An Improved CREAM Model Based on DS Evidence Theory and DEMATEL

Cognitive Reliability and Error Analysis Method(CREAM)is widely used in human reliability analysis(HRA).It defines nine common performance conditions(CPCs),which represent the factors thatmay affect human reliability and are used to modify the cognitive failure probability(CFP).However,the levels of CPCs are usually determined by domain experts,whichmay be subjective and uncertain.What’smore,the classicCREAMassumes that the CPCs are independent,which is unrealistic.Ignoring the dependence among CPCs will result in repeated calculations of the influence of the CPCs on CFP and lead to unreasonable reliability evaluation.To address the issue of uncertain information modeling and processing,this paper introduces evidence theory to evaluate the CPC levels in specific scenarios.To address the issue of dependence modeling,the Decision-Making Trial and Evaluation Laboratory(DEMATEL)method is used to process the dependence among CPCs and calculate the relative weights of each CPC,thus modifying the multiplier of the CPCs.The detailed process of the proposed method is illustrated in this paper and the CFP estimated by the proposed method is more reasonable.

Real-World Evidence in Localized Pancreatic: Coping with Uncertainty in Unselected Populations

Background: Localized pancreatic cancer, including resectable (R), borderline resectable (BR) and locally advanced unresectable disease (LAU), is considered in clinical guidelines for diverse treatment options based on clinical trials in selected populations. Hence, exploring with real world evidence (RWE) clinicians’ preferences for treatment options and their results seems pertinent. Methods: In a set of consecutive patients with localized pancreatic cancer assisted in a third level hospital from January 2013 to December 2022, medical records, symptoms, diagnostic process, distribution between subtypes, and treatment plans, with safety and efficacy results, were assessed. Results: A total of 152 patients with localized disease were included (43.4% R, 21.0% BR, 33.6% LAU). The population characteristics exemplified differences between daily practice and clinical trials. Tumor location and symptoms were as expected. Treatment plan was conditioned by PS or comorbidities in 23.0% of patients. In patients with R disease, surgery followed by different adjuvant chemotherapy (CT) regimes was the antineoplastic treatment of choice (64.8%) with efficacy results (OS 37.5 months;95% CI 18.4 - 56.7), in the range of contemporary standards. The common use of neoadjuvant CT for BR disease (94.4%), with surgery in 50% of them, and its results (OS 30.8 months;95% CI 10.5 - 51.2) reflected current controversies of treatment recommendations and evolution in this scenario. Paliative CT with or without radiotherapy was the standard specific treatment in LAU disease (95.1%) with survival results (PFS: 10.8 months;95% CI 8.8 - 12.7. OS: 20.3 months;95% CI 13.5 - 27.2) that justify the distinct character and the specific study of this entity. Conclusion: RWE for localized pancreatic cancer aroused from the analysis of this population confirms the distinct nature of patients assisted in daily practice, as well as mirrors the complexity of decision making in clinical assumptions in which achieving stronger evidence should be paramount.

Are case reports valuable?Exploring their role in evidence based medicine and patient care

Case reports,often overlooked in evidence-based medicine(EBM),play a pivotal role in healthcare research.They provide unique insights into rare conditions,novel treatments,and adverse effects,serving as valuable educational tools and generating new hypothesis.Despite their limitations in generalizability,case reports contribute significantly to evidence-based practice by offering detailed clinical information and fostering critical thinking among healthcare professionals.By acknowledging their limitations and adhering to reporting guidelines,case reports can contribute significantly to medical knowledge and patient care within the evolving landscape of EBM.This editorial explores the intrinsic value of case reports in EBM and patient care.

Levels of evidence and grades of recommendation supporting European society for medical oncology clinical practice guidelines

Background:The European Society for Medical Oncology(ESMO)guidelines are among the most comprehensive and widely used clinical practice guidelines(CPGs)globally.However,the level of scientific evidence supporting ESMO CPG recommendations has not been systematically investigated.This study assessed ESMO CPG levels of evidence(LOE)and grades of recommendations(GOR),as well as their trends over time across various cancer settings.Methods:We manually extracted every recommendation with the Infectious Diseases Society of America(IDSA)classification from each CPG.We examined the distribution of LOE and GOR in all available ESMO CPG guidelines across different topics and cancer types.Results:Among the 1,823 recommendations in the current CPG,30%were classified as LOEⅠ,and 43%were classified as GOR A.Overall,there was a slight decrease in LOEⅠ(−2%)and an increase in the proportion of GOR A(+1%)in the current CPG compared to previous versions.The proportion of GOR A recommendations based on higher levels of evidence such as randomized trials(LOEⅠ–Ⅱ)shows a decrease(71%vs.63%,p=0.009)while recommendations based on lower levels of evidence(LOEⅢ–Ⅴ)show an increase(29%vs.37%,p=0.01)between previous and current version.In the current versions,the highest proportion of LOEⅠ(42%)was found in recommendations related to pharmacotherapy,while the highest proportion of GOR A recommendations was found in the areas of pathology(50%)and diagnostic(50%)recommendations.Significant variability in LOEⅠand GOR A recommendations and their changes over time was observed across different cancer types.Conclusion:One-third of the current ESMO CPG recommendations are supported by the highest level of evidence.More well-designed randomized clinical trials are needed to increase the proportion of LOEⅠand GOR A recommendations,ultimately leading to improved outcomes for cancer patients.

