Objective:To evaluate the effectiveness of entrustable professional activities (EPAs) in the general practice internship of undergraduate clinical medicine students, identify issues that need improvement in the internship, and enhance medical students' competence.Methods:A total of 75 students in the five-year (English class) clinical medicine program enrolled in 2018 and 2019 who participated in general practice internship in Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from October 2021 to October 2023 were selected as study subjects. The design of core EPAs was adopted to assess the correlation among different EPA dimensions and to analyze the qualified rates.Results:The evaluation of EPAs showed that EPA2 (practicing respect, understanding and teamwork) had the highest mean score of 9.33, and EPA10 (chronic disease management and management of key populations) had the lowest mean score of 8.08. A supervision level of 3a and above was used as the criterion for qualification. The supervision levels of the students' EPAs were mostly concentrated at levels 3a and 3b. The highest qualified rate was for EPA2 (practicing respect, understanding and teamwork) at 85.33%, followed by EPA1 (complying with the rules of the profession and demonstrating professionalism) at 80.00% and EPA8 (reviewing information and solving clinical problems) at 72.00%. The lowest qualified rate was for EPA10 (chronic disease management and management of key populations) at 33.33%, followed by EPA4 (analyzing and interpreting test results) at 57.33%.Conclusions:EPAs concretize competency evaluation, which can effectively reflect the "competency-oriented" training objectives encompassing multiple elements such as knowledge, skills, values, and attitudes, while maintaining professional specificity. Undergraduates demonstrated strengths in professionalism and academics, but showed deficiencies in community chronic disease management and management of key populations. These findings suggest the need to strengthen the training in health and social care to better align with the competencies required during standardized residency training.

Objective:To investigation the situation of water improvement projects in villages affected by drinking water-type endemic fluorosis in Qinghai Province and the prevalence of dental fluorosis among children, in order to provide a basis for consolidating the achievements in prevention and control of drinking water-type endemic fluorosis and adjusting prevention and control measures.Methods:The monitoring data on drinking water-type endemic fluorosis were collected from the disease prevention and control centers in various counties of Qinghai Province from 2021 to 2023, the situation of water improvement projects, the fluorine content of domestic drinking water and the prevalence of dental fluorosis in children aged 8 to 12 years old were retrospectively analyzed.Results:From 2021 to 2023, the numbers of villages affected by drinking water-type endemic fluorosis in Qinghai Province were 338, 335, and 328, respectively. The numbers of water improvement projects were 125, 127 and 124, respectively. The normal operation rates were 100%, 100% and 99.19% (123/124), respectively. The qualified rates of water fluoride level were 100%, 99.21% (126/127) and 99.19% (123/124), respectively. The detection rates of dental fluorosis among children aged 8 to 12 were 4.34% (515/11 877), 5.70% (646/11 331) and 4.48% (490/10 943), respectively. There was a statistically significant difference in the detection rate of dental fluorosis among children in different years (χ 2 = 22.79, P < 0.001). Conclusions:The overall operation status of water improvement project in villages affected by drinking water-type endemic fluorosis in Qinghai Province is generally good, but there has been some relaxation in management and maintenance in the later stage, and there is a phenomenon of project intermittency. The detection rate of dental fluorosis among children aged 8 to 12 remains low, and endemic fluorosis caused by drinking water is under continuous control.

