtunkhwa Healthcare Service Providers and Facilities Act (2020), has been enacted, little is known about the law’s real-world impact—especially in post-conflict regions. This study assessed awareness of the Act and barriers to its effective implementation among caregivers (patient attendants) in the newly merged districts (NMDs) of Khyber Pakhtunkhwa, Pakistan. Methods: A cross-sectional survey of 769 caregivers in district hospitals of Bajaur, Khyber, and Kurram (August–November 2023) measured legal awareness, reporting behavior, and structural barriers. Data were analyzed descriptively and thematically, mapped to the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation science framework. Results: Awareness of the Act was low overall (27.6%), with marked district variation (7.9% in Khyber vs. 54.4% in Kurram). Most respondents preferred internal (hospital-based) reporting (75%), citing distrust in law enforcement and low policy visibility as primary barriers. Social and mass media were the main information sources. Factors impeding policy reach included low literacy, inadequate communication strategies, and limited institutional support. These findings reveal a persistent gap between legislative intent and frontline practice. Conclusion: Preventing workplace violence requires more than legislation. Embedding legal rights and violence-prevention training in healthcare curricula, establishing confidential reporting pathways, and engaging communities through targeted media and culturally sensitive campaigns are essential. A multi-sectoral, context-driven approach is needed to translate legal protections into tangible safety for healthcare workers in fragile settings
TP53 Gene Mutation and its Role in the Development of Endometrial Cancer
Introduction: Cardiovascular diseases (CVDs) represent one of the main causes of morbidity and mortality globally. Several lifestyle factors, such as diet, physical activity, alcohol consumption and smoking, have been widely studied for their impact on the incidence of heart disease. This systematic review seeks to analyse the relationship between lifestyle habits and the risk of developing CVD, consolidating scientific evidence on the influence of healthy behaviours in preventing these conditions. Methods: A systematic review of prospective studies published up to February 2023 was carried out, using databases such as PubMed, EMBASE and Web of Science. Studies that investigated the association between multiple lifestyle habits and the incidence of CVD were included. Statistical analysis involved estimates of relative risk (RR) and 95% confidence intervals (CI), using fixed and random effects models. In addition, subgroup analyses and meta-regression were conducted to assess the robustness of the findings. Results: The results indicated that individuals who adopt a set of healthy habits have a significant reduction of 58% in the risk of CVD and 55% in mortality from CVD. Among those already diagnosed with cardiovascular disease, adherence to a healthy lifestyle reduced the risk of disease recurrence by 62% and mortality from all causes by 67%. The dose-response analysis revealed that each increase in a healthy habit was associated with a 17% decrease in the risk of CVD and 19% in cardiovascular mortality. Discussion: The findings reinforce the importance of adopting multiple healthy habits in the prevention and management of CVD. Public health strategies should focus on promoting behavioural changes, encouraging the practice of physical activity, a balanced diet and smoking cessation. In addition, prevention policies should consider integrated approaches that combine multiple lifestyle factors to maximise health benefits. Conclusion: The systematic review confirms that the adoption of healthy habits is strongly associated with the reduction of CVD risk and improvement of prognosis in individuals already diagnosed. Rather than focusing on just one behaviour, it is recommended to promote multiple healthy habits as an effective strategy in preventing and controlling cardiovascular diseases.
Background: Healthcare related welfare is a matter of resource allocation. In modern market economies, redistribution in Western societies is accomplished through state welfare systems to balance the inequality of market resource allocation. However, resource allocation in socialist countries has its own peculiarities. And the relationship between market transformation (social transformation) and resource allocation methods in post-socialist countries is an important academic topic. This paper examines the changes in the rural cooperative medical system（RCMS）in China in order to explore the changes in rural cooperative healthcare governance mechanisms during recent social transformation. Objectives: The main purpose of this paper is to place the rural cooperative health care system（RCMS）in a macroeconomic-political context and to compare the changes in cooperative health care resource allocation mechanisms across time. Methods: The article undertakes a narrative literature review approach and method. The review used the following sources: Web of Science and PubMed. The search used the keywords" rural cooperative medical care system", "community benefits", " public service-based welfare" and "governance",and limited to articles published between January 2019 and June 2022. The selection of articles was based on the inclusion/exclusion criteria (keywords defined and time span of publication). Results: From collectivized cooperative medical care System（RCMS） to today's New Rural Cooperative Medical System（NRCMS), its governance mechanism has changed and the nature of welfare has changed with it. It has also changed from community welfare, where organized grassroots communities supply medical services, to government-led public service-based welfare. Main Contribution to Evidence-Based Practice: The paper shows the process of change in China's rural cooperative healthcarel system（RCMS), mainly analyzing the change of healthcare welfare governance mechanism. Thus ,it provides a reference for governmental health policies development and for international researchers.
Copyright (c) 2022 The Publisher https://creativecommons.org/licenses/by/4.0
Differential effects of family and friend support in sexual minority aging adults: Analysis of MIDUS 3
Background: Sexual minorities experience disproportionate stress from historical and current oppression and social discrimination/isolation compared to their heterosexual counterparts, leading to greater risks of adverse mental health. Although social support serves as a significant protector buffering stress on physical and mental health, little is known about its effect on psychological well-being among sexual minority aging adults. Study objective: We aimed to explore the effects of social support from family and family on three psychological outcomes: life satisfaction, self-esteem, and social well-being: between sexual minority and heterosexual aging adults using national representative data from the 2013-2014 Midlife Development in the United States (MIDUS 3) in the U.S. Methods: Key variables included: sexual orientation, family support, friend support, life satisfaction, self-esteem, and social well-being. We conducted adjusted, multiple linear regressions to examine life satisfaction/self-esteem/social well-being in relation to perceived discrimination, family support, friend support, and two-way interactions using backward stepwise regression. Results: Of the 2,596 U.S. participants (Mean[age]=64.19; SD=11.0), 3% identified as sexual minorities and 9.7 % were racial/ethnic minorities. Sexual minority participants were more likely to perceive discrimination and less likely to have family support compared to their heterosexual counterparts. Regarding to adjusted linear regression models, heterosexual participants with greater family support had greater psychological wellbeing compared to their sexual minority counterparts with greater family support. However, sexual minority participants with greater friend support experienced a steeper increase in psychological outcomes based on life satisfaction, self-esteem, and social well-being compared to heterosexual participants with greater friend support. Contribution to Evidence-Based Care: The findings suggest that sexual minority aging adults experience disproportionately more lifetime discrimination and lower family support compared to their heterosexual peers. Future studies and social programs should address the differential effects of family and friend support on physical and psychological indicators among sexual minority aging adults.
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Background: Patient satisfaction is a tool assessing the service quality of the provider that evaluated based on the measurement of perceived quality by the customer on aspects of service. This study aims to examine the relationships between various factors in the integrated model which included total quality management, perceived service quality, patient satisfaction, and patient loyalty. Methods: A conducted questionnaire was distributed to inpatients who were treated at a tertiary-level hospital in Vietnam during April 2018. The data analysis was used the Statistical Package of Social Sciences version 25.0 and Amos 25.0 for structural equation modeling. Results: The findings showed that all hypotheses were supported. Total quality management has a positive influence on perceived service quality and patient satisfaction, perceived service quality on patient satisfaction, and patient satisfaction on patient loyalty. Practice implications: Our model was used to measure patient satisfaction and loyalty. Findings indicate that total quality management and perceived service quality are the main factors that directly influence on patient satisfaction. This study has implications for managers who should consider total quality management and perceived service quality as the main factors that directly influence on patient satisfaction and thus increase customer loyalty. What is the main contribution to Evidence-Based Practice from this article? Based on practice, the article supports the body of evidence on the relevance of Patient Satisfaction for health professionals’ continuous improvement in their activity. Our model was used to measure customer satisfaction and loyalty. This study has practice implications for managers who should consider total quality management and perceived service quality as the main factors that directly influence customer satisfaction and thus increase customer loyalty
Background: The working conditions of many nurses and healthcare professionals around the world have deteriorated during the pandemic. Workplace bullying occurring among nurses has been reported more and more. Methods: The authors systematically searched the PubMed, Embase, and Web of Science databases for relevant articles on workplace bullying among nurses from 2020 till the present. The screening was performed strictly according to the inclusion and exclusion criteria, and finally, the relevant literature was read and summarized. Results: A total of 6 articles met the criteria published between 2020 and 2022. The status of research in the field of bullying in the nurse's workplace was identified, including influencing factors and their impact on patient outcomes, nurse work, etc. Conclusion: Published research has shown that workplace bullying among managing nurses has beneficial effects on outcomes for both nurses and patients. This study suggests that managers should pay more attention to the workplace bullying behavior of nurses and take management measures to reduce the turnover rate of nurses, improve the nursing level and reduce the level of nursing errors. Contribution to evidence-based practice: This article brings together advances in research on workplace bullying among nurses and identifies its harm, offering ideas for reducing bullying in the workplace.