An Evidence-Based CoCoSo Framework with Double Hierarchy Linguistic Data for Viable Selection of Hydrogen Storage Methods

Hydrogen is the new age alternative energy source to combat energy demand and climate change.Storage of hydrogen is vital for a nation’s growth.Works of literature provide different methods for storing the produced hydrogen,and the rational selection of a viable method is crucial for promoting sustainability and green practices.Typically,hydrogen storage is associated with diverse sustainable and circular economy(SCE)criteria.As a result,the authors consider the situation a multi-criteria decision-making(MCDM)problem.Studies infer that previous models for hydrogen storage method(HSM)selection(i)do not consider preferences in the natural language form;(ii)weights of experts are not methodically determined;(iii)hesitation of experts during criteria weight assessment is not effectively explored;and(iv)three-stage solution of a suitable selection of HSM is unexplored.Driven by these gaps,in this paper,authors put forward a new integrated framework,which considers double hierarchy linguistic information for rating,criteria importance through inter-criteria correlation(CRITIC)for expert weight calculation,evidence-based Bayesian method for criteria weight estimation,and combined compromise solution(CoCoSo)for ranking HSMs.The applicability of the developed framework is testified by using a case example of HSM selection in India.Sensitivity and comparative analysis reveal the merits and limitations of the developed framework.

Non-alcoholic fatty liver disease in type 2 diabetes:Emerging evidence of benefit of peroxisome proliferator-activated receptors agonists and incretin-based therapies

Nonalcoholic fatty liver disease(NAFLD)is a global epidemic,affecting more than half of the people living with type 2 diabetes(T2D).The relationship between NAFLD and T2D is bidirectional and the presence of one perpetuates the other,which significantly increases the hepatic as well as extrahepatic complications.Until recently,there was no approved pharmacological treatment for NAFLD/nonalcoholic steatohepatitits(NASH).However,there is evidence that drugs used for diabetes may have beneficial effects on NAFLD.Insulin sensitizers acting through peroxisome proliferator-activated receptor(PPAR)modulation act on multiple levels of NAFLD pathogenesis.Pioglitazone(PPARγ agonist)and saroglitazar(PPARα/γagonist)are particularly beneficial and recommended by several authoritative bodies for treating NAFLD in T2D,although data on biopsyproven NASH are lacking with the latter.Initial data on elafibanor(PPARα/δ agonist)and Lanifibranor(pan PPAR agonist)are promising.On the other hand,incretin therapies based on glucagon-like peptide-1(GLP-1)receptor agonists(GLP-1RA)and dual-and triple-hormone receptor co-agonists reported impressive weight loss and may have anti-inflammatory and antifibrotic properties.GLP-1 RAs have shown beneficial effects on NAFLD/NASH and more studies on potential direct effects on liver function by dual-and triple-agonists are required.Furthermore,the long-term safety of these therapies in NAFLD needs to be established.Collaborative efforts among healthcare providers such as primary care doctors,hepatologists,and endocrinologists are warranted for selecting patients for the best possible management of NAFLD in T2D.

Preceptors'experiences in guiding nursing students to use research findings and to implement evidence-based practice

Objective:Evidence-based practices(EBPs)have been taught to students by identifying the best evidence/evidence from research results.However,the experiences of Indonesian nurse preceptors in helping students implement research findings have not been explored thoroughly.This study aimed to explore Indonesian nurse preceptors in guiding nursing students to use research findings.Methods:This study used interpretive phenomenology analysis that involves 9 nurse preceptors from hospitals in West Kalimantan,Indonesia.Semi-structured in-depth interviews were recorded and then transcribed verbatim.Results:Three themes were generated during the analysis:“types of student supervision,”“issues during supervision,”and“the need for research literacy and supervision.”Conclusions:Nurse preceptors need support to supervise the nursing students to use research findings.In addition to upgrading nursing skills,nurse preceptors must receive training in research and its utilization.Developing an appropriate strategy to assist students in using research findings will enhance the promotion of evidence-based nursing practices on a daily basis.

