BackgroundLow anterior resection syndrome (LARS) is a common postoperative complication in patients with low rectal cancer, presenting with a spectrum of bowel dysfunction symptoms, including urgency, incontinence, evacuation disorders, and changes in stool frequency. Pelvic floor muscle training (PFMT) can alleviate LARS, but its effectiveness may be limited by poor accuracy of technique and low adherence during home-based training due to a lack of real-time feedback and monitoring devices. ObjectiveThis study aimed to evaluate the effects of a novel integrated balloon biofeedback device for home-based PFMT on accuracy of technique, adherence, quality of life, and LARS reduction in patients after sphincter-preserving surgery for low rectal cancer. MethodsA nonrandomized controlled trial was conducted among 164 patients with low rectal cancer who underwent temporary ileostomy without neoadjuvant therapy. Participants were assigned by surgical date to an intervention group (n=82) using an adjustable-pressure balloon device with real-time waveform feedback via a mobile app or a control group (n=82) performing PFMT without equipment. PFMT was initiated within 72 hours after temporary ileostomy and continued throughout the stoma period until 1 month after ileostomy reversal. Outcomes including PFMT accuracy of technique, adherence, LARS score and incidence, and quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30) were assessed 1 month after stoma reversal. ResultsAt baseline, major LARS was present in 47.6% (39/82) of patients in the intervention group and 62.2% (51/82) of patients in the control group. Compared with the control group, the intervention group showed significantly higher PFMT training accuracy and adherence (P<.001 in both cases). LARS scores were significantly lower in the intervention group (median 16.00, IQR 11.00-29.00 vs 32.00, IQR 13.75-36.00), with a markedly reduced proportion of major LARS (17/82, 20.7% vs 45/82, 54.9%; P<.001). Global health/quality of life scores were significantly higher in the intervention group (P<.001). ConclusionsThe integrated balloon biofeedback device improved the accuracy of technique and adherence to home-based PFMT, reduced the incidence and severity of LARS, and enhanced quality of life in patients after low rectal cancer surgery. These findings support further development and clinical implementation of the device. However, the nonrandomized, time-sequenced study design and baseline differences between groups may limit causal interpretation of the results, and randomized controlled trials with longer follow-ups are needed to confirm long-term efficacy.

Low anterior resection syndrome (LARS) is a disorder of bowel function that develops after sphincter-preserving surgery for rectal cancer. Transanal irrigation is a treatment for low anterior resection syndrome. This is a single-center prospective randomized controlled trial comparing stoma discharge reinfusion versus standard care 1 month following sphincter-preserving and temporary loop ileostomy surgery was performed. The primary endpoint was the proportion of patients with major LARS at 6 months after ileostomy reversal. Secondary endpoints included Glazer pelvic floor muscle (PFM) surface electromyography (SEMG) and microbiota analysis at 1 month after ileostomy reversal and Quality-of-Life Questionnaire Core 30 (QLQ C30) analysis during follow-up period. Of 60 randomized patients, 52 were included in the analysis (reinfusion group, n = 28; standard care group n = 24). The proportion of patients with major LARS was statistically lower after stoma discharge reinfusion compared with standard care at 6 months after ileostomy reversal (10.7 http://www.clinicaltrials.gov ).

Due to advancements in research, the concept of oral health literacy (OHL) has become rich in connotations, with over 250 definitions present in the literature and government and organizational reports. The diversity of OHL definitions and connotations not only produces conflicting results but also limits the production of accurate OHL measurement and assessment tools while simultaneously hindering the construction of health literacy intervention policies. To clarify the connotations of OHL and establish a scientific basis for evaluation, we conducted a systematic review, searching and analyzing the literature related to the conceptual connotations of OHL. Additionally, we extracted basic, methodological, and OHL conceptual connotation information from the literature. With reference to the review framework, we classified the conceptual connotations of OHL into antecedents of OHL, the core of OHL, mediators, and outcomes of OHL. The comprehensive conceptual connotations of OHL were obtained through a systematic review and concept mapping based on the related literature. Our analysis revealed that the antecedents of OHL can be classified in two categories: personal factors and external factors. The core conceptual connotations of OHL include three core dimensions (with 16 subdimensions): (1) basic skills—literacy, reading comprehension, numeracy, hearing, oral expression, communication, and knowledge; (2) information-related abilities—information acquisition, information understanding, information communication, information evaluation, information utilization, and information decision-making; and (3) oral health maintenance abilities—interpersonal skills, self-regulation, and goal achievement. The mediator of these connotations is oral health behaviors, with oral health being the result of OHL. This study further clarifies the conceptual connotations of OHL, serving as a reference for future OHL-related studies.

