Objective:To explore the predictive efficacy of the HFA-ICOS score for cancer therapy-related cardiac dysfunction (CTRCD) in Chinese patients with breast cancer and lymphoma.Methods:This study was a single-center retrospective cohort study which included patients with breast cancer and lymphoma who were treated with anthracyclines from February 2018 to February 2025 at the First Affiliated Hospital of Dalian Medical University. Patients were evaluated at baseline with cardiac biomarkers and echocardiography, including left ventricular ejection fraction and global longitudinal strain of the left ventricle. After anthracycline therapy, they were followed up at 1, 3, 6, and 12 months. Data involved biomarkers and echocardiography were collected to determine whether CTRCD had occurred. The patients were categorized into low-risk, intermediate-risk, high-risk, and very-high-risk groups using the HFA-ICOS scoring model. The cumulative probability of CTRCD under different HFA-ICOS risk stratification was analyzed using Kaplan-Meier survival curves. The effect of HFA-ICOS risk stratification on CTRCD was assessed using an univariate Cox proportional hazards regression model. The predictive efficacy of the HFA-ICOS model and its utility in clinical decision-making were assessed with receiver operating characteristic (ROC) curves, calibration curves, and decision curves at each time point.Results:A total of 286 patients, aged 55 (44, 61) years, were enrolled, of whom 33 (11.5%) cases were male. And 113 (39.5%) patients developed CTRCD during a median follow-up time of 111 (70, 210) days. HFA-ICOS risk stratification showed that 228 (79.7%) were low-risk, 49 (17.1%) were intermediate-risk, and a total of 9 (3.1%) were high-risk and very high-risk. The difference in the occurrence of CTRCD over time between patients with different HFA-ICOS risk stratification was statistically significant ( Plog-rank<0.001). Cox proportional regression hazards analysis showed an increased risk of CTRCD development in intermediate-risk ( HR=1.95, 95% CI 1.22-3.00, P=0.006) and high-risk and very high-risk patients ( HR=4.12, 95% CI 1.66-8.54, P=0.004) compared with low-risk patients. The ROC curves showed that the area under the curve of the HFA-ICOS model predicting CTRCD was 0.532, 0.597, 0.600 and 0.577 at 1, 3, 6 and 12 months, respectively. The calibration curves indicated Brier scores of 0.041 (95% CI 0.013-0.067), 0.144 (95% CI 0.115-0.173), 0.232 (95% CI 0.215-0.249) and 0.236 (95% CI 0.220-0.251) at 1, 3, 6 and 12 months, correspondingly. The clinical decision curve suggested that clinical intervention may have a net benefit when the risk threshold is between 0.15 and 0.18 at 1 month, between 0.10 and 0.50 at 3 months, and between 0.30 and 0.70 at 6 and 12 months. Conclusion:The HFA-ICOS score could predict the occurrence of CTRCD in patients with breast cancer and lymphoma treated with anthracycline drugs, although its predictive efficacy is limited, and the prediction model requires further validation in a larger population.

0bjective:To explore the responsiveness and minimal clinical significance difference(MCID)of the Chinese version of the Chelsea critical care physical assessment tool(CPAx),the Perme Score intensive care unit mobil-ity score(Perme Score),and the intensive care unit(ICU)mobility scale(IMS)for patients in ICU during the early-stage rehabilitation,providing more comprehensive evidence support for clinical application of these scales.Method:It is a prospective observational study.The convenience sampling method was used to select 114 pa-tients in a ICU of a Tertiary Hospital in Shanghai from March 2021 to December 2021.Patients were as-sessed by Chinese version of CPAx,Perme Score,and IMS before the first rehabilitation treatment and within 24 hours before discharge from ICU.Likert five-scale was used to evaluate the overall changes in health sta-tus of the patients after the last rehabilitation.Responsiveness includes both internal responsiveness and exter-nal responsiveness.Internal responsiveness was determined by pair t-test,effect size(ES)and standardized re-sponse mean(SRM);external responsiveness was assessed by using Spearman correlation coefficient.MCID was calculated by integrating the estimates from the distribution-based methods and the anchor-based methods.Result:Internal responsiveness outcomes indicated that there was significant difference between the score of CPAx,Perme Score and IMS before and after rehabilitation(P＜0.05),with ES of 1.03,1.09 and 1.14,and SRM of 1.75,1.52 and 1.73,respectively.The results showed that the scale had good internal responsiveness and could sensitively reflect the changes of patients'condition.External responsiveness outcoms showed that Spearman correlation coefficients of CPAx,Perme Score and IMS with global rating of change(GRC)were 0.67,0.50 and 0.30,respectively(P＜0.01),indicating that apart from IMS,the other scales had good external reactivity,and could reflect the changes of patients'self-perception during the rehabilitation process.The MC-ID of CPAx scale with ES as the intermediate index is 5.66,SEM is 5.48,self-therapeutic effects is 8.73.The MCID of Perme Score with ES is 2.43,SEM is 3.64,self-therapeutic effects is 5.00.The MCID of IMS scale with ES is 1.28,SEM is 2.01,self-therapeutic effects is 2.43.Conclusion:Except for the lack of external responsiveness of IMS,the other Chinese version scales had good internal and external responsiveness in early-stage rehabilitation of ICU patients.Combined with the litera-ture review and the actual situation of using the scale in the study,the mean values of distribution method and criterion method were taken to preliminarily determine that the MCID of Chinese version of CPAx,Perme Score and IMS in ICU early rehabilitation were 6.62,3.69 and 1.90,respectively.

