Effect of cetuximab plus FOLFOX4 regimen on clinical outcomes in advanced gastric carcinoma patients receiving evidence-based care

BACKGROUND Although chemotherapy is effective for treating advanced gastric carcinoma(aGC),it may lead to an adverse prognosis.Establishing a highly effective and low-toxicity chemotherapy regimen is necessary for improving efficacy and outcomes in aGC patients.AIM To determine the efficacy and safety of cetuximab(CET)combined with the FOLFOX4 regimen(infusional fluorouracil,folinic acid,and oxaliplatin)as firstline therapy for patients with aGC,who received evidence-based care(EBC).METHODS A total of 117 aGC patients who received EBC from March 2019 to March 2022 were enrolled.Of these,60 in the research group(RG)received CET+FOLFOX4 as first-line therapy,whereas 57 in the control group(CG)received FOLFOX4.The efficacy[clinical response rate(RR)and disease control rate(DCR)],safety(liver and kidney dysfunction,leukopenia,thrombocytopenia,rash,and diarrhea),serum tumor marker expression[STMs;carbohydrate antigen(CA)19-9,CA72-4,and carcinoembryonic antigen(CEA)],inflammatory indicators[interleukin(IL)-2 and IL-10],and quality of life(QOL)of the two groups were compared.RESULTS A markedly higher RR and DCR were observed in the RG compared with the CG,with an equivalent safety profile between the two groups.RG exhibited notably reduced CA19-9,CA72-4,CEA,and IL-2 levels following treatment,which were lower than the pre-treatment levels and those in the CG.Post-treatment IL-10 was statistically increased in RG,higher than the pre-treatment level and the CG.Moreover,a significantly improved QOL was evident in the RG.CONCLUSION The CET+FOLFOX4 regimen is highly effective as first-line treatment for aGC patients receiving EBC.It facilitates the suppression of STMs,ameliorates the serum inflammatory microenvironment,and enhances QOL,without increased adverse drug effects.

Application of Clinical Care Pathway in Perioperative Patients with Autologous Arteriovenous Fistula Balloon Expansion

[Objective] To explore the effect of clinical care pathways in perioperative patients with autologous arteriovenous fistula balloon expansion. [Method] 202 patients undergoing autologous arteriovenous fistula from July 2021 to June 2022 were randomly divided into a control group (101 cases) and an observation group (101 cases) to compare the incidence rates of postoperative complications, hospitalization days, hospitalization expenses, knowledge of self-management of arteriovenous fistula and nursing satisfaction. [Results] In the observation group, the incidence of arteriovenous fistula was higher than that of the control group, and the hospitalization days and hospitalization costs were lower than that of the control group. The difference between the two groups was statistically significant (P < 0.05). [Conclusion] The application of the clinical nursing path to intervene in patients with autologous arteriovenous fistula balloon dilation can reduce the incidence of postoperative complications, shorten the hospital length of time, reduce hospitalization costs and improve patient satisfaction, which is clinical promotion significance.

Necessary prerequisites for evidence-based practice:results of investigating nurses'informatics competency and information literacy skills

This study aimed to evaluate the correlation between nursing informatics(NI)competency and information literacy skills for evidencebased practice(EBP)among intensive care nurses.This cross-sectional study was conducted on 184 nurses working in intensive care units(ICUs).The study data were collected through demographic information,Nursing Informatics Competency Assessment Tool(NICAT),and information literacy skills for EBP questionnaires.The intensive care nurses received competent and low-moderate levels for the total scores of NI competency and information literacy skills,respectively.They received a moderate score for the use of different information resources but a low score for information searching skills,different search features,and knowledge about search operators,and only 31.5%of the nurses selected the most appropriate statement.NI competency and related subscales had a significant direct bidirectional correlation with information literacy skills for EBP and its subscales(P<0.05).Nurses require a high level of NI competency and information literacy for EBP to obtain up-to-date information and provide better care and decision-making.Health planners and policymakers should develop interventions to enhance NI competency and information literacy skills among nurses and motivate them to use EBP in clinical settings.

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.

