Clinical Practice Experience Research Articles

What makes a good clinical practice experience in radiography and sonography? An exploration of qualified clinical staff and student perceptions

IntroductionClinical practice can be a challenging experience for some healthcare students. The quality of the clinical experience can have a profound effect on the overall student learning experience in clinical practice and attrition. The aim of the study was to explore the perceptions of an optimal clinical practice experience by radiography and sonography students and qualified clinical staff. MethodsA qualitative research design was adopted utilising focus groups (n = 5). The study population comprised of qualified radiography/sonography staff (n = 10) from across a number of placement sites used by City, University of London and radiography and sonography students (n = 15) from the same institution. Full verbatim transcriptions were analysed thematically. ResultsFour key themes emerged: 1) favourable/unfavourable traits, 2) creating an optimal learning environment 3) challenges and 4) considerations for clinical education. Key factors for a positive learning experience included clinical supervisors being approachable, whilst encouraging and empowering students. Qualified radiography/sonography clinical staff highlighted student motivation as an important aspect for successful placement learning. ConclusionThe study has provided an insight into a number of positive attributes that enhance student learning experiences whilst on clinical placement. Unhelpful attributes and challenges, such as student motivation and time limitations, were also revealed. It is important that supervisors within the clinical departments actively work towards the provision of a positive learning experience. Implications for practiceThis study can better inform clinical staff regarding the importance of enhancing the student learning experience and facilitating high quality learning within the clinical department. Moreover, to encourage clinical staff to ensure robust “support” is established for students on placement.

Expert consensus on endocrine therapy of breast cancer (2023 edition)

Endocrine therapy is the primary systemic therapy for hormone receptor-positive breast cancer, which runs through the whole process of treatment for early and metastatic breast cancer. The development of new endocrine agents and targeted drugs such as cyclin-dependent kinases 4/6(CDK4/6)inhibitors has improved outcome of patients with hormone receptor-positive breast cancer and changed the treatment landscape. The update of clinical research data provides more treatment options, calling for treatment optimization. Experts had a deep discussion around the hot topics on endocrine therapy of breast cancer, and formulated the'Expert consensus on endocrine therapy of breast cancer (2023 edition)'.This consensus is based on research data worldwide and clinical practice experience, with the aims of standardizing clinical diagnosis and optimizing treatment in neoadjuvant, adjuvant and metastatic setting of hormone receptor-positive breast cancer.

Clinical characteristics and therapeutic outcomes of acromegalic patients with giant growth hormone-secreting pituitary adenomas: a single-center study of 67 cases.

Acromegalic patients with giant growth hormone-secreting pituitary adenomas (GHPAs) (≥ 40mm) are relatively rare, and their clinical characteristics and treatment outcome data are limited. This study aims to analyze the clinical practice experience of giant GHPAs. Sixty-seven acromegalic patients with giant GHPAs and 67 patients with macro GHPAs (10-39mm), matched for age and gender from the same hospital during the same period, were retrospectively recruited. The clinical characteristics, treatment, and outcomes were analyzed. Enlargement of the extremities and facial features were the most common symptoms in most patients (92.5%). Compared with the macroadenoma group, more frequent visual impairment (86.6% vs. 25.4%, P < 0.001) and gonadal axis dysfunction (49.3% vs. 34.3%, P = 0.008), higher preoperative fasting GH, nadir GH after OGTT and IGF-1 levels, and a higher proportion of extrasellar tumor invasion were seen in the giant adenoma group. As the adenoma size increases, the total resection rate decreases, and postoperative complications and multimodal treatment strategies increase significantly. Fasting and nadir GH levels remained higher at 1week postoperatively, and there were more surgical complications and cases of anterior hypopituitarism in the giant group. After a median follow-up of 36months, 12 patients (36.4%) in the giant GHPA group and 17 (36.2%) in the macro GHPA group achieved biochemical remission. Other factors such as age of onset, age of diagnosis, delayed diagnosis time, metabolic complications, p53 positive rate, and Ki-67 index showed no significant difference between the two groups. With aggressive multimodal therapy, the biochemical remission rate of acromegalic patients with giant GHPAs is comparable to that of patients with macro adenoma. However, postoperative complications and hypopituitarism need to be closely monitored.

