Which approach of total hip arthroplasty is the best efficacy and least complication?

BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,wound complication,and nerve injury)found DAA was the best approach followed by DSA/SuperPath.CONCLUSION DSA/SuperPath had better earlier functional outcome than PA,but still could not overcome the result of DAA.This technique might be the other preferred option with acceptable complications.

泰国老年人肌少症及相关因素的系统评价和meta分析

目的对泰国老年人肌少症的忠病率情况进行综述并确定相关因素。方法对PubMed、Embase、Scopus和泰国期刊引文索引(Thai-Journal Citation Index, TCI)数据库进行系统检索。检索文献的发表时间限定为2013年1月至2023年1月, 仅纳人观察性研究设计。使用澳大利亚乔安娜布里格斯研究所(Joanna BriggsInstitute, JBI)循证卫生保健研究中心关键评估工具评估研究质量。使用JBI SUMARI软件进行meta分析。该综述:方案已在PROSPERO注册(CRD42023420514)。结果共检索出308条文献,其中17项研究被纳人分析,共包括4 668名60岁及以上的老年人,男性1380名(29.6%),女性3 288名(70.4%)。泰国老年人肌少症的总体忠病率为20.7%(95%CI 14.4%~27.8%)。 基于研究场所的肌少症忠病率亚组分析显示,住院忠者为33.4%(95%CI 28.7%~38.3%), 门诊患者为23.2%(95%CI 12.5%-35.9%), 社区老年人为17.3%(95%CI 9.4%~26.8%)。高龄(0R 4.60 ,95% CI 3.07-6.91).男性(OR 2.30 ,95% CI 1.37-3.85). 低体重指数(OR 8.95 ,95%CI 6.05~ 13.25)和营养不良(OR 2.78,95% CI 2.09-3.70)是泰国老年人肌少症的关联因素。结论这项系统评价分析了文献中泰国老年人肌少症的总体忠病率和关联因素,对该国老年人肌少症的预防和管理具有重要参考意义。

Impact of Atrial Septal Defect Closure on Mortality in Older Patients

Background:Atrial septal defect(ASD)is a common form of adult congenital heart disease that can lead to long-term adverse outcomes if left untreated.Early closure of ASD has been associated with excellent outcomes and lower complication rates.However,there is limited evidence regarding the prognosis of ASD closure in older adults.This study aims to evaluate the mortality rates in older ASD patients with and without closure.Methods:A retrospective cohort study was conducted on patients aged 40 years or older with ASD between 2001 and 2017.Patients were followed up to assess all-cause mortality.Univariable and multivariable analyses were performed to identify the predictors of mortality.A p-value of<0.05 was considered statistically significant.Results:The cohort consisted of 450 patients(mean age 56.6±10.4 years,77.3%female),with 66%aged between 40 and 60 years,and 34%over 60 years.Within the cohort,299 underwent ASD closure(201 with transcatheter and 98 with surgical closure).During the median follow-up duration of 7.9 years,51 patients died.The unadjusted cumulative 10-year rate of mortality was 3%in patients with ASD closure,and 28%in patients without ASD closure(log-rank p<0.001).Multivariable analysis revealed that age(hazard ratio[HR]1.04,95%confidence interval[CI]1.006–1.06,p=0.01),NYHA class(HR 2.75,95%CI 1.63–4.62,p<0.001),blood urea nitrogen(BUN)(HR 1.07,95%CI 1.03–1.12,p<0.001),right ventricular systolic pressure(RVSP)(HR 1.07,95%CI 1.003–1.04,p=0.01),and lack of ASD closure(HR 15.12,95%CI 5.63–40.59,p<0.001)were independently associated with mortality.Conclusion:ASD closure demonstrated favorable outcomes in older patients.Age,NYHA class,BUN,RVSP,and lack of ASD closure were identified as independent factors linked to mortality in this population.

