Association between calcium supplementation and bone mineral density in children:a systematic review and meta-analysis

Objective:To evaluate the effects of calcium supplementation on bone mineral density in children.Methods:The PubMed,Embase,and Cochrane library were systematically searched.The retrieve inception date was between October 2001 and October 2019.Two reviewers independently performed the data extraction and assessed methodology quality.Studies were limited to randomized clinical trials comparing calcium supplement with a placebo for bone mineral density in children.A meta-analysis was performed to calculate standard mean difference(SMD)and 95%confidence interval(CI).Results:A total of 6 randomized controlled trials involving 408 participants(calcium supplementation group:198;placebo group:210)were finally included in this study.The meta-analysis revealed that,compared with placebos,calcium supplementation had no effect on the bone mineral densities[the whole-body:SMD with CI=0.43(-0.05-0.91),P=0.08,I2=75%;the 2nd-4th lumbar vertebrae:SMD with 95%CI=0.27(−0.17 to 0.70),P=0.07,I2=0%)].Sensitivity analysis revealed that the results of the whole-body bone mineral density were unstable and that the bone density of the 2nd-4th lumbar spine was robust.Conclusions:The results of this meta-analysis suggested that calcium supplementation did not improve bone mineral density in children.However,there continues to be a need for more high-quality studies to verify this fact in the future.

Polysaccharide-based drug delivery system rooted in traditional Chinese medicine unveils a gateway to immunotherapy

Tumor immunotherapy represents a pivotal scientific advancement,and the traditional Chinese medicine tenet of harmonizing the body’s equilibrium through the‘Yin-Yang(Yin and Yang refer to the two basic properties of things and things that are opposed to each other)balance’aligns conceptually with tumor immunotherapy’s goal of reinstating the immune system’s functionality[1].Current research suggests that incorporating the‘Yin-Yang balance’philosophy to guide traditional Chinese medicine polysaccharides in immune anti-tumor therapy may amplify their effectiveness in treating tumors[2].However,prevailing studies on the anti-tumor immune response of traditional Chinese medicine polysaccharides primarily focus on enhancing immune function,often overlooking a comprehensive exploration of immunosuppressive factors.Concurrently,the intricacies involved in analyzing and deciphering the composition and structure of traditional Chinese medicine polysaccharides have exacerbated the challenges associated with studying their oral absorption metabolism and in vivo mechanisms of action.This article addresses these intricacies by consolidating research on the structure-activity relationship,absorption and metabolism processes,and the molecular mechanisms influencing tumor immunity related to traditional Chinese medicine polysaccharides.Furthermore,it proposes a strategic framework for advancing the regulation of tumor immune responses through traditional Chinese medicine polysaccharides.This comprehensive exploration aims to establish a robust foundation for the development of novel oral Chinese herbal polysaccharide drugs tailored for the field of tumor immunotherapy.

The eligibility criteria,training content,and scope of practice for prescriptive authority for midwives:a modified Delphi study

Objective:To investigate the necessary eligibility criteria for prescriptive authority for midwives,gather suggestions from experts on training content for prescriptive authority for midwives,and explore the scope of practice of their prescriptive authority in certain circumstances.The results of this study could serve as a reference for the development of policies on prescriptive authority for midwives.Methods:Based on a literature search and semistructured interviews,a modified Delphi method was first used to conduct 2 rounds of expert consultation on eligibility criteria and training content for prescriptive authority for midwives.This stage included nursing experts(20)and medical experts(16)engaged in midwifery in many tertiary Grade A hospitals in China.Subsequently,consultation on the scope of practice of prescriptive authority for midwives was conducted with nursing experts(18)and medical experts(14)engaged in midwifery in many tertiary Grade A hospitals in China.The suggestions from the experts were analyzed using statistical methods to confirm the eligibility criteria for prescriptive authority,training content,circumstances,scope of practice for prescriptive authority,and the prescription forms.Results:Among the consulted experts,70.59%(the highest acceptance rate)considered an undergraduate degree to be the minimum educational requirement for midwives to be eligible for prescriptive authority,85.29%(the highest acceptance rate)considered the supervisor nurse to be the minimum technical position experience necessary for midwives to be eligible for having prescriptive authority,and 50%(the highest acceptance rate)considered 5 years to be the minimum number of years of experience in the specialty for midwives to be eligible for prescriptive authority.The applicants should at least be practicing at Grade C hospitals,which was the consensus among 91.18%of the consulted experts.Among the consulted experts,100%,100%,97.06%,94.12%,and 94.12%agreed that the applicants should have knowledge in pharmacology,laws and ethics,nursing,diagnostics,and midwifery,respectively.The consulted experts confirmed 22 related course topics and identified 6 specific circumstances in which the midwives could partially practice prescriptive authority,including uterine atony,excessive uterine contraction,postpartum hemorrhage,premature rupture of fetal membranes,normal labor,and neonatal asphyxia.Under these 6 circumstances,the consulted experts commonly agreed that there were 20 medication prescriptions and 13 auxiliary examination prescriptions that could be prescribed by midwives.Of these prescriptions,51.5%were independent prescriptions,30.3%were protocol prescriptions,and the remaining 18.2%were both independent and protocol prescriptions.Conclusions:Midwives who have an undergraduate degree,supervisor nurse position,and 5 years of practice in Grade C hospitals are considered eligible to apply for prescriptive authority.Partial prescriptive authority could be granted after regulated training in fundamental theories and practices,which could improve the independence and professionalism of midwifery.

A critical reflection on the discipline of nursing based on the correct analysis of the relationship between medicine and nursing

As nursing becomes a first-level discipline, the central focus of the development process of nursing science is the independent exploration of the future path of nursing care. Although many countries have made efforts to develop nursing as an independent discipline, no remarkable advancement has been achieved due to the incorrect understanding of the relationship between nursing and medicine and the improper comprehension of other factors involved in the process of nursing reform. Teaching and practicing nursing also face many problems. Based on our understanding of the relationship between nursing and medicine and through a careful analysis of the existing problems in the current nursing discipline, this paper provides some insights into the future directions of nursing development by exploring the independently developing nursing discipline in foreign countries.