OBJECTIVE To ensure the safety of patients’ drug use and control the risk of medical insurance expenditure by upgrading the pre-prescription review system to conduct pre-review on prescriptions from internet hospitals and external prescriptions， as well as to review the payment methods of drugs （including in-hospital and external drug dispensing）. METHODS The data interfaces of prescriptions from internet hospitals and external prescriptions were integrated to achieve real-time rational drug use intervention. Additionally， an intelligent review project for payment method was added to precisely intervene in the medical insurance payment methods of drugs. The effect of the system upgrade was evaluated by comparing the qualification rates of prescriptions from internet hospitals and external prescriptions and the suspected amounts of drug violations from January to April 2025 （before the system upgrade） and May to August 2025 （after the system upgrade）. RESULTS After the upgrade of the pre-prescription review system， the qualification rates of prescriptions from internet hospitals and external prescriptions increased by 3.5% [95% confidence interval （CI）＝0.3%-6.7%， P ＝0.037 ] ； the suspected amounts of drug violations decreased to 52.9% of the pre-upgrade level （95%CI＝31.6%-88.5%， P ＝0.026）， and the average monthly sequential decrease was 29.5% （95%CI＝12.2%-43.4%， P ＝0.012）. Moreover， the addition of the intelligent review project for payment methods promoted the management of off-label drug use in our hospital. After the upgrade， a total of 79 filling valid applications for off-label drug use were received and archived. CONCLUSIONS The upgrade of the pre-prescription review system effectively improves the review qualification rates of prescriptions from internet hospitals and external prescriptions and the accuracy of medical insurance payment for drugs， and strengthens the supervision of off-label drug use， achieving dual guarantees of clinical rationality and medical insurance compliance.

Objective: To analyze the trends in incidence and mortality of colorectal cancer in Jinhua City, Zhejiang Province from 2016 to 2024, and to predict the incidence and mortality from 2025 to 2027, so as to provide the evidence for improving regional colorectal cancer prevention and control strategies. Methods: Data on incidence and mortality of colorectal cancer in Jinhua City from 2016 to 2024 were collected through the Zhejiang Chronic Disease Surveillance Information Management System. The crude incidence and crude mortality were calculated, and standardized using the data from the Sixth National Population Census in 2010. Trends in incidence and mortality of colorectal cancer from 2016 to 2024 were analyzed using the average annual percent change (AAPC). A grey Markov model was constructed to predict the incidence and mortality of colorectal cancer from 2025 to 2027. Results: From 2016 to 2024, the crude incidence and standardized incidence of colorectal cancer in Jinhua City were 46.90/100 000 and 30.69/100 000, respectively, showing upward trends (AAPC=4.594% and 2.051%, both P<0.05). The crude mortality and standardized mortality were 17.47/100 000 and 10.36/100 000, respectively, and the trends were not statistically significant (both P>0.05). The standardized incidence and standardized mortality of colorectal cancer in males were higher than those in females (35.38/100 000 vs. 25.68/100 000, 11.96/100 000 vs. 8.57/100 000, both P<0.05). The crude incidence and crude mortality of colorectal cancer in the ≥80 years age group were the highest, at 220.04/100 000 and 186.86/100 000, respectively. From 2016 to 2024, the standardized incidence of colorectal cancer in males and females showed upward trends (AAPC=5.069% and 3.965%, both P<0.05), while the trends in standardized mortality were not statistically significant (all P>0.05). The crude incidence in the 70-<80 years age group showed an upward trend (AAPC=1.320%, P<0.05), and the crude mortality in the 40-<50 years age group showed a downward trend (AAPC=-3.756%, P<0.05). Trends in other age groups were not statistically significant (all P>0.05). The prediction results of the grey Markov model showed that the predicted values of crude incidence and crude mortality of colorectal cancer in the whole population would increase from 58.20/100 000 and 20.04/100 000 in 2025 to 61.70/100 000 and 21.26/100 000 in 2027. Conclusions From 2016 to 2024, the incidence of colorectal cancer in Jinhua City showed upward trends, while the mortality trend was stable. Males and the elderly aged ≥80 years are high-risk populations for colorectal cancer incidence and mortality. It is predicted that both crude incidence and crude mortality will increase from 2025 to 2027.

