Traditional Chinese medicine (TCM) emphasizes treatment based on syndrome differentiation, which is the core technology that can embody the characteristics and advantages of TCM diagnosis and treatment. This is based on holistic view to illustrate individual diagnosis and treatment and dynamic treatment. However, RCT, which is frequently used in TCM clinical studies, can not reflect the concept of treatment based on syndrome differentiation. The use of adaptive treatment strategies in clinical researches can adjust therapy in patients according to the changes of diseases, so it can reflect individual diagnosis and treatment and dynamic treatment. From this perspective, the process of treatment based on syndrome differentiation is a process of decision-making of adaptive treatment. So the method for developing adaptive treatment strategies can effectively evaluate the efficacy of different treatment strategies in TCM clinical studies. Adaptive treatment strategies have been used in some clinical studies from some published foreign literatures. However, the use of adaptive treatment strategies in domestic clinical researches is seldom reported. This article discussed the concept of adaptive treatment strategies and their important components in detail. In addition, it presented three methods which can take the delayed effects of the current treatment action into consideration and can compare the overall effect of different adaptive treatment strategies, with a purpose to lay some foundation for future TCM researches in the development of optimal clinical pathway and provide new ideas and methods for researches.

Traditional Chinese medicine (TCM) emphasizes treatment based on syndrome differentiation, which em-bodies the concept of individualized diagnosis and dynamic treatment on a holistic view. RCT was frequently used in TCM clinical study. However, it cannot reflect the concept of treatment based on syndrome differentiation. The use of adaptive treatment strategies (ATS) in clinical research can adjust therapy in patients according to the change of disease, so it can reflect personalized medicine and dynamic treatment. From this perspective, the process of treat-ment based on syndrome differentiation was a process of adaptive treatment decision. So the method for developing ATS can effectively evaluate the efficacy of different treatment strategies in TCM clinical study. ATS had been used in some clinical studies from published literatures abroad. However, the use of ATS in domestic clinical research was seldom been reported. This paper gave an outline of the concept of ATS. In addition, this paper focused on three methods which can take the delayed effects of current treatment action into consideration and can compare the over-all effect of different ATS. It was hoped to lay foundation for future scientific research of TCM in the implementation of SMART and provide a new idea.

Objective To explore the influence of the dual tutorial teaching mode on the undergraduate
nursing students′ critical thinking in the clinical training. Methods Two hundred and sixteen full-time undergraduate nursing students who did internships in the second Affiliated Hospital of Wenzhou Medical University from September 1st, 2013 to September 1st, 2015 were divided into the experimental group ( n=111) and the control group ( n=105) using the random number table. The nursing students in the control group received the traditional post tutor teaching mode, while the nursing students in the experimental group received the dual tutorial system teaching mode in the clinical teaching. After the internship, nursing students in the two groups completed the general information questionnaire and the critical thinking disposition inventory.Results The scores of critical thinking ability, open-minded ability, analytical ability, systematic ability, critical thinking self-confidence, curiosity, cognitive maturity dimension of the nursing students in the experimental group were (280.32±29.83), (40.53±5.75), (43.08±5.32), (37.69±6.08), (40.16±5.60), (43.89±6.71), (38.53± 7.17) respectively, which were significantly higher than the scores gained by the nursing students in the control group (t=-7.587, -6.138, -8.555, -3.530, -6.727, -8.023, -3.097;P<0.05).In the control group, they were (210.63±25.25), (29.86±6.31), (26.61±5.71), (32.19±6.17), (28.76±5.82), (25.96±6.53), (32.99±7.41), respectively.Conclusions The dual tutorial teaching mode improves undergraduate nursing trainees′critical thinking ability including open-minded ability, analytical ability, systematic ability, critical thinking self-confidence, curiosity, cognitive maturity, which can be applied in the clinical teaching of nursing students.

Objective To explore the current status and influencing factors of subjective well-being (SWB) in student nurses so as to provide a basis for formulating corresponding countermeasures.Methods A total of 652 student nurses at a classⅢ grade A hospital in Wenzhou City were selected as subjects by chester sampling from January 2015 to January 2017. They were investigated with the general condition questionnaire and the Chinese version of the Warwick-Edinburgh mental well-being scale (WEMWBS) . Results The total score of WEMWBS was (51.29±9.34) with a middle level in student nurses. Belief, self-report character, sexes, annual household income, body mass index had influences on SWB of student nurses (P<0.01).Conclusions The level of SWB of student nurses needs to be improved. Nurse educators and managers should pay high attention to mental health of student nurses and take positive measures to improve the SWB of student nurses so as to stabilize the construction of nursing team.

Objective To explore the influence of double tutor teaching model on nursing students'ideological quality and comprehensive ability cultivation in nursing clinical teaching. Methods From July 14th,2015 to April 24th,2016,a total of 136 full-time undergraduate nursing students in the Second Affiliated Hospital of Wenzhou Medical University were randomly divided into experimental group (n=68) and control group (n=68) according to random number table method. Post tutor teaching mode was applied as clinical teaching method in the control group,while double tutor teaching mode was administered in the experimental group. Theory,nursing intervention had been tested in each ward during internship for both two groups as well as a unified practice examination form for comprehensive evaluation. Results Theoretical score,operation score,comprehensive evaluation,general scores of the experimental group students were higher than those of the control group (t=27.52,14.82,13.89,14.95;P<0.01). Conclusions Application of double tutorial system teaching mode in clinical nursing practice is conductive to improve theoretical knowledge,operation skills,strengthen the ideological quality of nursing students as well as to elevate their ability of observation,learning,adaptation and communication.