Clinical application of multidisciplinary team-and evidence-based practice project in gynecological patients with perioperative hypothermia

BACKGROUND Perioperative hypothermia(PH)negatively affects the physical and mental health of patients to varying degrees.Currently,there is no effective multidisciplinary team(MDT)intervention for gynecological patients with PH.AIM To apply the best evidence on the prevention and management of PH in gynecological patients,improve the quality of perioperative evidence-based care based on treatment by an MDT for gynecological patients and analyze the effect of MDT-and evidence-based practice(EBP)projects on the psychological status and cognitive function of gynecological patients with PH.METHODS Under the guidance of knowledge translation and combined with the opinions of involved stakeholders and clinical experts,the best evidence for PH prevention and management in gynecological patients was selected and adjusted to suit the practice setting.Based on the evidence,the practice plan was developed,and the MDT intervention was carried out in the preoperative ward,the preoperative preparation room,the intraoperative operating room,the postanesthesia care unit,and the 24-hour postoperative gynecological ward through the EBP program.The incidence of hypothermia,the nurses’awareness,the implementation rate of examination indicators,and the thermal comfort level,psychological status and cognitive function of patients were compared before and after the implementation of the program.RESULTS The incidence of PH in gynecological patients decreased from 43.33%to 13.33%after the implementation of the scheme.The implementation rate of examination indicators 6-10,12,14,16-18,21,and 22 reached 100%,and that of other indicators was above 90%,except for examination indicators 5 and 13,which was 66.67%;the indices were significantly improved compared with the baseline(before evidence application)(P<0.05).The score of nurses'awareness of PH prevention and management in gynecological patients increased from 60.96±9.70 to 88.08±8.96,and the difference was statistically significant(P<0.001).The total score of the perioperative thermal comfort level of patients undergoing gynecological surgery was 27.97±2.04,which was significantly increased compared with the score of 21.27±1.57 observed by researchers at baseline(P<0.001).The perioperative Hamilton Depression Scale and Hamilton Anxiety Scale scores of patients undergoing gynecological surgery decreased from 15.03±3.16 and 13.93±2.64 to 4.30±1.15 and 3.53±0.78,respectively,with statistically significant differences(P<0.001).The perioperative Montreal Cognitive Assessment Scale score of the gynecological surgery patients increased from 23.17±1.68 to 26.93±1.11,also with statistical significance(P<0.001).CONCLUSION MDT-based EBP for PH prevention and management in gynecological patients during the perioperative period can standardize nursing operations,improve nurses'awareness and behavioral compliance with gynecological hypothermia management,and reduce the occurrence of PH in gynecological patients while playing a positive role in reducing patients’negative emotions and enhancing their cognitive function.

The artificial intelligence evidence-based medicine pyramid

Several studies exist in the literature regarding the exploitation of artificial intelligence in intensive care.However,an important gap between clinical research and daily clinical practice still exists that can only be bridged by robust validation studies carried out by multidisciplinary teams.

Reality of evidence-based practice in palliative care

There has been a paradigm shift in medicine away from tradition, anecdote and theoretical reasoning from the basic sciences towards evidence-based medicine(EBM). In palliative care however, statistically significant benefits may be marginal and may not be related to clinical meaningfulness. The typical treatment vs. placebo comparison necessitated by ‘gold standard' randomised controlled trials(RCTs) is not necessarily applicable. The complex multimorbidity of end of life care involves considerations of the patient's physical, psychological, social and spiritual needs. In addition, the field of palliative care covers a heterogeneous group of chronic and incurable diseases no longer limited to cancer. Adequate sample sizes can be difficult to achieve, reducing the power of studies and high attrition rates can result in inadequate follow up periods. This review uses examples of the management of cancer-related fatigue and death rattle(noisy breathing) to demonstrate the current state of EBM in palliative care. The future of EBM in palliative care needs to be as diverse as the patients who ultimately derive benefit. Non-RCT methodologies of equivalent quality, validity and size conducted by collaborative research networks using a ‘mixed methods approach' are likely to pose the correct clinical questions and derive evidencebased yet clinically relevant outcomes.

Evidence-based Care for Rehabilitation Nursing Effect of Patients with Patellar Fracture

Objective.To analyze the effect of applying evidence-based care in rehabilitation nursing effect of patients with patellar fractures.Methods.A total of 54 patients with patellar fractures were randomly selected from the hospital.The diagnosis and treatment time were from the beginning of July 2018 to end of June 2019.The digital table grouping was adopted to divide patients into two groups with each group consists of 27 patients with this disease.Both groups underwent routine nursing and the experimental group with increased evidence-based care.Results.Compared with the control group,the knee function evaluation,complications and nursing satisfaction of the experimental group were more ideal,and the difference was statistically significant(P<0.05).Conclusion.Evidence-based care in rehabilitation nursing of patients with patellar fracture can obtain ideal nursing effect.