Objective:To investigation the situation of water improvement projects in villages affected by drinking water-type endemic fluorosis in Qinghai Province and the prevalence of dental fluorosis among children, in order to provide a basis for consolidating the achievements in prevention and control of drinking water-type endemic fluorosis and adjusting prevention and control measures.Methods:The monitoring data on drinking water-type endemic fluorosis were collected from the disease prevention and control centers in various counties of Qinghai Province from 2021 to 2023, the situation of water improvement projects, the fluorine content of domestic drinking water and the prevalence of dental fluorosis in children aged 8 to 12 years old were retrospectively analyzed.Results:From 2021 to 2023, the numbers of villages affected by drinking water-type endemic fluorosis in Qinghai Province were 338, 335, and 328, respectively. The numbers of water improvement projects were 125, 127 and 124, respectively. The normal operation rates were 100%, 100% and 99.19% (123/124), respectively. The qualified rates of water fluoride level were 100%, 99.21% (126/127) and 99.19% (123/124), respectively. The detection rates of dental fluorosis among children aged 8 to 12 were 4.34% (515/11 877), 5.70% (646/11 331) and 4.48% (490/10 943), respectively. There was a statistically significant difference in the detection rate of dental fluorosis among children in different years (χ 2 = 22.79, P < 0.001). Conclusions:The overall operation status of water improvement project in villages affected by drinking water-type endemic fluorosis in Qinghai Province is generally good, but there has been some relaxation in management and maintenance in the later stage, and there is a phenomenon of project intermittency. The detection rate of dental fluorosis among children aged 8 to 12 remains low, and endemic fluorosis caused by drinking water is under continuous control.

Objective:To evaluate the effectiveness of entrustable professional activities (EPAs) in the general practice internship of undergraduate clinical medicine students, identify issues that need improvement in the internship, and enhance medical students' competence.Methods:A total of 75 students in the five-year (English class) clinical medicine program enrolled in 2018 and 2019 who participated in general practice internship in Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from October 2021 to October 2023 were selected as study subjects. The design of core EPAs was adopted to assess the correlation among different EPA dimensions and to analyze the qualified rates.Results:The evaluation of EPAs showed that EPA2 (practicing respect, understanding and teamwork) had the highest mean score of 9.33, and EPA10 (chronic disease management and management of key populations) had the lowest mean score of 8.08. A supervision level of 3a and above was used as the criterion for qualification. The supervision levels of the students' EPAs were mostly concentrated at levels 3a and 3b. The highest qualified rate was for EPA2 (practicing respect, understanding and teamwork) at 85.33%, followed by EPA1 (complying with the rules of the profession and demonstrating professionalism) at 80.00% and EPA8 (reviewing information and solving clinical problems) at 72.00%. The lowest qualified rate was for EPA10 (chronic disease management and management of key populations) at 33.33%, followed by EPA4 (analyzing and interpreting test results) at 57.33%.Conclusions:EPAs concretize competency evaluation, which can effectively reflect the "competency-oriented" training objectives encompassing multiple elements such as knowledge, skills, values, and attitudes, while maintaining professional specificity. Undergraduates demonstrated strengths in professionalism and academics, but showed deficiencies in community chronic disease management and management of key populations. These findings suggest the need to strengthen the training in health and social care to better align with the competencies required during standardized residency training.

Objective:To construct an integrated early rehabilitation program for healthcare and rehabilitation system based on the information-motivation-behavioral skills (IMB) model and evaluate its application effect in patients treated with total hip arthroplasty (THA).Methods:Construction of the rehabilitation program: An integrated research team was established, composed of head burse of orthopedics, orthopedic nursing specialists, orthopedic surgeons, anesthesiologists, and rehabilitation therapists. Considering the key points of perioperative early rehabilitation of THA patients, an integrated early rehabilitation program was constructed based on the IMB model through literature review and expert panel method. Clinical application of the rehabilitation program: A retrospective cohort study was conducted to analyze the clinical data of 100 THA patients admitted to Qingdao Municipal Hospital from March to December 2023, including 47 males and 53 females, aged 60-85 years [(69.8±5.5)years]. Patients were divided into two groups according to their admission time: 50 patients admitted from March to July 2023, receiving routine care (routine care group) and 50 admitted from August to December 2023, receiving intervention through an early rehabilitation program of an integrated healthcare and rehabilitation system based on routine care (integrated care group). The first postoperative ambulation time and length of hospital stay were compared between the two groups. The Harris hip function score was used to assess hip function in both groups at 3 days, 1, 3, and 6 months postoperatively; the Barthel index was used to assess the daily living self-care capacity in both groups preoperatively, at 1, 3, and 6 months postoperatively. The incidence of complications within 6 months after surgery was compared between the two groups.Results:An early integrated rehabilitation program based on the IMB model comprised 25 specific measures of three domains: information support, motivational intervention, and behavioral skills. All the patients were followed up for 6 months. The first postoperative ambulation time and length of hospital stay in the integrated care group were (1.3±0.5)days and (7.4±2.3)days, shorter than (1.5±0.5)days and (8.5±2.3)days in the routine care group ( P<0.05). There were no statistically significant differences in the Harris hip function scores at 3 days postoperatively or preoperative Barthel index between the two groups ( P>0.05). At 1, 3, and 6 months postoperatively, the Harris hip function scores in the integrated care group were (80.3±6.0)points, (88.6±5.2)points, and (92.5±4.1)points, respectively, higher than (75.1±6.3)points, (84.2±5.7)points, and (88.0±5.2)points in the routine care group ( P<0.01); the Barthel index in the integrated care group were (79.2±8.7)points, (87.7±5.7)points, and (92.3±4.9)points, respectively, higher than (72.1±9.0)points, (83.5±6.6)points, and (88.6±5.0)points in the routine care group ( P<0.01). At 6 months postoperatively, the incidence of complications in the integrated care group was 4% (2/50), lower than 16% (8/50) in the routine care group ( P<0.05). Conclusion:Compared with the routine care, an integrated early rehabilitation program for medical care and health based on the information-motivation-behavioral skills model for THA patients can shorten the first postoperative ambulation time and length of hospital stay, restore hip joint function, improve daily living self-care capacity and reduce the incidence of complications.

