Staging Sequential Treatment of Ischemic Stroke Based on Syndrome Differentiation of Deficiency and Excess in Eight Principles / 中国实验方剂学杂志

The core of diagnosing and treating diseases in traditional Chinese medicine lies in syndrome differentiation. The eight principles of syndrome differentiation serve as guidance for syndrome differentiation. As one of the eight principles of syndrome differentiation， the differentiation of deficiency and excess is the basic and critical method. Ischemic stroke is currently the leading cause harming the health of Chinese residents. Although the hypotheses about the cause of ischemic stroke have evolved from external wind to the later internal wind and to the modern theory of toxin damaging the brain collaterals， they all believe that this disease is rooted in internal deficiency and external excess. According to available studies， although stroke is characterized by complex pathogenesis and rapid progression of syndromes， the key cause evolution has a regularity， that is， from excess to deficiency. This article analyzes the historical evolution of the etiology， pathogenesis， and syndrome differentiation schemes of stroke. There are diverse schemes for the syndrome differentiation of stroke， which make it difficult to choose in clinical practice. In view of this problem， this paper puts forward a new approach of staging sequential treatment of ischemic stroke based on the differentiation of deficiency and excess according to the evolution law of the key cause of stroke. Furthermore， we conducted a randomized controlled study on 100 patients with ischemic stroke to evaluate this new approach. The results showed that the staging sequential treatment of ischemic stroke based on the differentiation of deficiency and excess demonstrated definite clinical efficacy. In addition， this article reviews the previous research results of our team and the research achievements of other teams to preliminarily explore the relationship between stroke syndromes and biomarkers， aiming to provide an objective basis for unveiling the pathogenesis of stroke. In summary， according to the key cause evolution （from excess to deficiency）， the treatment of ischemic stroke by stages based on differentiation of deficiency and excess can facilitate the rapid intervention and improve the clinical efficacy on ischemic stroke.

Research progress on dental materials for preventing root caries / 口腔疾病防治

@#The high incidence and untreated rate of root caries, a common and frequently occurring oral disease with challenging treatment in elderly individuals, is the main cause of tooth loss among elderly people, as rapid development results in pulpitis and periapical periodontitis or residual crown and root, which has been regarded as one of the common chronic oral diseases seriously affecting the quality of life of elderly people. Thus, early intervention and prevention are important. Traditional dental materials for preventing root caries have been widely used in clinical practice; however, they have the disadvantages of tooth coloring, remineralization and low sterilization efficiency. A series of new dental materials for preventing root caries have gradually become a research hotspot recently, which have the advantages of promoting the mineralization of deep dental tissue, prolonging the action time and enhancing adhesion. Future caries prevention materials should be designed according to the characteristics of root surface caries and the application population and should be developed toward simplicity, high efficiency and low toxicity. This review describes current research regarding anti-caries prevention material application, serving as a theoretical underpinning for the research of root caries prevention materials, which is important for both promotion in the effective prevention of root caries and improvement in the status of oral health and the quality of life among old people.

Assessment of the learning curve of peribulbar blocks using the Learning-Curve Cumulative Sum Method (LC-CUSUM): an observational study

Abstract Introduction: This study aimed to assess the learning curves of peribulbar anesthesia and estimate the number of blocks needed to attain proficiency. Methods: Anonymized records of sequential peribulbar blocks performed by first-year anesthesia residents were analyzed. The block sequential number and the outcomes were extracted from each record. Success was defined as a complete sensory and motor block of the eye, and failure was defined as an incomplete block requiring supplemental local anesthetic injections or general anesthesia. Learning curves using the LC-CUSUM method were constructed, aiming for acceptable and unacceptable failure rates of 10% and 20%, and 10% probability of type I and II errors. Simulations were used to determine the proficiency limit h0. Residents whose curves reached h0 were considered proficient. The Sequential Probability Ratio Test Cumulative Sum Method (SPRT-CUSUM) was used for follow-up. Results: Thirty-nine residents performed 2076 blocks (median = 52 blocks per resident; Interquartile Range (IQR) [range] = 27-78 [4-132]). Thirty residents (77%) achieved proficiency after a median of 13 blocks (13-24 [13-24]). Conclusions: The LC-CUSUM is a robust method for detecting resident proficiency at peribulbar anesthesia, defined as success rates exceeding 90%. Accordingly, 13 to 24 supervised double-injection peribulbar blocks are needed to attain competence at peribulbar anesthesia.