Security Risk Assessment in Container Terminals:Empirical Evidence from Greece

The most prominent risk assessment techniques are founded on the values of measuring and controlling the frequency and the consequences of risks in order to assure an“acceptable level”of“safeness”mainly in the lines of environmental,health and hygiene and port product issues.This paper examines security risk assessment approaches within the emerging role of ports.This paper contributes to the current literature by considering the ports of Greece as a case in point and by measuring the degree of its security risk orientation based on certain valid risk factors drawn from the current literature.Moreover,it presents a security risk assessment methodology into the domain of port container terminals.Their potential for ports were quantitatively and qualitatively assessed by discussing issues of security approaches within the maritime industry,in order to facilitate improvement strategies.A two-dimension empirical study was conducted,in a time range of ten years(2010-2020)in order to provide evidence regarding security risk assessment in the port container terminal of Thessaloniki,in Greece.The findings of this study have significant strategic policy implications and shed more light on the role of security risks in the overall risk orientation of container terminals in practice.Finally,further research directions in security risk in ports are proposed.

Summary of the Best Evidence for Tube Feeding Intolerance in Critically Ill Children

Objective:To summarize the evidence of tube feeding intolerance in critically ill children,aiming to provide evidence-based information for clinical nursing staff.Methods:Evidence search was done in Chinese and English databases to guide network and professional associations at home and abroad.The search time limit was from January 2014 to January 2024,nearly 10 years of relevant literature,mainly including guidelines,consensus,expert advice,best practice,evidence summary,system evaluation,and meta-analysis.Literature quality evaluation and evidence extraction were independently performed by two researchers.Results:This paper included 13 articles,including three guidelines,three systematic evaluations,three expert opinions,and four expert consensus.Twenty-six pieces of evidence were summarized from 10 aspects of feeding intolerance definition,team building,nutritional assessment,nutritional preparation,feeding protocol,feeding route,feeding management,pipeline management,gastric residual volume,and drug application.Conclusion:This paper summarized the evidence of tube feeding intolerance in critically ill children,which can provide evidence-based information for clinical practice.The abdominal signs should be closely observed when evaluating feeding intolerance,focusing on the prevention and reduction of feeding interruption.

Evidence-Based Nursing Practice of Reducing Immune-Related Skin Toxicity of Tumor Patients Guided by Sensitive Indicators

Purpose research on nursing sensitive indicators in tumor Patients application effect in immune-related skin toxicity management. Method select our hospital April to June, 202360 cases patients with immune therapy settings as the control group. August-October, 2023 60 cases the patients treated with immune therapy were the experimental group. The control group adopted regular nursing methods, while the experimental group sensitive Indicators, evidence-based give preventive care. The social situation, psychological state, physical function, quality of life score, incidence of skin toxicity caused by immune checkpoint inhibitors, moderate and above of the two groups of patients were compared. Incidence of skin toxicity. Result: experience group SAS score, SDS score higher than the control group, the difference was statistically significant (P < 0.05);The incidence of skin toxic reactions caused by immune checkpoint inhibitors and the incidence of moderate and above skin toxic reactions in the experimental group are lower than those in the control group, and the difference is statistically significant (P < 0.05). Conclusion: sensitive indicator guidance evidence-based preventive care can reduce the degree of immune-related skin toxicity, improve the psychological state and quality of life of tumor patients treated with immune therapy and reduce the incidence of adverse reactions, improve nursing quality and patient satisfaction.

Clinical Practice of Evidence-Based PDCA Cycle Management Model in Accelerated Recovery of Lung Cancer Patients

Objective: To explore the nursing effect of evidence-based PDCA cycle management mode in accelerated rehabilitation of patients undergoing thoracoscopic lung cancer radical surgery. Methods: 104 patients who underwent thoracoscopic lung cancer radical surgery in our hospital from June 2022 to February 2023 were randomly divided into control group and intervention group, with 52 cases in each group. The control group implemented evidence-based ERAS clinical pathway management, while the intervention group implemented evidence-based PDCA cycle quality management. The postoperative recovery of the two groups of patients was compared. Results: The postoperative recovery of the intervention group was significantly better than that of the control group. The first time to get out of bed, the first time to eat, the duration of chest drainage tube placement, and the length of hospital stay were significantly shorter than those of the control group. The incidence of postoperative chest complications and hospitalization costs were significantly lower than those of the control group, and patient satisfaction was significantly higher than that of the control group (P Conclusion: Evidence-based PDCA cycle quality management mode can effectively improve the implementation quality of accelerated rehabilitation nursing for patients undergoing thoracoscopic lung cancer radical surgery, and it is worthy of clinical promotion.

