In the context of accelerated population aging, the demand for geriatric hospice care services is increasing significantly.The standard "Setting Standards for Elderly Hospice Care Wards(WS/T 844—2024)" issued by the National Health Commission of the People's Republic of China in July 2024 is of considerable importance.This standard outlines the configuration requirements for elderly hospice care wards regarding wards, personnel, beds, equipment, and quality management.It applies to medical institutions at all levels as well as integrated medical and elderly care institutions.Its implementation not only provides practical quantitative indicators for the construction of elderly hospice care wards, effectively standardizes clinical practices, and addresses the urgent needs of elderly end-stage patients for hospice care services, but also helps ensure the dignity and comfort of the elderly in the final stages of life.Furthermore, it enhances the overall quality of hospice care services and plays a positive role in promoting the Healthy China Initiative.

Objective:To investigate the knowledge, attitudes, practices (KAP), and demands of medical staff in family physician teams regarding the application of artificial intelligence (AI) in contracted services, and to analyze the influencing factors.Methods:A cross-sectional study was conducted from June to July 2023. A total of 602 medical staff members from family physician teams in Shanghai Minhang District were selected as subjects. Data on demographics (age, gender, institution, position, education, work experience, household registration, professional title, marital status, fertility status) and KAP/demand regarding AI application in contracted services were collected using a self-designed questionnaire. Intergroup differences were analyzed. Multiple stepwise linear regression was employed to identify the main factors influencing AI application demand.Results:Among the 602 participants, 484 (80.4%) were aged 30-49 years, 466 (77.40%) were females, 559 (92.9%) held a bachelor′s degree or higher, and 505 (83.9%) had intermediate or senior professional titles. The awareness rate for knowledge, positive attitude rate, and practice implementation rate regarding AI application were 47.2% (284/602), 73.1% (440/602), and 32.1% (193/602), respectively. The mean scores for knowledge, attitude, and practice were 15.72±3.40, 18.34±3.41, and 14.60±3.89, respectively. Significant differences were found among the items within each KAP dimension (knowledge: F=7.688, P<0.001; attitude: F=5.106, P<0.001; practice: F=6.763, P<0.001). Within knowledge, item K3 (awareness of intelligent elderly monitoring devices) scored lowest (3.00±0.79), differing significantly from K1, K2, K4, and K5 (all P<0.05). Within attitude, item A5 (willingness to fully trust AI′s accuracy and convenience in contracted services) scored lowest (3.57±0.75), differing significantly from A3 and A4 (all P<0.05). Within practice, item P3 (increasing reliance on AI in daily contracted services) scored lowest (2.79±0.93), differing significantly from P1 and P2 (all P<0.05). KAP scores differed significantly across demographic subgroups. Knowledge scores differed significantly by age, gender, and marital status (all P<0.05). Attitude scores differed significantly by gender, household registration, and fertility status (all P<0.05). Practice scores differed significantly by gender, position, and marital status (all P<0.05). Regarding demand, the most frequently selected areas were follow-up services (28.74%, 173/602), data management (26.25%, 158/602), and data collection (25.42%, 153/602). Univariate analysis identified age, gender, education, professional title, fertility status, and KAP scores as significant factors influencing AI application demand (all P<0.05). Multiple stepwise linear regression revealed that older age ( t=3.905, P<0.001), female gender ( t=3.548, P<0.001), and higher practice scores ( t=-3.044, P=0.002) were significant predictors of greater AI application demand. Conclusions:Significant variations exist in the KAP levels regarding AI application among family physician team members. Gender, age, and practice behavior significantly influence demand. Tailored strategies for different subgroups, coupled with timely targeted training and practical exercises, are recommended to enhance the effective and widespread adoption of AI technology in family physician contracted services.