BackgroundVisual impairments related to non-correctable vision loss, including blindness and low vision, have been consistently shown to lower a person's health-related quality of life. This study assessed the reliability, validity, and discrimination of the Quality of Life Scale for Children with Visual Impairments (QOLS-CVI) in China.MethodsThe Pediatric Quality of Life Inventory™ 4.0 and World Health Organization Quality of Life-Disability Scale for physical disability were selected to define conceptual frameworks and item libraries based on relevant existing studies. According to two rounds of expert consultations and group discussions, some items were modified, and the draft scale was developed. Two item selection processes based on classical test theory and item response theory were used to conduct a preliminary survey and a formal survey in special schools in Shanxi and Hebei Provinces. Finally, the reliability and validity of the quality of life scale for visually impaired children in China were verified.ResultsThe final QOLS-CVI consisted of 38 items, 10 subdomains, and 6 domains. Reliability was verified by Cronbach's alpha coefficient, split-half reliability, and test-retest reliability (Cronbach's alpha for the full scale, 0.841; split-half reliability, 0.629; and test–retest reliability, 0.888). The validity results showed that the multidimensional scale met expectations: exploratory factor analysis and confirmatory factor analysis indicated good fitting models for children with visual impairments.ConclusionsThe QOLS-CVI was determined to be reliable and valid and to have strong feasibility and effectiveness. This scale can be used as an evaluation tool to study the QOL and social-participation ability of children with visual impairments.

AIMS:To assess relationships between characteristics of methadone maintenance treatment and long-term cessation of injecting (> or = 1 year).DESIGN AND PARTICIPANTS:The incidence of cessation of injecting and relapse from non-injecting to injecting was estimated among 488 participants of the Amsterdam cohort study among drug users. We used a nested matched case-control design to identify methadone treatment characteristics significantly and independently related to cessation of injecting. To ensure detailed and valid assessment of methadone treatment, data of the Central Methadone Register were linked with cohort data. For 339 of 488 subjects of the initial study group methadone data were available.FINDINGS:The incidence of cessation of injecting increased from 2.2/100 person years in 1985-89 to 5.5/100 per year in 1995-97 (Ptrend = 0.005). Relapse to injecting was high: 17.2/100 person years (no trend). Methadone dosage and frequency of methadone programme attendance in themselves were not significantly related to cessation of injecting. However, an individual increase of 5 mg or more per year (OR 4.20, 95% CI 1.54-11.46) and receiving methadone mainly via the outpatient clinic for drug-abusing prostitutes and foreigners (OR 0.18, 95% CI 0.05-0.59) were independent predictors of cessation of injecting. After cessation of injecting, there were no HIV-seroconversions during the period of non-injecting (129 person years). After relapse to injecting there was one seroconverter; however, follow-up was small (23 person years). The HIV-incidence of those who continued injecting was 3.2/100 per year.CONCLUSIONS:Steadily increasing the methadone dosage in a harm reduction setting may be useful in supporting injecting drug users in the process of cessation of injecting and reducing the spread of HIV-infection.

Purpose With the widespread development of low and ultra-low rectal sphincter-preservation surgery, low anterior resection syndrome, a new clinical challenge, has received increased attention. As the principal practitioners of this syndrome management, colorectal surgery nurses require sufficient relevant knowledge and skills, but few studies have been conducted of their actual ability and practice of managing the syndrome. The study adopted a knowledge, attitude, and practice model to evaluate low anterior resection syndrome management among colorectal surgery nurses. Method A multicenter cross-sectional study was conducted, in which 361 registered nurses in colorectal surgery from 6 hospitals in 4 cities were enrolled. A structured paper questionnaire was used to collect demographics, scale scores for knowledge, attitudes and management practice, and training needs. Results Participants scored poorly in knowledge, attitude, and practice. Whether training had been received or not was an important factor affecting the knowledge, attitude, and practice of nurses, and the majority of participants had not received training. Nurses with lower levels of education had worse knowledge and practice, and contract nurses scored lower than staff nurses in terms of knowledge and attitude. Conclusions The critical role of nurses in patient management places high demands on their knowledge, attitude, and practice. However, the present study demonstrated that the current knowledge, attitude, and practice of colorectal surgery nurses regarding the syndrome gave cause for concern, and whether training had been received was a key factor affecting these three aspects. Therefore, training is a key strategy to eliminate the gaps identified.