Background Internal audit operates within international professional practices established by the Institute of Internal Auditors (IIA). It contains an independent role from the organizational structure and represents the third line of defense in the implemented model of government, risk management, and internal control. Internal audit provides reasonable safety regarding the quality of the processes, including reporting to management about internal control and risk management. Objective Internal control processes and risk management in the scope of the processing of calls and the charging of the outsourcing company. Formulate recommendations for performance improvement in the ambit of health policies. Methods For its fulfilment, this work was based on international norms for professional practice in Internal Audit. The risk management methodology – COSO ERM (Enterprise Risk Management – Integrating with Strategy and Performance) and COSO (Internal Control – Integrated Framework) were also used for the analysis of internal control. Results There were identified two risks of operational nature and internal origin, two risks of a strategic nature related to the market, and three risks of a technological nature. Conclusions The recommendations described in the report are based on the relationship between public and health policies that have gained importance in recent years with the Covid-19 pandemic, since the beginning of 2020, accelerating the digital transition process in Portugal. Contributing to outstanding dissemination of Teleconsultations, technological development and privileging paperless recipes, meeting the guidelines for EU Digitization by 2030. What is already known on this topic? The European Commission sees eHealth as a priority and encourages the creation of a global strategy in the countries of the European Union, with the objective of developing the transformation, the Telehealth Contact Center sorting system has been optimized with the introduction of Artificial Intelligence in the branching of the algorithms and in the conclusion diagnosis. Main contribution to Evidence-Based Practice In the current context, with the growing tendency to health digitalization and the market potential in telehealth, the role of internal audit has been gaining an indispensable position in the success of a company, fomenting quality and rigor in decision making. In this way, internal audit is capable of significatively contributing to risk reduction and the improvement of management quality, converting itself into lucrative processes for the company. Implications for healthcare practice The relation between the diagnosed risks and the improvement recommendations allowed the correlation of internal policies with public health which sustains the sector.
On Community Pharmacists and Promotion of Lifestyle Modification in Adults with Hypertension
Introduction The growing prevalence of hypertension is a problem of public health importance globally. Lifestyle modification is an important first-step in the management of hypertension requiring promotion by all healthcare professionals. However there is not enough focus on the contribution of pharmacists towards promotion of lifestyle modification (PLM) in the management of hypertension in Nigeria. Methods A phenomenological study involving in-depth interviews of 12 community pharmacists was conducted to explore how community pharmacists promote lifestyle modification in adults with hypertension Lagos, Nigeria and to develop a practice protocol for community pharmacists for guiding the practice of PLM. Participants were purposively selected as key knowledgeables who could give rich and nuanced insights about the phenomenon of PLM and an interview protocol was used to guide the interviews. Results From a thematic data analysis conducted, 7 themes emerged to categorize the practice of PLM by community pharmacists among hypertensive adults and the essence of a practice protocol. The themes pertaining to practice were cognitive factors, contextual factors, strategies, and self efficacy. From the perspectives of the participants, a practice protocol was developed that can serve as a guide to community pharmacists in Lagos while performing the role of PLM among adults with hypertension. Conclusion Community pharmacists are well positioned in communities to contribute to reducing the incidence and prevalence of hypertension in Nigeria. The availability of a practice protocol will enhance the performance of community pharmacists while promoting lifestyle modification and can help to standardize the practice of PLM. Key words: Hypertension, practice protocol, promotion of lifestyle modification, community pharmacists, phenomenology
Background: The COVID-19 pandemic has seriously affected global public health security and economic development, and is a huge test for China and other countries around the world. Among the factors affecting the outbreak of the epidemic, human abuse of wildlife appears to be the most important. Under the influence of relevant factors, China has formulated and implemented policies, laws and regulations on a comprehensive ban on wildlife. Objectives: Through the integration and impact analysis of China's comprehensive wildlife fasting policy and relevant laws and regulations, this paper aims to provide reference for other countries in epidemic prevention and control and the improvement of public health governance. Methods: Through the integration of relevant policies and regulations and detailed introduction, the author studied from three aspects: policies and regulations related to people's life, health and safety, improvement of public health and safety risk prevention and promotion of environmental protection and human civilization development, and analyzed its impact on all aspects of human society, especially public health safety and emergency management system and management capacity, to remind people to change the habit of over eating wild animals. Results: The article is of reference and guiding significance in promoting the global implementation of comprehensive fasting for wild animals, and in the current epidemic prevention and control of other countries, maintaining social public health and security governance, and safeguarding human health. Main Contribution to Evidence-Based Practice: The article demonstrates that the relevant policies, laws and regulations of China's comprehensive prohibition of wildlife have reference and guiding significance for epidemic prevention, maintenance of social public health and safety management, and protection of human health. In addition, it has promoted the global implementation of a comprehensive ban on wildlife.
On Ethics, Biomedical Education and Health Promotion
This article is a Commentary that reflects on scientific research and education by exploring a potential social dimension in terms of its implications to population health and public welfare. With particular attention to biomedical technology, it argues that the development of a keen awareness and ethical standards has become a pressing need for social policy to promote scientific social responsibility (SSR) for research and educational institutions. A biopsychosocial view of health and mental health is applied along with an international perspective in relation to China’s current ideological and political contexts to indicate the complexity of the issues involved.
Background: China's child welfare system is a the process of transition from compensation-type to moderate inclusive type. However, it still heavily relies on the path of compensation-type. Based on insufficient national governance capabilities, the core of welfare in China is being challenged and it has lead to the dislocation and insufficiency of welfare supply to children with rare diseases. A multi-coordinated national care service system is urgently in need to be developed. Objectives: In the context of state parental power, what is the current situation of welfare of children with rare diseases in China? What are the characteristics? How to play a coordinated role of all stakeholders in the care delivered to children with rare diseases? Methods: The methods of interview, literature review and questionnaire survey were used to understand the basic situation of children with rare diseases and the interaction between the welfare provider and the providing mechanism. Basic information on children with rare diseases, family status and needs were collected. Relevant literature on the protection of children with rare diseases from the central government was analyzed. Results: Fourfold dislocation impedes the provision of resources for the welfare delivered to children with rare diseases. Economically, the government's basic welfare services for children with rare diseases seems insufficient In the healthcare field, the quality of specific services offered by healthcare organizations is uneven. In terms of timing, children with rare diseases face the effects of having few caregivers allocated. Main Contribution to Evidence-Based Practice: This paper analyzes the status quo of welfare services and healthcare delivered to children with rare diseases. It analyzes the causes of difficulties and insufficiency of the welfare services and policies for the children with rare disease and puts together knowledge for evidence-based practice and policy-making for children with rare diseases.
On Disparities in Breast Cancer Screening
Background. Despite the death rates of breast cancer declining in the last two decades, new breast cancer cases have disproportionately affected some marginalized populations such as African American women. Since mammography screening disparities by sexual orientation and gender identity are inconsistent, it is important to understand the patterns of mammography screening to inform public health interventions. Aims. This secondary data analysis study aimed to examine the disparities in mammography screening by sexual orientation and gender identity among females assigned at birth (FAAB) overall and stratified by race/ethnicity in the U.S. Methods. By using 2014, 2016, and 2018 Behavioral Risk Factor Surveillance Survey (BRFSS) data, we conducted adjusted multivariable logistic regression models to estimate the odds of receiving an up-to-date mammography screening in relation to sexual orientation, gender identity, and other correlates among FAAB aged 50-74 years (unweighted N=228,257). Results. Overall, the lifetime and up-to-date prevalence of mammography screening were 96.3% and 76.0% in U.S. FAAB, respectively. Non-Hispanic Black (NHB) participants reported a higher rate of up-to-date mammography screening (84.13%) whereas those who had an income less than $15,000 per year had the lowest (71.31%). Being insured, overweight/obese, and not a current smoker were positively associated with receiving an up-to-date mammography screening across racial and ethnic groups. Besides, being physically active was significant for an up-to-date mammography screening in non-Hispanic White (NHW) and Hispanic participants. Also, Hispanic transgender participants were more likely to have an up-to-date mammography screening than their same-ethnic cisgender counterparts. Contribution to Evidence-Based Care. The findings reveal that the disparities in receiving an up-to-date mammography screening varied by sexual identity, gender identity, and race/ethnicity in FAAB aged 50-74 years. The lower rate of an up-to-date mammography screening was found particularly in Hispanic, bisexual AFAB. Future tailored mammogram programs should integrate physical activity and cultural components for people with multiple minority identities.
