Multi-stage optimization strategy based on contextual analysis to create M-health components for case management model in breast cancer transitional care: the CMBM study as an example.

BACKGROUND: None of the early M-Health applications are designed for case management care services. This study aims to describe the process of developing a M-health component for the case management model in breast cancer transitional care and to highlight methods for solving the common obstacles faced during the application of M-health nursing service. METHODS: We followed a four-step process: (a) Forming a cross-functional interdisciplinary development team containing two sub-teams, one for content development and the other for software development. (b) Applying self-management theory as the theoretical framework to develop the M-health application, using contextual analysis to gain a comprehensive understanding of the case management needs of oncology nursing specialists and the supportive care needs of out-of-hospital breast cancer patients. We validated the preliminary concepts of the framework and functionality of the M-health application through multiple interdisciplinary team discussions. (c) Adopting a multi-stage optimization strategy consisting of three progressive stages: screening, refining, and confirmation to develop and continually improve the WeChat mini-programs. (d) Following the user-centered principle throughout the development process and involving oncology nursing specialists and breast cancer patients at every stage. RESULTS: Through a continuous, iterative development process and rigorous testing, we have developed patient-end and nurse-end program for breast cancer case management. The patient-end program contains four functional modules: "Information", "Interaction", "Management", and "My", while the nurse-end program includes three functional modules: "Consultation", "Management", and "My". The patient-end program scored 78.75 on the System Usability Scale and showed a 100% task passing rate, indicating that the programs were easy to use. CONCLUSIONS: Based on the contextual analysis, multi-stage optimization strategy, and interdisciplinary team work, a WeChat mini-program has been developed tailored to the requirements of the nurses and patients. This approach leverages the expertise of professionals from multiple disciplines to create effective and evidence-based solutions that can improve patient outcomes and quality of care.

Effect of blood glucose level on the prognosis of breast cancer patients with type 2 diabetes mellitus / 肿瘤研究与临床

Objective To investigate the impact of blood glucose level on the prognosis of breast cancer patients with type 2 diabetes mellitus. Methods Clinical data of 416 breast cancer patients with type 2 diabetes mellitus in Tianjin Medical University Cancer Institute and Hospital from January 2005 to December 2009 were analyzed retrospectively. Patients were divided into 2 groups according to the postprandial 2 hours of blood glucose level (＜11.1 mmol/L and ≥11.1 mmol/L). Clinicopathological characteristics and survival of the two groups were compared. Results There were 310 cases of postprandial 2 hours of blood glucose level (＜11.1 mmol/L), and 106 cases of postprandial 2 hours of blood glucose level (≥11.1 mmol/L) in 416 patients. There was no statistical difference in the clinicopathological features between the two groups (both P＞ 0.05). Univariate analysis showed that the 5-year disease-free survival rate was 81.6 % (253/310) and 67.0 % (71/106) for patients with postprandial 2 hours of blood glucose level＜11.1 mmol/L and postprandial 2 hours of blood glucose level ≥11.1 mmol/L, respectively (χ2= 8.575, P=0.003). The 5-year overall survival rate was 87.7 % (272/310) and 75.5 % (80/106) for patients with postprandial 2 hours of blood glucose level ＜11.1 mmol/L and postprandial 2 hours of blood glucose level≥11.1 mmol/L, respectively (χ2=8.722, P =0.003). Multivariate analysis showed that 2 hours of blood glucose level≥11.1 mmol/L was an independent risk factor of 5-year disease-free survival rate ( HR=1.701, 95 % CI 1.110-2.604, P= 0.015) and 5-year overall survival rate ( HR= 1.972, 95 % CI 1.186-3.279, P= 0.009) for diabetic breast cancer patients. Conclusion The poor control of blood glucose level for the breast cancer patients complicated with type 2 diabetes is related with the increased risk of 5-year recurrence and death, which requires to strictly control the blood glucose level for improving the prognosis of type 2 diabetic breast cancer patients.

Comparison of two surgical approaches in treatment of calcaneal fracture / 中国医师进修杂志

