Objective:To summarize the essential elements of clinical doctors′ ward rounds etiquette norms from the perspective of whether doctors′ speech and behavior in actual ward rounds pay attention to patients′ feelings and reflect humanistic care, in order to provide references for improving patients′ treatment effects and medical experience management.Methods:From July to October 2023, a purposeful sampling method was employed to select 16 clinical doctors with ward rounds experience from the eastern, central, western, and northeastern regions across the country. Semi-structured interviews were conducted online via video, focusing on issues related to etiquette norms during ward rounds. The Colaizzi′s seven-step analysis method was used to conduct an inductive analysis of the interview materials.Results:four themes were distilled: friendly and caring body language; accurate, understandable, clear, and timely explanations; appropriate praise and affirmation to encourage patients to actively participate in their disease management; and admonitions to patients and their families regarding disease-related precautions. These four themes were summarized as the " four essentials of ward rounds, " which could be encapsulated as " altruistic inquiry; accurate explanation; affirmative engagement and adequate advice" .Conclusions:The " four essentials of ward rounds" can be made a mandatory part of the clinical doctors′ workflow in the medical quality management process and are recommended for nationwide promotion. This can further enhance the communication skills of clinical doctors, strengthen patients′ trust, improve treatment compliance, and improve doctor-patient relationships, thereby improving the treatment effects, satisfaction, and experience of inpatients.

Objective:To summarize the essential elements of clinical doctors′ ward rounds etiquette norms from the perspective of whether doctors′ speech and behavior in actual ward rounds pay attention to patients′ feelings and reflect humanistic care, in order to provide references for improving patients′ treatment effects and medical experience management.Methods:From July to October 2023, a purposeful sampling method was employed to select 16 clinical doctors with ward rounds experience from the eastern, central, western, and northeastern regions across the country. Semi-structured interviews were conducted online via video, focusing on issues related to etiquette norms during ward rounds. The Colaizzi′s seven-step analysis method was used to conduct an inductive analysis of the interview materials.Results:four themes were distilled: friendly and caring body language; accurate, understandable, clear, and timely explanations; appropriate praise and affirmation to encourage patients to actively participate in their disease management; and admonitions to patients and their families regarding disease-related precautions. These four themes were summarized as the " four essentials of ward rounds, " which could be encapsulated as " altruistic inquiry; accurate explanation; affirmative engagement and adequate advice" .Conclusions:The " four essentials of ward rounds" can be made a mandatory part of the clinical doctors′ workflow in the medical quality management process and are recommended for nationwide promotion. This can further enhance the communication skills of clinical doctors, strengthen patients′ trust, improve treatment compliance, and improve doctor-patient relationships, thereby improving the treatment effects, satisfaction, and experience of inpatients.

Mucus plugs is a feature of fatal asthma, which is the abnormally thick mucus accumulated in the airway of patients.The study of airway mucus plugs in asthmatic patients began 100 years ago.In addition to the manifestation of primary disease, asthma patients with mucus plugs may have acute exacerbation of asthma or poor treatment effect.At this time, we should pay attention to the existence of mucus plugs.Multidetector computed tomography can be used to identify and evaluate mucus plugs.This article briefly describes the generation of airway mucus, and introduces the formation mechanism, clinical characteristics, identification and scoring system of mucus plugs in asthmatic patients, and reviews the differential diagnosis and treatment of mucus plugs.

The clinical data of a cystic fibrosis (CF) child with allergic bronchopulmonary aspergillosis (ABPA) and hemoptysis in the Department of Respiratory Disease Ⅰ, Beijing Children′s Hospital, Capital Medical University in May 2021 were retrospectively analyzed.Meanwhile, relevant literature was reviewed to analyze the clinical characteristics, diagnosis and treatment of CF patients with ABPA.This patient was a 15 years and 4 months old boy and complained of recurrent cough with sputum.The test showed increased blood eosinophils, total serum IgE higher than 500 IU/mL, positive aspergillus fumigatus specific IgE and IgG antibodies.Chest CT revealed central bronchiectasis and high-density mucus thrombus, and the patient was initially diagnosed with ABPA.Further examinations suggested the sweat chloride concentration was 89 mmol/L, and the genetic results showed a compound heterozygous mutation of CFTR (c.2909G>A from his father, c.3310G>T from his mother). Then, he was diagnosed with CF complicated with ABPA and treated with glucocorticoid and antifungal therapy.The disease was repeated after drug withdrawal.Due to hemoptysis, the right upper lobe lobectomy was performed.Unfortunately, ABPA occurred again 2 years later.The child is being followed up at present.CF is a rare monogenetic disease with poor prognosis.It is difficult to treat CF patients with ABPA and the disease repeats easily.Early identification and treatment will improve the prognosis.

Exercise is medicine.Exercise is not only the cornerstone of children′s normal growth and development, but also the necessary condition of physical and mental health.Moreover, exercise contributes to the management of childhood asthma.Exercise prescription is an effective method for children with asthma, but there is no much experience in China, we should continuously explore and optimize it.Therefore, the level of physical activity could be improved in children with asthma.

Guideline or consensus for the vaccination of children with special conditions like immunocompromised children may be more suitable for pediatricians.However, the vaccination of children in China is mainly performed by general practitioners or child health care practitioners in community health service centers.They need to master the screening knowledge of contraindications and precautions for the vaccination of children, and make the decision to referral to specialists.Based on the technical guidelines for Immunization of National Health Commission of the People′s Republic of China, Best Practices Guidance of the Advisory Committee on Immunization Practices and contraindications and precautions proposed by the Immunization Action Coalition, 20 suggestions for primary screening of children with vaccination contraindications and referral recommendations for primary care providers were developed by experts from the Integration of Medicine and Prevention in Children of Health Commission of Shenzhen Municipality.

Objective To explore the clinical features of chronic granulomatous diseases and Mcleod syndrome caused by continuous X chromosome deletion. Methods The clinical data of two children diagnosed as chronic granulomatous disease and Mcleod syndrome by gene detection were retrospectively analyzed. Results Two males, 4 year 1 month and 1 year 9 month old, were both hospitalized due to persistent pulmonary infections. Both of them had a history of repeated severe infections and BCG vaccine associated lymphadenitis, and were diagnosed as X-linked chronic granulomatous disease for respiratory burst defects and deletion of all CYBB exons. Both of them had retarded motor development, and were diagnosed as DMD for detection of DMD gene exons and muscle speciifc promoter region and exon 1-2 deletion by MLPA. One case was found with obvious echinocytes, the other case showed whole exons deletion of XK gene. Both of them were diagnosed as Mcleod syndrome. Conclusion Continuous X chromosome deletion could lead to combination of Mcleod syndrome, DMD, and X-CGD, which may complicate the condition. Due to the lack of Kx antigen, repeated common blood transfusion can produce relative antibody, which lead to severe hemolytic crisis.