Introduction Cancer patients receiving myelosuppressive chemotherapy risk developing chemotherapy-induced pancytopenia (neutropenia, anemia, thrombocytopenia) with possible negative impact on survival due to dose delays or reductions. Moxibustion, the use of heat to stimulate acupuncture points, is a traditional East Asian intervention that may have potential to reduce pancytopenia. This study explored the feasibility of teaching chemotherapy patients in a National Health Service (NHS) cancer center a 10-minute daily intervention. It also aimed to obtain preliminary data to assess the completion of chemotherapy according to both dosage and schedule and assess any reduction of chemotherapy toxicities. Methods This uncontrolled, single-arm study aimed to recruit breast, colorectal or gynecological cancer patients undergoing chemotherapy regimens for which granulocyte-colony stimulating factor (G-CSF) is not indicated. The primary outcome was concordance with daily self-administered moxibustion (starting 7‒10 days before commencing chemotherapy and continuing for three weeks after the final cycle) measured by daily moxibustion diaries. Secondary measures included blood counts, variation to planned chemotherapy schedule, health-related quality of life measured by functional assessment of cancer therapy (FACT)-general, FACT-anemia, and FACT-neutropenia, patient activation measure (PAM-13), chemotherapy-related toxicities, and adverse events of moxibustion. Results Twenty-five participants were recruited. Of a potential 2944 applications, 1369 were recorded; overall concordance rate was 46.5% (individual range 4%‒96%). Main reasons for non-concordance included chemotherapy-related sickness, fatigue, and forgetfulness. There were no serious adverse events. The intervention was acceptable to some patients and oncology healthcare professionals. Challenges to collecting and analyzing data using the outcome measures were identified. Conclusion This was the first known attempt in the West to research using self-applied moxibustion in a conventional cancer care setting. The results indicate this intervention is generally acceptable and that it is possible to recruit to a study. The challenges identified inform recommendations for future study design.

Introduction Myopia is an escalating public health challenge worldwide, with a particularly high burden in China. Although conventional treatments are available, their effectiveness is often limited by issues related to adherence, cost, or safety. Traditional Chinese medicine (TCM), specifically Tuina therapy, offers a preventive approach, with studies suggesting its potential efficacy in the management of pediatric myopia. However, clinical adoption is hindered by lack of standardized treatment protocols. This study aimed to assess the efficacy and safety of Tuina therapy for pediatric myopia and establish a standardized protocol based on the Zhi Wei Bing (prevention first) theory. Methods A multi-method, consensus-based approach was employed, comprising three stages: (i) Problem Identification: Semi-structured expert interviews; (ii) Evidence Retrieval and Synthesis: A systematic literature search (up to September 2023) across Chinese and English databases; and (iii) Recommendation Formulation: A two-round Delphi process, involving 203 ophthalmologists and 76 Tuina specialists, achieved predefined agreement (≥60% consensus) on procedures, acupoint protocols, and TCM pattern differentiation. Recommendations were developed using evidence-to-decision frameworks and Good Practice Statements. Evidence quality and recommendation strength were assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Results Tuina therapy demonstrated favorable efficacy and safety in the prevention and treatment of low-degree myopia and pseudomyopia in children. A consensus was reached regarding five TCM patterns. A standardized acupoint protocol was established: 14 core acupoints for the preventive stage, 21 for progression management, and 25 for pattern differentiation. A combined strategy using both foundational and pattern-specific acupoints is recommended. The foundational protocol can be applied alone if no specific pattern is identified. Home-based eye exercises were endorsed as complementary strategies. Conclusion This study developed the first evidence-based standardized Tuina protocol for pediatric myopia, addressing a critical gap in non-pharmacological management. These findings suggest that Tuina is an effective and safe therapeutic approach.

Introduction Artificial intelligence (AI) is penetrating medical education and its research status needs to be reviewed and suitably integrated. This study aimed to analyze the current status, hotspots, and trends of AI in medical education. Methods Data were retrieved from the Web of Science Core Collection (WOSCC), PubMed, China National Knowledge Infrastructure (CNKI), Wanfang, Chinese Scientific Journal Database (VIP) databases. Using CiteSpace, relevant data were extracted to analyze burst citation detection for keywords, clustering, keyword timelines, and keyword emergence. VOSviewer was used to generate visual collaborative network graphs for the keyword timelines. Results This study identified 2437 published in English and 326 Chinese papers. Cluster analysis identified three core themes: technology-driven medical educational innovation, the intelligent transformation of clinical ability training, and the construction of ethical risk and governance systems. In western research, the focus has been on specific technologies, such as deep learning and robotic surgery, with concentrated ethical discussions emerging in 2022. However, Chinese research is driven by the New Medicine policy, which focuses on the macro-integration of AI and the medical education system, with ethical review mechanisms appearing in clusters in 2024. In general, both Chinese and English articles considered the improvement of practical ability using augmented reality and virtual reality technology and the paradigm shift from knowledge transfer to training in higher-order thinking. Conclusion While specific technologies and earlier ethical debates have been prioritized in English research, policy-driven systemic integration and later governance frameworks have been emphasized in Chinese research, both coverage on enhancing practical abilities and shifting educational paradigms. In future research, AI should be further integrated with medical education values and student-centered innovations should be promoted.