Aplicabilidade de teoria de enfermagem para intervenção práxica na atenção primária à saúde: revisão integrativa / Aplicabilidad de la teoría de enfermería para intervención práxica en la atención primaria de salud: revisión integrante / Applicability of nursing theory for praxis intervention in primary health care: an integrative review

Objetivo: analisar as evidências científicas acerca do uso da Teoria de Intervenção Práxica da Enfermagem em Saúde Coletiva na atenção primária à saúde por meio de estudos de fontes primárias. Método: trata-se de uma revisão integrativa, sem delimitação de tempo e idiomas, com pesquisas nas bases de dados LILACS, MEDLINE/PubMED, CINAHL, SCOPUS, EMBASE e Web of Science e na biblioteca eletrônica SciELO. Resultados: foram incluídos 15 artigos, que se restringiram às fases de captação (nas dimensões estrutural, particular e singular) e interpretação da realidade objetiva, o que evidenciou uma lacuna de conhecimentos quanto à efetividade da teoria em relação à intervenção na realidade objetiva. Considerações finais: a análise das evidências científicas ratificou, apesar da utilização discreta e pontual da Teoria de Intervenção Práxica da Enfermagem em Saúde Coletiva, o seu potencial para o direcionamento das práticas dos enfermeiros na atenção primária à saúde.

Objetivo: analizar las evidencias científicas acerca del uso de la Teoría de Intervención Práxica de la Enfermería en Salud Colectiva en la atención primaria de salud por medio de estudios de fuentes primarias. Método: se trata de una revisión integrativa, sin delimitación de tiempo e idiomas, con investigaciones en las bases de datos LILACS, MEDLINE/PubMED, CINAHL, SCOPUS, EMBASE y Web of Science y en la biblioteca electrónica SciELO. Resultados: se incluyeron 15 artículos, que se restringieron a las fases de captación (en las dimensiones estructural, particular y singular) e interpretación de la realidad objetiva, lo que evidenció una laguna de conocimientos en cuanto a la efectividad de la teoría en relación con la intervención en la realidad objetiva. Consideraciones finales: el análisis de las evidencias científicas ratificó, a pesar de la utilización discreta y puntual de la Teoría de Intervención Práxica de la Enfermería en Salud Colectiva, su potencial para el direccionamiento de las prácticas de los enfermeros en la atención primaria a la salud.

Objective: analyzing the scientific evidence about the use of the Theory of Praxis Intervention of Public Health Nursing in primary health care through studies of primary sources. Method: this is an integrative review, without delimitation of time and languages, with searches in the databases LILACS, MEDLINE/PubMED, CINAHL, SCOPUS, EMBASE and Web of Science and the electronic library SciELO. Results: fifteen articles were included, which were restricted to the phases of capture (in the structural and singular dimensions) and interpretation of the objective reality, which showed a lack of knowledge about the effectiveness of theory in relation to intervention in objective reality. Final considerations: the analysis of scientific evidence confirmed, despite the discrete and punctual use of the Theory of Praxis Intervention of Nursing in Collective Health, its potential for the direction of nurses' practices in primary health care.

A way forward in pulmonary aspiration incidence reduction: ultrasound, mathematics, and worldwide data collection

Abstract Aspiration of gastric contents during induction of general anesthesia remains a significant cause of mortality and morbidity in anesthesia. Recent data show that pulmonary aspiration still accounts for many cases with implications on mortality despite technical and technological evolution. Practical, ethical, and methodological issues prevent high-quality research in the setting of aspiration and rapid sequence induction/intubation, and significant controversy is ongoing. Patients' position, drugs choice, dosing and timing, use of cricoid force, and a reliable risk assessment are widely debated with significant questions still unanswered. We focus our discussion on three approaches to promote a better understanding of rapid sequence induction/intubation and airway management decision-making. Firstly, we review how we can use qualitative and quantitative assessment of fasting status and gastric content with the point-of-care ultrasound as an integral part of preoperative evaluation and planning. Secondly, we propose using imaging-based mathematical models to study different patient positions and aspiration mechanisms, including identifying aspiration triggers. Thirdly, we promote the development of a global data collection system aiming to obtain precise epidemiological data. Therefore, we fill the gap between evidence-based medicine and experts' opinion through easily accessible and diffused computer-based databases. A better understanding of aspiration epidemiology obtained through focused global data gathering systems, the widespread use of ultrasound-based prandial status evaluation, and development of advanced mathematical models might potentially guide safer airway management decision making in the 21st century.