On Correlation between successful aging and Traditional Chinese Medicine
Aims and objectives: To investigate the correlation between successful aging (SA) and Traditional Chinese medicine (TCM) constitution and quality of life (QOL) in elderly diabetic patients. Background: Traditional Chinese medicine (TCM) could be used in the management of elderly patients with type 2 diabetes (T2DM) to improve their quality of life (QOL). Design: This was a cross-sectional study in elderly patients with T2DM. Methods: The convenience sampling method was used to recruit elderly patients with T2DM at the Community Health Service Center, from May to August 2019. The study methods were compliant with the Strobe checklist (See Supplementary File 1). Results: The average score of SA was 58.0±7.7 points in 143 participants. The factors associated with SA were sex, education, way of living, drinking habits, exercising, sleeping, health condition, and participation in social activities. The elderly diabetic patients with Yin-Yang harmony had the highest score of SA. The elderly diabetic patients with Yin-Yang harmony had the highest score of QOL in all dimensions. The score of SA was positively correlated with QOL in all dimensions (total score: r=0.498, P<0.001; subscores: r=0.281-0.550, all P<0.05). Conclusions: The status of the SA of elderly diabetic patients in the community was moderate. TCM constitution, QOL, and SA were correlated with each other.
A Study on the Roles of Online Social Tools for the Prevention and Control of Covid-19 Pandemic
Background: In recent years, especially during the Covid-19 pandemic period, online social tools have been widely used involving the fields including medical treatment, education, healthcare, governance, etc. What kind of functions do online social tools play for the prevention and control of the pandemic? Objectives: The main purposes of this article are to explore further the roles of online social tools, taking the most popular APP, that is Wechat, as an example, and to clarify the speciality of different social tools in different countries. Methods: By deep participatory observation and using the method of case study, the authors conducted in-depth interviews with 5 community workers, 2 volunteers, and 3 Party member liaisons in Yuejiyuan Community, China. Data collection methods included semi-structured interviews, content analysis. Results: The study identifies that online social tools play important roles in the prevention and control of the Covid-19 pandemic, which can be summarized as information dissemination and guidance, psychological counseling, emotional resonance and support, convenience and benefit to the people. Meanwhile, this study reveals the powerful community governance by the local and the central government. Main Contribution to Evidence-Based Practice: The article puts together the recent evidence from recent fieldwork on the Roles of Online Social tool for Community Governance in the Prevention and Control of Covid-19 Pandemic to support clinical decision-making and evidence-based practice. It is helpful to give effective suggestions for policy formulation and provide practical paths for anti-epidemic practice.
On Role conflict and role ambiguity：the case of Social Workers in healthcare teams
Background: Is there any ongoing role ambiguity in healthcare teams? What is the evolving role of social workers in heathcare? In recent years there has been great international interest in understanding how to improve the integration of different professions in healthcare teams. Objectives: The article aims at contributing to the international debate on clarifying the role of social workers in healthcare teams and produce recommendations for policy making and healthcare teams management and the ongoing challenge of role ambiguity and role conflict in health systems. Methods: The study undertook in-depth semi-structured interviews with 12 social workers working at hospitals. The participants were recruited using purposive sampling. The data collection methods were semi-structured interviews, content analysis and direct observation. Results: The study identified an ongoing ambiguity concerning the role of healthcare teams in China as identified in other countries around the World. Their role has been evolving around social case intervention practiced on an individual basis without clear integration in the healthcare team plan or relation with the patient/client. Main Contribution to Evidence-Based Practice: The article contributes to the international understanding of role conflict and role ambiguity of social work in healthcare identifying key recommendations for olicy-making and health systems development .
On The Economic Impact of the Covid-19 Pandemic in China
Background: The outbreak of the COVID-19 Pandemic has exposed the world to the biggest decline in economy since the Second World War. What are the most profound impacts on the economy caused by Covid-19? And what does current research reveal about worldwide economic impacts on the socical security systems? Covid-19 virus related pandemic restrictions lasted over a long time. Negative impacts from a variety of pandemic prevention and control measures posed great economic pressure upon health systems around the world, but also on national social security systems. This article puts together recent evidence and research results exploring the economic impacts of the Pandemic on social security systems. Objectives: The main aim of the article is to systematically explore and identify economic impacts of the Covid-19 Pandemic on the social security systems and related challenges to the sustainable development of a country or region. Thus, generating a review of knowledge to support evidence-based policy-making intervention is the fundamental objective of the article. Methods: The rapid literature review is a form of evidence synthesis that provides timely information for decision making and evidence-based practice compared with standard systematic reviews and other types of reviews. This review used Web of Science, Proquest and CNKI as database sources. Keywords included ‘Covid-19’ ‘Social security’ and ‘Unemployment、Pension insurance’. The publications are confined from July 2021 to June 2022. Results: Seven publications in English and three in Chinese were identified as relevant to the objectives of this article. These were individually evaluated on the contribution to economic impact of the Covid-19 on the social security systems. The economic impact seems obvious, but it is not easy to assessment. The follow-up articles measure this effect in different ways. Main Contribution to Evidence-Based Practice: The article puts together recent evaluations of economic effects of the Covid-19 Pandemic on social security systems to support evidence-based policy making and the international debate.
On Fertility Behavior of Professional Women in China
Background: The actual fertility level is lower than the policy fertility rate reflects in China. Family planning based on fertility intention has replaced national planning as an important variable affecting fertility levels. The lower than expected fertility rate reflects the existence of many inhibitory factors in family fertility decision-making. Professional women's participation in labor has become an inhibitory factor in second-child fertility behavior. Objectives: The study explores the difference in fertility behavior between professional women and non-professional women and aims to contribute to the debate on to what extent the increase in labor participation rate reduces women's fertility behavior and whether the emergence of professional women is an inhibitor of second-child fertility behavior. Methods: The authors developed an analysis of national data from the social survey involving 10,968 records applying the Heckman model. The sample used for the study consists of 3,912 females registered in the national survey according to the formal definition of ‘professional woman’. The empirical research developed aimed at testing if the selection bias exists. That is, whether the characteristics of professional women's education, urban, income, and other factors led to differences in fertility intention and fertility behavior, applying confounding variables through propensity score matching. Results: It was possible to demonstrate that there is a selective effect among low-birth behaviors of professional women. However, the selective effect of fertility intention was not significant. On the other hand, labor participation reduced the fertility behavior confirming the existence of fertility dilemma. Therefore, the study indicates that it is necessary to explore how to alleviate the fertility dilemma within options of social support, family support and employment environment. Main Contribution to Evidence-Based Practice: The article demonstrates how the Heckman model contributes to facilitate the understanding of participation on fertility intention and fertility behavior. Additionally, it contributes to the international debate on the topic.
A Longitudinal study on the Emotional Support Mechanism of the Mental Health of Empty Nesters
Background: With the gradual decline of the physiological functions of elderly people, "big events" in social roles and social relations such as widowhood, retirement, disability, etc. will have a major negative impact on their mental state, make them show mental depression and other conditions, people with severe symptoms may even choose to commit suicide. Objectives: Whether living alone or living only with a spouse is significantly related to the depression tendency of elderly people; Whether the high frequency of intergenerational meetings will alleviate the depression tendency of elderly people who live alone or only with their spouse; Whether social interaction will relieve the depression tendency of elderly people who live alone or only with their spouses; Whether there are significant urban-rural differences in the relationship between different living patterns and the depression tendency of the elderly, as well as the relationship between "visit home often", social interaction and depression tendency of the elderly. Methods: Taking mental depression as an example, this article uses the CHARLS data and OLS regression model to analyze the correlation between different living patterns and depression tendency in urban and rural areas, and introduce the interaction effect analysis of intergenerational meeting frequency variable "visit home often" to explain its mechanism. Results: The elderly people living alone or living only with a spouse do have a high tendency to depression, and the depression tendency of living alone is more obvious; “visit home often” can effectively reduce the depression tendency of elderly people living alone or living only with a spouse. Social interaction has a weaker influence on the mental depression of elderly people; The elderly people living alone or living only with a spouse in rural areas have a higher tendency to depression. And "visit home often" is more obvious to reduce the mental depression of the elderly living alone or living only with a spouse in urban areas. Main Contribution to Evidence-Based Practice: The article puts together the recent evidence about the effect of empty nest on depression symptom in Elderly People；compares the impact of urban-rural differences；explores the mechanism of intergenerational frequency of interaction between residential patterns and depression.