ObjectiveTo analyze trends in the incidence and mortality of pancreatic cancer among the registered residents in Jinhua City of Zhejiang Province from 2016 to 2024, and to predict incidence and mortality rates from 2025 to 2027, thereby providing a reference for refining prevention and control strategies. MethodsData on pancreatic cancer incidence and mortality among the registered residents in Jinhua City from 2016 to 2024 were collected. The Joinpoint regression model was used to calculate the average annual percentage change (AAPC) to analyze the temporal trends of pancreatic cancer incidence and mortality. Furthermore, a GM (1,1) model was constructed using Excel 2019 to predict incidence rates and mortality rates for the years 2025 to 2027. ResultsFrom 2016 to 2024, the crude incidence and crude mortality rates of pancreatic cancer among the registered residents in Jinhua City were 8.41/100 000 and 8.19/100 000, respectively, both showing upward trends (AAPC=3.55%, 95%CI: 1.69%-5.63%; AAPC=3.35%, 95%CI: 1.08%-5.93%), while the standardized incidence and mortality rates were 5.21/100 000 and 4.93/100 000, respectively, with no statistically significant trends (AAPC=1.12% and 0.52%, both P>0.05). The incidence and mortality rates of pancreatic cancer were higher in men than in women. Both crude incidence and crude mortality rates rose steadily with increased age (both P<0.01). According to the GM (1,1) model, the crude mortality rate of pancreatic cancer among the registered residents in Jinhua City is projected to continue its upward trend from 2025 to 2027 (9.37/100 000, 9.60/100 000, and 9.83/100 000, respectively). ConclusionFrom 2016 to 2024, both the crude incidence and crude mortality rates of pancreatic cancer among registered residents in Jinhua City showed continuous upward trends, and the crude mortality rate is likely to continue rising from 2025 to 2027. Efforts to prevent and control pancreatic cancer should be strengthened, particularly among men and the very elderly.

As one of the common chronic bacterial infections, Helicobacter pylori (Hp) infection is a key pathogenic factor of chronic gastritis, peptic ulcer and gastric cancer. In the formation of gastric ulcer, Hp virulence factors directly damage the gastric mucosal barrier, induce the local inflammation and immune response, interfere with the regulation of gastric acid secretion, and ultimately destroy the mucosal stability. In the occurrence of gastric cancer, Hp-driven chronic inflammation is the basis of inflammation-cancer transformation, and it induces the genomic instability and epigenetic changes by interfering with key signaling pathways in host cells, thereby promoting malignant transformation. This paper systematically reviews the related mechanisms of Hp-induced gastric ulcer and gastric cancer in recent years, holding great significance for the development of new intervention strategies and the precise prevention and treatment of gastric cancer.

Objective Based on the concept of quality by design(QbD),to establish the design space of Zhihuang detumescence gel plaster extraction process.Methods With Zhihuang detumescence gel plaster as the model drug,geniposide content and extract yield as critical quality attributes(CQA),failure mode effects analysis(FMEA)combined with fishbone diagram was used to evaluate the risk of extraction process,and single factor experiment was used to determine the critical process parameters(CPPs).The mathematical model of CPPs and CQAs was established by Box-Behnken experimental design,and the design space was obtained and verified by Monte Carlo method.Results The ethanol volume fraction,solvent multiplication and extraction times were determined as CPPs,the mathematical model established by Box-Behnken experimental design was statistically significant at P＜0.05,and combined with the production experience,the resulting operable space was:ethanol volume fraction of 67％-70％,solvent multiplication of 7.5-9 times,and the number of times of extraction was 3 times,Extraction time 1 h.Conclusion The establishment of the extraction process design space of Zhihuang detumescence gel plaster is helpful to improve the quality stability and controllability of the traditional Chinese medicine compound preparation,lay an experimental foundation for the development of subsequent preparations,and provide a reference for the application of the design space method to the compound preparation of traditional Chinese medicine.