Seeing beneath the surface:Harnessing point-of-care ultrasound for internal jugular vein evaluation

Point-of-care ultrasound(POCUS)of the internal jugular vein(IJV)offers a noninvasive means of estimating right atrial pressure(RAP),especially in cases where the inferior vena cava is inaccessible or unreliable due to conditions such as liver disease or abdominal surgery.While many clinicians are familiar with visually assessing jugular venous pressure through the internal jugular vein,this method lacks sensitivity.The utilization of POCUS significantly enhances the visualization of the vein,leading to a more accurate identification.It has been demonstrated that combining IJV POCUS with physical examination enhances the specificity of RAP estimation.This review aims to provide a comprehensive summary of the various sonographic techniques available for estimating RAP from the internal jugular vein,drawing upon existing data.

Quantitative hepatitis B core antibody and quantitative hepatitis B surface antigen:Novel viral biomarkers for chronic hepatitis B management

The management of hepatitis B virus(HBV)infection now involves regular and appropriate monitoring of viral activity,disease progression,and treatment response.Traditional HBV infection biomarkers are limited in their ability to predict clinical outcomes or therapeutic effectiveness.Quantitation of HBV core antibodies(qAnti-HBc)is a novel non-invasive biomarker that may help with a variety of diagnostic issues.It was shown to correlate strongly with infection stages,hepatic inflammation and fibrosis,chronic infection exacerbations,and the presence of occult infection.Furthermore,qAnti-HBc levels were shown to be predictive of spontaneous or treatment-induced HBeAg and HBsAg seroclearance,relapse after medication termination,re-infection following liver transplantation,and viral reactivation in the presence of immunosuppression.qAnti-HBc,on the other hand,cannot be relied on as a single diagnostic test to address all problems,and its diagnostic and prognostic potential may be greatly increased when paired with qHBsAg.Commercial qAnti-HBc diagnostic kits are currently not widely available.Because many methodologies are only semi-quantitative,comparing data from various studies and defining universal cut-off values remains difficult.This review focuses on the clinical utility of qAnti-HBc and qHBsAg in chronic hepatitis B management.

Genomic medicine and cancer clinical trial in Thailand

Introduction Cancer treatment has been revolutionized with the advent of targeted therapy and immunotherapy.In the past,when cancer treatment modalities were restricted,conventional chemotherapy was the only option for systemic disease.Because chemotherapy empirically affects all dividing cells,the targets are virtually non-specific.In this regard,toxic effects on normal tissue are essentially inevitable.

Associations of PNPLA3 and LEP genetic polymorphisms with metabolic-associated fatty liver disease in Thai people living with human immunodeficiency virus

BACKGROUND The prevalence of metabolic-associated fatty liver disease(MAFLD)is a growing public health issue in people living with human immunodeficiency virus(PLWH).However,the pathophysiology of MAFLD is still unknown,and the role of genetic variables is only now becoming evident.AIM To evaluate the associations of gene-polymorphism-related MAFLD in PLWH.METHODS The study employed transient elastography with a controlled attenuation parameter≥248 dB/m to identify MAFLD in patients from a Super Tertiary Hospital in central Thailand.Candidate single-nucleotide polymorphisms(SNPs)were genotyped using TaqMan®MGB probe 5'nuclease assays for seven MAFLD-related genes.Statistical analyses included SNP frequency analysis,Fisher's Exact and Chi-square tests,odds ratio calculations,and multivariable logistic regression.RESULTS The G-allele carriers of PNPLA3(rs738409)exhibited a two-fold rise in MAFLD,increasing by 2.5 times in MAFLD with human immunodeficiency virus infection.The clinical features and genetic patterns imply that LEP rs7799039 A-allele carriers had a nine times(P=0.001)more significant chance of developing aberrant triglyceride among PLWH.CONCLUSION The current study shows an association between PNPLA3 rs738409 and LEP rs7799039 with MAFLD in PLWH.