On Blood Glucose monitoring in pregnant women with gestational diabetes mellitus
Background: Women with gestational diabetes mellitus (GDM) are more likely to develop pre-eclampsia during pregnancy, and to have the birth induced, suffer trauma to the perineum during birth, or to give birth by caesarean section. Good blood glucose control throughout pregnancy will reduce the risk of fetal macrosomia, trauma during birth (for her and her baby), induction of labor and/or caesarean section, neonatal hypoglycemia, and perinatal death. Monitoring of blood glucose levels is an important way to maintain control of sugar concentrations in the blood. However, it is not clear which is best method or frequency for monitoring blood glucose for limiting health complications for women and their babies. The purpose of this rapid literature review is to identify the most recent evidence and knowledge concerning blood glucose monitoring in pregnant women with gestational diabetes mellitus. Methods: We undertook a Rapid Literature Review focusing on articles published from 2020 to 2022 thus offering the readers access to most up-to-date evidence concerning the topic. We searched the online databases of Pubmed, EMBASE, Cochrane Library, and BMJ from January 2020 till May 15, 2022. Inclusion criteria were studies of blood glucose monitoring for pregnant women with gestational diabetes mellitus. Results: Nine papers were included in the final review. Recent evidence on frequency of blood glucose monitoring, new glucose monitoring technologies, remote monitoring technologies and reminder systems in blood glucose monitoring were summarized. Main Contribution to Evidence-Based Practice: Recommendations for frequency of blood glucose monitoring should be tailored according to pregnant women’s blood glucose management plan. Continuous glucose monitoring (CGM) should be considered for pregnant women under some specific conditions. Remote monitoring technologies or reminder systems based on smartphones, computers and tablets could be considered to improve patient’s compliance toward blood glucose monitoring.
On the Psychological experiences of Hematopoietic stem cell donors
Background: Hematopoietic stem cell (HSC) transplantation using bone marrow and peripheral blood stem cells is a lifesaving treatment for patients with leukemia or other blood disorders. Hematopoietic stem cell donors are afraid of harming themselves by donating and are also under pressure from other relatives. Therefore, it is easy to produce negative emotions such as tension, anxiety, panic, depression and so on during the donation period. Although major physical complications of hematopoietic stem cell donors are uncommon, their psychosocial impact remains relatively unknown. Methods：The authors undertook a Rapid Literature Review focusing on articles published from 2020 to 2022 thus offering the readers access to most up-to-date evidence concerning the topic. This article, therefore, adopts a narrative review methodology. Results: A total of 7 articles were identified and scrutinized. Hematopoietic stem cell donors generally suffered from physical and mental discomfort. Factors influencing psychological experiences included donation stage, gender, kinship, and transplant results. Main Contribution to Evidence-Based Practice: The purpose of this rapid literature review is to identify the most recent evidence and knowledge concerning psychological experiences of hematopoietic stem cell donors, in-depth analysis of the real psychological feelings of hematopoietic stem cell donors, in order to further improve the quality of nursing services, relieve the doubts of hematopoietic stem cell donors and mobilize the motivation of hematopoietic stem cell donors provides a reference.
On School Bullying and Mental Health in Adolescence
This article is a comprehensive narrative review on school bullying, which has been taken as a significant public health issue in relation to our children or ourselves. It increases the risk of lifelong consequences including mental disorders and social problems. Though there are existing reviews summarizing some critical parts of this topic, it is scarce of systematic examination to the fundamentals of bullying and comparisons across different bullying roles of victims, perpetrators, and in particular, positive and negative bystanders. By examining prevalence rates, types, influencing factors, consequences, correlates, preventions and mediators, this article aims to consolidate in-depth understanding of school bullying dynamics and their mental health implications. Additionally, the synthesis of both Western and Chinese studies offers a cross-cultural perspective. Finally, this review also provides suggestions on future research direction, emphasizing the need for attention to negative bystanders and targeted and culturally sensitive prevention strategies. Main Contribution to Evidence-Based Practice The main contribution of this study is the provision of evidence-based insights and knowledge that equip stakeholders in the healthcare sector with a holistic view of the bullying phenomena, especially affecting adolescents in the school environment. It allows for informed decision-making, the formulation of effective policies, and the advancement of prevention of bullying and mental health challenges to benefit adolescents at schools across the World.
Clinical pathological features and radiotherapy treatment for adenoid cystic carcinoma of the head and neck
Adenoid Cystic Carcinoma (ACC) is a slow-growing, locally invasive malignant tumour, with a deceptively benign histological appearance, a high probability of local recurrence and distant metastasis. The tumour comprises basaloid cells with small, angular and hyperchromatic nuclei and scarce cytoplasm arranged into three significant prognostic patterns: cribriform, tubular, and solid. In some tumours, dedifferentiation to a high-grade form occurs. The authors have reviewed numerous studies which have attempted to demonstrate accurate histological prognostic features, but these have often produced conflicting results. The literature review suggests that Analysis of microarray and gene expression profiles provided new potential diagnostic and prognostic markers. However, tumor grade, lymph node metastasis, invasion of major nerves, and resection margin status continue to be the most consistent predictors of prognosis. The optimal treatment of ACC has not yet been fully established, although most studies advocate using surgical excision and postoperative radiotherapy. Careful tumor staging and grading with documentation of perineural invasion and margin status remain important prognostic tools. ACC has been incurable, and most patients will eventually succumb to local recurrence, distant metastasis, or both. The clinical course of the disease can be surprisingly heterogeneous, with some patients surviving decades and others surviving only months. The combination of surgery and radiotherapy in the postoperative period has shown the best locoregional disease control. Contribution to Evidence-Based healthcare: This review contributes to a better understanding of the treatment of patients diagnosed with cystic adenocarcinoma of the head and neck, with regard to treatment with curative radiotherapy, as part of the proposed treatment or even to reduce the effects of the disease.
Background: Aging populations worldwide are grappling with the challenge of long-term care for the disabled elderly, particularly in countries like China that are aging before they become affluent. The number of disabled elderly in China is sharply increasing, necessitating effective strategies to meet their care needs. Objectives: This study aims to conduct a comprehensive scientometric analysis of research trends, hotspots, and future directions in the field of long-term care for disabled elderly individuals in China using CiteSpace software. Methods: Employing CiteSpace 6.2.R1, this study analyzed 1,914 relevant publications from 1999 to 2024 in the Web of Science and CNKI databases. Keyword analysis, clustering, and visualization were performed using CiteSpace software to identify key themes and trends. Results: The analysis indicates an overall upward trend in publications since 1999, with a significant increase between 2013 and 2017. High-frequency keywords mainly include influencing factors, integration of medical and nursing care, and service quality. Research hotspots include family caregiving, health status, demand factors, and mental health. Conclusions: This study reveals the research trends, hotspots, and future directions in the field of long-term care for disabled elderly individuals in China. It shows a rapid increase in research quantity over time. High-frequency keyword analysis identified ongoing topics of interest such as influencing factors, integration of healthcare, and service quality. Keyword clustering analysis revealed that research hotspots are concentrated in areas such as family caregiving, health status, demand factors and mental health, with each field containing rich research content. Main Contribution to Evidence-Based Practice: This study uses CiteSpace visualization analysis software and bibliometric methods to organize and analyze existing literature, clarifying the research status, hotspots, and trends in the field. This information is intended to help scholars, practitioners, and policymakers better understand the progress in this area and provide a reference for future in-depth research.
On Risk analysis of the use of Cannabinoids compounds as therapy in Dementia
Background: Nowadays dementia pharmaceutical treatment has an unfavourable risk-benefit relation. New therapeutic approaches’ adoption is need due to the high prevalence of this condition. Objective: To evaluate the risk of using cannabinoids compounds as nonharmful therapeutic approach in dementia. Methods: A systematic literature review based on PRISMA was performed. PubMed and Clinical Trials database were used to collect articles between 2012 and 2022. Cochrane and Consort instruments were used to evaluate the methodology quality and report quality of adverse effects. Results: Tetrahydrocannabinol and Nabilone were associated to a moderate effectiveness in the symptomatology related with Dementia and to favourable safety and tolerability profiles. Contributions for evidence-based care: Evidence obtained shows the importance of these two compounds as a new approach to dementia treatment.