Concepción teórica para favorecer la transferencia de la rapidez de movimientos técnicos en el lanzamiento del martillo

El presente artículo se realizó a partir de detectar insuficiencias teórico-metodológicas y prácticas en el proceso de preparación técnica del lanzador de martillo categoría escolar; por tal razón, se propuso como objetivo general elaborar una concepción teórica para favorecer el entrenamiento en la transferencia de la rapidez de movimientos técnicos de los giros al instante final del lanzamiento del martillo, en atletas categoría escolar de la Eide "Pedro Batista Fonseca" de la provincia de Granma. Para el logro del objetivo antes expuesto se emplearon métodos de la investigación científica como los teóricos, el análisis y síntesis, el hipotético-deductivo y el sistémico estructural funcional; dentro de los empíricos, el análisis de documentos, la observación y la medición y como método matemático-estadístico la estadística descriptiva, además, se utilizó como técnica de investigación la entrevista. La propuesta permitió la sistematización de aquellos elementos relacionados directamente con la transferencia en el deporte y el proceso de entrenamiento del lanzador de martillo; de tal manera se previó, con su aplicación, el perfeccionamiento técnico de los atletas implicados en la investigación, así como un incremento en su rendimiento y resultados deportivos.

O presente artigo foi realizado a partir da detecção de insuficiências teórico-metodológicas e práticas no processo de preparação técnica do arremessador de martelos da categoria escola; por esta razão, foi proposto como objetivo geral elaborar uma concepção teórica para favorecer o treinamento na transferência da velocidade dos movimentos técnicos das voltas para o instante final do arremesso do martelo, na categoria escola atletas do Eide "Pedro Batista Fonseca" da província de Granma. Para alcançar o objetivo acima mencionado, foram utilizados métodos de pesquisa científica, tais como métodos teóricos, de análise e síntese, hipotéticos-dedutivos e estruturais-funcionais sistêmicos; dentro dos métodos empíricos, análise de documentos, observação e medição, e estatística descritiva como método matemático-estatístico; além disso, a entrevista foi utilizada como técnica de pesquisa. A proposta permitiu a sistematização daqueles elementos diretamente relacionados com a transferência no esporte e o processo de treinamento do martelo lançador; de tal forma que, com sua aplicação, foi previsto o aperfeiçoamento técnico dos atletas envolvidos na pesquisa, bem como um aumento de seu desempenho e resultados esportivos.

The present article was carried out from the detection of theoretical-methodological and practical insufficiencies in the process of technical preparation of the school category hammer thrower; For this reason, it was proposed as a general objective to develop a theoretical conception to favor training in the transfer of the speed of technical movements of the turns to the final moment of the hammer throw, in school category athletes of the Eide" Pedro Batista Fonseca" of Granma province. To achieve the aforementioned objective, scientific research methods such as theoretical, analysis and synthesis, hypothetical-deductive and structural-functional systemic were used; within the empirical, the analysis of documents, observation and measurement and as a mathematical-statistical method descriptive statistics, in addition, the interview was used as a research technique. The proposal allowed the systematization of those elements directly related to the transfer in sport and the training process of the hammer thrower; In this way, with its application, the technical improvement of the athletes involved in the research was foreseen, as well as an increase in their performance and sports results.

La dinámica de las tecnologías de la información y el conocimiento, en la Educación Física

Se considera una necesidad, la de promover una nueva imagen de la Educación Física escolar desde el acompañamiento de las tecnologías de la información y el conocimiento, al considerar su esencia informativa, interactiva, comunicativa y su carácter polémico y activo-renovador que proveen a las actividades físico-deportivas de una gran vitalidad en el contexto del aprendizaje del ejercicio físico. Por lo que se propone como objetivo elaborar una estructura metodológica, desde la relación tecnológica-cognitiva-motora, en función de la dinámica de la interacción del escolar con el conocimiento teórico de la Educación Física mediado por el uso de las tecnologías de la información y el conocimiento, en el segundo ciclo de la Educación Primaria. Como resultado, se generó una herramienta didáctica para estimular el conocimiento teórico en la Educación Física, así como el diseño de espacios para su uso como modelo de aprendizaje, encaminado a lograr un equilibrio entre lo tecnológico, lo cognitivo y lo motor en el proceso de enseñanza-aprendizaje. Se emplearon como métodos teóricos el análisis-síntesis y la inducción-deducción, empíricos la observación, la encuesta y la entrevistas y el método matemático-estadístico-descriptivo. Se concluye que la apropiación del conocimiento teórico en un espacio interactivo mediado por herramientas informáticas tuvo un efecto positivo en el aprendizaje del ejercicio físico en los escolares, pues fortaleció el aprendizaje desarrollador e integrador durante el proceso.

