Objective:From the perspective of behavioral economics,it analyzes the reasons for the low utilization rate of palliative care and propose intervention measures,to promote the acceptance and application of palliative care by terminal cancer patients and their families.Methods:Using the theories and methods of behavioral economics to explore how cognitive and behavioral biases lead to irrational medical decisions in the choice of palliative care;based on the dual-process theory and nudge method,it aims to construct an intervention model for"palliative"care decision-making and propose intervention strategies.Results:Terminal cancer patients and their families with bounded rationality tend to prefer short-term aggressive treatment plans while making decisions,and use the extension of survival as the decision anchor point,weakening the influence of quality of life factors.The lack of sound mechanisms related to palliative care will further increase the cognitive bias of cancer patients and their families,putting them in a negative choice framework and risking losses,leading to the abandonment of more rational palliative care plans.Conclusion:By adopting the"perceptual-rational"thinking from the dual-process theory,transforming inter-temporal selection into the most cost-effective option,anchoring treatment expectations to patients'quality of life,increasing the value of palliative care benefits,and constructing a supportive selection framework as a target for intervention,it can help promote the use of palliative care.

Objective:From the perspective of behavioral economics,it analyzes the reasons for the low utilization rate of palliative care and propose intervention measures,to promote the acceptance and application of palliative care by terminal cancer patients and their families.Methods:Using the theories and methods of behavioral economics to explore how cognitive and behavioral biases lead to irrational medical decisions in the choice of palliative care;based on the dual-process theory and nudge method,it aims to construct an intervention model for"palliative"care decision-making and propose intervention strategies.Results:Terminal cancer patients and their families with bounded rationality tend to prefer short-term aggressive treatment plans while making decisions,and use the extension of survival as the decision anchor point,weakening the influence of quality of life factors.The lack of sound mechanisms related to palliative care will further increase the cognitive bias of cancer patients and their families,putting them in a negative choice framework and risking losses,leading to the abandonment of more rational palliative care plans.Conclusion:By adopting the"perceptual-rational"thinking from the dual-process theory,transforming inter-temporal selection into the most cost-effective option,anchoring treatment expectations to patients'quality of life,increasing the value of palliative care benefits,and constructing a supportive selection framework as a target for intervention,it can help promote the use of palliative care.

Objective:From the perspective of behavioral economics,it analyzes the reasons for the low utilization rate of palliative care and propose intervention measures,to promote the acceptance and application of palliative care by terminal cancer patients and their families.Methods:Using the theories and methods of behavioral economics to explore how cognitive and behavioral biases lead to irrational medical decisions in the choice of palliative care;based on the dual-process theory and nudge method,it aims to construct an intervention model for"palliative"care decision-making and propose intervention strategies.Results:Terminal cancer patients and their families with bounded rationality tend to prefer short-term aggressive treatment plans while making decisions,and use the extension of survival as the decision anchor point,weakening the influence of quality of life factors.The lack of sound mechanisms related to palliative care will further increase the cognitive bias of cancer patients and their families,putting them in a negative choice framework and risking losses,leading to the abandonment of more rational palliative care plans.Conclusion:By adopting the"perceptual-rational"thinking from the dual-process theory,transforming inter-temporal selection into the most cost-effective option,anchoring treatment expectations to patients'quality of life,increasing the value of palliative care benefits,and constructing a supportive selection framework as a target for intervention,it can help promote the use of palliative care.

Objective:From the perspective of behavioral economics,it analyzes the reasons for the low utilization rate of palliative care and propose intervention measures,to promote the acceptance and application of palliative care by terminal cancer patients and their families.Methods:Using the theories and methods of behavioral economics to explore how cognitive and behavioral biases lead to irrational medical decisions in the choice of palliative care;based on the dual-process theory and nudge method,it aims to construct an intervention model for"palliative"care decision-making and propose intervention strategies.Results:Terminal cancer patients and their families with bounded rationality tend to prefer short-term aggressive treatment plans while making decisions,and use the extension of survival as the decision anchor point,weakening the influence of quality of life factors.The lack of sound mechanisms related to palliative care will further increase the cognitive bias of cancer patients and their families,putting them in a negative choice framework and risking losses,leading to the abandonment of more rational palliative care plans.Conclusion:By adopting the"perceptual-rational"thinking from the dual-process theory,transforming inter-temporal selection into the most cost-effective option,anchoring treatment expectations to patients'quality of life,increasing the value of palliative care benefits,and constructing a supportive selection framework as a target for intervention,it can help promote the use of palliative care.