On Healthcare management dilemmas in patients with osteoarthritis of the knee
Background: Knee Osteoarthritis (KOA) was estimated to affect about 250 million people worldwide, with symptomatic KOA affecting about 10 to 16 percent of people over the age of 60. The epidemiological study of KOA in the Chinese population showed that the prevalence of KOA in China was about 18%, with 11% in men and 19% in women, and the prevalence of KOA in women was significantly higher than that in men. Methods: Systematic search of PubMed, Web of Science, The Cochrane Library, Embase, and CINAHL for studies on health management dilemmas in KOA patients. The search was conducted from the time the library was constructed until January 2024. Results: A total of 496 documents were retrieved, with 441 remaining after deletion of duplicates. After reviewing the titles and abstracts of 441 documents, 390 documents were excluded. The remaining 51 literatures were read in full text and 40 literatures were excluded. 11 literatures were finally included. Conclusion: Although a few scholars have achieved some success in the exploration of KOA health management, due to the large randomness of their research, lack of systematic and rigour, and the KOA health management model suitable for different regions has not been established. More research is still needed in the future to explore the shortcomings of KOA health management and to establish a complete KOA health management programme and system to promote patients' disease control. Contribution to Evidence-Based Care: The article helps to make healthcare professionals aware of the current dilemmas in the health management of KOA patients. It helps healthcare professionals to develop a scientific discharge plan and apply it in the clinic to promote health management outcomes for KOA patients.
On Assessing Compliance and Attitude to patient safety goal of patient identification among nurses: A cross-sectional observational survey
Abstract: Background: Patient identification is an important patient safety goal, healthcare providers have primary responsibility for verifying a patient's identity appropriately before intended interventions in the hospital. It is important for the hospital management team to develop and ensure the practice of patient identification policy. Objective: To assess knowledge, attitude, and compliance to patient safety goal of patient identification Methods: An observational cross-sectional study was conducted among 231 staff nurses of inpatient departments using random sampling at a tertiary hospital. The staff nurses were assessed for knowledge, attitude, and practices on patient safety of right patient identification using a knowledge-based questionnaire, structured validated questionnaire to measure attitude towards patient safety, and observational checklist for compliance to patient identification in practice Results: More than 50 percent of the nurses had a positive attitude towards reporting, acknowledging and dealing with mistakes, and concentrating on causes that could result in improving patient safety. Majority believed, management provided fair treatment for reporting but were more inclined and invested towards meeting targets of the organization. The compliance with all the identification practices was more than 80% with few areas of improvement identified for a compliance rate of less than 90%. Conclusion: Patient identification practices require special attention in health care delivery to avoid misleading errors and harm. It is thereby important to measure compliance and attitude of HCP at regular intervals to improve reporting and devising strategies. The compliance rate can be further improved by using strategies like standardizing approaches, provision of clear protocol, training, and patient education, and most importantly creating a culture of reporting and demonstrating management's inclination towards quality assurance
Construction of an integrated emergency treatment platform for chemical injuries
The treatment of chemical injury patients is becoming increasingly complicated. Analyzing the chemical and hazardous chemical accidents that have occurred in China in recent years and the future construction direction of the smart chemical zone and building an integrated emergency treatment platform for chemical injury are of great significance to improve the level of emergency treatment of chemical injury, especially the emergency treatment capability of group chemical injury, and guarantee the safe and high-quality development of the smart chemical zone. Based on the preliminary research results of the subject group and the summary of the practical experience of chemical injury treatment in hospitals, this study adopts the expert consultation method and literature research method to gain an in-depth understanding of the construction direction and content of the intelligent chemical injury integrated emergency treatment platform. Explore the establishment of "information, data, network, intelligent" as the center of the future chemical injury integrated emergency treatment platform. By integrating technologies such as the Internet of Things, big data, cloud computing, artificial intelligence (AI), 5G digital communication, and information interaction, the concept of building an integrated chemical injury emergency rescue prehospital warning platform, an integrated wisdom platform for chemical injury emergency rescue prehospital and in-hospital treatment, and an intelligent platform for chemical injury emergency command and dispatch and decision making are proposed. The integrated chemical injury emergency treatment platform provides strong theoretical and application support to comprehensively improve the regional chemical injury emergency rescue and protection capability and provides professional advice to the government in the governance and decision-making of smart chemical parks. Keywords: Chemical injuries, integrated, emergency treatment, intelligent chemical park, intelligent platform
The world's elderly population with diabetes is growing and self-management has its challenges, not only because of the complications that age brings, but also because of possible co-existing diseases. It is important to identify the influence of age and its complications of diabetes self-management, so that effective and efficient strategies can be created to combat the complications associated with the disease. Elderly diabetics are a heterogeneous group with varying clinical, functional and psychosocial characteristics and, in order to achieve efficient and effective self-management, specific self-management behaviors must be taken into account on an ongoing basis in order to avoid complications. An individualized, multi-faceted approach to diabetes management should be taken and an investment should be made in diabetes self-management education. Therefore, this review focuses on the influence of advanced age and its complications on the the elderly diabetes self-management and proposes strategies for effective self-management of the disease.
A study on the spatial distribution and optimization strategies of day care centers for the elderly
Background: At present, the degree of ageing in China is becoming severe, especially in Shanghai, which is the largest city with the highest degree of aging in China. How to adjust the community to effectively meet the needs of the elderly groups has become the focus of social attention. Objectives: In this study, spatial analysis was used to explore the matching degree of the elderly population with the distribution of day care centers in Xuhui District, Shanghai, China, to explore the problems, and to propose optimization strategies with a view to providing feasible suggestions for the construction of old-age daycare. Methods: This research adopts the methods of literature study, map analysis, questionnaire survey, especially tries to use the spatial analysis software of Arc GIS in order to set up a spatial database of Xuhui District's elderly population based on street administrative territorial entity. Results: The results show that the quantity and quality of the day care centers in Xuhui District can not meet the actual needs of the elderly. Secondly, the services provided in daycare centers deviate from the actual needs of older population. Thirdly, the day care service content lists are quite homogeneous, which neglects the diversified and personalized needs . Main Contribution to Evidence-Based Practice: From the perspective of spatial distribution study, this article enriches the theory of the construction and management of the elderly care facilities in urban areas, and provides reference for the formulation of aging policy. Meanwhile, it gives some suggestions on optimizing the spatial distribution of community facilities to fulfil the actual needs for optimal matching of the elderly care resources.
On Comorbidity and Haemodialysis Adequacy in End-Stage Kidney Disease Patients in Lesotho
Background: Low- and middle-income countries including Lesotho are faced with a huge burden of end-stage kidney disease in people experiencing human immune virus (HIV), hypertension (HTN) and diabetes mellitus (DM). Objectives: To assess the comorbidity, mortality rate and evaluate the haemodialysis adequacy in patients with end-stage kidney disease in Motebang government hospital. Methods: A retrospective study was conducted in 142 adult male and female patients enrolled for haemodialysis from 1st October 2017 to 30th June 2023 in Motebang government hospital. Patient’s characteristics and clinical outcomes data were analysed using descriptive statistics Results: Among 142 patients enrolled, there were 84 (59.2%) males and 58 (40.8%) females. 19 (13.4%) patients were below 34 years while 33 (23.3%) patients were between 45 and 64 years. In all age groups, 41 (28.9%) patients had HIV, 37 (26.1%) patients had HTN alone and 24 (16.9%) patients had combination of HTN and DM. In 63 deceased patients, there were 36 (57.1%) males and 27 (42.7%) females. Among deceased, 18 (28.5%) patients had HIV, 15 (23.8%) had combination of HTN and DM, 14 (22.3%) patients had HTN alone, while all the patients (99.3%) were also anaemic. Since 2017, 19 (30.2%) patients died in 2020, 12 (19%) died in 2022 while only 4 (6.3%) patients died up to date (June 2023). Among 79 patients, only 1 (1.3%) patient had urea- reduction ratio (URR) greater than 65%. Conclusions: Chronic diseases are the major risks factors in patients with end-stage kidney disease in Motebang hospital. Haemodialysis adequacy should form the integral part of monitoring in patients with end-stage kidney disease to prolong life.
On Primary Amoebic Meningoencephalitis Caused by Naegleria fowleri
BACKGROUND: Naegleria fowleri is a free-living amoeba (FLA) ubiquitous to the environment. Although harmless when ingested, it can access a person's brain through the nasal cavities and cause an acute infection known as primary amoebic meningoencephalitis (PAM). METHODS: A scoping literature review presenting valuable information to healthcare providers about the critical features and pathogenesis of N. fowleri by synthesizing the existing literature databases accessible on the National Library of Medicine (NCBI) platform. RESULTS: The prodromal stage of PAM is vague and often misdiagnosed as viral or bacterial meningitis, and regardless of treatments and supportive care, patients rapidly succumb once symptoms appear. Delayed and ineffective care, along with unnecessary tests and procedures, can cause irreversible brain damage and ultimately lead to death. Additionally, the exact mechanism of action for treatment remains unclear, and the standard therapeutic protocol recommended by the Centers for Disease Control and Prevention (CDC) consists of an aggressive but unreliable combination of antibiotics. CONTRIBUTION TO EVIDENCE-BASED CARE: PAM is a rare disease with a high fatality rate, so prioritizing prevention and early detection highlights the importance of preparedness in healthcare settings. A postmortem brain tissue examination is typically required to confirm the diagnosis. Overall, raising awareness about the risks of N. fowleri and the importance of prompt diagnosis and treatment is crucial to reducing the incidence and impact of this deadly disease.