SÍNTESE É considerada uma necessidade de promover uma nova imagem da Educação Física escolar a partir do acompanhamento das tecnologias da informação e do conhecimento, considerando a sua essência informativa, interactiva, comunicativa e o seu carácter polémico e activo-renovador que proporcionam às actividades físico-desportivas uma grande vitalidade no contexto da aprendizagem do exercício físico. Portanto, o objectivo é elaborar uma estrutura metodológica, a partir da relação técnico-cognitivo-motora, baseada na dinâmica da interacção do aluno com o conhecimento teórico da Educação Física mediada pela utilização das tecnologias da informação e do conhecimento, no segundo ciclo do Ensino Primário. Como resultado, foi gerada uma ferramenta didáctica para estimular o conhecimento teórico em Educação Física, bem como a concepção de espaços para a sua utilização como modelo de aprendizagem, visando alcançar um equilíbrio entre os aspectos tecnológicos, cognitivos e motores no processo de ensino-aprendizagem. Os métodos teóricos utilizados foram a análise-síntese e indução-dedução, os métodos empíricos foram a observação, o inquérito e as entrevistas, e o método matemático-estatístico-descritivo. Conclui-se que a apropriação de conhecimentos teóricos num espaço interactivo mediado por instrumentos informáticos teve um efeito positivo na aprendizagem do exercício físico nas crianças em idade escolar, uma vez que reforçou a aprendizagem desenvolvimentista e integradora durante o processo.

It is considered a necessity to promote a new image of school Physical Education from the accompaniment of information and knowledge technologies, considering its informative, interactive, communicative essence and its controversial and active-renovating character that they provide to the physical-sporting activities of great vitality in the context of learning physical exercise. Therefore, the objective is to develop a methodological structure, from the technological-cognitive-motor relationship, based on the dynamics of the interaction of the school with the theoretical knowledge of Physical Education mediated by the use of information technologies and knowledge, in the second cycle of Primary Education. As a result, a didactic tool was generated to stimulate theoretical knowledge in Physical Education, as well as the design of spaces for use as a learning model, aimed at achieving a balance between the technological, the cognitive and the motor in the teaching-learning process. Analysis-synthesis and induction-deduction were used as theoretical methods, empirical observation, survey and interviews, as well as the mathematical-statistical-descriptive method. It is concluded that the appropriation of theoretical knowledge in an interactive space mediated by computer tools had a positive effect on the learning of physical exercise in schoolchildren, since it strengthened developer and integrative learning during the process.

Traditional Chinese medicines for non-small cell lung cancer: Therapies and mechanisms / 中草药·英文版

The most common subtype of lung cancer is non-small cell lung cancer (NSCLC), which has a poor prognosis and seriously threatens the health of human beings. The multidisciplinary comprehensive treatment model has gradually become the mainstream of NSCLC treatment. Traditional Chinese medicine (TCM) can be used effectively either as an adjunctive therapy or alone throughout the NSCLC therapy, which has a significant impact on survival, quality of life, and reduction of toxicity. Therefore, this paper reviewed the theoretical basis, the latest clinical application, and combined treatment mechanisms in order to explore the advantage stage of TCM treatment and the synergistic therapeutic mechanisms.

Exploring acupuncture treatment strategies for snoring based on meridian theory / 中国针灸

Starting from the perspective of meridian theory, this article briefly analyzes the meridian pathophysiology of snoring and the relationship between snoring and meridian theory. It proposes that acupuncture treatment for snoring should focus on regulating qi from the shaoyang meridians, harmonizing the spirit by the governor vessel, resolving phlegm through the three yang meridians, and harmonizing qi and blood from the yangming meridians. Additionally, attention is placed on both the root cause and the symptoms, the theory of "four seas". The ultimate goal is to promote the flow of meridian and qi-blood, improve symptoms such as nighttime snoring, poor sleep quality, and daytime sleepiness, and achieve the desired outcome of stopping snoring and ensuring restful sleep.

Progress in the Application of Various Theoretical Models in Advance Care Planning / 中国医学伦理学

Advance care planning (ACP) is an important part of hospice care, a core index of high-quality palliative care, and one of the effective indicators for improving the life quality of end-of-life patients. By reviewing the progress of various theoretical models and their applications in ACP, including planned behavior theory, behavioral change wheel theory, self-determination theory, prospect theory, change theory, and cultural suitability theory, this paper delved into the advantages and limitations of each theoretical model and analyzed its research prospects in future ACP clinical practice to promote researchers’ correct understanding of the role of different theoretical models in various types of studies, with a view to providing new ideas for clinical research on ACP.