Objective:To construct an integrated early rehabilitation program for healthcare and rehabilitation system based on the information-motivation-behavioral skills (IMB) model and evaluate its application effect in patients treated with total hip arthroplasty (THA).Methods:Construction of the rehabilitation program: An integrated research team was established, composed of head burse of orthopedics, orthopedic nursing specialists, orthopedic surgeons, anesthesiologists, and rehabilitation therapists. Considering the key points of perioperative early rehabilitation of THA patients, an integrated early rehabilitation program was constructed based on the IMB model through literature review and expert panel method. Clinical application of the rehabilitation program: A retrospective cohort study was conducted to analyze the clinical data of 100 THA patients admitted to Qingdao Municipal Hospital from March to December 2023, including 47 males and 53 females, aged 60-85 years [(69.8±5.5)years]. Patients were divided into two groups according to their admission time: 50 patients admitted from March to July 2023, receiving routine care (routine care group) and 50 admitted from August to December 2023, receiving intervention through an early rehabilitation program of an integrated healthcare and rehabilitation system based on routine care (integrated care group). The first postoperative ambulation time and length of hospital stay were compared between the two groups. The Harris hip function score was used to assess hip function in both groups at 3 days, 1, 3, and 6 months postoperatively; the Barthel index was used to assess the daily living self-care capacity in both groups preoperatively, at 1, 3, and 6 months postoperatively. The incidence of complications within 6 months after surgery was compared between the two groups.Results:An early integrated rehabilitation program based on the IMB model comprised 25 specific measures of three domains: information support, motivational intervention, and behavioral skills. All the patients were followed up for 6 months. The first postoperative ambulation time and length of hospital stay in the integrated care group were (1.3±0.5)days and (7.4±2.3)days, shorter than (1.5±0.5)days and (8.5±2.3)days in the routine care group ( P<0.05). There were no statistically significant differences in the Harris hip function scores at 3 days postoperatively or preoperative Barthel index between the two groups ( P>0.05). At 1, 3, and 6 months postoperatively, the Harris hip function scores in the integrated care group were (80.3±6.0)points, (88.6±5.2)points, and (92.5±4.1)points, respectively, higher than (75.1±6.3)points, (84.2±5.7)points, and (88.0±5.2)points in the routine care group ( P<0.01); the Barthel index in the integrated care group were (79.2±8.7)points, (87.7±5.7)points, and (92.3±4.9)points, respectively, higher than (72.1±9.0)points, (83.5±6.6)points, and (88.6±5.0)points in the routine care group ( P<0.01). At 6 months postoperatively, the incidence of complications in the integrated care group was 4% (2/50), lower than 16% (8/50) in the routine care group ( P<0.05). Conclusion:Compared with the routine care, an integrated early rehabilitation program for medical care and health based on the information-motivation-behavioral skills model for THA patients can shorten the first postoperative ambulation time and length of hospital stay, restore hip joint function, improve daily living self-care capacity and reduce the incidence of complications.