Opportunities and challenges in cross-border healthcare
Background The dynamic nature of healthcare delivery and patient mobility in the area has led to an increased focus on cross-border healthcare within the European Union (EU). Cross-border healthcare plans and strategies must take into account the EU's dedication to supporting the "four freedoms" of free movement of people, capital, goods, and services. To grasp the opportunities and problems present in this field, it is essential to comprehend how the four Freedoms interact with cross-border healthcare. With a focus on case studies based on the Court of Justice of the European Union (CJEU), this article seeks to examine the benefits and drawbacks of cross-border healthcare within the EU. Methods This article uses the content analysis method to collect all of the case information on the European High Court's website to date and determine the most popular topics. Following that, using case analysis, the typical cases of these dispute-prone locations will be examined to determine the key issues in the area. Results The statistical analysis demonstrates that social security, employee regulations, and freedom to provide services account for the three highest percentages of subject matters addressed by the CJEU. The analysis reveals existing gaps and inconsistencies in the interpretation and implementation of the legal framework. The case study of the CJEU highlights the challenges and complexities associated with harmonizing healthcare systems across member states. Main Contribution to Evidence-Based Practice The main contribution is the provision of evidence-based insights and knowledge that equip stakeholders in the healthcare sector with a holistic view of the field. It allows for informed decision-making, the formulation of effective policies, and the advancement of cross-border healthcare to benefit patients and healthcare systems across the EU.
Nurses' knowledge of patients´' swallowing ability
Background: oropharyngeal dysphagia is the result of a series of neuromuscular disorders that can impair swallowing. These alterations compromise adequate nutritional support and often endanger the safety of the person with dysphagia. The prevalence of dysphagia is known to increase with age, but it is still an underdiagnosed problem, which should be a concern for nurses. Objective: To identify nurses' knowledge of patients' swallowing ability in a Portuguese hospital. Methodology: Quantitative, descriptive-correlational, cross-sectional study using a non-probabilistic convenience sample of 62 nurses. The online survey includes sociodemographic/ professional indicators, an assessment of nurses' knowledge of swallowing ability, relevant data for dysphagia diagnosis and compensatory swallowing strategies. Results: 62 nurses were included, mostly female (80.6%), with an average age of 38.50 years, with a prevalence of those under 39 (53.2%), with a degree (71.0%) and who had been working in the profession for 14 years or less (54.8%), there was a higher percentage of men who had not had any training in dysphagia compared to women (66.7% vs. 52. 0%). The multiple linear regression showed as predictors of knowledge of swallowing ability: knowledge of relevant data to diagnose dysphagia, knowledge of compensatory strategies and inversely professional exercise (p<0.000). Conclusions: The higher the knowledge about compensatory swallowing strategies and the knowledge about the relevant data for diagnosing dysphagia, and the shorter the time spent in professional practice, the greater the nurses' knowledge about dysphagia. These results suggest the need of continuous education about dysphagia for more experienced professionals. What is the main contribution to evidence-based practice from this research? The article contributes to promote a a better Identification of nurses' knowledge about the signs of dysphagia and compensatory swallowing strategies in case of dysphagia.
Ana Isabel Nunes Pereira de Azevedo e Andrade
International comparison of the financing mechanism of basic medical insurance and its implications for China
Background: For more than 20 years, China's basic medical insurance system has realized the span from "system construction" to "improving quality and efficiency". At present, as the core issue of medical insurance system design, the current financing mechanism is difficult to adapt to the current situation and tasks. Objectives: Based on the theory of social equity, this paper uses literature analysis and comparative research to analyze the forms of social health insurance financing in four developed countries: Germany, the United States, Singapore and the United Kingdom. On this basis, it makes a systematic reference and reflection on the financing mechanism of basic medical insurance in China. Methods: The author adopts the method of literature analysis and comparative study. Through the existing research literature and the theoretical analysis of the medical insurance financing mechanism, the conceptual connotation and dimension of the basic medical insurance financing mechanism are further summarized and analyzed, which provides the reference and theoretical basis for the writing ideas of this paper. By analyzing and comparing the typical practice of the social medical insurance model in four developed countries, the basic ideas, main practices, direction goals, principle adherence, implementation results, realistic difficulties and obstacles of obtaining medical insurance financing are discussed. This paper analyzes the development status of medical insurance financing mechanism between China and four developed countries by means of classification, induction and comparison, and puts forward the optimization path based on the experience of the latter's fair practice. Results: it proposes that the current funding mechanism of China's basic medical insurance has three problems: An unbalanced funding structure and unreasonable sharing of responsibility; low level of coordination and unfair funding method; and dynamic growth mechanism of endogenous medical insurance funding has not yet been established. Main Contribution to Evidence-Based Practice: On the basis of the international experience, the author puts forward some enlightening reform measures to solve the existing problems in China: first, through the reasonable definition of the rights and responsibilities of multi-stakeholder, to construct the appearance of fair implementation; Second, reform the existing fixed financing methods and establish a fair financing mechanism linked to income; The third is to improve the actuarial mechanism of fund adjustment and promote the dynamic and sustainable growth of medical insurance funds. We will further optimize the financing mechanism of basic medical insurance and promote the high-quality and sustainable development of China's basic medical insurance.
Diet effect on Cardiac Vascular Diseases
Aim: To determine the experiences of Indian origin having minimize cardiac vascular diseases with diet modification. Summary of method: These studies explore and understand the lived experience of the persons with CVD throughout their lives and determine specific positive aspects that act as catalyst for their positive living during the illness. This research will be a valuable addition in explaining how and why elements are recurring and provide answers about experiences, perceptions and perspectives of CVD patients. Semi structured in depth interviews were carried out. The interview questions were asked in a way to enable patients to answer questions in their own words, which will help to understand their views. The interview session includes open ended questions to include the respondent’s own perspectives and experiences in their own words. This study includes the personal views and perceptions of the cardiovascular patients that may have not been previously considered, and it will add importance to understanding of the study focus. Result: The result showed how these 10 participants have lived with CVD. Living with CVD starts with being diagnosed, then accepting the condition and wanting to find more information about the condition. It moves on to learning, adjusting and committing to diet modifications. The issues pertaining to healthcare setting for Indian ethnic group was viewed and the participants expressed themselves such as despite the efforts and advancement by the government, there are still people belonging to indigenous background have limitations to cope and comprehend the benefits of Government’s intervention efforts for nutritional intervention programs according to Indian culture. More concerning factors were the facts where CVD patients were ignorant about the health promotions and intervention aspects. Majority of the respondents complained the NHS center was too far away from their residents and have faced difficulties in getting an appointment. The more concerning part was very revealing that the doctors and GPS have difficulty to educate the patients about their health issue and treatment care because of language misunderstanding Conclusion: In conclusion, the better intervention process it becomes essential to understand one’s ethnic background, religious beliefs and diet patters in terms of CVD.
On Planning and Designing General Hospitals in Smart Technology Contexts
Taking high-quality development of hospitals as the new era and the key health management direction, the paper draws lessons from advanced planning and design experience from an international perspective and discusses the construction of hospitals to be compliant, orderly, efficient and focusing on providing high quality care. The article formulates an overall strategy for the planning and development of the hospitals keeping in mind the whole life cycle based on current technological trends, practical, forward-looking and developmental space, as well as promote the organic integration of high-quality care and hospital buildings with the surrounding environment, so as to drive an overall coordinated development of the region where hospitals are located.