Background : Smartphones have captured the attention of many researchers in the field of health and medical services. This study aimed to quantify research ‘hotspots’ in this field, analyse the relationship between research hotspots and the resulting knowledge groups, and provide visual representations of the findings. Methods : Using bibliometric analysis software tools for keyword frequency analysis, we identified research hotspots using keywords from PubMed entries from a 14-year period. The analyses of hotspots were performed using keyword co-occurrence analysis, social network analysis, principal component analysis (PCA), multidimensional scaling analysis, and network visualization technology. Results : The results confirmed that the number of articles has been increasing each year. The topics of mobile applications, telemedicine, self-care, Diabetes Mellitus, treatment outcomes, health promotion, and patient satisfaction associated with smartphones were highlighted. The 35 high-frequency keywords that were extracted constituted five principal components of research related to information technology and telemedicine, diabetes, t-health promotion, and smartphones/handheld computers. Figures of knowledge network maps and perceptual maps show the relationship between the high-frequency keywords. Conclusions : The research of smartphones for health and medical services has experienced significant growth and expansion in knowledge in the last 14 years. Research hotspots for smartphone-related information technology, telemedicine, and health promotion have broad prospects for development. Moreover, this study provides directions for research hotspots and future research in the field of smartphone applications for health and medical services.

Children are exposed to toxic metals via diet and environment, which results in adverse health effects. Several trace elements are important for the nutritional status of children; however, little information is available for rural regions in Asia. Our goal was to assess the body burden of lead, cadmium, and aluminum (Al) as toxic metals and calcium (Ca), zinc, copper, selenium (Se), strontium, and boron as trace elements in children. Multiple environmental samples, including soil, dust, fine particulates, drinking water, and food, were collected for each family. A survey was conducted by trained personnel to record detailed information about children attending a rural school. Twenty-four-hour urine samples were collected. The levels of toxic and essential trace elements were determined by inductively coupled plasma mass spectrometry. We found that the daily intake of toxic metals was below the recommended maximum, suggesting low health risks. More attention should be given to the ingestion of Al by the hand-to-mouth pathway. Ca deficiency was discovered to be a serious health problem for rural children, with Ca inadequacies reaching 96%. The excessive intake of Se-rich products from industry suggests an increased risk of toxicity. This study highlights the health risks to children who live in rural regions and the importance of dietary Ca supplementation in school meals.

This study aims to reveal the evolution of publication hotspots in the field of electronic health records (EHRs) and differences among countries. We applied keyword frequency analysis, keyword co-occurrence analysis, principal component analysis, multidimensional scaling analysis, and visualization technology to compare the high-frequency Medical Subject Heading (MeSH) terms in six countries during the periods 1957-2008 and 2009-2016. After 2009, the number of MeSH terms reflecting information exchange and information mining increased, and various types of evaluations based on EHRs and cohort studies significantly increased. The top 20 MeSH terms between 2009 and 2016 constitute five relatively larger knowledge groups. Thus, we conclude that publication hotspots in EHR field have shifted from issues related to the adoption of EHRs to the utilization of EHRs, and the knowledge structure has become systematic. The publication's focus was different in the six countries, which may relate to their national characteristics.

Objectives: The aim of this study was to reveal research hotspots in the field of regional health information networks (RHINs) and use visualization techniques to explore their evolution over time and differences between countries. Methods: We conducted a literature review for a 50-year period and compared the prevalence of certain index terms during the periods 1963-1993 and 1994-2014 and in six countries. We applied keyword frequency analysis, keyword co-occurrence analysis, multidimensional scaling analysis, and network visualization technology. Results: The total number of keywords was found to increase with time. From 1994 to 2014, the research priorities shifted from hospital planning to community health planning. The number of keywords reflecting information-based research increased. The density of the knowledge network increased significantly, and partial keywords condensed into knowledge groups. All six countries focus on keywords including Information Systems; Telemedicine; Information Service; Medical Records Systems, Computerized; Internet; etc.; however, the level of development and some research priorities are different. Conclusions: RHIN research has generally increased in popularity over the past 50 years. The research hotspots are evolving and are at different levels of development in different countries. Knowledge network mapping and perceptual maps provide useful information for scholars, managers, and policy-makers.

Introduction: Telemedicine has been implemented in many countries and has captured the attention of many researchers. Herein, we aim to quantify publication hotspots in the field of telemedicine, analyse their evolution, compare them in different countries, and provide visual representations. Methods: We used software tools to process PubMed entries for a 54-year period and identified publication hotspots using keyword frequency analysis. We employed a keyword co-occurrence analysis, principal component analysis, multidimensional scaling analysis, and network visualization technology. Results: The number of Medical Subject Heading (MeSH) terms increased with time. The most common subcategories of telemedicine between 1962 and 2015 were Remote Consultation, Teleradiology, and Telepathology. The most popular information communication technologies in telemedicine publications were related to the Internet and cell phones. The topics of Patient Satisfaction, Treatment Outcomes, and Home Care Services associated with telemedicine were highlighted after the 1990s. Use frequency of the terms Cell Phones and Self-Care increased drastically in the past six years, and the publication focus in six countries that had the highest output was different. Knowledge network maps and perceptual maps show the relationship between high-frequency MeSH terms. Discussion: The telemedicine field has experienced significant growth and expansion in knowledge and innovation in the last 54 years. Publication hotspots for telemedicine lean towards clinical treatment, home care services, and personal care, and countries emphasize publishing in areas related to their national characteristics. This study quantitatively discusses publication hotspots, provides an objective and systematic understanding of this field, and suggests directions for future telemedicine research.