Objective:To analyze the regularity and related influencing factors of lateral cervical lymph node metastasis (LLNM) in papillary thyroid carcinoma (PTC) with primary lesion > 1 cm, and to guide clinical diagnosis and treatment.Methods:The clinicopathological data of 155 PTC patients with primary lesion > 1 cm and LLNM who underwent radical surgery in Anhui Cancer Hospital from Jan. 2022 to Dec. 2022 were retrospectively analyzed. The observation indicators were as follows: gender, age, operation method, number of primary lesions, maximum diameter, location, Hashimoto's thyroiditis (HT), total number and positive number of lymph nodes in central and lateral cervical regions, proportion and rate of metastasis. The measurement data were analyzed by t test, and the count data were analyzed by χ2 test. Pearson correlation analysis and multivariate regression analysis were used to evaluate the influencing factors of lymph node metastasis. Results:The maximum diameter of PTC in 155 cases was (19.67±8.15) mm. A total of 1933 central lymph nodes were dissected, with metastasis ratio of 91.61% and average metastasis rate of 50.77%±29.14%. A total of 5371 lateral lymph nodes were dissected, with an average metastasis rate of 14.44%±9.89%. The proportion of LLNM in level III and level IV was 70.97% and 60.10% respectively, and the positive rate was 19.51% and 17.07% respectively. 43 cases were single-level LLNM, including 23 cases of single-level oligometastasis. There was a positive correlation between central lymph node metastasis (CLNM) rate and LLNM rate (Pearson=0.28, P=0.000). Gender ( P=0.022), age ( P=0.038), number of lesions ( P=0.025), maximum diameter of lesions ( P=0.002), and HT ( P=0.000) were independent factors of CLNM rate. Among the factors influencing the LLNM rate, only the maximum diameter of lesion showed statistical significance ( P=0.040). Single-level LLNM was only associated with HT ( P=0.034). HT ( OR=3.515, P=0.008) and single lesion ( OR=3.217, P=0.047) were independent factors for single-level oligometastasis. Conclusions:In PTC cases with primary lesion > 1 cm, LLNM rate is positively correlated with that of CLNM. LLNM occurres most frequently in level III and level IV. Single-level LLNM is more likely to occur in patients with HT, and when there’s a single focus, single-level oligometastasis is more likely to occur. Accurate preoperative evaluation should be emphasized for such patients.

Objective:To explore the latent profiles of intellectual humility in primary colorectal cancer (CRC) postoperative patients and analyze the correlation between their intellectual humility and self-management.Methods:A total of 250 patients with primary CRC who underwent radical tumor surgery in anorectal department of Qinghai Provincial Hospital of Traditional Chinese Medicine from October 2021 to June 2023 were selected to accept a cross-sectional survey through convenient sampling method. They were surveyed by basic information questionnaire, comprehensive intellectual humility scale and cancer patient self-management assessment scale.Results:Finally, 243 valid questionnaires were obtained, it contained 125 males and 118 females with age 32- 68 (52.45 ± 10.24) years old. The score of primary CRC postoperative patients′intellectual humility was (67.59 ± 13.26) points, it could be divided into low-level intellectual humility type with 30 cases(12.34%), confident intellectual humility type with 36 cases (14.82%), mid-level intellectual humility type with 93 cases (38.27%), and high-level intellectual humility type with 84 cases (34.57%). Disordered multi-classes Logistic regression analysis showed that gender(female, OR=2.465), education level (high school or vocational school, OR=0.012) and diagnosis time(1-3 months, OR=15.289) were significant influencing factors to primary CRC postoperative patients from confident intellectual humility type (all P<0.05), gender (female, OR=5.354) and education level (high school or vocational school education, OR=0.012) were significant influencing factors to primary CRC postoperativepatients from mid-level intellectual humility type (both P<0.05), gender (female, OR=11.253), age (<45 years old, OR=7.532), education level (high school or vocational school, OR=0.017) and diagnosis time (<1 month, OR=0.054) were significant influencing factors to primary CRC postoperative patients from high-level intellectual humility type (all P<0.05). The score of primary CRC postoperative patients′self-management was (142.03 ± 19.83) points. There were statistically significant differences among scores of self-management, daily life management, symptom management and other six dimensions in patients from different categories of intellectual humility ( F values were 25.42-490.55, all P<0.05). There were positive correlation between the CRC patients′inteilectual humility and postoperatice self-managemeat ( r values were 0.373 - 0.749, all P<0.05). Conclusions:Primary CRC patients have a moderate level of knowledge humility and postoperative self-management. Their knowledge humility can be divided into low knowledge humility type, confident knowledge humility type, medium knowledge humility type, and high knowledge humility type. Knowledge humility can enhance postoperative self-management, and targeted interventions should be carried out for CRC patients with different types of knowledge humility to provide them with better cancer care and enhance their self-management level.