Objective:From the perspective of behavioral economics,it analyzes the reasons for the low utilization rate of palliative care and propose intervention measures,to promote the acceptance and application of palliative care by terminal cancer patients and their families.Methods:Using the theories and methods of behavioral economics to explore how cognitive and behavioral biases lead to irrational medical decisions in the choice of palliative care;based on the dual-process theory and nudge method,it aims to construct an intervention model for"palliative"care decision-making and propose intervention strategies.Results:Terminal cancer patients and their families with bounded rationality tend to prefer short-term aggressive treatment plans while making decisions,and use the extension of survival as the decision anchor point,weakening the influence of quality of life factors.The lack of sound mechanisms related to palliative care will further increase the cognitive bias of cancer patients and their families,putting them in a negative choice framework and risking losses,leading to the abandonment of more rational palliative care plans.Conclusion:By adopting the"perceptual-rational"thinking from the dual-process theory,transforming inter-temporal selection into the most cost-effective option,anchoring treatment expectations to patients'quality of life,increasing the value of palliative care benefits,and constructing a supportive selection framework as a target for intervention,it can help promote the use of palliative care.

Objective:From the perspective of behavioral economics,it analyzes the reasons for the low utilization rate of palliative care and propose intervention measures,to promote the acceptance and application of palliative care by terminal cancer patients and their families.Methods:Using the theories and methods of behavioral economics to explore how cognitive and behavioral biases lead to irrational medical decisions in the choice of palliative care;based on the dual-process theory and nudge method,it aims to construct an intervention model for"palliative"care decision-making and propose intervention strategies.Results:Terminal cancer patients and their families with bounded rationality tend to prefer short-term aggressive treatment plans while making decisions,and use the extension of survival as the decision anchor point,weakening the influence of quality of life factors.The lack of sound mechanisms related to palliative care will further increase the cognitive bias of cancer patients and their families,putting them in a negative choice framework and risking losses,leading to the abandonment of more rational palliative care plans.Conclusion:By adopting the"perceptual-rational"thinking from the dual-process theory,transforming inter-temporal selection into the most cost-effective option,anchoring treatment expectations to patients'quality of life,increasing the value of palliative care benefits,and constructing a supportive selection framework as a target for intervention,it can help promote the use of palliative care.

Objective:To examine the efficacy and experience of staged and segmented two hybrid surgeries for total repair of Debakey type Ⅰ aortic dissection (TIAD).Methods:This study was a retrospective case series. The clinic data of 10 patients with acute TIAD who were admitted to the Department of Cardiac Surgery, Second Hospital of Lanzhou University or the First People′s Hospital of Lanzhou, between January 2016 and August 2022, were retrospectively studied. Ten patients underwent hybrid surgeries in two hospitalizations (stages), including 7 males and 3 females with an age of (60±7) years (range: 49 to 71 years). In stage 1, the first type Ⅱ hybrid arch repair was performed to treat the ascending, total arch, and descending thoracic aorta for acute TIAD without circulatory arrest. In stage 2, the second hybrid surgery including infrarenal abdominal aorta replacement, visceral arteries bypass and endovascular thoracoabdominal aortic repair was performed to treat residual thoracoabdominal aortic dissection after the first hybrid operation (segmented). Basic data, preoperative concomitant diseases, high-risk factors, surgical approaches and postoperative complications of all important organs, as well as CT imaging were analyzed.Results:There was no death in the 20 hybrid surgical procedures. In stage 1 type Ⅱ hybrid surgery, 4 cases underwent reconstruction of the aortic sinutubular junction, while Bentall and David surgery was performed for 3 cases, respectively. A patient received coronary artery bypass grafting. Then all patients were sequentially treated with arch debranching and thoracic aortic endovascular repair. Postoperative complications included renal insufficiency (4/10), hemofiltration (1/10), hypoxemia (4/10), neurologic event (1/10) and type Ⅱ endoleak (1/10). Complete false lumen thrombosis occurred in 9/10 of the patients. All complications recovered successfully at discharge and the average hospital stay was (21±4) days (range: 16 to 28 days) in the first hospitalization. At stage 2, the second hybrid surgery was successfully performed in all patients. No paraplegia, hepatic or renal insufficiency, or endoleak occurred. However, branch graft embolism of the left renal artery was found in one patient 3 days after laparotomy, as well as of superior mesenteric artery in another. Superior mesenteric artery occlusion was successfully treated by endovascular recanalization. Complete false lumen thrombosis occurred in all patients. Although all patients had different degrees of intestinal dysfunction, they were gradually relieved at discharge, and the average hospital stay was (19±2)days (range:16 to 21 days) in the second hospitalization. During follow-up, CT angiography showed aortic remodeling in all patients.Conclusion:Staged and segmented two hybrid surgeries are safe and feasible for total repair of Debakey type Ⅰ aortic dissection and are associated with acceptable early and midterm outcomes.