Betalains protect various body organs through antioxidant and anti-inflammatory pathways

Betalains are natural coloring pigments with betalamic acid as the core structure of all subclasses.Besides their coloring properties,betalains exhibit various biological activities,including antioxidant and anti-inflammatory properties,which are highly imperative.Further in-vivo studies reported that betalains protect various body organs,leading to health enhancement.Body organs,including the heart,liver,kidney,lung,etc.,are important for a healthy life.However,these organs can be affected or damaged by various stress factors,toxicants,and harmful substances.Recent studies have claimed that betalains could protect all vital organs of the body through antioxidant and anti-inflammatory mechanisms.This review article described the in-vivo antioxidant and anti-inflammatory activities of betalains in various cell-line or animal models.A comprehensive discussion has been provided on the mechanism of action of betalains in protecting various body organs,including cardio-protective effect,hepato-protective ability,renal protection capacity,repro-protective ability,neuro-protective effect,lung protection,and gut protection ability.Finally,future research directions and conclusions have been outlined.

Surgical strategies for challenging common bile duct stones in the endoscopic era: A comprehensive review of current evidence

While endoscopic retrograde cholangiopancreatography(ERCP)remains the primary treatment modality for common bile duct stones(CBDS)or choledocho-lithiasis due to advancements in instruments,surgical intervention,known as common bile duct exploration(CBDE),is still necessary in cases of difficult CBDS,failed endoscopic treatment,or altered anatomy.Recent evidence also supports CBDE in patients requesting single-step cholecystectomy and bile duct stone removal with comparable outcomes.This review elucidates relevant clinical anatomy,selection indications,and outcomes to enhance surgical understanding.The selection between trans-cystic(TC)vs trans-choledochal(TD)approaches is described,along with stone removal techniques and ductal closure.Detailed surgical techniques and strategies for both the TC and TD approaches,including instrument selection,is also provided.Additionally,this review comprehensively addresses operation-specific complications such as bile leakage,stricture,and entrapment,and focuses on preventive measures and treatment strategies.This review aims to optimize the management of CBDS through laparoscopic CBDE,with the goal of improving patient outcomes and minimizing risks.

Associated Factors with Prolonged Stay in Pediatric Observation Ward of Urban University Hospital in Thailand

Background: Pediatric observation ward (OW) is the area where the patient can be monitored or have early investigation/management and observe part of emergency department (ED);patients are admitted to this area with an expectation of discharge within 24 hours. Observation ward was beneficial in preventing avoidable hospitalizations, due to the high volume of patients in ED, OW increasing demands, overcrowding, and prolonged stay. Objective: This study aimed to examine the characteristics and factors associated with prolonged length of stay (LOS) more than 24 hours in the pediatric observation ward. General demographic data were recorded including age, sex, LOS, diagnosis and disposition. Results: This is a retrospective study of children 15 years old or younger who admit to Pediatric OW at urban university hospital and prolonged stay more than 24 hours during January 2014 to June 2015. There were 670 patients admitted at OW during the study period (median age of 5 years;53% were male). Mean length of stay in OW was 61 hours. The most common top 5 diagnoses were respiratory problem (32%), gastrointestinal problem (29%), infectious disease (11%), neurological (7%), and dental problem (6%). The majority of patients were discharge home 602/670 cases (90%), and 10% (68/670 cases) were admitted to inpatient ward. There were 552 patients (82%) who had prolonged OW more than 24 hours. Compared with the factors in both group, we found that the associated factor for prolonged OW stay was the age of patient, which seems to be younger in the prolonged stay group (median age of 4 years 3 months vs 3 years 5 months, p = 0.04). Younger children had significant factors for prolonged stay in OW (p < 0.001) compared to all age categorized less than 1 year, 1 - 5 years, 5 - 10 years, 10 - 15 years and more than 15 years respectively. Conclusion: This was the study for report of pediatric observation ward utilization. The younger patient was the associated factor for prolonged stay in OW. Understanding this related issue will be the starting points for assessing patients carefully before admitting to OW for improving efficiency and quality of care in pediatric OW.