Objective The study aimed to investigate the prevalence of various Traditional Chinese Medicine(TCM)syndromes during the acute phase of ischemic stroke and identify the key symptoms associated with each syndrome.Methods A total of 1011 patients in the acute phase of ischemic stroke were assessed for TCM syndromes using the"Diagnostic criteria for stroke in Traditional Chinese Medicine"within 72 h of symptom onset,on the 7th day post onset,and on the 14th day.R4.2.3 software was utilized to analyze the TCM syndromes and symptoms,as well as to conduct network analysis.Results The incidence of phlegm syndrome was the highest(54.10％,51.18％,49.39％)at 72 h,7th and 14th day of disease onset,respectively,followed by wind syndrome,fire-heat syndrome,blood stasis syndrome,qi deficiency syndrome and excessive yang due to yin deficiency syndrome.The incidence of wind syndrome gradually decreased over time(x2=15.619,P＜0.001).In the network of 44 TCM syndrome entries,TZ-5(pulse)had the highest centrality index(strength=2.4)and was located at the most central position of the network.In the network analysis of different TCM syndrome,TZ-5(pulse)(strength=1.91)was located in the center of the phlegm syndrome network,FZ-1(onset)(strength=1.61)was located in the center of the wind syndrome network,HRZ-2(tongue coating)(strength=1.37)was located in the center of the network in the fire-heat syndrome,XYZ-1(tongue texture)(strength=1.18)was located at the center of the network for the blood stasis syndrome.Conclusion The phlegm syndrome is the most important syndrome in the acute phase of ischemic stroke.Employing network analysis can elucidate the central symptoms of different syndromes and the interconnections between the symptoms,providing new ideas for the identification of ischemic stroke.

Objective:To assess the efficacy and safety profile of anlotinib-based chemotherapy as the primary treatment modality for PSTC.Methods:This study included patients with locally advanced or metastatic PSTC who had not received any prior anti-tumor treatments between Jan. 2018 and Jul. 2023 at the Department of Breast Surgery, First Affiliated Hospital of the University of Science and Technology of China. The enrolled patients were administered anlotinib at a dose of 12 mg every 1 to 14 days for a total duration of 21 days, across 2 to 6 cycles. The chemotherapy regimen comprised paclitaxel, capecitabine, or docetaxel in combination with carboplatin or capecitabine. The assessed endpoints included the objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and disease-specific survival (DSS) .Results:Fourteen patients were recruited for the study. Among them, one patient achieved a CR, seven patients attained a PR, five patients exhibited SD, and one patient presented with PD. The highest recorded ORR was 57.1%, accompanied by a DCR of 64.3%. The median PFS was 3.7 months, and the median DSS was 7.8 months. Notably, approximately 71.4% of patients experienced adverse events (AEs). The majority of AEs were manageable, with only one patient requiring a dosage adjustment, and no patients discontinued medication due to AEs.Conclusions:Anlotinib-based chemotherapy, as the primary therapeutic approach, demonstrates safety and efficacy in managing patients diagnosed with PSTC.