간호학생의 임상실습 중 갈등 경험

Objectives This study is a phenomenological study to identify and describe the nature and structure of conflict experiences during clinical practice of nursing students.&#x0D; Methods Participants in this study were 3rd and 4th graders with clinical practice experience, and 10 nursing stu-dents who wanted to actively state their experiences among students who experienced conflict or are currently experiencing it during clinical practice. The main question was, “What was the conflict you experienced during clinical practice as a nursing student?” and it took an average of about 40 minutes per participant. The analysis of transcription data through individual in-depth interviews of participants followed the procedure proposed by Colaizzi.&#x0D; Results The study participants' conflict experiences during clinical practice could be identified into 3 categories: “unfairness about an unfair practice environment,” “disappointment and skepticism due to conflict,” and “scapegoat for conflict resolution,” 8 collections and 16 topics.&#x0D; Conclusions In conclusion, many of the clinical practices experienced by participants are related to negative hu-man relationship experiences, which are caused by unfairness in an unfair practice environment, disappointment and skepticism caused by conflicts, and anguish caused by falling victim to conflict resolution.

Back from the rabbit hole. Theoretical considerations and practical guidelines on psychedelic integration for mental health specialists.

The growing interest in and prevalence of the use of psychedelics, as well as the potential benefits and negative consequences associated with psychedelic experiences, create a need for mental health specialists to be able to provide adequate and effective intervention regarding the content and consequences of these experiences, that is, psychedelic integration. At the same time, current graduate training in psychiatry, psychology, psychotherapy, counseling, etc., fails to adequately prepare professionals for such interventions. In order to fill this gap, an international, bottom-up project was established to attempt developing guidelines. This project was conducted by means of literature reviews as well as roundtable discussions among project participants, leading to a consensus on the guidelines' final scope and content. Drawing from the outcomes of this project, this article presents proposed comprehensive guidelines covering both theoretical and practical aspects of psychedelic integration, that are intended to serve as a resource for various mental health specialists who may encounter individuals in need of support considering their psychedelic experiences. These guidelines encompass clinician-friendly information on the effects of psychedelics, a definition of psychedelic integration, the general theoretical considerations linked to utilization of psychedelic experiences in clinical practice, a simple model organizing the course of psychedelic integration practice, as well as an overview of the current models of psychedelic integration, along with a selective presentation of basic and specific interventions derived from various psychotherapeutic approaches that can be employed in the practice of psychedelic integration.

Патогенез и описания амблиопии. Часть 1. Причины эволюции представлений

This article explains the necessity to clarify the ideas about the etiology and pathogenesis of amblyopia due to the accumulation of information. Firstly, due to the appearance of new ophthalmological and optometric instruments, it became possible to detect distinct signs of organic and functional pathology of various kinds in patients diagnosed with amblyopia, which were previously impossible to detect. Secondly, modern highly effective and informative neurophysiological methods of vision process investigation allowed to develop complete and more adequate concept of structural and functional organization of human visual system and its possible impairments which lead to amblyopia. Thirdly, considering the entire experience of clinical practice testifies to the greater heterogeneity of this disease than it was previously imagined and points to the incompleteness of the initial descriptions and definitions of this pathology. Key words: etiology of amblyopia, pathogenesis of amblyopia, evolution of concepts on amblyopia

Chronic Hyperkalaemia with Patiromer in Haemodialysis: A Single-Center, Prospective Observational Study in the Clinical Practice

Introduction: Chronic Kidney Disease (CKD) patients on Hemodialysis (HD) experience increased risk of hyperkalemia, a serious potential fatal electrolyte disorder. Although novel effective strategies for managing hyperkalaemia are available, experience in routine clinical practice is still insufficient. Here we report chronic hyperkalemia prevalence and analyze the effects of different treatments on potassium management, adherence ratio and gastrointestinal symptoms in HD population. Methods: 12-week, prospective, single-center study in HD patients with chronic hyperkalaemia (&gt;5.5 mmol/l). Three study phases were established: Phase 1, Dietary Advice (DA); Phase 2, Calcium Polystyrene Sulfonate Resins (CPSRs); and Phase 3, patiromer. Sociodemographic and biochemical data, treatment adherence and compliance (Simplified Medication Adherence Questionnaire), gastrointestinal symptoms (Gastrointestinal Symptom Rating Scale, GSRS), HD characteristics and usual medical treatment were analyzed in each phase. Results: Serum potassium values decreased significantly (p&lt;0.05) only in phase 3 (–0.75 mmol/l), with a higher patient percentage reaching optimal K range. Compared with CPSRs, patiromer yielded significantly better overall GSRS scores: abdominal pain (3.7 versus 2.5), constipation (7.1 versus 5.3), indigestion (6.2 versus 5.6); and better treatment compliance. No significant changes were found in other biochemical data, HD characteristics or usual medication over the course of the study. Conclusions: Chronic hyperkalemia is a highly prevalent disorder on our HD unit. Compared to DA and traditional potassium binders; patiromer was effective in managing chronic hyperkalemia, improving gastrointestinal symptoms and treatment adherence with no associated severe adverse effects. Therefore, patiromer can be considered a first-line treatment for chronic hyperkalemia in patients with HD.