Influencing factors of self-management behavior in cancer patients based on a theoretical domain framework / 浙江大学学报·医学版

OBJECTIVES@#To explore the factors that influence self-management behavior in cancer patients based on the theoretical domain framework.@*METHODS@#Studies in Chinese and English about factors influencing self-management behavior in cancer patients were searched from Wanfang database, CNKI, VIP, SinoMed, PubMed, Embase, CINAHL, Web of Science Core Collection, Cochrane library and Medline from inception to June 2022. Two investigators independently identified, extracted data, and collected characteristics and methodology of the studies. Factors were analyzed with Nvivo12, and the theoretical domain framework was mapped to the theoretical domain. Then the secondary node was generalized by theme analysis. Finally, the specific influencing factors were summarized and analyzed.@*RESULTS@#Thirty-four studies were included for analysis. A total of 194 factors were mapped to 13 theoretical domains, and 31 secondary nodes were summarized. Theoretical domains environmental context and resources, social/professional role and identity, and beliefs about consequences were the most common factors. Knowledge, age, self-efficacy, disease stage, social support, gender, economic status and physical status were the most influential factors for self-management in cancer patients.@*CONCLUSIONS@#The influencing factors of self-management of cancer patients involve most of the theoretical domains, are intersectional, multi-source and complex.

L-glutamine supplementation reduced morphological damage in the renal glomerulus of rats with Walker-256 tumor

ABSTRACT Purpose: To evaluate the effects of the experimental subcutaneous Walker-256 tumor and L-glutamine supplementation, an antioxidant, on the glomerular morphology of rats. Methods: Twenty Wistar rats were distributed into four groups (n = 5): control (C); control treated with 2% L-glutamine (CG); rats with Walker-256 tumor (WT); and rats with Walker-256 tumor treated with 2% L-glutamine (WTG). Renal histological samples were submitted to periodic acid-Schiff and Masson's Trichrome staining to analyze glomerular density, morphometry of glomerular components and glomerulosclerosis; and to immunohistochemistry for fibroblast growth factor-2 (FGF-2). Results: WT showed 50% reduction in body mass gain and cachexia index > 10%, while WTG demonstrated reduction in cachexia (p < 0.05). WT revealed reduction of glomerular density, increase in the glomerular tuft area, mesangial area, matrix in the glomerular tuft, decrease in the urinary space and synechia, and consequently higher glomerulosclerosis (p < 0.05). L-glutamine supplementation in the WTG improved glomerular density, and reduced glomerular tuft area, urinary space, mesangial area, and glomerulosclerosis compared to WT(p < 0.05). WT showed higher collagen area and FGF-2 expression compared to C (p < 0.05). WTG presented lower collagen fibers and FGF-2 expression compared to WT (p < 0.05). Conclusions: L-glutamine supplementation reduced cachexia and was beneficial for glomerular morphology of the rats, as well as it reduced kidney damage and improved the remaining glomeruli morphology.

Modelos teóricos: reflexões necessárias / Theoretical models: necessary reflections

RESUMO Objetivo: Apresentar reflexões teórico-metodológicas sobre elaboraçõo, tipos e funções dos modelos teóricos, bem como suas estruturas conceituais e de análise. Métodos: Trata-se de um ensaio cujo processo de coleta do material foi realizado de forma não sistemática, eleito exclusivamente e baseado na linha de argumentaçõo e reflexão que os autores pretendem submeter à apreciaçõo e ao debate público. Resultados: Este trabalho apresenta reflexões sobre tipos e funções dos modelos teóricos, fundamentaçõo teórica nas pesquisas e reflexões sobre a importância dos modelos teóricos para as pesquisas em saúde pública e sua relaçõo com o processo de elaboraçõo, desenvolvimento e relato nos estudos científicos. Além disso, são descritos tipos de modelos teóricos referentes aos planos conceitual e empírico, e a importante elaboraçõo e descriçõo da junçõo de ambos para o fazer científico. Conclusão: Espera-se que este artigo levante discussões e reflexões sobre os métodos atuais que permeiam o fazer científico e fomentem a utilizaçõo dos modelos teóricos como base das pesquisas científicas em seu processo de elaboraçõo, desenvolvimento e relato.

ABSTRACT Objective: To present theoretical-methodological reflections on the elaboration, types, and functions of theoretical models as well as their conceptual and analytic frameworks. Methods: This is an essay, whose material collection was carried out in a non-systematic way, by electing studies exclusively based on the line of argument and reflection that the authors intend to submit to appreciation and public debate. Results: We present reflections on the types and functions of theoretical models, theoretical foundations in research, and reflections on the importance of theoretical models for public health research and their relation with the process of elaboration, development, and reporting in scientific studies. In addition, we describe types of theoretical models referring to the conceptual and empirical levels and the important elaboration and description of their combination for scientific practice. Conclusion: With this article, our intention is to stimulate discussions and reflections on current methods that permeate scientific practice and encourage the use of Theoretical Models as a basis for scientific research in its elaboration, development, and reporting process.