Objective:To construct a training program for epilepsy specialist nurses, so as to provide a theoretical basis for the training and development of epilepsy specialist nurses.Methods:A preliminary training program for epilepsy specialist nurses was developed based on literature review, semi-structured interview, focus group discussion and clinical practice experience. Delphi method was used to select 20 experts from several regions of China for two rounds of consultation.Results:In the two rounds of expert consultation, the effective recovery rate of the questionnaire was both 100%, the expert authority coefficient was 0.908 and 0.958, and the degree of coordination of expert opinions was 0.180 to 0.229 and 0.138 to 0.189, respectively ( P<0.05). The standardized training program for epilepsy specialist nurses was finally constructed, including 5 first-level indicators (admission conditions, general theory courses, specialty theory courses, specialty nursing practice courses, training modes and effectiveness evaluation), 15 second-level indicators and 61 third-level indicators. Conclusions:The training program constructed for epilepsy specialist nurses is scientific and reasonable, with certain reliability and practicality, which provides a theoretical basis for the training of epilepsy specialist nurses, and promotes the common development of China's epilepsy specialist nurse team.

0bjective:To explore the responsiveness and minimal clinical significance difference(MCID)of the Chinese version of the Chelsea critical care physical assessment tool(CPAx),the Perme Score intensive care unit mobil-ity score(Perme Score),and the intensive care unit(ICU)mobility scale(IMS)for patients in ICU during the early-stage rehabilitation,providing more comprehensive evidence support for clinical application of these scales.Method:It is a prospective observational study.The convenience sampling method was used to select 114 pa-tients in a ICU of a Tertiary Hospital in Shanghai from March 2021 to December 2021.Patients were as-sessed by Chinese version of CPAx,Perme Score,and IMS before the first rehabilitation treatment and within 24 hours before discharge from ICU.Likert five-scale was used to evaluate the overall changes in health sta-tus of the patients after the last rehabilitation.Responsiveness includes both internal responsiveness and exter-nal responsiveness.Internal responsiveness was determined by pair t-test,effect size(ES)and standardized re-sponse mean(SRM);external responsiveness was assessed by using Spearman correlation coefficient.MCID was calculated by integrating the estimates from the distribution-based methods and the anchor-based methods.Result:Internal responsiveness outcomes indicated that there was significant difference between the score of CPAx,Perme Score and IMS before and after rehabilitation(P＜0.05),with ES of 1.03,1.09 and 1.14,and SRM of 1.75,1.52 and 1.73,respectively.The results showed that the scale had good internal responsiveness and could sensitively reflect the changes of patients'condition.External responsiveness outcoms showed that Spearman correlation coefficients of CPAx,Perme Score and IMS with global rating of change(GRC)were 0.67,0.50 and 0.30,respectively(P＜0.01),indicating that apart from IMS,the other scales had good external reactivity,and could reflect the changes of patients'self-perception during the rehabilitation process.The MC-ID of CPAx scale with ES as the intermediate index is 5.66,SEM is 5.48,self-therapeutic effects is 8.73.The MCID of Perme Score with ES is 2.43,SEM is 3.64,self-therapeutic effects is 5.00.The MCID of IMS scale with ES is 1.28,SEM is 2.01,self-therapeutic effects is 2.43.Conclusion:Except for the lack of external responsiveness of IMS,the other Chinese version scales had good internal and external responsiveness in early-stage rehabilitation of ICU patients.Combined with the litera-ture review and the actual situation of using the scale in the study,the mean values of distribution method and criterion method were taken to preliminarily determine that the MCID of Chinese version of CPAx,Perme Score and IMS in ICU early rehabilitation were 6.62,3.69 and 1.90,respectively.