Evidence-Based Practice and Job Satisfaction of Nurses in Long-Term Care

Purpose: The purpose of this study was to identify the relationship between evidence-based practice (EBP) and job satisfaction among nurses working in long-term care facilities. Methods: The study used a descriptive cross-sectional design. A total of 146 nurses working in 6 long-term care facilities in South Korea self-reported their perception of EBP implementation, barriers to research utilization, and job satisfaction. Results: The level of job satisfaction was higher in nurses who were single, older, more experienced, and had a higher income. Lower perceived barriers to research utilization were associated with greater job satisfaction. However, there was no significant relationship between a level of EBP implementation and job satisfaction. Factors influencing job satisfaction included lower barriers to the organization and communication domains of research utilization, being unmarried and older. Conclusion: Decreasing barriers to research utilization may improve the job satisfaction of nurses working in long-term care facilities.

基于CARES模式下大学生就业价值取向及提升路径研究——以天津大学为例

就业是最大的民生,党和国家及高校高度重视大学生就业,在新时代,高校大学生就业价值取向出现了新的变化。学生就业意愿降低,“慢就业”现象严重。理想职业岗位与目标发生变化,“求稳”心态加剧。求职高标准高期待,存在“畏难”情绪。文章通过就业认知、就业能力、亲友资源、就业期望和社会环境五个方面,探究学生就业价值取向变化原因,同时给予提升对策,即广泛体验,端正学生就业认知;精准出击,增强学生就业能力;家校合作,科学利用亲友资源;正向引导,合理设置就业期望;多措并举,拓宽就业求职渠道;提高重视,提升政策宣传力度。

基于fsQCA组态视角的我国医疗资源配置效率提升路径分析

背景当前我国医疗资源配置区域失衡、公平性缺失问题仍然突出。党的“二十大”报告明确提出要“促进优质医疗资源扩容和区域均衡布局”。目的探究提升我国医疗资源配置效率的具体路径,为实现我国医疗资源合理且高效配置、促进基本公共服务均等化提供科学参考。方法于2022年9月—2023年2月开展研究,数据源于《2021中国统计年鉴》《2021中国卫生健康统计年鉴》。将医疗卫生机构数、卫生技术人员数、床位数作为投入指标,以诊疗人次和入院人数为产出指标,通过数据包络分析(DEA)方法对我国2020年31个省份医疗资源配置效率进行测度;以医疗资源配置效率为结果变量,以卫生技术人员占比、每千人口床位数、出院者平均住院日、人均国内生产总值(GDP)、居民可支配收入、财政收入分权和医疗卫生财政预算支出占比为条件变量,运用模糊集定性比较分析(fsQCA)方法从组态视角探究内外部要素对医疗资源配置效率的协同影响机制,剖析高或非高水平医疗资源配置效率的条件组态,明确医疗资源高效率和低效率配置的多重路径。结果2020年我国31个省份医疗资源配置效率整体水平较高,均值为0.852,但省际存在较大差异。组态分析结果可知,医疗资源配置效率的提升是多因素共同作用的结果,共存在3种医疗资源高效率配置的路径。路径1:政府主导型驱动路径,以广西壮族自治区为典型案例。路径2:内外协调型驱动路径,以云南省和甘肃省为代表案例。路径3:均衡型驱动路径,代表案例主要有广东省、福建省和湖北省。非高医疗资源配置效率的路径也存在3条。路径1:政府制约型路径。路径2:经济-政府双重制约型路径,代表案例有黑龙江省和吉林省。路径3:内外制约型路径,典型案例有山西省和西藏自治区。结论内外部各要素及要素间的协同在良性互动过程中共同影响着医疗资源配置效率水平,需优化内外部环境,并对关键资源要素进行有效整合,以形成合力,促进区域医疗资源合理配置。