Objective To compare sinus tarsi approach(STA) and extensile L shape approach (ELA) in the surgical treatment of calcaneal fractures. Methods A total of 51 cases of calcaneal fractures treated from May 2014 to December 2016 were enrolled. Twenty of them were performed ORIF via the sinus tarsi approach, while the other 31 cases were performed ORIF via lateral extensile L shape approach. X-ray films were taken postoperatively to record the changes of B?hler angle and Gissane angle. The AOFAS, VAS and SF-36 scores were adopted to assess the therapeutic effect. Results The average follow-up period of STA group was 15.5 months. And patients in ELA group were followed up for an average period of 18.4 months. All the fractures in the series had a boney union at or before the final follow-up. The final correction of B?hler angle (34.60 ± 2.91)° , and Gissane angle (114.45 ± 2.91)° was significantly increased in the STA group; and the final correction of B?hler angle (33.55 ± 2.73)° , and Gissane angle (112.81 ± 4.15)° was also significantly increased in the ELA group; while there was no significant difference between the two groups. The final AOFAS scores , VAS scores and SF-36 scores of the STA were (83.56 ± 7.13), (1.78 ± 0.89), (88.95 ± 4.31) scores, while those in ELA group were (81.91 ± 9.89), (2.01 ± 1.33) and (86.65 ± 4.95) scores. There was no significant difference between the two groups (P>0.05). No wound problem happened in STA group, but there were 2 cases who had wound complications in ELA group. Conclusions No significant difference is found between the two groups in the short-term efficacy of the treatment for calaneal fracture. However, STA has the advantages of lower soft tissue complication rate.

Molecular Characterization of the Duck Enteritis Virus UL4 Gene / 中国病毒学·英文版

Duck enteritis virus (DEV) is a herpesvirus that causes an acute, contagious and fatal disease. In the present article, the DEV UL4 gene was cloned and sequenced from a vaccine virus. A degenerate oligonucleotide primer for the consensus site of herpesvirus UL3 gene and a specific primer located in UL5 were used in the polymerase chain reaction (PCR) to amplify a DNA product 2 086 bp in size. DNA sequence analysis revealed that a 714 bp open reading frame (ORF) of DEV encoding a 237 amino acid polypeptide is homologous to the family of herpesvirus UL4 proteins and therefore has been characterized as a DEV UL4 gene. Alignment of the DEV UL4 protein sequence with those of other alphaherpesviruses showed that 10 amino acid residues are completely conserved. Phylogenetic tree analysis showed that the seventeen alphaherpesviruses viruses analyzed were classified into four large groups, and the duck enteritis virus branched separately, closely related to the Mardiviruses group comprising Gallid herpesvirus 2 (GaHV-2), Gallid herpesvirus 3 (GaHV-3) and Meleagrid herpesvirus 1 (MeHV-1). The present study showed that the evolutionary relationship of the UL4 protein could be used for classification of alphaherpesviruses.

Causes analysis and management of postoperative complications after femoral fractures treated with interlocking intramedullary nails / 中国矫形外科杂志

[Objective]To investigate the causes and treatment methods of postoperative complications of femoral fractures treated with interlocking intramedullary nails.[Method]A total of 243 cases of femoral fractures from Jan 1999 to Dec 2004 were treated with interlocking intramedullary nails.There were 14 cases having complications,delayed union in 1,nonunion in 3,nailing failure in 6(locking scerw loosen in 4,locking scerw folding in 1,locking scerw breakage in 2),nail breakage in 1,re-fracture in 1 and knee ankylosis in 1.Two cases with delayed union to convert the fixation from statictody namicin time;3 cases with nonunion were treated with bone grafting.Breakage nail and re-fractuer cases were treated with enlarging intramedullary tunels,exchanging nails and bone grafting.One of locking scerw loosen were treated with exchanging nails and bone grafting.Knee ankylosis were treated with quadriceps plasty.[Result]Through treatment,the delayed union and the nonunion were all healed and got recovery of knee function.[Conclusion]Though it has certain complications,the interlocking intramedullary nails used for femoral fractures have more advantages than other internal fixations.It needs to take valid measures to reach a satisfying result when complication appears.

Surgical treatment of the complex fractures of the tibial plateau / 中华创伤骨科杂志

Objective To study surgical treatment of complex fractures of the tibial plateau. Methods Forty eight cases of complex fractures of the tibial plateau were treated with internal fixation from January 1997 to December 2001. According to Schatzker classification, 12 cases were type Ⅲ, 9 cases type Ⅳ, 14 cases type Ⅴand 13 cases type Ⅵ. They were treated with open reduction and internal fixation with buttress plates and allograft implantation for defective fractures. Results Forty six cases of the forty eight were followed up for 1 to 4 years. The excellent and good rate was 77%. Conclusion The complex fractures of the tibia plateau should be treated surgically, and the operation procedures should be varied according to the fracture types.

Herbert screw treating displaced radial head fractures and a review of literatures / 中华创伤杂志

Objective To evaluate advantages of the Herbert screw in treating displaced radial head fractures. Methods The Herbert screw was used to treat 25 segmental fractures of the radial head from since 1991 and the results were compared with those of other treatment methods mentioned in the literature. Results A follow up averaging 6 years and 8 months showed that postoperative function was all excellent or good and that most cases recovered to normal absolutely, without complications. Conclusions The Herbert screw provides such rigid internal fixation for displaced radial head fractures that, after operation, a plaster cast is rarely required and most patients are able to return to work within a few weeks. This method of treatment appears to offer significant advantages over conventional techniques.