The success of implementation research is closely tied to the institution's pre-implementation readiness. This study aims to explore the organizational readiness for change (ORC) and its influencing factors on primary healthcare settings in the implementation of the "Shared Medical Appointment for Diabetes (SMART) in China: design of an optimization trial" and to enhance ORC and provide insights to support the effective implementation of the program.

This study aimed to localize the workplace readiness questionnaire (WRQ) and validate its applicability for assessing readiness for implementation of evidence-based practices (EBP) in primary care settings in China. The localization of the instrument will provide a practical instrument for assessing organizational readiness for change (ORC).

Objective: To investigate the implementation of sex education and its influencing factors among preschool teachers in Luzhou City, Sichuan Province, so as to provide insights into promoting the development of sex education, physical and mental health for preschool children. Methods: In January 2022, preschool teachers were sampled in 24 kindergartens in Longmatan District, Naxi District and Hejiang County of Luzhou City using the stratified random cluster sampling method. Demographic information, knowledge, attitudes, implementation of sex education, as well as difficulties, support, and needs in implementing sex education among preschool teachers were collected through questionnaire surveys. Factors affecting practice of sex education by preschool teachers were analyzed using a multivariable logistic regression model. Results: A total of 461 preschool teachers were included, including 456 females (98.92%), and had a median age of 28.00 (interquartile range, 9.50) years. The proportions of preschool teachers with good and pass of knowledge about sex education for preschool children were 10.20% and 57.48%, respectively. The proportions of preschool teachers with positive and general attitudes towards sex education were 28.20% and 36.44%, respectively. A total of 343 preschool teachers had implemented sex education (74.40%). A lack of a relaxed social environment was the main difficulty in carrying out sex education for preschool children (76.14%), while support from parents of preschool children was the primary need for conducting sex education activities (75.27%). Multivariable logistic regression analysis showed that age (>30 years, OR=2.218, 95%CI: 1.256-3.917), kindergarten type (public, OR=2.101, 95%CI: 1.253-3.524), attitude towards sex education (positive, OR=2.083, 95%CI: 1.036-4.187), participation in activities related to sex education (OR=6.355, 95%CI: 3.362-12.015), and communication with parents about sex education (OR=5.399, 95%CI: 3.152-9.248) were influencing factors for practice of sex education by preschool teachers. Conclusions The main difficulty in the practice of sex education for preschool children by preschool teachers in Luzhou City is a lack of a relaxed social environment, and there is a high demand for support from parents. Age, kindergarten type, attitude towards sex education, participation in activities related to sex education, and communication with parents about sex education are associated factors.

In the process of conducting implementation research on health service issues, stakeholders' preference for contents related to evidence-based practice (EBP) and implementation strategies is closely related to whether EBP can be effectively implemented.However, multiple preference assessment methods exist, each with their own strengths, weaknesses, and application scenarios, which makes it challenging for researchers to select appropriate and effective preference assessment methods. This paper aims to review the origins, characteristics, and application scenarios of commonly used preference assessment methods, with the hope of providing valuable reference and lessons for domestic scholars to select and apply appropriate preference assessment methods in implementation research.

In the field of healthcare service, it is crucial to optimize medical innovation services by combining the preferences of health service providers and demanders (i.e., stakeholders). The best-worst scaling (BWS) method is a recently developed stated preference method for assessing preferences with distinctive advantages. Nevertheless, there is a lack of a comprehensive introduction to stakeholder preference assessment using BWS, thus constraining its applications and promotion. This paper introduces the process of using BWS to assess service providers' preferences for the Shared Medical Appointment for diabetes (SMART), an integrated healthcare service of medicine and health management, in the hope of providing reference for researchers for promoting the use of BWS in implementation research.

In the process of conducting implementation research on health service issues, stakeholders' preference for contents related to evidence-based practice (EBP) and implementation strategies is closely related to whether EBP can be effectively implemented.However, multiple preference assessment methods exist, each with their own strengths, weaknesses, and application scenarios, which makes it challenging for researchers to select appropriate and effective preference assessment methods. This paper aims to review the origins, characteristics, and application scenarios of commonly used preference assessment methods, with the hope of providing valuable reference and lessons for domestic scholars to select and apply appropriate preference assessment methods in implementation research.

AIM: To investigate the correlation between axial length and diabetic retinopathy(DR)in patients with type 2 diabetes mellitus.METHODS:This study is a cross-sectional study. A total of 53 cases(104 eyes)of type 2 diabetes patients who admitted to the ophthalmology department of the Jining No.1 People's Hospital between January and May 2023 were included. Among these cases, 51 patients had both eyes included, while 2 patients had only one eye included. The patients were divided into two groups based on the presence or absence of fundus lesions. The non-diabetic retinopathy(NDR)group consisted of 32 eyes, and the DR group consisted of 72 eyes. Within the DR group, the patients were further categorized based on the severity of fundus lesions. The non-proliferative diabetic retinopathy(NPDR)group comprised of 27 eyes, and the proliferative diabetic retinopathy(PDR)group consisted of 45 eyes. The axial lengths of eyes in the DR group were divided into four groups using quartiles: 19 eyes in the 20.00～22.09 mm group, 17 eyes in the 22.10～22.70 mm group, 18 eyes in the 22.71～23.12 mm group, and 18 eyes in the 23.13～24.48 mm group. Binary Logistic regression analysis was employed to investigate the factors influencing the occurrence of DR and PDR.RESULTS:Binary Logistic regression analysis showed that both axial length and age significantly influenced the development of DR and PDR.(Axial length: OR=0.296, 95%CI:0.130～0.672, P<0.05; OR=0.237, 95%CI:0.076～0.736, P<0.05; age: OR=0.949, 95%CI:0.907～0.994, P<0.05; OR=0.879, 95%CI: 0.820～0.942, P<0.05). The risk of PDR in the group with axial length of 23.13～24.48 mm was reduced compared to the group with axial length of 20.00～22.09 mm(OR=0.057; 95%CI: 0.006～0.515, P=0.011).CONCLUSION:The findings indicate that longer axial length in patients with type 2 diabetes are associated with a decreased risk of developing DR, as well as a reduced likelihood of DR progressing to PDR. Therefore, a long axial length can be considered a protective factor against DR.