Objective:To evaluate the safety and complications of external cephalic version(ECV)for term breech presentation and to explore factors influencing the occurrence of ECV-related complications.Methods:Pregnant women with term breech presentation who underwent ECV(ECV group,n=751)and those who under-went direct cesarean section(CS)without ECV(CS group,n=706)at Guangzhou Women and Children's Medi-cal Center of Guangzhou Medical University,from January 1,2018,to July 31,2024,were enrolled.Differences in maternal clinical characteristics and neonatal outcomes were compared between the two groups.The ECV group was further divided into a successful ECV subgroup(n=537)and a failed ECV subgroup(n=214)to compare complication rates.Based on the presence or absence of complications,the ECV group was divided into a compli-cation subgroup(n=86)and a no-complication subgroup(n=665).Univariate analysis was performed on the clinical data of these subgroups.Statistically significant factors identified in the univariate analysis were subse-quently included in a multivariate Logistic regression analysis to identify high-risk factors for ECV complications.Results:①Among the 751 women undergoing ECV,the success rate was 71.50％(537/751).The vaginal deliv-ery rate following successful ECV was 57.26％(430/751).The overall complication rate was 11.45％(86/751),with a perinatal mortality rate of 0.13％(1/751).②There were no significant differences with regard to severe neonatal asphyxia and neonatal intensive care admission rate between ECV group and CS group(P＞0.05).③The total complication rate,incidence of cesarean delivery(CS)within 24 h,and incidence of uterine contrac-tions were significantly higher in the failed ECV group compared to the successful ECV group(P＜0.05).Howev-er,there was no statistically significant difference in the incidence of severe complications(fetal demise,placental abruption,emergency CS)between the two groups(P＞0.05).④Univariate and multivariate Logistic regression analyses revealed that three factors were associated with a reduced risk of ECV complications(P＜0.05):a high-er amniotic fluid index(AFI),non-engagement of the presenting part,and a palpable fetal head.Conversely,the use of anesthesia and the use of nifedipine as the tocolytic were associated with an increased risk of ECV compli-cations(P＜0.05).Conclusions:ECV does not increase the adverse outcomes of full-term neonates with breech presentation.But failed ECV can increase complications.Higher amniotic fluid index,not engaged of fetal presen-tation,touchable of fetal head and appropriate tocolytic agent application can reduce the complications while anes-thesia during ECV procedure can increase the complications of ECV.

Objective:To evaluate the safety and complications of external cephalic version(ECV)for term breech presentation and to explore factors influencing the occurrence of ECV-related complications.Methods:Pregnant women with term breech presentation who underwent ECV(ECV group,n=751)and those who under-went direct cesarean section(CS)without ECV(CS group,n=706)at Guangzhou Women and Children's Medi-cal Center of Guangzhou Medical University,from January 1,2018,to July 31,2024,were enrolled.Differences in maternal clinical characteristics and neonatal outcomes were compared between the two groups.The ECV group was further divided into a successful ECV subgroup(n=537)and a failed ECV subgroup(n=214)to compare complication rates.Based on the presence or absence of complications,the ECV group was divided into a compli-cation subgroup(n=86)and a no-complication subgroup(n=665).Univariate analysis was performed on the clinical data of these subgroups.Statistically significant factors identified in the univariate analysis were subse-quently included in a multivariate Logistic regression analysis to identify high-risk factors for ECV complications.Results:①Among the 751 women undergoing ECV,the success rate was 71.50％(537/751).The vaginal deliv-ery rate following successful ECV was 57.26％(430/751).The overall complication rate was 11.45％(86/751),with a perinatal mortality rate of 0.13％(1/751).②There were no significant differences with regard to severe neonatal asphyxia and neonatal intensive care admission rate between ECV group and CS group(P＞0.05).③The total complication rate,incidence of cesarean delivery(CS)within 24 h,and incidence of uterine contrac-tions were significantly higher in the failed ECV group compared to the successful ECV group(P＜0.05).Howev-er,there was no statistically significant difference in the incidence of severe complications(fetal demise,placental abruption,emergency CS)between the two groups(P＞0.05).④Univariate and multivariate Logistic regression analyses revealed that three factors were associated with a reduced risk of ECV complications(P＜0.05):a high-er amniotic fluid index(AFI),non-engagement of the presenting part,and a palpable fetal head.Conversely,the use of anesthesia and the use of nifedipine as the tocolytic were associated with an increased risk of ECV compli-cations(P＜0.05).Conclusions:ECV does not increase the adverse outcomes of full-term neonates with breech presentation.But failed ECV can increase complications.Higher amniotic fluid index,not engaged of fetal presen-tation,touchable of fetal head and appropriate tocolytic agent application can reduce the complications while anes-thesia during ECV procedure can increase the complications of ECV.