Evaluación del modelo de calidad de Donabedian en base a los criterios de Chinn y Kramer / Evaluation of the Donabedian quality model based on the Chinn and Kramer criteria

INTRODUCCIÓN: La evaluación de teorías es un proceso crucial para el desarrollo del conocimiento enfermero, permite seleccionar y utilizar la teoría en función de los problemas y fenómenos del cuidado, sin embargo, es escasamente realizada, especialmente en teorías de otras disciplinas. OBJETIVO: Analizar críticamente el modelo de calidad de la atención de salud de Donabedian, a través de la propuesta metodológica de Chinn y Kramer. DESARROLLO: Se realizó un estudio descriptivo-reflexivo del componente teórico y conceptual del modelo de Donabedian, se explica el propósito, conceptos, relaciones, estructura y supuestos. Se continua con la evaluación crítica del modelo, analizada bajo los criterios de claridad, sencillez, generalidad, accesibilidad e importancia, a través de una revisión narrativa de la literatura. CONCLUSIÓN: el modelo es útil para la gestión, los procesos de mejora, evaluación de estrategias y programas. Con valor para enfermería, puesto que coinciden en el significado e importancia otorgada a la calidad de la atención, reconociendo su contribución en la implementación, desarrollo de intervenciones y mejoramiento de la salud.

NTRODUCTION: The evaluation of theories is a crucial process for the development of nursing knowledge, as it allows the selection and use of such theories to address the problems of patient care. However, it is scarcely performed, especially with theoriesfrom disciplines other than nursing. OBJECTIVE: To critically analyze the Donabedian model of health care quality, through the methodological approach of Chinn and Kramer (1999). METHODOLOGY: A descriptive-reflexive study of the theoretical and conceptualcomponent of the Donabedian model was carried out, explaining its purpose, concepts, relationships, structure, and assumptions. A critical evaluation of the model was then conducted, using the criteria of clarity, simplicity, generality, accessibility, and importance, through a narrative review of the literature. CONCLUSIONS: The model is useful for management, improvement processes, and the evaluation of strategies and programs. It is especially valuable for nursing, since it coincides with the meaning and importance given to the quality of nursing care, recognizing its contribution in the development and implementation of interventions and improvement of health.

Articular mobilization promotes improvement in functional and inflammatory parameters in a gouty arthritis model

ABSTRACT Objective Gouty arthritis is characterized by painful inflammation due to the deposition of monosodium urate crystals in joint tissues. Despite available treatments, many patients experience ineffective management and adverse effects. This study evaluated a manual therapy protocol involving passive joint mobilization at the peak of inflammation in a gouty arthritis model using functional and inflammatory parameters. Methods Twenty male Wistar rats, 12 weeks old, were divided into two groups (n=10 each): Gouty Arthritis and Control Groups, which were further subdivided into treated and untreated groups (n=5 each). The Gouty Arthritis Group received intraarticular knee injection of 50µL of monosodium urate crystals, while the Control Group received 50µL of phosphate buffered saline. The treatment involved a 9-minutes session of grade III joint mobilization (according to Maitland). Nociception, grip strength, and edema were evaluated before induction (EV0), 7 hours after assessment (EV1), immediately after treatment (EV2), and 1 hour after treatment (EV3). The animals were euthanized, and synovial fluid was collected to analyze leukocyte migration. Results The model mimicked the signs of the Gouty Arthritis Group, with a decrease in the threshold of nociception and strength and an increase in edema and leukocyte count. The mobilization protocol significantly increased the nociceptive threshold and grip strength and reduced edema; however, it did not reverse the increase in leukocyte count. Conclusion Our results suggest that mobilization promotes analgesia and may modulate the inflammatory process owing to reduced edema and subtle attenuation of cell migration, which contributes to strength gain.