Objective Current study used quantitative research methods to reveal the regional medical information research in hotspots, and summarize the mainstream knowledge base to provide the reference for researchers in the field.Methods A systematic search was conducted to find publications in CNKI, Wanfang Database and PubMed.Bibliometrics method, social network analysis, coword analysis, principal component analysis and multidimensional scaling analysis were used in this study.Results ① total 11,482 articles published from 1984 to 2013 were screened out.The development of research publications showed an increasing trend, and the papers were distributed in 1233 types of journals.The number of authors who located in Beijing, Guangdong, Jiangsu, Shanghai,Shandong ranked top five.② The top 59 high frequency key words were identified that representing the hot contents in regional health information technology research field, and was used to build knowledge network map.Among them, HIS, electronic medical records, hospital information technology,information technology were at the core of this research area.③ We summarized research and development in the field of nine major mainstream knowledge base include: research on electronic medical records, medical personnel, information systems, information security, information networks, information sharing, information integration, information technology, and information management, resident' s health record related studies;qualitative analysis and problem-oriented research;HIS and telemedicine-related research;community related research, two-way referral related research, health care reform and cloud computing-related research, telemedicine related research and V43 related research.Conclusions The development of regional medical information research has good momentum and closely follow the international trend, but the research contents and methods are still distance from international standard..Research mostly focused on hospital information system construction, regional research and applied research are weak and need to be further improved.

Objective To reveal the status quo and emerging issues of co-authorship in regional health informatization research community in China.Methods The terms or keywords describing and covering regional health informatization were used to search the most relevant literatures about the subject in CNKI,Wanfang database and PubMed.Software tools were used to extract bibliographic,Social network analysis (SNA);co-authorship,and co-word analysis were used in this study.Results ①11,482 articles with 16,449 authors in the period of 1984-2013 were found.Each publication has an average of 1.43 authors,and each author has 0.70 publications.The number of coauthored literature was 7741 (67.42 ％).Both production and collaboration have been growing steadily.② Coauthored knowledge network was build which composed by 150 high-yielding Authors.The largest component comprises 43 authors(28％,43/156).The intermediate centrality of 57 authors were above 0.③ 230 2-plexes were found,and 65 2-plexes scale was 4 and over;and there was overlap among them.There were extensive cooperation between the military institutions,a large number of regional health information technology research talent were found in army research institutes..Cohesive subgroups density showed an E-I index=-0.901,which indicated that factionalism was comparatively weaker in this field,and the relationship tended to occur among subgroups.④ Cooperative network was established between the provinces and municipalities.Beijing,Guangdong,Jiangsu,Hubei were the core area.⑤ The average distance between the author=3.155,and it consistent with the small-world characteristics.⑥ The largest component of the network research can be summarized into three categories:HIS-related research,electronic medical records related research,and regional health informatization related research.Conclusions Although such collaboration is growing steadily,the collaboration behavior about regional health informatization study needs to be enhanced.Policy makers and researchers can refer to the relevant information and promote cooperation,improve the capacity of regional health information research and construction.

A comparison is made on the healthcare systems,economy,informationization environment,developers,investment and compensation mechanisms in nine countries featuring early startup,rich experiences,and relatively higher ratio of success in their development projects.This lead to a discussion focusing on the construction steps and development strategies for regional health informationization,and an analysis of the present regional health informationization overseas,common measures taken,and key factors for successful regional health informationization.Based on these,recommendations were made on development of regional health informationization compliant to China's circumstances.

区域医疗服务信息平台的建设、运行与管理是一个复杂的系统工程,其不仅仅涉及平台本身,还涉及众多利益相关集团[1-2].研究表明,利益相关集团间的冲突明显影响着当前区域医疗信息化建设的进程[2-5].即使平台建设由政府统一投入,也存在中央政府、地方政府、医疗机构等利益相关者投资回报与利益界定方面的困难,且利益链条的驱动机制不明[5].

By means of literature review,the paper made a comparative study of key development projects of healthcare information in China over the last decade,in terms of their project characteristics,economic environment,development entity,investment and compensation practice,development strategy,coverage,experience and promotional values.Setbacks identified include the following:discrepancy in regional development stages of healthcare information; successful pilots are limited to scientific research samples; lack of regional models; systems separation; poor continuity and coordination; waste and insufficiency of resources in the investment and construction among others.The authors recommend a better exchange of experiences in building the regional healthcare information service platforms,greater investment,better compensation mechanism,better top-tier design,and maximized coverage within reach of supervision and technology.