Background: What is the definition of Long COVID-19? What are its currently acknowledged symptoms? As this is a new condition suspected to be evolving as a potentially post-Pandemic new disease, it becomes relevant to clarify the current definitions of Long COVID-19. The article puts together the most recent definitions and briefly discusses points of common understanding and points of uncertainty. Objectives: The main aim of the article is to clarify the definitions and symptoms of Long COVID-19 as international evidence defines them. This is relevant to support health professionals and interested parties to access a structured clarification of the disease at this stage of knowledge. Supporting evidence-based intervention is the fundamental objective of the article. Methods: The Rapid Literature Review is a form of evidence synthesis that provides timely information for decision making and evidence-based practice compared with standard systematic reviews. The review used the following sources: Web of Science and PubMed,. The Search used the keywords ‘Long Covid-19’, ‘Definitions’ and ‘Symptoms’ and limited to articles published between January 2021 and June 2022. There were two reviewers to select articles based on the inclusion/exclusion criteria (keywords defined and time span of publications). Both reviewers appraised critically and rigorously within the criteria defined and a summary was produced. Results: Six articles were identified as relevant for the objectives of this article. These were individually evaluated on the contribution to clarifying definitions and symptoms of Long COVID-19. Definitions seem to follow the initial definition made available in a publication from World Health Organization. However, the follow-up articles seem to add additional interpretations and associated symptoms. Main Contribution to Evidence-Based Practice: The article puts together the recent evolution of the definition of Long COVID-19 and associated symptoms to support clinical decision-making and evidence-based practice.
On Knowledge and Attitudes towards Living Wills among Medical University students
Objectives of the study: During palliative care some patients cannot independently choose which therapies to accept or not to accept at the end of life and it is hence significant to promote and legalize the understanding of living wills amongst health professionals. To understand the status of medical students' cognition and attitude toward living wills to provide a reference basis for future related research and promotion. Methods: A random cluster sampling survey was conducted among 718 medical students from five majors attending a medical university in Dalian, China. Results: The study showed that the awareness rate of living wills among medical students was 31.9%, 31.2% of medical students knew the essence of living wills, and only 16.7% of medical students fully understood the contents of living wills. 72.4% of medical students believed that was necessary to popularize living wills, and the biggest obstacle was that people's attitude towards life and concept of death were in the stage of multiple contradictions, and the right to death autonomy was still controversial, accounting for 77.0%. Conclusions: The level of medical students' cognition of living wills is only broad but receives a relatively high support. Healthcare organizations should improve the cognition of living wills amongst meidcal students by hoilding training programs and creating a supporting environment, establish a Registration Center under the guidance of governments and gradually rdevelop the formulation of relevant laws and regulations. Main Contribution to Evidence-Based Practice: The paper contributes to learn about the knowledge and attitudes towards living wills, especially among medical students. It also found detailed difficulties of promoting living wills, which can play a part in popularizing and legalizing living wills around the World.
On the Treatment and Disposal of Clinical Waste based on Bluetooth and LoRa Wireless IoT
With the maturity of the Internet of Things technology, medical institutions have established a positioning and sensing wireless IoT platform for the entire medical institution by using technologies such as Bluetooth positioning beacons, LoRa communication base stations, positioning and map engines. The intelligent medical waste collection and transfer vehicle integrates the wireless Internet of Things platform in the hospital based on 4G/5G modules, Bluetooth positioning terminals, electronic weighing and other technologies. An information-based, intelligent, and visualized "smart medical waste" management system covering all aspects of medical waste generation, collection, temporary storage, transfer, and disposal has been established in medical institutions. This set of solutions can greatly reduce the number of communication base stations deployed in hospital indoor buildings, the number of weak current construction and access switches in hospitals, save a lot of unnecessary costs for weak current construction and access switches and meet the real-time needs of intelligent medical waste collection and transfer vehicles such as real-time positioning, real-time tracking, video linkage, trajectory playback, and transfer route deviation alarms, which have certain reference significance in the practice of intelligent medical waste construction technology in hospitals based on smart IoT. The article describes one case of implementation of the technology in a university Hospital.
On difficulties faced by patients following orthopedic day surgery
Background: An increasing share of orthopedic surgery is delivered as day surgery. Care during home rehabilitation becomes particularly important. To better provide continuity of care, understanding difficulties faced by patients is getting increasing attention by researchers and professionals around the world. Methods：The authors systematically searched the PubMed, Embase and Web of Science databases for relevant articles on orthopedic day surgery patients’ recovery experience after discharge from 2017 till present. Screening was performed strictly according to the inclusion and exclusion criteria, and finally, the relevant literature was read and summarized. Results: A total of 5 articles met the criteria published between 2017 and 2022. A diversity of difficulties faced by patients was identified, including flaws related to follow-up, education, emotional support, unclear functional rehabilitation exercise guidance and other challenges identified by recent evidence. Conclusion: Published studies indicate the importance and necessity of effective postoperative care for day surgery patients. This review also suggests that nurses should pay more attention to the recovery experience, and difficulties faced by orthopedic day surgery patients to provide high-quality continuity of care. The issue may not be receiving the best required attention in what should be a priority of healthcare management and concern with impacts on the patients’ recovery. Contribution to Evidence-Based Practice: The article contributes to an update on difficulties faced by orthopedic day surgery patients during their recovery and rehabilitation period. Professionals around the world can find a diversity of practical challenges summarized by recent international literature. This can support better patient care and rehabilitation planning following orthopedic day-surgery. Additionally, the article sustains that evidence-based nursing care can ensure better quality of care and contribute to the improvement of impacts on patients' rehabilitation.
A Study on Organizational Climate and Career Development of Nurses
Background Defining professional calling clearly can ignite the intrinsic work drive and passion of ICU nurses and is conducive to enhancing their professional identity and sense of accomplishment. Nevertheless, only a scarce number of studies have paid attention to the relationship between the professional calling, organizational climate, and work flourishing of ICU nurses. Objective To comprehend the level of career calling among ICU nurses and probe into the relationship among career calling, organizational climate, and thriving at work. Methods A cross-sectional study was carried out with reference to 162 ICU nurses in China through an online survey, which included Career Calling Scale, Thriving At Work Scale, Organizational Climate Scale. The data were analyzed using SPSS and AMOSE software. Results The overall score for career calling of ICU nurses was 45.33 ± 6.02, and the average score was 3.78 ± 0.50, signifying a moderate degree of career calling. Age, job tenure, organizational climate, and thriving at work are the major influencing factors of career calling among ICU nurses. Thriving at work partially mediates the relationship between organizational climate and career calling. Conclusion The career calling of ICU nurses is at a moderate level. Nursing managers should place priority on the professional development of novice nurses. They should offer training to boost their career calling, cultivate a positive organizational climate, optimize the work environment for ICU nurses, enhance their career calling, and further promote the stable development of the department.
Latent Profiles of Nurse Burnout and Their Relationship with Job Performance: A Cross-sectional Survey
Background: The prevalence of nurse burnout is high, and it has a significant impact on the job performance. However, currently, nurse burnout is evaluated solely based on the overall score, and a single analysis is conducted to examine the relationship between a certain dimension and the nurses' job performance. The Latent Profile Analysis (LPA) can focus on the individual differences, dividing the nursing group into different potential categories. Based on this analysis, we studied the relationship between different potential categories and the work performance of nurses. Methods: A cross-sectional design using a multi-stage stratified cluster random sampling method. From December 2022 to January 2024, eligible nurses were recruited from four Grade-A tertiary hospitals in Shandong Province, yielding 1,877 valid questionnaires. The survey instruments included a self-designed demographic questionnaire, the Maslach Burnout Inventory-Human Service Survey (MBI-HSS), and the Work Performance Scale. Latent Profile Analysis (LPA) was utilized to categorize nurse burnout. Additional statistical analyses included descriptive statistics, one-way ANOVA, general linear regression analysis. Data were processed using SPSS 26.0 and Mplus 7.0. This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: Through LPA, we identified four distinct burnout profiles: "Low Burnout," "Emotional Exhaustion/Depersonalization," "Reduced Personal Accomplishment," and "Moderate Burnout." Significant differences were observed across these profiles in total job performance scores, task performance. and contextual performance. Post-hoc tests revealed that nurses in the "Low Burnout" group scored significantly higher in task performance, contextual performance, and total job performance than those in the other three categories. Conversely, nurses in the "Reduced Personal Accomplishment" group had significantly lower scores for contextual and total job performance than those in the "Low Burnout" and "Emotional Exhaustion/Depersonalization" groups. General linear regression analysis, controlling for age, gender, marital status, education level, years of service, and monthly night shifts, indicated that compared to the "Low Burnout" group, job performance scores for the "Emotional Exhaustion/Depersonalization," "Reduced Personal Accomplishment," and "Moderate Burnout" groups decreased by 3.814 standard deviations, respectively. Conclusion: The prevalence of burnout among nurses in Grade-A tertiary hospitals is high. Nurse burnout can be categorized into four latent profiles: "Low Burnout," "Emotional Exhaustion/Depersonalization," "Reduced Personal Accomplishment," and "Moderate Burnout." Nurses in the "Low Burnout" group demonstrated the best job performance, whereas those in the "Reduced Personal Accomplishment" group exhibited the poorest performance.