Integrative approach to the development of situation specific theories: theoretical reflection / Enfoque integrativo para el desarrollo de teorías de situación específicas: reflexión teórica / Abordagem integrativa para o desenvolvimento de teorias de situação específica: reflexão teórica

ABSTRACT Objective: reflect on the use of the integrative approach and its contribution as a methodological path for the development of situation specific theories in nursing. Method: reflexive study, considering the methodological framework of Im and Meleis and the possibilities of its incorporation into Brazilian nursing for the development of situation specific theories. Results: the following topics are presented: Integrative approach: possibilities to develop situations specific theories; and, Usefulness of the development of situation specific theories from the integrative approach. The reflection is based on the experience of using the methodological framework for the development of situation specific theories, in addition to discussing the potentialities the framework has regarding the construction of theories that guide nursing care in particular contexts. Conclusion: the integrative approach is underused in the Brazilian context of theory production, despite being a nursing reference. Therefore, it needs to be made visible to strengthen the development of knowledge that represents diverse and specific realities in order to advance in clinical practice.

RESUMEN Objetivo: reflexionar sobre el uso del enfoque integrador y su contribución como camino metodológico para el desarrollo de teorías de situaciones específicas en enfermería. Método: estudio reflexivo, considerando el marco metodológico de Im y Meleis y las posibilidades de su incorporación en la enfermería brasileña para el desarrollo de teorías de situaciones específicas. Resultados: se presentan los siguientes temas: Enfoque integrador: posibilidades de desarrollar teorías de situaciones específicas; y, Utilidad del desarrollo de teorías de situaciones específicas desde el enfoque integrador. La reflexión se basa en la experiencia de utilizar el marco metodológico para el desarrollo de teorías de situaciones específicas, además de discutir las potencialidades que tiene el marco en cuanto a la construcción de teorías que orientan el cuidado de enfermería en contextos particulares. Conclusión: el enfoque integrador está subutilizado en el contexto brasileño de producción teórica, a pesar de ser un referente en enfermería. Por lo tanto, es necesario visibilizarlo para fortalecer el desarrollo de conocimientos que representen realidades diversas y específicas para avanzar en la práctica clínica.

RESUMO Objetivo: refletir sobre a contribuição do uso da abordagem integrativa como caminho metodológico para o desenvolvimento de teorias de situação específica em enfermagem. Método: estudo do tipo reflexivo, considerando o referencial metodológico de Im e Meleis e as possibilidades de sua incorporação pela enfermagem brasileira para o desenvolvimento de teorias de situação específica. Resultado: são apresentados os tópicos: Abordagem integrativa: possibilidades para desenvolver teorias de situação específica; e, Utilidade do desenvolvimento de teorias de situação específicas a partir da abordagem integrativa. A reflexão sustenta-se na experiência de utilização do referencial metodológico para o desenvolvimento de teorias de situação específica, bem como discute o potencial do referencial para a construção de teorias que guiem o cuidado de enfermagem em contextos particulares. Conclusão: a abordagem integrativa é subutilizada no contexto brasileiro de produção de teorias, mesmo sendo um referencial próprio da enfermagem. Por isso, necessita ser visibilizada para fortalecer o desenvolvimento de conhecimento que represente realidades diversas e específicas a fim de avançar na prática clínica.

Reflexão crítica da teoria de Jean Watson: estudo fundamentado no modelo de Chinn e Kramer / Critical reflection of Jean Watson's theory: a based study on the Chinn and Kramer model / Reflexión crítica de la teoría de Jean Watson: un estudio basado en el modelo de Chinn y Kramer

Objetivo: analisar a teoria do Cuidado Humano de Jean Watson, a partir do modelo de reflexão crítica proposto por Chinn e Kramer. Método: estudo teórico- reflexivo, realizado em abril de 2021, a partir do modelo de reflexão crítica elaborado por Chinn e Kramer, com ênfase nos seguintes componentes: clareza, simplicidade, generalidade, acessibilidade e importância da teoria. Resultados: da análise do modelo proposto, observou-se que a teoria do Cuidado Humano de Jean Watson apresenta relativa clareza semântica devido aos seus elementos complexos, no entanto pode ser classificada como geral, acessível, importante, valiosa e útil, podendo assim, ser empregada como importante subsídio para a atuação profissional por sua abrangência de significados e de valor prático. Conclusão: a Teoria do Cuidado Humano pode ser utilizada nas mais diversas situações de cuidados, independentemente da situação de saúde do indivíduo, permitindo a promoção de um cuidado holístico e com atenção aos aspectos biopsicossocioespirituais.

Objective: to analyze Jean Watson's theory of Human Caring, based on the critical reflection model proposed by Chinn and Kramer. Method: theoretical- reflective study, carried out in April 2021, based on the critical reflection model developed by Chinn and Kramer, with emphasis on the following components: clarity, simplicity, generality, accessibility and importance of the theory. Results: from the analysis of the proposed model, it was observed that Jean Watson's theory of Human Caring presents relative semantic clarity due to its complex elements, however it can be classified as general, accessible, important, valuable and useful, thus being able to be used as an important subsidy for professional performance due to its range of meanings and practical value. Conclusion: the Theory of Human Care can be used in the most diverse care situations, regardless of the individual's health situation, allowing the promotion of holistic care and attention to biopsychosocial-spiritual aspects.