Physiotherapists' experiences of clinical practice: A Phenomenological Study

Teaching physical therapists demonstrate in their clinical practice various attitudes and methods that contribute to the professional development of their students. The purpose of the study was to analyze the responses of the teaching physical therapist's experiences in relation to the clinical practice of the physical therapy student. Therefore, a qualitative study was carried out with a phenomenological approach in which an interview was conducted through a guide of semi-structured questions, using the Atlas.ti content analysis technique, to 5 teaching physical therapists with extensive experience in a clinical teaching institution. The results revealed that the category of teaching skills in evaluation obtained the highest number of citations, followed by the category of learning in the clinical setting. In conclusion, the clinical/teaching physical therapists perceived positively the change towards continuous improvement in their practices with students, despite limitations such as lack of standardization in practical activities

COVID-19 팬데믹 상황에서의 간호대학생 임상 실습 경험

Objectives The purpose of this study was to provide clinical practice methods and improvement guidelines by&#x0D; in-depth understanding and analysis of the meaning of clinical practice experiences of nursing students during&#x0D; the COVID-19 pandemic.&#x0D; Methods The research method is a qualitative research to derive the meaning of the clinical practice experience&#x0D; in the COVID-19 pandemic. The participants in the study were 16 nursing students from a college located in M&#x0D; city who agreed to the study. All informed consent was obtained before the study, and subjects were recruited&#x0D; using the snowball method through participants. Data collection was conducted through 1:1 interviews using a&#x0D; semi-structured questionnaire. Data was analyzed using the Colaizzi method, a phenomenological method.&#x0D; Results As a result of the study, 4 subject groups were derived from 10 subjects. The four thematic collections&#x0D; are &lt;Mandatory courses that cannot be skipped&gt;, &lt;Fewer learning opportunites&gt;, &lt;Fields fully armed with quarantine&gt;,&#x0D; and &lt;My career without regrets&gt;. The need for clinical practice was recognized while directly seeing and&#x0D; performing what had not been experienced in online practice. In addition, due to COVID-19, they experienced regret&#x0D; due to the restrictions of the practice environment, and made efforts to prevent infection themselves in the&#x0D; thorough quarantine system of the practice institution. Through the appearance of nurses taking care of infected&#x0D; patients infected with COVID-19, it was found that they had an awareness of the meaning of the job of nurses&#x0D; and that they would go the path of nurses.&#x0D; Conclusions Based on this study, it will be necessary to improve the clinical practice system and develop various&#x0D; practice methods in the context of infection, and to continue research on practice education methods. In addition,&#x0D; a coping plan should be prepared to relieve anxiety and stress of nursing students in the situation of infection.

Alternative Clinical Practice Experiences of Korean Nursing Students during the COVID-19 Pandemic.

Background: Routine clinical practice (RCP) experiences provide nursing students with the opportunity to gain confidence in their professional roles. The purpose of this study was to explore the alternative clinical practice (ACP) experiences of nursing students during the COVID-19 pandemic using the Q methodology. Methods: Fifty-two nursing students located in four cities across South Korea participated. The participants sorted the order of and ranked 41 Q statements about their experiences with ACP into a Q sort table; the data were analyzed using the PQ method. Results: The following three distinct viewpoints were extracted: (1) ACP helps with balancing learning and life (favorable view of ACP); (2) ACP does not help with balancing theory and clinical field practice (critical view of ACP); and (3) RCP cannot be replaced by ACP (negative view of ACP). Conclusions: The findings of this study indicate that developing a curriculum for clinical practice that can enhance the strengths of ACP while compensating for its weaknesses will help promote learning among nursing students.