Objective:To construct a training program for epilepsy specialist nurses, so as to provide a theoretical basis for the training and development of epilepsy specialist nurses.Methods:A preliminary training program for epilepsy specialist nurses was developed based on literature review, semi-structured interview, focus group discussion and clinical practice experience. Delphi method was used to select 20 experts from several regions of China for two rounds of consultation.Results:In the two rounds of expert consultation, the effective recovery rate of the questionnaire was both 100%, the expert authority coefficient was 0.908 and 0.958, and the degree of coordination of expert opinions was 0.180 to 0.229 and 0.138 to 0.189, respectively ( P<0.05). The standardized training program for epilepsy specialist nurses was finally constructed, including 5 first-level indicators (admission conditions, general theory courses, specialty theory courses, specialty nursing practice courses, training modes and effectiveness evaluation), 15 second-level indicators and 61 third-level indicators. Conclusions:The training program constructed for epilepsy specialist nurses is scientific and reasonable, with certain reliability and practicality, which provides a theoretical basis for the training of epilepsy specialist nurses, and promotes the common development of China's epilepsy specialist nurse team.

Objective:To explore the predictive efficacy of the HFA-ICOS score for cancer therapy-related cardiac dysfunction (CTRCD) in Chinese patients with breast cancer and lymphoma.Methods:This study was a single-center retrospective cohort study which included patients with breast cancer and lymphoma who were treated with anthracyclines from February 2018 to February 2025 at the First Affiliated Hospital of Dalian Medical University. Patients were evaluated at baseline with cardiac biomarkers and echocardiography, including left ventricular ejection fraction and global longitudinal strain of the left ventricle. After anthracycline therapy, they were followed up at 1, 3, 6, and 12 months. Data involved biomarkers and echocardiography were collected to determine whether CTRCD had occurred. The patients were categorized into low-risk, intermediate-risk, high-risk, and very-high-risk groups using the HFA-ICOS scoring model. The cumulative probability of CTRCD under different HFA-ICOS risk stratification was analyzed using Kaplan-Meier survival curves. The effect of HFA-ICOS risk stratification on CTRCD was assessed using an univariate Cox proportional hazards regression model. The predictive efficacy of the HFA-ICOS model and its utility in clinical decision-making were assessed with receiver operating characteristic (ROC) curves, calibration curves, and decision curves at each time point.Results:A total of 286 patients, aged 55 (44, 61) years, were enrolled, of whom 33 (11.5%) cases were male. And 113 (39.5%) patients developed CTRCD during a median follow-up time of 111 (70, 210) days. HFA-ICOS risk stratification showed that 228 (79.7%) were low-risk, 49 (17.1%) were intermediate-risk, and a total of 9 (3.1%) were high-risk and very high-risk. The difference in the occurrence of CTRCD over time between patients with different HFA-ICOS risk stratification was statistically significant ( Plog-rank<0.001). Cox proportional regression hazards analysis showed an increased risk of CTRCD development in intermediate-risk ( HR=1.95, 95% CI 1.22-3.00, P=0.006) and high-risk and very high-risk patients ( HR=4.12, 95% CI 1.66-8.54, P=0.004) compared with low-risk patients. The ROC curves showed that the area under the curve of the HFA-ICOS model predicting CTRCD was 0.532, 0.597, 0.600 and 0.577 at 1, 3, 6 and 12 months, respectively. The calibration curves indicated Brier scores of 0.041 (95% CI 0.013-0.067), 0.144 (95% CI 0.115-0.173), 0.232 (95% CI 0.215-0.249) and 0.236 (95% CI 0.220-0.251) at 1, 3, 6 and 12 months, correspondingly. The clinical decision curve suggested that clinical intervention may have a net benefit when the risk threshold is between 0.15 and 0.18 at 1 month, between 0.10 and 0.50 at 3 months, and between 0.30 and 0.70 at 6 and 12 months. Conclusion:The HFA-ICOS score could predict the occurrence of CTRCD in patients with breast cancer and lymphoma treated with anthracycline drugs, although its predictive efficacy is limited, and the prediction model requires further validation in a larger population.