Objective Exploring the effect of Bian-stone-based herbal heat therapy on herbal heat ironing in gastrointestinal reactions during the preconditioning period of hematopoietic stem cell transplantation patients.Methods Convenience sampling method was used to select 68 cases of hematopoietic stem cell transplantation patients who attended the hematology department of a tertiary-level Chinese medicine hospital in Hangzhou from October 2023 to April 2024 as the study subjects,and the SPSS 26.0 statistical software was used to generate a random number for grouping into an experimental and a control group,with 34 cases in each group.On the basis of intravenous antiemetic medication and routine,the experimental group implemented the Bian-stone-based herbal heat therapy on the basis of intravenous antiemetic medication and conventional nursing care.In the control group,intravenous antiemetic drugs and routine care were used,and the intervention duration of both groups was 14 d,of which 7 d was a course of treatment,with a total of 2 courses of treatment.The incidence of gastroin-testinal reactions,Gastrointestinal Symptom Rating Scale(GSRS)score,Pepsin Ⅰ(PG Ⅰ),Pepsin Ⅱ(PG Ⅱ),and the ratio of PG Ⅰ to PG Ⅱ(PGR)before and after the intervention were compared between the 2 groups.Results The final sample of 66 cases was collected in this study,and 1 patient was dislodged from each of the control group and the experimental group.The comparison of the incidence of gastrointestinal reactions between the 2 groups within 14 days showed that the incidences of nausea,vomiting,abdominal distension,and diarrhea were lower in the experimental group than those in the control group(P＜0.05).GSRS scores on days 1,8,and 14 of intervention were compared,and there were effects between groups in both groups(F=5.338,P=0.017).The levels of PG Ⅰ,PG Ⅱ in the experimental group on day 8 of the intervention were lower than those in the control group.The levels of PGR was higher than that in the control group(all P＜0.05).The safety of the 2 groups after treatment was evaluated,and the results showed that no serious adverse events occurred in the 2 groups.Conclusion Bian-stone-based herbal heat therapy can improve gastrointestinal reactions and reduce the incidence of gastrointestinal reactions during the preconditioning period of hematopoietic stem cell transplantation patients,which provides clinical guidance for the application of Bian-stone-based herbal heat therapy by nursing staff in the future.

Objective:To develop a Knowledge-Attitude-Practice (KAP) Scale for Dietary Management During Hemodialysis and to test its reliability and validity.Methods:Based on the KAP theoretical framework, an initial version of the scale was developed through a literature review and expert consultations. A convenience sampling method was used to recruit hemodialysis patients from four hospitals in Suzhou in March 2024. Questionnaire item analysis and reliability and validity tests were conducted.Results:A total of 460 questionnaires were distributed and 438 valid responses were collected, with an effective response rate of 95.22%. The final scale included three dimensions (knowledge, attitude, and practice) with 34 items. Content validity at the scale level was 0.910, and the item level ranged from 0.800 to 1.000. Exploratory factor analysis extracted three common factors, with a cumulative variance contribution rate of 74.520%. Confirmatory factor analysis showed a good model fit. The total Cronbach's α coefficient of the scale was 0.971, and the Cronbach's αcoefficients for the three dimensions were 0.963, 0.933, and 0.934, respectively. The test-retest reliability coefficient was 0.839.Conclusions:The Knowledge-Attitude-Practice Scale for Dietary Management During Hemodialysis demonstrates good reliability and validity, making it a valuable tool for assessing the KAP level of dietary management in hemodialysis patients.

Objective:To conduct a scoping review of studies on the application of exercise interventions in the rehabilitation of patients with hemophilic arthropathy (HA) .Methods:A systematic search was conducted in PubMed, Web of Science, Cochrane Library, Embase, CINAHL, China National Knowledge Infrastructure, Wanfang Data, VIP, and China Biology Medicine disc. The search period was from the database inception to March 1, 2024. Relevant literature was screened, summarized, and analyzed.Results:A total of 31 studies were included. The study population mainly consisted of adult patients with moderate to severe hemophilia suffering from elbow, knee, and ankle arthropathy, who were in a stable bleeding phase without coagulation factor inhibitors. Exercise types included resistance training, aerobic exercise, balance/proprioceptive exercises, and flexibility training. The exercise intensity was predominantly low to moderate. The duration of each session was mostly 30-60 minutes, with a frequency of 2-5 times per week and a total intervention period of 4-12 weeks. Exercises were mostly conducted in medical institutions under face-to-face supervision. Exercise interventions led to varying degrees of improvement in mobility, balance/proprioceptive function, joint function, cardiopulmonary fitness, psychological well-being, and quality of life.Conclusions:Exercise interventions for patients with hemophilic arthropathy are diverse, demonstrating safety, feasibility, and efficacy. Future research should focus on a multidisciplinary, exercise-centered rehabilitation approach, standardizing evaluation criteria, and dynamically monitoring the rehabilitation process to develop standardized exercise rehabilitation protocols.