Cumulative Clinical Experience of the Use of Paliperidone Palmitate 3-Monthly Long-Acting Injection in the Treatment of Schizophrenia: A Critical Appraisal.

Paliperidone palmitate 3-monthly (PP3M), an approved maintenance treatment for patients with schizophrenia, was the first long-acting antipsychotic injectable (LAI) to require only four administrations per year. Here, we aimed to review the available evidence about its use in the management of schizophrenia to date and highlight key study findings in order to provide a balanced overview of current experience in clinical practice. For that purpose, an extensive search of available literature from PubMed, Embase, and Web of Science was conducted in March 2023. Emerging data from real-world studies appear to signal that the benefits of the use of PP3M may well extent beyond the obvious convenience for patients and resource efficiency for services and may be actually associated with improved effectiveness and patient satisfaction. Large naturalistic studies from Australia, Europe and the US comparing treatment continuation between newer LAIs and/or oral antipsychotics showed that patients treated with PP3M had higher compliance rates and a longer period of continuous use. The risk of relapse, re-hospitalization and number of bed days was also lower with PP3M compared to PP1M and other LAIs as demonstrated by several cohort studies. Furthermore, patients treated with PP3M were using lower doses of benzodiazepines and concomitant oral antipsychotics compared with other LAIs. What is more, PP3M appears to positively impact patients' satisfaction and quality of life, facilitating long-term goals. In fact, recent studies recorded better quality-adjusted life years and decreased stigma, with improved social acceptability and promotion of rehabilitation for patients transitioning to PP3M. The rates of general satisfaction rates with PP3M were also higher among psychiatrists and caregivers who reported overall less concerns. In conclusion, clinical exposure and a growing body of evidence thus far, reinforce the use of PP3M in an effort to enhance patient outcomes alongside individual experience and treatment persistence.

Pain management after thoracic surgery or chest trauma.

Accidental or surgically induced thoracic trauma is responsible for significant pain that can impact patient outcomes. One of the main objectives of its pain management is to promote effective coughing and early mobilization to reduce atelectasis and ventilation disorders induced by pulmonary contusion. The incidence of chronic pain can affect more than 35% of patients after both thoracotomy and thoracoscopy as well as after chest trauma. As the severity of acute pain is associated with the incidence of chronic pain, early and effective pain management is very important. In this narrative review, we propose to detail systemic and regional analgesia techniques to minimize postoperative pain, while reducing transitional pain, surgical stress response and opioid side effects. We provide the reader with practical recommendations based on both literature and clinical practice experience in a referral level III thoracic trauma center.

Preceptor Tools for Success: Student Review on Creating an Effective Clinical Rotation.

The purpose of this article was to explore student perspectives regarding effective preceptors with the intention to improve development of supervised clinical practice experiences. In total, 136 clinical year physician assistant (PA) students, representing 9 accredited PA programs, participated in a mixed-methods survey, including a 5-point Likert scale to identify characteristics of an effective preceptor. The survey achieved a 36.2% response rate. Quantitative data were analyzed based on mean and standard deviation (SD) with the analysis of variance to promote generalizability. Thematic analysis was performed on qualitative responses. Students reported the highest level of agreement that an effective preceptor welcomes questions from the student (mean 4.88, SD 0.54), are enthusiastic about having a student (4.84, 0.52), and provide a welcoming support staff who encourages student education (4.71, 0.66). Students also highlighted the positive effect of preceptor engagement during clinical rotations. A preceptor who actively engages their student has the greatest positive impact on clinical education. Preceptors can implement clinical teaching strategies from this article to improve student-perceived effectiveness of their rotation.