Objectives: To construct a nomogram for prediction of intrahepatic cholangiocarcinoma (ICC) lymph node metastasis based on inflammation-related markers,and to conduct its clinical verification. Methods: Clinical and pathological data of 858 ICC patients who underwent radical resection were retrospectively collected at 10 domestic tertiary hospitals in China from January 2010 to December 2018. Among the 508 patients who underwent lymph node dissection,207 cases had complete variable clinical data for constructing the nomogram,including 84 males,123 females,109 patients≥60 years old,98 patients<60 years old and 69 patients were pathologically diagnosed with positive lymph nodes after surgery. Receiver operating characteristic curve was drawn to calculate the accuracy of preoperative imaging examinations to determine lymph node status,and the difference in overall survival time was compared by Log-rank test. Partial regression squares and statistically significant preoperative variables were screened by backward stepwise regression analysis. R software was applied to construct a nomogram,clinical decision curve and clinical influence curve,and Bootstrap method was used for internal verification. Moreover,retrospectively collecting clinical information of 107 ICC patients with intraoperative lymph node dissection admitted to 9 tertiary hospitals in China from January 2019 to June 2021 was for external verification to verify the accuracy of the nomogram. 80 patients with complete clinical data but without lymph node dissection were divided into lymph node metastasis high-risk group and low-risk group according to the score of the nomogram among the 858 patients. Log-rank test was used to compare the overall survival of patients with or without lymph node metastasis diagnosed by pathology. Results: The area under the curve of preoperative imaging examinations for lymph node status assessment of 440 patients was 0.615,with a false negative rate of 62.8% (113/180) and a false positive rate of 14.2% (37/260). The median survival time of 207 patients used to construct a nomogram with positive or negative postoperative pathological lymph node metastases was 18.5 months and 27.1 months,respectively (P<0.05). Five variables related to lymph node metastasis were screened out by backward stepwise regression analysis,which were combined calculi,neutrophil/lymphocyte ratio,albumin,liver capsule invasion and systemic immune inflammation index,according to which a nomogram was constructed with concordance index(C-index) of 0.737 (95%CI: 0.667 to 0.806). The C-index of external verification was 0.674 (95%CI:0.569 to 0.779). The calibration prediction curve was in good agreement with the reference curve. The results of the clinical decision curve showed that when the risk threshold of high lymph node metastasis in the nomogram was set to about 0.32,the maximum net benefit could be obtained by 0.11,and the cost/benefit ratio was 1∶2. The results of clinical influence curve showed that when the risk threshold of high lymph node metastasis in the nomogram was set to about 0.6,the probability of correctly predicting lymph node metastasis could reach more than 90%. There was no significant difference in overall survival time between patients with high/low risk of lymph node metastasis assessed by the nomogram and those with pathologically confirmed lymph node metastasis or without lymph node metastasis (Log-rank test:P=0.082 and 0.510,respectively). Conclusion: The prediction accuracy of preoperative nomogram for ICC lymph node metastasis based on inflammation-related markers is satisfactory,which can be used as a supplementary method for preoperative diagnosis of lymph node metastasis and is helpful for clinicians to make personalized decision of lymph node dissection for patients with ICC.

Development of extramural health care for chronic wounds is still in its infancy in China, and thus it is urgent and vital to establish a correct concept and practicable principles. The authors reviewed recent domestic and international literature and summarized the following treatment procedures and principles for extramural health care of chronic wounds. (1) The patient needs to do self-assessment of the wound by using available simple methods; (2) The patient consults with professional physicians or nurses on wound care to define the severity and etiology of the non-healing wound; (3) Professionals evaluate the existing treatment strategies; (4) Etiological treatments are given by professionals; (5) Patients buy needed dressings via the more convenient ways from pharmacies, e-commerce platform or others; (6) Professionals provide a standardized and reasonable therapeutic plan based on the patient's wound conditions; (7) Both professionals and the patient pay attention to complications to prevent adverse outcomes; (8) Professionals strengthen the public education on wound care and integrated rehabilitation. This review expected to provide new perspectives on the therapeutic strategies for chronic wounds in an extramural setting.
Humans ; Wound Healing ; Health Facilities ; Delivery of Health Care ; China ; Wounds and Injuries/therapy*

Humans ; Intestinal Polyps ; Colonic Polyps/surgery* ; Intestinal Polyposis ; Colorectal Neoplasms