In the context of accelerated population aging, the demand for geriatric hospice care services is increasing significantly.The standard "Setting Standards for Elderly Hospice Care Wards(WS/T 844—2024)" issued by the National Health Commission of the People's Republic of China in July 2024 is of considerable importance.This standard outlines the configuration requirements for elderly hospice care wards regarding wards, personnel, beds, equipment, and quality management.It applies to medical institutions at all levels as well as integrated medical and elderly care institutions.Its implementation not only provides practical quantitative indicators for the construction of elderly hospice care wards, effectively standardizes clinical practices, and addresses the urgent needs of elderly end-stage patients for hospice care services, but also helps ensure the dignity and comfort of the elderly in the final stages of life.Furthermore, it enhances the overall quality of hospice care services and plays a positive role in promoting the Healthy China Initiative.

Objective:To investigate the knowledge, attitudes, practices (KAP), and demands of medical staff in family physician teams regarding the application of artificial intelligence (AI) in contracted services, and to analyze the influencing factors.Methods:A cross-sectional study was conducted from June to July 2023. A total of 602 medical staff members from family physician teams in Shanghai Minhang District were selected as subjects. Data on demographics (age, gender, institution, position, education, work experience, household registration, professional title, marital status, fertility status) and KAP/demand regarding AI application in contracted services were collected using a self-designed questionnaire. Intergroup differences were analyzed. Multiple stepwise linear regression was employed to identify the main factors influencing AI application demand.Results:Among the 602 participants, 484 (80.4%) were aged 30-49 years, 466 (77.40%) were females, 559 (92.9%) held a bachelor′s degree or higher, and 505 (83.9%) had intermediate or senior professional titles. The awareness rate for knowledge, positive attitude rate, and practice implementation rate regarding AI application were 47.2% (284/602), 73.1% (440/602), and 32.1% (193/602), respectively. The mean scores for knowledge, attitude, and practice were 15.72±3.40, 18.34±3.41, and 14.60±3.89, respectively. Significant differences were found among the items within each KAP dimension (knowledge: F=7.688, P<0.001; attitude: F=5.106, P<0.001; practice: F=6.763, P<0.001). Within knowledge, item K3 (awareness of intelligent elderly monitoring devices) scored lowest (3.00±0.79), differing significantly from K1, K2, K4, and K5 (all P<0.05). Within attitude, item A5 (willingness to fully trust AI′s accuracy and convenience in contracted services) scored lowest (3.57±0.75), differing significantly from A3 and A4 (all P<0.05). Within practice, item P3 (increasing reliance on AI in daily contracted services) scored lowest (2.79±0.93), differing significantly from P1 and P2 (all P<0.05). KAP scores differed significantly across demographic subgroups. Knowledge scores differed significantly by age, gender, and marital status (all P<0.05). Attitude scores differed significantly by gender, household registration, and fertility status (all P<0.05). Practice scores differed significantly by gender, position, and marital status (all P<0.05). Regarding demand, the most frequently selected areas were follow-up services (28.74%, 173/602), data management (26.25%, 158/602), and data collection (25.42%, 153/602). Univariate analysis identified age, gender, education, professional title, fertility status, and KAP scores as significant factors influencing AI application demand (all P<0.05). Multiple stepwise linear regression revealed that older age ( t=3.905, P<0.001), female gender ( t=3.548, P<0.001), and higher practice scores ( t=-3.044, P=0.002) were significant predictors of greater AI application demand. Conclusions:Significant variations exist in the KAP levels regarding AI application among family physician team members. Gender, age, and practice behavior significantly influence demand. Tailored strategies for different subgroups, coupled with timely targeted training and practical exercises, are recommended to enhance the effective and widespread adoption of AI technology in family physician contracted services.

The traditional acute care model, focused on disease diagnosis and treatment, is struggling to meet the complex needs of elderly patients at the end of life, encompassing physical, psychological, social, and spiritual aspects.Hospice care, designed to enhance the quality of life and death for patients in this stage, offers a suitable service model for the elderly.Hospice care for elderly patients at the end of life should be centered around the patient, honoring their preferences, and delivering comprehensive care that addresses their overall well-being.The lack of knowledge about hospice care among healthcare professionals often hinders its implementation, negatively impacting the quality of life for these patients.This article aims to outline the key features of hospice care services for elderly patients at the end of life, serving as a valuable reference for clinical practice.