Objective:To examine the efficacy and experience of staged and segmented two hybrid surgeries for total repair of Debakey type Ⅰ aortic dissection (TIAD).Methods:This study was a retrospective case series. The clinic data of 10 patients with acute TIAD who were admitted to the Department of Cardiac Surgery, Second Hospital of Lanzhou University or the First People′s Hospital of Lanzhou, between January 2016 and August 2022, were retrospectively studied. Ten patients underwent hybrid surgeries in two hospitalizations (stages), including 7 males and 3 females with an age of (60±7) years (range: 49 to 71 years). In stage 1, the first type Ⅱ hybrid arch repair was performed to treat the ascending, total arch, and descending thoracic aorta for acute TIAD without circulatory arrest. In stage 2, the second hybrid surgery including infrarenal abdominal aorta replacement, visceral arteries bypass and endovascular thoracoabdominal aortic repair was performed to treat residual thoracoabdominal aortic dissection after the first hybrid operation (segmented). Basic data, preoperative concomitant diseases, high-risk factors, surgical approaches and postoperative complications of all important organs, as well as CT imaging were analyzed.Results:There was no death in the 20 hybrid surgical procedures. In stage 1 type Ⅱ hybrid surgery, 4 cases underwent reconstruction of the aortic sinutubular junction, while Bentall and David surgery was performed for 3 cases, respectively. A patient received coronary artery bypass grafting. Then all patients were sequentially treated with arch debranching and thoracic aortic endovascular repair. Postoperative complications included renal insufficiency (4/10), hemofiltration (1/10), hypoxemia (4/10), neurologic event (1/10) and type Ⅱ endoleak (1/10). Complete false lumen thrombosis occurred in 9/10 of the patients. All complications recovered successfully at discharge and the average hospital stay was (21±4) days (range: 16 to 28 days) in the first hospitalization. At stage 2, the second hybrid surgery was successfully performed in all patients. No paraplegia, hepatic or renal insufficiency, or endoleak occurred. However, branch graft embolism of the left renal artery was found in one patient 3 days after laparotomy, as well as of superior mesenteric artery in another. Superior mesenteric artery occlusion was successfully treated by endovascular recanalization. Complete false lumen thrombosis occurred in all patients. Although all patients had different degrees of intestinal dysfunction, they were gradually relieved at discharge, and the average hospital stay was (19±2)days (range:16 to 21 days) in the second hospitalization. During follow-up, CT angiography showed aortic remodeling in all patients.Conclusion:Staged and segmented two hybrid surgeries are safe and feasible for total repair of Debakey type Ⅰ aortic dissection and are associated with acceptable early and midterm outcomes.