Biofeedback assisted deep breathing training in refractory disorders of gut-brain interaction – our first experience, impressions and suggestions for further clinical practice

Summary: Introduction: Disorders of gut-brain interaction represents a group of a wide variety of chronic gastrointestinal diseases with plethora of symptoms related to disorder of specific organ. There is no specific cure for DGBI and the therapy is mostly focused on alleviating the symptoms. One of the potential new therapies to alleviate the symptoms could be deep breathing training. Available data suggest that biofeedback assisted deep breathing pacing may lead to reduction of pain perception even visceral pain originating from gastrointestinal tract. Methods: This is a retrospective analysis of clinical data obtained from patients who were treated with deep breathing training for refractory case of disease of gut-brain interaction. The DGBI was diagnosed based on the ROME IV criteria. Before the training, the proper mechanism of deep abdominal breathing was thoroughly explained to the patients. Patients have also filled the STAI-X1, STAI-X2 questionaries to assess their anxiety levels. After initial office-based training, the patients were instructed to continue in home-based deep abdominal breathing for 3 to 5 times a week. The effect of the therapy was evaluated after one month. Results: Fifteen eligible patients were offered biofeedback assisted deep breathing training. Nine patients attended the check-up appointment after 4 weeks and are therefore considered in the analysis. Five patients experienced mild alleviation of the symptoms. Two patients experienced resolution of the symptoms and contrary, two patients didn’t report any change in symptoms. There were no statistically significant changes in the anxiety levels. Conclusion: The deep breathing training for symptom alleviation in disorders of gut-brain interaction seems to be a promising ad on therapy. This is based on published studies and our own experience. However more rigorous data are needed before more definite conclusion. Key words: biofeedback – deep breathing training – IBS – globus – dyspepsia

Application of intraoperative endoscopic in laparoscopic gastric cancer surgery

The application of intraoperative endoscopic in laparoscopic gastric cancer surgery can compensate for the limitations of a single laparoscopic mode that only relies only on serous vision, and work as the Chinese saying "four ounces can move a thousand pounds". Intraoperative endoscopy not only effectively helps to accurately locate the tumor boundary in real-time and achieve precise resection, but also enables real time and interactive inspection of the quality of esophagojejunal anastomosis, reduces postoperative complications such as anastomotic leakage and bleeding, and accelerates postoperative recovery. However, most centers in China do not emphasize the application of intraoperative endoscopy in laparoscopic gastric cancer surgery due to the lack of a good cooperation mechanism between the gastrointestinal surgery team and the digestive endoscopy team. Therefore, based on clinical practice experience, the author briefly discusses the application of intraoperative endoscopic in routine laparoscopic gastric cancer surgery, including pre-examination preparation operator position, endoscopic techniques, postoperative management, etc., covering application scenarios such as early tumor localization, confirmation of upper esophageal margin confirmation, anastomotic examination, biopsy of primary lesion specimens in neoadjuvant/conversion treatment cases. We hope that it will help gastroenterologists to better apply intraoperative endoscopy in laparoscopic gastric cancer surgery, and assist in precise resection and safe anastomosis of the operation.

Reliability and practicability of PSMA-RADS 1.0 for structured reporting of PSMA-PET/CT scans in prostate cancer patients

ObjectivesAs structured reporting is increasingly used in the evaluation of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) for prostate cancer, there is a need to assess the reliability of these frameworks. This study aimed to evaluate the intra- and interreader agreement among readers with varying levels of experience using PSMA-RADS 1.0 for interpreting PSMA-PET/CT scans, even when blinded to clinical data, and therefore to determine the feasibility of implementing this reporting system in clinical practice.MethodsPSMA-PET/CT scans of 103 patients were independently evaluated by 4 readers with different levels of experience according to the reporting and data system (RADS) for PSMA-PET/CT imaging PSMA-RADS 1.0 at 2 time points within 6 weeks. For each scan, a maximum of five target lesions were freely chosen and stratified according to PSMA-RADS 1.0. Overall scan score and compartment-based scores were assessed. Intra- and interreader agreement was determined using the intraclass correlation coefficient (ICC).ResultsPSMA-RADS 1.0 demonstrated excellent interreader agreement for both overall scan scores (ICC ≥ 0.91) and compartment-based scores (ICC ≥ 0.93) across all four readers. The framework showed excellent intrareader agreement for overall scan scores (ICC ≥ 0.86) and compartment-based scores (ICC ≥ 0.95), even among readers with varying levels of experience.ConclusionsPSMA-RADS 1.0 is a reliable method for assessing PSMA-PET/CT with strong consistency and agreement among readers. It shows great potential for establishing a standard approach to diagnosing and planning treatment for prostate cancer patients, and can be used confidently even by readers with less experience.Clinical relevance statementThis study underlines that PSMA-RADS 1.0 is a valuable and highly reliable scoring system for PSMA-PET/CT scans of prostate cancer patients and can be used confidently by radiologists with different levels of experience in routine clinical practice.Key PointsPSMA-RADS version 1.0 is a scoring system for PSMA-PET/CT scans. Its reproducibility needs to be analyzed in order to make it applicable to clinical practice.Excellent interreader and intrareader agreement for overall scan scores and compartment-based scores using PSMA-RADS 1.0 were seen in readers with varying levels of experience.PSMA-RADS 1.0 is a reliable tool for accurately diagnosing and planning treatment for prostate cancer patients, and can be used confidently in clinical routine.