OBJECTIVE To sort out the evaluation mechanism and methodology of published cases of comprehensive clinical evaluation of drugs in China,and provide a reference for promoting standardized comprehensive clinical evaluation of drugs and strengthening policy transformation in China.METHODS Clinical comprehensive evaluation cases of drugs published in China from CNKI,Wanfang Data,PubMed and Web of Science were systematically searched,and the retrieval time was from the inception to December 31st,2023.The summary and analysis were performed from the aspects of theme selection,indicator system construction,evaluation methods,comprehensive decision-making,quality control,etc.RESULTS A total of 143 pieces of literature were ultimately included from 2014 to 2023.The number of publications has shown a rapid upward trend since 2019.The subjects of the evaluation cases were mainly pediatric drugs,Chinese patent medicines,cardiovascular drugs and anti-tumor drugs.The evaluation dimensions were between 3-8,all involving safety and effectiveness dimensions.Most cases adopted rapid evaluation methods based on literature review and expert interviews/questionnaire surveys with less emphasis on real-world research.Most cases did not involve comprehensive decision-making,quality control,or policy transformation.CONCLUSIONS The clinical comprehensive evaluation of drugs in China has made rapid progress under the guidance of national policies.However,there are still issues and challenges such as incomplete evaluation methods and standards,few cases of evaluation results being converted into decision-making,and a lack of quality control mechanisms.It is suggested that standardized evaluation paths and quality control mechanisms should be explored;when the evidence-based basis is insufficient,real-world research should be conducted as much as possible,so as to accelerate the policy transformation of evaluation results.

Patients with chronic obstructive pulmonary disease have the disease phenomenon of fear of exercise because of dyspnea, which can accelerate the body degradation rate, weaken muscle strength, reverse increase dyspnea, and delay the recovery of the disease. As a result, this article examines the theoretical underpinnings and specific measures of dyspnea belief intervention programs for chronic obstructive pulmonary disease patients at home and abroad, summarizes the limitations of previous studies, and makes pertinent recommendations in an effort to serve as a guide for early patient prevention and the development of scientific and feasible intervention programs.

Objective:To study the biological traits and mutations of the influenza A (H3N2) virus in order to produce a vaccine and offer references for controlling and preventing influenza epidemics.Methods:Four strains of the influenza A(H3N2) virus were chosen from the Huai′an surveillance network laboratory. Nucleic acid extraction, library building, and sequencing (CridION x5 MKI Nanopore) were used to produce the whole-genome sequences. Using homologous alignments of whole-genome sequences, phylogenetic tree construction, and amino acid variant screening, bioinformatics analysis was carried out.Results:The nucleotide identity between 8 gene segments ranged from 97.1% to 100.0%. The gene that differed the most from the reference sequences was HA (97.1%-99.9%), and the gene that differed the least was MP (98.6%-99.9%). The HA gene (3.06%) and MP gene (1.43%) were the regions with the greatest and lowest frequencies of nucleotide site change, respectively. The rates of nucleotide change varied significantly between the genes ( χ2=14.293, P=0.046). Four influenza A(H3N2) virus strains′ whole-genome phylogenies from each of the eight gene segments maintained a roughly consistent topological structure. One strain was linked to the 3C.2a1b.1b clade, which was lost at the 142NWT, 149NGT(HA1), and 436NLS(NA). Three strains were linked to the 3C.2a1b.2a.1a clade lineage. Amantadine and NA inhibitors were effective against all Huai′an strains. Conclusions:The antigenicity of one strain of Huai'an strain changed and its matching with the vaccine strain of that year was low. It is suggested that the genetic surveillance of H3N2 influenza virus should be continuously strengthened to provide scientific basis for influenza prevention and control and influenza vaccine screening.

Objective:To form the expert consensus on nursing care of adults with status epilepticus (SE), promote nurses to provide standardized and safe first aid, monitoring and support to SE patients, and effectively prevent and control complications, with a view to controlling seizures as soon as possible.Methods:The medical and nursing evidence on SE was retrieved, evaluated and summarized, and the retrieval time limit was from the establishment of the database to March 31, 2022. Recommendations and studies were extracted to form a first draft of consensus. A total of 31 experts were selected to conduct two rounds of Delphi expert consultation and expert demonstration meetings to analyze, revise and improve the experts' suggestions and form a consensus final draft.Results:The expert positive coefficient was 100.00% (31/31), the expert judgment coefficient was 0.93, the familiarity degree was 0.87, and the authority coefficient was 0.90. Kendall's harmony coefficient was 0.25 to 0.27 ( P<0.05). The final consensus included adult SE identification, first aid, monitoring and support, complication prevention and control, and effect evaluation of terminating SE. Conclusions:This consensus is practical and provides guidance for clinical nursing practice and quality control of SE patients.