Summary of Evidence for Wound Care in Patients With Granulomatous Lobular Mastitis
Background: Granulomatous lobular mastitis (GLM) is a chronic inflammatory breast disease with poorly understood etiology. Current wound management lacks standardized protocols, highlighting the need for evidence synthesis to inform clinical decision-making. Objectives: To comprehensively search the relevant literature on wound treatment and nursing in patients with granulomatous lobular mastitis at home and abroad, to sort out and analyze the included literature, and to extract, sort out and integrate the items of wound-related interventions, so as to provide a framework and basis for the construction of breast wound care programs for patients with granulomatous lobular mastitis. Methods: We conducted a Descriptive literature review following the 6S evidence pyramid model (Jan 2023 version). Twelve databases were searched from inception to January 2025, including: BMJ Best Practice, Up to Date, The Journal of the American Medical Association (JAMA), Scottish Intercollegiate Guidelines Network (SIGN), CNKI, Wan fang, CBM. Inclusion criteria covered clinical studies and guidelines addressing GLM wound care. Two reviewers independently performed quality assessment using AMSTAR-2 (for reviews) and JBI tools (for primary studies), with evidence graded (Level 1-5) and recommendations categorized (Grade A/B). Results: From 1,333 screened records, 19 studies met inclusion criteria:3 systematic reviews,3 consensus guidelines,6 RCTs,6 quasi-experimental studies,1 cohort study. Key findings were synthesized into 38 evidence statements across four domains: Assessment (8 items): Recommended use of GMDAI for inflammatory activity monitoring, Wound care (20 items): Strong evidence (Grade A) for TCM patching in chronic phases. Education (5 items): Structured self-care programs reduced recurrence by 30%. Follow-up (5 items): Combined digital and clinic follow-ups improved compliance. Conclusion: This study summarized the evidence of wound care for GLM patients through evidence-based nursing methods, and provided evidence support for the clinical formulation of breast wound care programs for GLM patients. Healthcare professionals can apply evidence to the clinic based on the clinical context to improve breast wounds and quality of life.
On Monitoring Devices for glucose in critical patients during the COVID-19 pandemic
Background: Hyperglycemia is common in Intensive Care Unit (ICU) and was reported with high mortality and adverse patients’ outcomes. The infection of COVID-19 is identified as a main source of increase in the incidence of hyperglycemia and associated elevated mortality. In order to reduce the healthcare providers exposure and the personal protective equipment use during the pandemic, the US Food and Drug Administration (FDA) regulated the usage of continuous glucose monitoring (CGM) devices to address these concerns as well as control the glucose level at a desired range. What are the benefits of using CGM applications? The article updates knowledge on this topic. Methods：We did our search on the following databases: MEDLINE, EMBASE and Cochrane database, articles included were all recent and between January 2020 to July 2022. Our main focus was on articles with evidence concerning the effectiveness and the accuracy of continuous blood glucose monitoring methods in ICU during the COVID-19 pandemic. Results: A few recent articles were identified and scrutinized. These allow the article to present an overview of the most recent international evidence on the topic, ts benefits and a comparison between methods and devices. Main Contribution to Evidence-Based Practice: The article puts together the most recent evidence on the demonstrated benefits of continuous glucose monitoring and identifies the few glucose Monitoring Devices about which there is recent published scientific evidence on its application to critical care.
On Patient Readiness for Hospital Discharge
Background: With the development of the "person-centered" model of nursing care, for a better understanding of patient self-reported Readiness for Hospital Discharge (RHD) the theme is being studied extensively by researchers and professionals around the world. Methods: Using search terms such as "readiness for hospital discharge", (RHD) we systematically searched the PubMed database for relevant articles on patients with RHD from 2019 to the present. Screening was performed strictly according to the inclusion and exclusion criteria, and finally, the relevant literature was read and summarized. Results: A total of 8 articles met the criteria published between 2019 and 2022. The probability of being unprepared for discharge varied by disease type. Factors influencing patient RHD included demographic characteristics, psychological status, disease-related information, and hospital setting factors. Conclusions: Studies of RHD patients have been extensively developed in recent years. There is evidence to sustain that some patients leave the hospital unprepared, and in conditions that would require further attention of clinical staff. The issue may not be receiving the best required attention in what should be a priority of healthcare management and concern with impacts on the patients’ quality of life. Contribution to Evidence-Based Care: The article contributes to an update on how to identify patients with low RHD in the context of busy nursing workloads and make clear interventions, thus improving the efficiency of nursing care. In addition, according to the factors affecting patients' RHD, scientific discharge plans were constructed and used clinically to promote the application of nursing research results in nursing practice. Finally, the article sustains taht evidence-based nursing care can ensure better quality ofcare and contribute to the improvement of impacts on patients' quality of life.
Assessing the Quality of Western Medicine Practitioners' education on Traditional Chinese Medicine
Aims and Objectives To identify and assess factors influencing Western medicine practitioners’ motivation to learn Traditional Chinese Medicine (TCM). Design and Setting A cross-sectional study conducted in Shandong Province, China. Methods In 2024, 207 Western medicine practitioners participating in TCM training sessions were enrolled. Validated questionnaires collected demographic and experiential data, followed by univariate and binary logistic regression analyses to identify independent predictive factors. Results The overall satisfaction score was 4.54 ± 0.58 (mean ± SD), with structural dimensions scoring lowest (4.45 ± 0.64). Importance-Performance Analysis (IPA) revealed seven critical improvement areas, predominantly policy clarity (structural dimension) and clinical applicability (process dimension). Conclusions While Shandong’s Western Medicine-TCM (WM-TCM) integration program demonstrates high participant satisfaction, strategic enhancements in policy transparency, equitable resource allocation, and curriculum integration are essential to ensure long-term efficacy. Insights from global integrative medicine frameworks provide actionable pathways for program optimization.
Intersection of Patient Satisfaction, Expense Management, and Profitability at Washington State Hospitals
Purpose: Explore relationships between hospital expense management, profitability, and patient satisfaction. Methodology: Hospital financial statement and patient satisfaction scores in Washington State were analyzed to identify financial approaches between hospitals with high and low patient satisfaction scores. Finding: Hospitals with high patient satisfaction scores invest significantly more in surgical services than do hospitals with lower scores. While surgical services are typically viewed as lucrative revenue streams for most hospitals, high-scoring hospitals’ higher levels of investment in surgical services, and other areas linked to diagnosis and postoperative care, suggests that these hospitals are committed not just to generating revenue but also to enhancing patient outcomes and experiences. Hospitals with high patient satisfaction scores also invested more in data processing. Unlike areas in which increased spending is directly related to providing clinical services, data processing is part of an administrative domain can be considered a strategic move to leverage technology for better patient outcomes and experiences. All hospitals in the study spent similar amounts in some areas of hospital operations, including acute care, central services, laundry and linen, and in-service education. Yet, for hospitals with high patient satisfaction scores, these specific expenses correlate with profitability. This result suggests that although both sets of hospitals are incurring similar expenses, their returns on investments differ. Addition research is warranted to better understand the reasons for this disparity including internal differences in operational efficiencies, service quality, the internal built environment, and external factors such as payer mix and regional demographics. Originality/Value: This study can support healthcare organization in developing a framework to optimize best practices around patient satisfaction and expense management.
Understanding the role of policy to bridge the digital divide of the elderly
Background: In the digital age, the growing elderly people has gradually been marginalized and become a " vulnerable group " who is facing the digital divide problems that need to be solved urgently. With the support of relevant policies, all sectors of society have attached great importance to the digital shift for the elderly, which has brought certain convenience to their life, but there is still a reality of insufficient digital inclusion for them. So, re-examining the existing policies in related fields is necessary. Objectives: The article aims at examining potential inadequacies in policies about the digital divide of the elderly, and proposes corresponding policy recommendations to enhance the well-being and sense of acquisition of the elderly worldwide. Methods: By the perspective of policy tools, this study undertakes content analysis method to code and analyze 44 policy texts related to the digital divide of the elderly using NVivo12 qualitative analysis software. Results: It indicates that 'supply-based tool' accounted for the highest proportion (55.20%), followed by 'environment-based tool' (30.40%), and the lowest was 'demand-based tool' (14.40%) by the analysis of policy tool dimensions. Analyzing the dimension of 'policy tool-behavior subject' found that the proportion of policy regulations related to the 'government' is the highest (46.94%), and the proportion of 'academic and research institutions' is the lowest (2.33%). Relevant policies have the problems of unbalanced structure of policy tools and insufficient vitality of policy participation of multiple actors. Main Contribution to Evidence-Based Practice: The article contributes to promoting evidence-based practice and policy-making for the elderly facing the digital divide in China and worldwide, and helping the elderly enjoy better life in modern society.