Research on the Application of Evidence-Based Quality Control Circle to Improve the Implementation Rate of Airway Management Measures in Adult Critically Ill Patients

Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs Institute (JBI) evidence-based health care model, the best evidence of airway management in adult critically ill patients was obtained and applied to the clinic. Results: The total implementation rate of airway management measures in adult critically ill patients increased from 23.62% before the implementation of quality control circle to 88.82%, and the pulmonary infection rate in critically ill patients decreased from 42.31% to 21.74%, with statistical significance between the two groups (P 0.05). Conclusion: Evidence-based quality control circle activities can standardize the practice standards of airway management in critically ill patients, reduce the occurrence of patients’ airway related complications, and improve clinical outcomes.

高位推动、注意力配置与中国政策扩散模式——基于三个典型案例的比较分析

传统渐进模式和以政策爆发为典型样态的非渐进模式,共同勾绘出中国政策扩散实践的整体图景,但鲜有研究对二者的生成机理进行比较阐释。依循注意力基础观的“情境—过程—结果”逻辑进路,注意力视域下的中国政策扩散分析框架包含“高位推动—府际注意力配置—政策扩散”三大核心链条。多案例比较分析结果发现:由高位推动嵌入主导的“吸纳-辐射”过程,是诱致压力型体制下大规模政策扩散的决定性力量;受府际注意力配置机制驱动,地方源创新的竞争性政绩建构,实现了对上级注意力的有效吸引,高层注意力的纵向传导,催化下级潜在采纳者注意力的再分配与聚合,形构出“地方首创—上级吸纳推广—地方跟进采纳”的一般扩散路径。不同高位推动策略所蕴含的政治势能存在结构性差异,约束政策采纳议程设置的响应速度和集中程度,最终形塑出渐进或爆发的差异化政策扩散模式。

政策工具视角下我国教育数字化转型的现状与审思

政策工具是政策文本的表现形式,也是政策目标和政策行动之间的连接机制,通过施用于有关部门与目标团体从而实现相关政策目标。文章基于28份与教育数字化转型相关的政策文件,通过工具分类、议题界定、政策编码的手段,遵循“政策工具—政策议题”的二维矩阵分析框架进行统计分析,将我国当前教育数字化转型相关政策的现状予以完整呈现。研究发现,我国教育数字化转型的相关政策可分为“改善基础设施、开发在线资源、构建网络空间、改革治理体系、发展师生能力、开展试点案例”六大议题。当前,我国教育数字化转型的相关政策存在政策工具整体结构失衡、内部运用失调、选择偏向单一的问题。在未来政策制定上,应调整政策工具结构、加大基础设施建设的政策供给、加强试点示范与实践推进、优化政策工具与政策议题配置。

我国数字乡村试点的政策工具偏好及区域差异——基于全国72个试点县域的扎根分析

以数字技术赋能乡村建设是推动农业农村现代化转型的必然要求,也是实现乡村振兴、推动共同富裕的重要战略目标。自2020年中央一号文件首次提出数字乡村试点以来,全国各试点地积极推进数字乡村建设实践。已有研究或从乡村发展与变迁视角来阐释数字化建设对于乡村高质量发展的战略意义,或从数字治理视角呈现数字化驱动乡村治理的过程和机制,而较少关注“试点”政策本身,更缺乏政策工具的类型学归纳和分析。基于政策工具视角,研究对全国72个数字乡村试点县域的一、二手资料进行扎根分析,最终提炼出能力建设型、协同治理型和创新激励型三类政策工具,并在此基础上构建数字乡村建设的“价值实践张力—动力机制—政策工具选择—政策目标实现”分析框架。研究表明,以政府主导为依托的能力建设型工具处于绝对优势地位,在此基础上叠加协同治理型与创新激励型两类政策工具,共同促进数字乡村建设的纵深发展。具体而言,东部沿海及部分中部地区因其自身物质基础较好,偏重多种政策工具的组合运用,西部及东北地区则更偏好能力建设型工具的运用。然而政策工具的选取并非一成不变,而是随着情境的变化由单一转向动态化与多样化。本研究可为数字乡村试点的深入推进提供工具借鉴,也可为相关部门的决策提供参考。