Objectives: To investigate the factors influencing the height of anterior peritoneal reflection (APR) for patients with rectal cancer, and to analyze the relationship between the APR and the lateral lymph node metastasis. Methods: Clinical data of 432 patients with tumor located within and below APR were retrospectively collected from the rectal cancer database at the Department of General Surgery, Peking Union Medical College Hospital from August 2020 to September 2022. Ninty-eight non-rectal cancer patients were also enrolled as a control group. There were 308 males and 124 females in the tumor group, aged (M(IQR)) 62 (16) years (range: 24 to 85 years) and 53 males and 45 females in the control group, aged 60 (22) years (range: 27 to 87 years). The APR height, pelvis, and tumor-related parameters were measured by MRI. A multifactor linear regression model was established to analyze the dependent correlation factors of APR height. These factors of the two groups were matched by propensity score matching and their APR heights were compared after matching. An ordinal Logistic regression model was established to explore the relationship between APR-related parameters and radiographic lateral lymph node metastasis. Results: The APR height of the tumor group was (98.7±14.4) mm (range: 43.3 to 154.0 mm) and the control group was (95.1±12.7) mm (range: 68.0 to 137.9 mm). Multivariable linear regression revealed that the greater the weight (B=0.519, 95%CI: 0.399 to 0.640, P<0.01), the anterior pelvic depth (B=0.109, 95%CI: 0.005 to 0.213, P=0.039) and the smaller the bi-ischial diameter (B=-0.172, 95%CI:-0.294 to -0.049, P=0.006), the higher the APR height. The tumor group had a higher APR height than the control group after propensity score matching ((98.3±14.2) mm vs. (95.1±12.7) mm, t=-1.992, P=0.047). Ordinal Logistic regression indicated that the longer segment of the tumor invade the nonperitoneal rectum was an independent influencing factor of radiographic lateral lymph node metastasis (OR=1.016, 95%CI: 1.002 to 1.030, P=0.021), while the distance between the anal verge and the tumor was not (OR=0.986, 95%CI: 0.972 to 1.000, P=0.058). Conclusions: The higher the weight, the deeper and narrower the pelvis, the higher the APR height. There is a certain relationship between APR and lateral lymph node metastasis on imaging.

The development of clinical practice guidelines involves a series of evidence-based decision-making processes, of which the formation of recommendations is particularly challenging. It demands decision-makers to have a thorough and precise understanding of the evidence, weigh the potential benefits and risks of interventions, and make valuable judgments and clinical choices. Compared to traditional approaches of presenting evidence information, the use of visualization tools can facilitate the communication and analysis of evidence, simplify information interpretation, and improve the efficiency of decision-making. Based on previousstudies, this paper proposes a visualization tool, vitruvian plot, for summarizing evidence and provides illustrative examples to demonstrate its usage and effects, with the aim of offering valuable guidance for researchers.

OBJECTIVE: To analyze the clinical characteristics of bloodstream infection (BSI) in patients treated by hematopoietic stem cell transplantation (HSCT). METHODS: The clinical characteristics, distribution of pathogenic bacteria causing BSI and drug sensitivity of 910 patients treated by HSCT in our department from January 2013 to June 2020 were retrospectively analyzed. RESULTS: Among 910 HSCT patients, 111 patients were diagnosed as BSI within 100 days after transplantation, and 98 patients showed BSI during the period of agranulocytosis. Multivariate analysis showed that the usage of anti-thymocyte globulin (ATG), long duration of agranulocytosis and low infusion volume of mononuclear cell (MNC) were the independent risk factors affecting BSI after HSCT. Among 121 pathogenic bacteria isolated, 76 Gram-negative (G^-) bacteria (62.8%), 40 Gram-positive (G⁺) bacteria (33.0%), and 5 fungi (4.1%) were detected out. The top three pathogens were Escherichia coli, Staphylococcus epidermidis and Pseudomonas aeruginosa. The drug-resistance rates of Escherichia coli and Klebsiella pneumoniae to carbapenems was 14.3% and 7.7%, respectively, and Pseudomonas aeruginosa was 66.7%. The susceptibility of G⁺ bacteria to vancomycin, linezolid and teicoplanin was 97.5%, 100% and 100%, respectively. The crude mortality rate of the patients with BSI at 100 days after HSCT was significantly higher than that of patients without BSI (P<0.001). CONCLUSION The usage of ATG, long duration of agranulocytosis and low infusion volume of MNC are independent risk factors for BSI after HSCT. The pathogens after HSCT are mainly G- bacteria. Pseudomonas aeruginosa is highly resistant to carbapenems. Key words　　;
Bacteremia/epidemiology* ; Bacteria ; Hematopoietic Stem Cell Transplantation ; Humans ; Retrospective Studies ; Sepsis