Systemic treatment for metastatic colorectal cancer

Significant progress has been achieved in the treatment of metastatic colorectal cancer(mCRC)patients during the last 20 years.There are currently numerous treatments available for the first-line treatment of mCRC.Sophisticated molecular technologies have been developed to reveal novel prognostic and predictive biomarkers for CRC.The development of next-generation sequencing and wholeexome sequencing,which are strong new tools for the discovery of predictive molecular biomarkers to facilitate the delivery of customized treatment,has resulted in tremendous breakthroughs in DNA sequencing technology in recent years.The appropriate adjuvant treatments for mCRC patients are determined by the tumor stage,presence of high-risk pathologic characteristics,microsatellite instability status,patient age,and performance status.Chemotherapy,targeted therapy,and immunotherapy are the main systemic treatments for patients with mCRC.Despite the fact that these novel treatment choices have increased overall survival for mCRC,survival remains optimal for individuals with non-metastatic disease.The molecular technologies currently being used to support our ability to practice personalized medicine;the practical aspects of applying molecular biomarkers to regular clinical practice;and the evolution of chemotherapy,targeted therapy,and immunotherapy strategies for the treatment of mCRC in the front-line setting are all reviewed here.

Systemic treatment for advanced pancreatic cancer

Pancreatic cancer is a deadly disease with an extremely poor 5-year survival rate due to treatment resistance and late-stage detection.Despite numerous years of research and pharmaceutical development,these figures have not changed.Treatment options for advanced pancreatic cancer are still limited.This illness is typically detected at a late stage,making curative surgical resection impossible.Chemotherapy is the most commonly utilized technique for treating advanced pancreatic cancer but has poor efficacy.Targeted therapy and immunotherapy have made significant progress in many other cancer types and have been proven to have extremely promising possibilities;these therapies also hold promise for pancreatic cancer.There is an urgent need for research into targeted treatment,immunotherapy,and cancer vaccines.In this review,we emphasize the founda-tional findings that have fueled the therapeutic strategy for advanced pancreatic cancer.We also address current advancements in targeted therapy,immuno-therapy,and cancer vaccines,all of which continue to improve the clinical outcome of advanced pancreatic cancer.We believe that clinical translation of these novel treatments will improve the low survival rate of this deadly disease.

Tuberculosis of the spine

Pott’s spine,commonly known as spinal tuberculosis(TB),is an extrapulmonary form of TB caused by Mycobacterium TB.Pott’s paraplegia occurs when the spine is involved.Spinal TB is usually caused by the hematogenous spread of infection from a central focus,which can be in the lungs or another location.Spinal TB is distinguished by intervertebral disc involvement caused by the same segmental arterial supply,which can result in severe morbidity even after years of approved therapy.Neurological impairments and spine deformities are caused by progressive damage to the anterior vertebral body.The clinical,radiographic,microbiological,and histological data are used to make the diagnosis of spinal TB.In Pott’s spine,combination multidrug antitubercular therapy is the basis of treatment.The recent appearance of multidrug-resistant/extremely drug-resistant TB and the growth of human immunodeficiency virus infection have presented significant challenges in the battle against TB infection.Patients who come with significant kyphosis or neurological impairments are the only ones who require surgical care.Debride-ment,fusion stabilization,and correction of spinal deformity are the cornerstones of surgical treatment.Clinical results for the treatment of spinal TB are generally quite good with adequate and prompt care.

Age-appropriateness of decision for brain CT scan in elderly patients with mild traumatic brain injury

Traumatic brain injury(TBI)is a prevalent issue among patients presenting in emergency departments(EDs),with mild TBI being the most common form.[1,2]Mild TBI is characterized by symptoms such as loss of consciousness,amnesia,disorientation,or a Glasgow Coma Scale(GCS)score of 13–15.[3]Although most patients with mild TBI can be safely discharged,Yuksen et al[4]reported that about 14.12%of all mild TBI patients were found to be positive for intracranial hemorrhage on a head CT scan.Computed tomography(CT)scans are widely used as a diagnostic tool for TBI,as they provide a quick and reliable diagnosis.[5]

Is fascial closure required for a 12-mm trocar?A comparative study on trocar site hernia with long-term follow up