Background and Aims:The repair of giant incisional hernia is challenging,as closing the significant defect in the abdominal wall can lead to life-threatening complications like abdominal compartment syndrome(ACS).Botulinum toxin type A(BTA)can temporarily relax the abdominal wall muscles,facilitating defect repair,while preoperative progressive pneumoperitoneum(PPP)can increase intra-abdominal volume,reducing intra-abdominal pressure caused by hernia content reintegration.Combining BTA with PPP for the preoperative preparation of giant incisional hernia repair may have a complementary effect.This study was conducted to evaluate the clinical value of combining BTA and PPP in the repair of giant abdominal incisional hernia. Methods:The clinical data of 213 patients with giant abdominal incisional hernia treated at the Sixth Affiliated Hospital of Sun Yat-sen University from December 2015 to December 2019 were retrospectively analyzed.Two weeks after receiving combined BTA and PPP treatment,changes in bilateral abdominal wall muscle,intra-abdominal adhesions,abdominal circumference,abdominal cavity volume,and hernia sac volume ratio were assessed using CT.Intraoperative details,incidence of complications,and postoperative follow-up outcomes were recorded. Results:Following combined BTA and PPP treatment,CT scan showed a significant extension of bilateral lateral abdominal wall muscles towards the midline in all 213 patients,with an average increase of 2.45(1.53-3.29)cm on the left side and 2.54(1.68-3.40)cm on the right side;muscle thickness was reduced by an average of 0.84(0.64-1.00)cm on the left and 0.82(0.62-1.05)cm on the right,the average distance between viscera and the abdominal wall increased to(7.52±1.78)cm,with a mean increase of 6.1(4.2-6.9)cm;the mean increase in abdominal cavity volume was 1 802(1 494.98-2 316.26)mL,and the hernia sac volume ratio decreased by an average of 9％(6％-12％),all changes were statistically significant(P＜0.05).Post-PPP CT scan revealed no abdominal adhesions in 18 patients(8.45％),while 195 patients(91.55％)had varying degrees of adhesions,including 39 cases(18.31％)of sheet adhesions and 156 cases(73.24％)of mixed adhesions.Adhesions mainly consisted of omentum and intestinal tissues in 59.15％of cases.There were 43 cases(20.19％)of grade Ⅰ complications during the BTA-PPP process,including abdominal pain(28 cases),shoulder pain(9 cases),subcutaneous emphysema(6 cases),and dyspnea(3 cases).Dyspnea improved with oxygen therapy,while other complications required no special intervention.All 213 patients successfully underwent laparoscopic incisional hernia repair without conversion to open surgery or organ resection for volume reduction.Fascial closure was achieved in 209 cases(98.12％),with 4 cases(1.88％)having incomplete defect closure.The average time for adhesiolysis was 28(11.00-44.50)min,with a total operative time of 178.0(132.50-255.00)min and an average blood loss of 20(10-30)mL.The median intra-abdominal pressure(IAP)after operation was between 10 mmHg(9.00-12.00 mmHg),Among them,47 cases(22.07％)had IAP exceeding 12 mmHg,and after implementing proactive measures such as diuresis and diachoresis to reduce intra-abdominal contents,the IAP in these patients decreased to below 12 mmHg.No severe complications such as skin flap necrosis or ACS were observed.There were no deaths within postoperative 30 d,and during a follow-up period of 26(16.50-33.00)months,13 cases(6.10％)had surgical site events,including infections in 5 cases(2.35％),seromas in 7 cases(3.29％),and hematoma in 1 case(0.47％),with no hernia recurrence. Conclusion:The combination of BTA and PPP not only aids in identifying abdominal wall adhesion areas,improving preoperative surgical planning and enhancing surgical safety,but also significantly increases abdominal cavity volume and extends lateral abdominal wall muscles,facilitating the closure of giant incisional hernia defects and reducing the incidence of severe postoperative complications like ACS.This approach is worthy of clinical promotion.

Objective:To explore the factors influencing the supportive communication ability of medical undergraduates, and to propose strategies to improve supportive communication.Methods:By cluster sampling, we selected 388 medical undergraduates of grades 2017 and 2018 from Harbin Medical University for a questionnaire survey on supportive communication, general self-efficacy, and health education abilities. SPSS 22.0 was used for descriptive statistical analysis. AMOS 22.0 was used to construct a structural equation model to verify the relationship between the three variables. Mediating effects were also tested.Results:The students showed good supportive communication ability, with a total score of (74.28±10.84) points. The general self-efficacy score was (27.81±5.58) points, and the total score of health education ability was (25.50±4.76) points. General self-efficacy had direct positive effects on supportive communication and health education abilities ( β=0.75, 0.31, both P<0.001). Health education ability had a direct positive effect on supportive communication ability ( β=0.14, P<0.001). Health education ability played a significant mediating role in the influence of general self-efficacy on supportive communication ability (standardized mediating effect value=0.042, P<0.01), with the mediating effect accounting for 5.1%. Conclusions:The health education competency of medical undergraduates can mediate the effect of general self-efficacy on supportive communication ability. By strengthening medical humanities education to increase general self-efficacy and also emphasizing the cultivation of health education competency, the supportive communication ability of students can be improved.