中国旅游电商政策的演进与发展趋势

以186份中国旅游电商相关政策文件为研究样本,综合使用政策计量、数据分析和人工判读等方法,全面梳理了中国旅游电商领域政策发展历程及演变特征,为今后更好地制定相关政策、促进旅游电商经济发展提供启示和借鉴。结果发现:中国旅游电商政策演进大致可分为4个阶段,分别是2001—2008年萌芽期、2009—2014年起步期、2015—2019年上升期、2020年至今成长期;旅游电商政策主要内容包括在线旅游企业和平台监管、扶贫语境下乡村旅游电商发展、智慧旅游和电商促产业发展等三大类,整体呈现出发文主体多方参与但合力不足、发文主题与时俱进并不断丰富等特征。未来需要在电商行业市场秩序监管、数字文旅产业创新、业态融合力促部门深化合作、乡村振兴配套政策支持等方面增加政策关注。

政策工具视角下残疾人就业政策研究——基于31份国务院政策文本的分析

就业是民生之本,也是残疾人全面发展、融入社会、迈向共同富裕最为直接的路径。残疾人就业政策是促进和推动残疾人事业发展的制度依据。通过内容分析方法,构建政策工具和政策目标两个分析维度,使用Nvivo12plus质性分析软件对31份国务院发布的残疾人就业政策样本进行分析,探讨残疾人就业政策体系的内部逻辑、政策工具分布以及政策工具模糊性的问题。研究发现,残疾人就业政策表现出路径依赖、政策高模糊性和政府主导型的特点。因此,在中国式现代化的语境之下,提出调整政策工具结构、促进政策精细化和落实社会责任三项建议。

我国融合教育政策变迁的三维审视与展望

融合教育保障了残疾学生进入普通学校接受教育的权利,让每一位学生享有公平而有质量的教育。融合教育改革与发展受政策推动、引导和调整,政策反映了社会中潜在的意识形态和假设。运用“工具—要素—时间”三维分析框架对我国融合教育政策变迁历程进行分析发现:我国融合教育政策经历了解决残疾儿童入普通学校难的问题、扩大融合教育规模、兼顾规模与质量、向高质量融合教育发展迈进四个阶段。伴随政府职能转变以及融合教育发展,融合教育政策中的工具选择及其组合更为科学有效,融合教育政策中的支持要素也更加适应残疾学生的个性化需求。为实现高质量融合教育发展目标,未来的融合教育政策应做好顶层设计以推进融合教育法治化建设,合理组合多种政策工具以解决融合教育发展困境,完善融合教育政策内容以优化融合教育支持要素。

健康中国背景下医养结合服务政策内容分析与优化建议——基于政策工具与参与主体的二维视角

党的二十大报告指出,推进健康中国建设,实施积极应对人口老龄化国家战略,发展养老事业和养老产业。作为实施健康中国战略的重要举措,医养结合的发展既需要公共政策工具驱动,也需要多元主体的积极协同和共同参与。通过整理2013年至2022年7月中央层面出台的医养结合服务政策文本,采用内容分析法,结合政策工具维度和参与主体维度构建二维分析框架,对筛选出的50份政策文本进行编码归类以及计量分析。研究发现,当前我国医养结合服务政策在工具选择和结构组合上表现出不均衡状态,自愿型工具运用不多;对社区、老年人群体和民间资本的关注不够,激励不足;具体政策呈现碎片化状态,完善而成熟的政策体系尚未建立。未来,应该在此基础上,优化政策工具结构,重视多元主体参与,构建政策工具组合体系。

短视频平台公共政策传播的信息框架效应——基于“双减”政策的视频内容分析与实验

[目的/意义]短视频作为新兴的互联网信息表达方式,已逐渐成为政策传播的重要工具。探索短视频平台在公共政策信息传播中的效力以及受众采纳意愿,有助于提升公共政策传播效果。[研究设计/方法]以“双减”政策为例,根据框架效应理论和信息采纳理论,通过内容分析法归纳总结短视频平台中“双减”政策信息框架的组织方式,同时分析不同政策信息框架对传播效果的影响;此外,采用在线控制实验法验证了不同政策信息框架对受众采纳意愿的影响。[结论/发现]在短视频平台中有近四成的信息使用了目标框架,其中损失框架居多,多数采用集体主义视角和非叙事陈述方式;目标框架、文化框架、叙事框架对受众的评论、转发、点赞意愿并未产生显著影响;双减政策信息中,损失、收益框架,集体、个人主义价值观以及叙事和非叙事要素都能增强受众的采纳意愿,并且目标框架与文化框架之间存在交互效应。[创新/价值]研究结论对于政策宣传部门及相关政府机构优化政策传播策略,提高传播效果具有启示作用。