BACKGROUND Despite the infrequency of trocar site hernias(TSHs),fascial closure continues to be recommended for their prevention when using a≥10-mm trocar.AIM To identify the necessity of fascial closure for a 12-mm nonbladed trocar incision in minimally invasive colorectal surgeries.METHODS Between July 2010 and December 2018,all patients who underwent minimally invasive colorectal surgery at the Minimally Invasive Surgery Unit of Siriraj Hospital were retrospectively reviewed.All patients underwent cross-sectional imaging for TSH assessment.Clinicopathological characteristics were recorded.Incidence rates of TSH and postoperative results were analyzed.RESULTS Of the 254 patients included,70(111 ports)were in the fascial closure(closed)group and 184(279 ports)were in the nonfascial closure(open)group.The median follow up duration was 43 mo.During follow up,three patients in the open group developed TSHs,whereas none in the closed group developed the condition(1.1%vs 0%,P=0.561).All TSHs occurred in the right lower abdomen.Patients whose drains were placed through the same incision had higher rates of TSHs compared with those without the drain.The open group had a significantly shorter operative time and lower blood loss than the closed group.CONCLUSION Routine performance of fascial closure when using a 12-mm nonbladed trocar may not be needed.However,further prospective studies with cross-sectional imaging follow-up and larger sample size are needed to confirm this finding.

An Efficient ResNetSE Architecture for Smoking Activity Recognition from Smartwatch

Smoking is a major cause of cancer,heart disease and other afflictions that lead to early mortality.An effective smoking classification mechanism that provides insights into individual smoking habits would assist in implementing addiction treatment initiatives.Smoking activities often accompany other activities such as drinking or eating.Consequently,smoking activity recognition can be a challenging topic in human activity recognition(HAR).A deep learning framework for smoking activity recognition(SAR)employing smartwatch sensors was proposed together with a deep residual network combined with squeeze-and-excitation modules(ResNetSE)to increase the effectiveness of the SAR framework.The proposed model was tested against basic convolutional neural networks(CNNs)and recurrent neural networks(LSTM,BiLSTM,GRU and BiGRU)to recognize smoking and other similar activities such as drinking,eating and walking using the UT-Smoke dataset.Three different scenarios were investigated for their recognition performances using standard HAR metrics(accuracy,F1-score and the area under the ROC curve).Our proposed ResNetSE outperformed the other basic deep learning networks,with maximum accuracy of 98.63%.

Immunotherapy for advanced gastric cancer

Gastric cancer(GC)is believed to be the fifth most common cancer and the third most common cause of death worldwide.Treatment techniques include radiation,chemotherapy,gastrectomy,and targeted treatments are often employed.Some hopeful results from the development of GC immunotherapy have already changed treatment approaches.Along with previous combination medicines,new immunotherapies have been developed that target distinct molecules.Despite ongoing studies into the current therapeutic options and significant improvements in this field,the prognosis for the ailment is poor.Since there are few treatment options and a delay in detection,the illness actually advances,spreads,and metastasizes.The bulk of immunotherapies in use today rely on cytotoxic immune cells,monoclonal antibodies,and gene-transferred vaccines.Immune checkpoint inhibitors have become more popular.In this review,we sought to examine the viewpoint and development of several immunotherapy treatment modalities for advanced GC,as well as the clinical results thus far reported.Additionally,we outlined tumor immune escape and tumor immunosurveillance.