Research progress on the treatment of epilepsy with traditional Chinese medicine

BackgroundTraditional Chinese Medicine (TCM) system is a medical system that has been expanding for thousands of years that was formed by the extensive clinical practice experience of many physicians and the accumulation of personal medication habits in China. In TCM, there is a history of long-term medication for epilepsy, the main treatment for epilepsy is TCM drugs and its prescription, supplemented by TCM modalities such as acupuncture therapy, moxibustion therapy, tuina, emotion adjustment therapy, etc. PurposeWith the modernization of TCM, the active ingredients and molecular mechanisms of TCM for epilepsy treatment have been gradually revealed. This review aimed to comprehensively summarize the TCM treatment of epilepsy, focusing on the current TCM drugs and some TCM formulae for the treatment of epilepsy, and to discuss the research progress of TCM for the treatment of epilepsy, and to provide a reference to develop future related studies in this field. Materials and methodsThe mechanism of action of antiepileptic drugs (AEDs) was interpreted from different perspectives by searching online databases and querying various materials identify drugs used in both modern medicine and TCM systems for the treatment of epilepsy. We collected all relevant TCM for epilepsy literature published in the last 30 years up to December 2022 from electronic databases such as PubMed, CNKI and Web of Science, and statistically analyzed the literature for the following keyword information. The search terms comprise the keywords “TCM”, “phytochemistry”, “pharmacological activity”, “epilepsy” and “traditional application” as a combination. Scientific plant names were provided by “The Plant List” (www.theplantlist.org). ResultsEpilepsy is a complex and serious disease of the brain and nervous system. At present, the treatment of epilepsy in modern medicine is mainly surgery and chemotherapy, but there are many serious side effects. By summarizing the treatment of epilepsy in TCM, it is found that there are various methods to treat epilepsy in TCM, mainly TCM drugs and its formulae. Many TCM drugs have antiepileptic effects. Now found that the main effective TCM drugs for the treatment of epilepsy are Curcumae Longae Rhizoma, Scorpio, Acori Tatarinowii Rhizoma, Uncariae Ramulus Cum Uncis and Ganoderma, etc. And the main compounds that play a role in the treatment of epilepsy are curcumin, gastrodin, ligustrazine, baicalin and rhynchophylline, etc. These TCM drugs have played an important role in the treatment of epilepsy in TCM clinic. However, the chemically active components of these TCM drugs are diverse and their mechanisms of action are complex, which are not fully understood and need to be further explored. ConclusionsTCM treats epilepsy in a variety of ways, and with the discovery of a variety of potential bioactive substances for treatment of epilepsy. With the new progress in the research of other TCM treatment methods for epilepsy, TCM will have greater potential in the clinical application of epilepsy.

Fascia and defensive qi: construction of body view in classical acupuncture theory

Influenced by the concept of "qi-void" in Taoist philosophy during the Qin and Han dynasties, the early acupuncture theory attaches the importance to the "fascial (muscular) interstices" distributed widely in the human body. The defensive qi runs through everywhere in these interstices that is easily invaded by the pathogenic wind and cold, and bi syndrome of jingjin (muscle region of meridian) is involved. Besides, fascial (muscular) interstices are the places for the delivery of relaxing needling and joint needling. Fascial tissue is a crucial structure to produce deqi, while, the function of defensive qi is tightly connected to the autonomic nerve in modern medicine, both of which actually belong to the different expressions of patients' body feeling. Medical scholars at early era, in reference with "fascia" and "defensive qi ", has summarized and refined their clinical practice experience. Thereby, the concepts of "arrival of qi " and "fascial (muscular) interstices" are extended, which constructs the peripheral framework of core concepts in acupuncture theoretic system, e.g. meridians and acupoints, and becomes an important component of the body view in classic acupuncture theory.