Objetivo: analizar la teoría del Cuidado Humano de Jean Watson, a partir del modelo de reflexión crítica propuesto por Chinn y Kramer. Método: estudio teórico- reflexivo, realizado en abril de 2021, a partir del modelo de reflexión crítica desarrollado por Chinn y Kramer, con énfasis en los siguientes componentes: claridad, sencillez, generalidad, accesibilidad e importancia de la teoría. Resultados: del análisis del modelo propuesto, se observó que la teoría del Cuidado Humano de Jean Watson presenta relativa claridad semántica debido a sus elementos complejos, sin embargo, puede clasificarse como general, accesible, importante, valiosa y útil, pudiendo así ser utilizado como un importante subsidio para el desempeño profesional debido a su variedad de significados y valor práctico. Conclusión: la Teoría del Cuidado Humano puede ser utilizada en las más diversas situaciones de cuidado, independientemente de la situación de salud del individuo, permitiendo la promoción del cuidado holístico y la atención a los aspectos biopsicosociales-espirituales.

Theoretical exploration and research pathways of the harmonious symbiotic mechanism in the tiered medical treatment system / 中华医院管理杂志

The tiered medical treatment system stands as a cornerstone in the deepening reforms of China′s medical and health sectors, playing a crucial role in building a healthy China. Exploring the harmonious coexistence mechanism of multiple entities on the supply and demand sides of the tiered diagnosis and treatment system, and promoting the formation of a scientific and reasonable tiered diagnosis and treatment order, has become an urgent public proposition that needs to be answered and has significant social impact. Addressing the challenges in China′s tiered medical treatment system, particularly its need for a more systematic, comprehensive, and collaborative approach, this study is informed by a thorough literature review. Based on the harmonious management and symbiosis theories, the authors proposed a theoretical concept and future research path for the formation of a harmonious symbiotic mechanism in the tiered diagnosis and treatment system, in order to pave the way for exploring the harmonious symbiotic mechanism in the tiered diagnosis and treatment system.

Constructing theory model for medical quality and safety management based on grounded theory / 中华医院管理杂志

Objective:To construct future-oriented theoretical management model for medical quality and patient safety.Methods:Procedure grounded theory was applied to code data including 30 expert interview records from July 2021 to June 2022 and the qualitative analysis results of 71 core literatures in Chinese and English, and then the theoretical model was constructed.Results:After three-level coding, 555 reference points, 249 initial concepts, 41 categories, 27 main categories and 7 core categories related to medical quality and safety management were sorted out, and the theoretical model of SQ (I-SPORT) matrix for medical quality and safety management was constructed. This model extended the traditional dimension in quality and safety management.Conclusions:Regarding medical quality and safety management, on one hand, should focus on the systematic improvement of structure, process, results, reengineering, education and training in terms of management functions; on the other hand, it is necessary to improve the organization, employees, resources, technology and tools, and patient experience in terms of management elements.

Construction of a generalized structure-process-outcome theoretical model of medical quality and safety management in China / 中华医院管理杂志

Objective:To construct a theoretical model of medical quality and safety management based on the current situation of medical quality and safety management mode in China, providing reference for continuous improvement of medical quality and safety management.Methods:The CNKI database was used as the data source to search literature, with a high citation index H=38 as the judgment standard, the core literature related to the quality and safety management in China was selected. Based on the structure-process-outcome (SPO) model, Nvivo qualitative analysis software was used to code and analyze the included literature, sort out the relevant elements of China′s medical quality and safety management, and clarify the logical relationship between the elements, forming a generalized SPO model of China′s medical quality and safety management.Results:Through a systematic summary and review of relevant literature, a generalized SPO model for medical quality and safety management was proposed, including 5 structural elements (organizational structure, personnel management, resource management, informatization, management standards), 2 process elements (management methods, service processes), and 3 outcome elements (patient outcomes, employee outcomes, organizational results). The logical relationships between and within the three major elements were constructed.Conclusions:To improve the level of medical quality and safety management in China, the structural dimension should be focused on clarifying the responsibilities of the main body of quality management, establishing an independent and perfect quality control department, strengthening the investment and construction of information technology, and promoting the implementation of the medical quality management standard; the process dimension should be focused on promoting the rational application of quality management tools; and the outcome dimension should be focused on strengthening the management of patient safety and improving the individual satisfaction.