人文经济学:中国式现代化的文化自觉

促成经济发展与人文价值的互动融合,实现经济发展从“效用经济到人文/公平经济”的深刻转换,是中国式现代化的深层内核和发展愿景,是中国式现代化人文关怀的真谛。但人文经济和市场/效用经济不是截然断裂的,它不是继市场经济之后新生发的经济形态,而恰恰是以现实市场经济体制为基础,通过市场配置资源以实现人文价值的高级经济形态。在具体样态上,人文经济体现为“以人民为中心”的文化经济,一方面强调一切市场经济实践都要以保障人的幸福和尊严为目的,尊重人的生命及其价值,彰显人文关怀,为人的自由全面发展和价值实现创造现实条件;另一方面,以人民大众作为经济社会发展的根本动力,充分重视文化和人文精神在经济发展过程中的积极作用。在此语境中,学界要强化人文经济学基础理论研究;加强人文经济学的基础设施建设;坚持问题导向,运用人文经济学一般原理对中国式现代化进程中人文与经济融合发展的实践、矛盾和问题进行深入研究和分析,总结和提炼人文经济运行发展的规律性认识,为建构中国特色人文经济学提供思想、学科和实践基础。

数字经济赋能养老产业的增长路径研究

数字经济的发展为养老产业增长注入新动能,智慧养老成为一种有效应对人口老龄化的数字化治理模式,推动养老产业增长。基于组态视角,采用模糊集定性比较分析方法(fsQCA),以养老产业增长为结果变量,以中国内地30个省级行政区(不含数据缺失较多的西藏)为案例,从数字经济的基础、发展及规模三个维度,探寻数字经济发展赋能养老产业增长的组态路径,为养老产业的数字化转型提供参考。研究发现:数字经济单一要素并不构成养老产业高增长水平的必要条件,养老产业高增长水平是数字经济多种要素协同作用的结果;“数字基础设施”与“数字人才”是各地发展养老产业的核心要素,“数字应用”、“数字交易”及“数字金融”等要素更多情况下作为辅助条件发挥作用;“数字基础设施+数字人才”奠基型、“数字人才+数字应用”推动型、“数字化基础+规模”驱动型、“数字化基础+发展+规模”引领型是四条有效增长养老产业的路径。基于此,提出发挥要素协同作用、强化数字化基础建设及打造数字化养老平台等对策建议,从而实现养老产业的高质量增长。

社会企业介入社区居家养老的路径探索

在生育率下降和老龄化程度加深的背景下,缓解养老服务供给失衡已成为社会关注的重大问题。社会企业兼具“经济-福利”的双重价值、结合“竞争-合作”两股力量,为老年人提供“多元化+多层次”的养老服务供给。但由于中国社会企业发展得不成熟,在介入社区居家养老服务方面存在资源短缺、身份矛盾和地位尴尬的现实问题,需要通过政府主导、放松规制与健全法律的路径加以改善,以期进一步培育和发展社会力量,破解养老难题,提升社会治理现代化水平。

人口老龄化背景下辽宁省实施智慧医养服务有效路径分析

随着全球人口老龄化程度的加深,我国迎来了“银发时代”,养老问题在面临严峻挑战的同时也衍生出了新的机遇.目前,辽宁省已经进入深度老龄化社会,随着人们养老需求的增加及电子信息技术的飞速发展,智慧医养成为老龄化时代的必然产物.通过对国家统计局、中国互联网络信息中心、智慧医养等相关平台发布的数据进行统计、对比分析,发现辽宁省实施智慧医养服务面临着在老年群体中推广度较低、覆盖面不全、基础有待提升、网络信息平台存在安全隐患等困境,最终从4个方面提出针对辽宁省实施智慧医养服务的有效实施路径,希望能够以此促进辽宁省智慧医养服务高质量发展,对辽宁经济的发展及健康中国战略的实施起到一定的推动作用.

共同富裕目标下长期护理保险的发展困境与优化路径——基于“路径-目标”理论的分析框架

长期护理保险作为社会保障体系的重要构成,在一定程度上能够有效促进共同富裕,但其逻辑机理、发展困境和优化路径并未得到充分揭示。基于路径-目标理论,将共同富裕和长期护理保险发展目标相结合,从“共同”和“富裕”两个维度分析长期护理保险发展面临如下困境:部分群体未纳入长期护理保险的参保范围,对困难群体的支持力度不足,失能等级评估标准尚不统一,监督和监管机制还不完善,长期护理服务体系不健全,护理费用报销差异大,筹资渠道单一,基金规模整体不大,护理服务人数较少且服务设计缺乏人文关怀,慈善事业和社会互助参与力度不足。鉴于此,应从“共同”和“富裕”两个维度进一步优化,提升长期护理保险的公平性和可持续性,助力实现共同富裕。