A Clinical Model for the Differentiation of Suicidality: Protocol for a Usability Study of the Proposed Model.

Even though various types of suicidality are observed in clinical practice, suicidality is still considered a uniform concept. To distinguish different types of suicidality and consequently improve detection and management of suicidality, we developed a clinical differentiation model for suicidality. We believe that the model allows for a more targeted assessment of suicidal conditions and improves the use of evidence-based treatment strategies. The differentiation model is based on the experience with suicidality that we have encountered in clinical practice. This model distinguishes 4 subtypes of entrapment leading to suicidality. The earliest description of this model and a proposal for usability research has been previously presented in a book chapter. In this study, we present the most recent version of the 4-type differentiation model of suicidality and a protocol for a study into the usability of the proposed model. The 4-type differentiation model of suicidality distinguishes the following subtypes: (1) perceptual disintegration, (2) primary depressive cognition, (3) psychosocial turmoil, and (4) inadequate coping or communication. We plan to test the usability of the 4 subtypes in a pilot study of 25 cases, and subsequently, we will include 75 cases in a follow-up study. We looked at the case notes of 100 anonymized patients with suicidality who presented to mental health care emergency service in The Hague International Center. The summary and conclusions of the letters sent to the patients' general practitioners after suicide risk assessment will be independently rated by 3 psychiatrists and 3 nurse-scientists for absolute and dimensional scores. The Suicidality Differentiation version 2 (SUICIDI-II) instrument, developed for this study, is used for rating all the cases. Intraclass correlation coefficients for absolute and dimensional scores will be calculated to examine type agreement between raters to examine the usability of the model and the feasibility of the SUICIDI-II instrument. We consider the model tentatively valid if the intraclass correlation coefficients are ≥0.70. Subsequently, if the model turns out to be valid, we plan to rate 75 other cases in a follow-up study, according to a similar or adjusted procedure. Study results are expected to be published by the end of 2023. The theoretical roots of the differentiation model stem from classic and contemporary theoretical models of suicidality and from our clinical practice experiences with suicidal behaviors. We believe that this model can be used to adjust the diagnosis, management, treatment, and research of suicidality, in addition to distinguishing different dynamics between practitioners and patients with suicidality and their families. DERR1-10.2196/45438.

Chinese herbal medicine alleviates autophagy and apoptosis in ovarian granulosa cells induced by testosterone through PI3K/AKT1/FOXO1 pathway

Ethnopharmacological relevancePolycystic ovary syndrome (PCOS) is a common gynecological endocrine and metabolic disorder. Chinese herbal medicine has some advantages in the treatment of PCOS with its unique theoretical system and rich clinical practice experiences. Aim of the studyThe present study was to investigate the potential mechanisms of Bu-Shen-Jian-Pi Formula (BSJPF) on the treatment of PCOS. Material and methodsThe combination of ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC/Q-TOF-MS/MS) rapid analysis, network pharmacology, molecular docking analysis and bio-experiments were firstly conducted to identify the main effective components of BSJPF, and to predict the potential mechanisms. The ovarian granulosa cell line (KGN) was treated with testosterone to construct the PCOS model in vitro, and the cells were further treated with the lyophilized powder of BSJPF. The levels of proliferation, autophagy and apoptosis were detected to explore the mechanisms of BSJPF on treating PCOS. ResultsFirstly, thirty-six active compounds were identified in BSJPF and thirty-one potential targets on PCOS were found. Then, PI3K and PDK1 were verified to have good binding activity with the active compounds through molecular docking analysis. In bio-experiments, BSJPF significantly alleviated the arrested proliferation of KGN cells in G0/G1 phase and reduced the active levels of autophagy and apoptosis of KGN cells induced by testosterone. Additionally, the inhibition of autophagy diminished apoptosis, while the repression apoptosis enhanced autophagy. Finally, BSJPF significantly decreased the FOXO1 expression levels induced by testosterone, especially for nuclear FOXO1, and significantly activated the PI3K/AKT pathway. ConclusionsBSJPF significantly alleviated the activated autophagy and apoptosis in KGN induced by testosterone through PI3K/AKT1/FOXO1pathway, which is an effective treatment for PCOS.