Objective:To understand the current status of health management cognition and healthcare behaviors of community residents in Shanghai, and to analyze their related influencing factors, in order to promote the optimization of proactive health-oriented health management strategies.Methods:This study was a cross-sectional survey. From February to May 2023, 1-4 community health service centers were randomly selected from each administrative district in Shanghai by stratified random sampling using the random number table method. Ultimately, 28 community health service centers were selected as research sites. The research team then used convenience sampling method to select at least 50 patients as research subjects from those visiting each selected center. A total of 1 436 community residents were included in this study in the form of on-site completion of questionnaire stars, and the study covered the residents′ level of health management cognition, chronic disease management, intention to seek medical care, physical examination behavior, and handling of abnormal values. Multiple regression analysis was used to assess the correlation between health management cognition and medical consultation behavior and their influencing factors.Results:The results of the health management awareness survey showed that 827 residents (57.6%) had a relatively high level of awareness. Among the 755 residents (52.6%) with chronic diseases, the proportion of self-assessed stable control was significantly higher in the high-cognition group (318 (76.0%)) than that in the low-cognition group (223 (66.2%)), and the difference was statistically significant ( χ2=9.01, P=0.003). Multiple regression analysis showed that females ( OR=1.293, 95% CI: 1.028-1.627),≤44 years old and 45-59 years old ( OR=2.328, 95% CI: 1.648-2.328; OR=1.351, 95% CI: 1.035-1.763), bachelor′s degree or above ( OR=1.784, 95% CI: 1.256-2.534), living in suburban area ( OR=1.577, 95% CI: 1.235-2.014), use of employee health insurance and resident health insurance ( OR=2.294, 95% CI: 1.629-3.232; OR=1.628, 95% CI: 1.149-2.306), suffering from a chronic disease ( OR=3.110, 95% CI: 1.918-5.042), and having a contracted family doctor ( OR=1.870, 95% CI: 1.431-2.442) were all positive correlation with health management perception(all P<0.05). In terms of health care behavior, 908 (63.2%) residents showed a high active intention to seek medical care, and 906 (63.1%) and 796 (55.4%) residents showed active participation in medical check-ups and timely handling of medical check-up abnormal values, respectively. Residents in the high awareness group were significantly better than those in the low awareness group in terms of intention to seek medical care ( χ2=33.26), mode of medical checkups ( χ2=110.71), frequency of medical checkups ( χ2=45.37), and the way of dealing with abnormal values after medical checkups ( χ2=93.14), with the difference being statistically significant(all P<0.05). The results of linear regression analysis of the factors influencing the medical behavior of community residents showed that age≤44 and 45-59 ( B=0.479, 0.167), high school and specialist versus bachelor′s degree and above ( B=0.465, 0.739), use of employee medical insurance and residents′ health insurance ( B=0.604, 0.420), the number of current chronic diseases 1 ( B=0.919) and contracted family doctor ( B=0.134) of community residents′ health care behaviors are better (all P<0.05). Conclusions:The level of community residents′ health management cognition needs to be improved, and high health management cognition can significantly promote proactive healthcare-seeking behavior. However, residents′ medical behavior is still influenced by multidimensional factors. Signing a contract with a family doctor is significantly associated with high cognition and quality healthcare behaviors.

Objective:To develop and validate a knowledge-attitude-practice questionnaire for clinical nurses on postoperative thirst management.Methods:From July 2023 to May 2024, based on the theory of knowledge, belief and practice, a preliminary questionnaire was formed after literature review, Delphi expert consultation and pre-survey. A total of 243 clinical nurses were investigated, and the questionnaire was compiled and the reliability and validity were tested.Results:The questionnaire was composed of 31 items in three dimensions of knowledge, attitude and behavior. The cumulative variance contribution rate of the three factors in exploratory factor analysis was 76.130%. The overall Cronbach′s α coefficient was 0.965. The test-retest reliability was 0.913. The items of the questionnaire ranged from 0.857 to 1.000, and the questionnaire was 0.968. Conclusions:The questionnaire has good reliability and validity, which is suitable for clinical nurses to investigate the knowledge, attitude and behavior of postoperative thirst management.