我国社区居家养老服务政策的变迁:历程、逻辑与展望——基于历史制度主义的分析

完善社区居家养老服务政策既是健全基本养老服务体系的内在要求,也是在“好好过日子”文化语境下实现“老有所养”的重要抓手。基于历史制度主义分析发现,我国社区居家养老服务政策经历了初步探索期、逐步成型期、快速发展期、提质增效期的变迁历程。从演变逻辑来看,制度背景催生了社区居家养老服务政策设立,关键节点影响了社区居家养老服务政策变迁,路径依赖驱动了社区居家养老服务政策强化。未来需要通过政策迭代升级,彰显社区居家养老服务作为准公共产品的社会性、公共性与生活性,推动社区居家养老服务高质量发展。

基层卫生健康事业高质量发展内涵与路径分析

目的:分析新发展格局下基层卫生健康事业高质量发展内涵与实现路径,期望充分发挥基层卫生在优质高效整合型医疗卫生服务体系构建过程中的网底优势。方法:基于Donabedian结构—过程—结果三维质量理论分析基层卫生健康事业高质量发展的核心内涵与实现路径。结果:基层卫生健康事业高质量发展内涵包括整合协同式的资源结构、创新内涵式的服务过程、优质高效的结果产出三个方面。通过体系创新与发展、创新供给侧结构性改革促进供需双方的健康主体责任落实、建立以健康结果考核为激励导向的评价机制,助力基层卫生健康事业实现高质量发展。结论:基层卫生健康事业高质量发展需要多要素之间协同联动,重点关注供给与需求之间的协调与平衡,围绕健康目标,创新服务模式,延伸服务提供,实现基层卫生健康从治疗服务型向健康管理型转变,促进基层卫生健康事业形成生存与发展的良性循环。

中国式老龄化:新结构经济学的新见解

中国式老龄化是中国式现代化的重要组成部分,文章采用新结构经济学的分析方法,提出了关于中国式老龄化六方面的新见解。第一,中国式老龄化彰显的是人口老龄化的中国之问与中国之治。中国成功拓展了人类老龄化可能性边界,中国式现代化能与中国式老龄化齐头并进,老龄事业高质量发展应是中国式老龄化的首要任务。第二,中国式老龄化的成因主要源于中国的预期寿命革命。新中国建立的社会主义制度创造了健康奇迹,由此引起的预期寿命革命产生了中国目前数量巨大的老龄人口,新时代的健康中国战略将使中国进入长寿时代并进一步加速老龄化。第三,中国式老龄化的影响并不会如流行观点认为的那样悲观。中国式老龄化是人类发展的奇迹而非拖累,不会拖累中国的经济增长,但会引发经济结构的系统性变革。第四,中国式老龄化的治理需要符合国情。只有立足于反映国情的禀赋结构,才能走出一条中国特色积极应对人口老龄化的道路;只有立足老龄人口禀赋结构,才能实现老龄事业高质量发展;只有重塑适宜的养老体系,才能创造中国的养老奇迹。第五,中国式老龄化有可供世界借鉴的经验。创造中国预期寿命革命的初级卫生保健经验就写入了《阿拉木图宣言》,中国的经验(尤其是在老龄化进程中保持经济增长的经验)更适合发展中国家应对“未富先老”的挑战。第六,中国式老龄化有可供世界分享的机遇。中国共同富裕进程中将形成规模巨大的银发经济,但需要有效市场和有为政府更好地结合,产业按比较优势适老化转型,才能壮大银发经济。总之,中国式老龄化既有各国老龄化的共同特征,更有基于自身国情的中国特色,可以借鉴但不可模仿发达国家的老龄化制度与政策。

“互联网+护理服务”护理路径的构建及应用研究

目的:构建“互联网+护理服务”实施路径,为项目开展提供参考。方法:基于信息平台,设计实施路径,提供母婴护理、专科护理等服务内容,进行效果评价。结果:2022年1月至2023年7月,完成服务90例,满足特殊人群居家护理需求,不仅提高护理满意度,提升护理服务影响力,同时还提升护士职业价值感。结论:实施“互联网+护理服务”护理路径,满足了人民群众健康服务需求,但还需完善服务的监管及运行机制,以保障运行效果。