泰国青少年哮喘患者自我管理行为、症状控制及健康相关生活质量的调查研究

目的探讨泰国青少年哮喘患者自我管理行为、症状控制、健康相关生活质量及其影响因素之间的因果关系。方法采用横断面研究设计,应用便利抽样法,共纳人泰国曼谷3所三级医院的240例青少年哮喘患者及其照顾者。2020年11月至2021年7月,通过访谈和系列调查问卷评估青少年哮喘患者健康相关生活质量、哮喘症状控制、哮喘自我管理行为、健康素养、抑郁状况、合并症、家庭支持、同伴支持、家庭环境管理以及与医疗保健提供者的关系。基于修订后的自我和家庭管理理论框架构建模型,使用描述性统计和路径分析对数据进行分析。结果所提出的模型与实证数据基本吻合,可以反映健康相关生活质量变异的67.2%。抑郁状况和哮喘症状控制直接影响青少年哮喘患者的生活质量(分别为β=-0.132,β=0.740,均P<0.05),而哮喘自我管理行为未显示有影响。抑郁和哮喘自我管理行为通过哮喘症状控制对生活质量产生间接影响(分别为β=-0.382,β=0.225,均P<0.05)。健康素养(β=0.343)、家庭支持(β=0.167)、同伴支持(β=1.163)以及与医疗保健提供者的关系(β=0.181)显示对哮喘自我管理行为有直接影响(均P<0.05)。结论研究结果证实了泰国青少年哮喘患者的症状控制、自我管理行为、抑郁和健康相关生活质量之间的因果关系。研究发现,青少年健康素养、来自家人和同伴的支持以及与医疗保健提供者的关系也会影响哮喘自我管理行为。为达到有效控制哮喘和提高生活质量的目标,应该制订促进泰国青少年哮喘自我管理的综合干预措施,还应尽早发现抑郁症状并进行有效干预。

脑卒中患者及家庭干预方案的整群随机对照试验研究

目的研究针对脑卒中患者及其家属的家庭干预方案的有效性。方法采用整群随机对照试验设计。2021年10月至2022年6月在泰国中部猜纳省抽取6个地区,分为实验组(3个地区)和对照组(3个地区),各招募了31个家庭,即31例新发脑卒中患者及家属(家庭照顾者和家庭成员)。以纽曼系统模型为框架,构建包含压力评估和基于家庭干预措施的脑卒中患者家庭干预方案。实验组实施脑卒中患者家庭干预方案,对照组接受常规护理。在基线、4周和12周后,分别对脑卒中后患者的功能状态、抑郁和并发症,家庭照顾者的护理负担和压力,以及家庭照顾者和家庭成员的家庭功能进行了评估。统计方法采用描述性统计、χ^(2)检验和重复测量方差分析等。结果实施家庭干预方案12周后,与对照组相比,脑卒中患者的功能状态改善,抑郁症状减轻,照顾者负担和压力减轻,家庭功能改善,差异均有统计学意义(P<0.05)。实验组有3例患者出现并发症,对照组有7例出现并发症。结论基于纽曼系统模型构建的脑卒中患者家庭干预方案对于改善泰国社区脑卒中患者状况、减轻家庭照顾者负担及改善其家庭功能有重要作用。可考虑延长该干预方案的持续时间,并评估其持续效果。

新型冠状病毒疫情期间泰国东北部社区卫生护士在老年人护理中的作用

目的社区卫生护士在初级卫生保健服务中发挥着重要作用,特别是在新型冠状病毒疫情期间。本研究旨在描述新型冠状病毒疫情期间泰国东北部社区卫生护士在老年人护理中的工作和作用。方法采用质性研究方法,通过用观察、深入访谈、二次数据和焦点小组讨论等方法,从46名关键信息提供者处获取资料。2022年2-8月在泰国东北部收集资料,使用内容分析法对资料进行分析。结果本研究结果包括3个主题:1)社区卫生护士在新型冠状病毒疫情期间对老年人的照护作用,包括12个子主题;2)大流行期间社区卫生护士在照顾老年人方面的障碍,包括两个子主题;3)社区卫生护士在疫情期间成功进行老年人健康管理的影响因素,包括4个子主题。结论在新型冠状病毒疫情期间,社区卫生护士发挥了重要作用,如教育和倡导者、提供护理、促进和增强社区人群的健康意识,以及为老年人提供情感和营养支持。这项研究可为政策制定者和卫生相关机构制定卫生保健战略和优化社区卫生护士老年人健康管理提供参考。探讨社区卫生护士的作用有助于发展和改善初级卫生保健工作,加强社区卫生保健服务,并让社区中每个人都做好准备,迎接未来全球大流行可能带来的挑战。