Introduction In recent years, guidelines and consensus statements have recommended Chinese patent medicines (CPMs) for the treatment of functional constipation (FC). The latest Chinese Health Care Directory also lists CPMs for FC; however, the supporting evidence remains insufficient. In this study, we aimed to evaluate the effectiveness and safety of CPMs in the treatment of FC using a network-meta-analysis (NMA). Methods We searched for eligible randomized controlled trials (RCTs) published in the databases of PubMed, Cochrane Library, Embase, SinoMed, China National Knowledge Infrastructure, Wanfang, and Chinese Scientific Journals Database. Bayesian NMA and pairwise comparisons were performed to determine the frequency of spontaneous bowel movements, clinical effects, recurrence rate, dyschezia score, and defecation time score. Results A total of 61 studies were included. The methodological quality of the included studies was relatively poor, and the reliability of the synthetic outcomes was low. Our findings indicate that in older individuals, according to the self-established clinical efficacy criteria, Liuwei Anxiao combined with prokinetics demonstrated superior clinical effectiveness compared to prokinetic monotherapy (risk ratio [RR]: 1.46, 95% confidence interval [CI]: 1.17, 1.96), with lower scores for defecation times (mean difference: −0.30, 95% CI: −0.60, −0.02). Dalitong granules combined with prokinetics showed better clinical efficacy than prokinetic monotherapy (RR: 1.59, 95% CI: 1.03, 2.53). In older participants, based on published clinical efficacy criteria, Shouhui Tongbian capsule combined with an osmotic laxative exhibited superior clinical effectiveness compared to osmotic laxative monotherapy (RR: 1.21, 95% CI: 1.00, 1.48). Reported adverse events included stomachache, diarrhea, and nausea. Conclusions Several positive outcomes were observed, including better clinical effects across different criteria and lower defecation frequency scores. However, the quality of the included studies and the conclusions on CPM coverage areas were limited. Future research should include more high-quality studies directly comparing the effects of different CPMs.

Introduction Chronic heart failure (CHF) confers high mortality and heavy economic burden as a critical public health issue. Qili Qiangxin (QLQX) capsules, a traditional Chinese patent medicine, may improve clinical outcomes in CHF patients. This study evaluated the economic value of QLQX capsules for CHF. Methods A health economic analysis was performed from the healthcare system perspective. Cost-effectiveness analysis was used for short-term outcomes, and a Markov model-based cost-utility analysis for long-term outcomes. Robustness was tested using one-way and probabilistic sensitivity analyses. Results A total of 1555 patients were equally randomized to two groups: QLQX capsules plus standard of care (QLQX group) or standard of care alone (control group). Baseline characteristics were comparable between groups. In the QLQX group, 1-year direct medical costs were ¥9368.08 (\$1311.53; 95% confidence interval [CI]: [¥8980.61, ¥9755.55]), versus ¥6402.21 (\$896.31; 95% CI: [¥5903.50, ¥6900.91]) in the control group. The higher costs in the QLQX group were primarily driven by medication expenses. Composite endpoint events occurred in 19.00% (95% CI: [17.07%, 21.03%]) of the QLQX group compared with 23.40% (95% CI: [21.34%, 25.61%]) of the control group (P = 0.003). The incremental cost-effectiveness ratio (ICER) was ¥67 406.14 (\$9436.86). Over a 15-year time horizon, the QLQX group incurred total costs of ¥57 096 (\$7993.44) and achieved 5.46 QALYs, whereas the control group incurred ¥34 016 (\$4762.24) and achieved 5.07 QALYs, resulting in an ICER of ¥58 946 per QALY (\$8252.44/QALY). This value is below China’s 2023 per capita gross domestic product threshold (¥89 358; \$12 510.12), suggesting that QLQX capsule is highly cost-effective. Sensitivity analyses further confirmed the robustness of these findings. Conclusion QLQX capsules were associated with higher short-term costs but greater efficacy than standard care, and long-term modeling supports their high cost-effectiveness.

This article reviews the newly published book Theory and Methods of Health Technology Assessment in Traditional Chinese Medicine. In response to the mismatch between conventional health technology assessment (HTA) frameworks and the holistic, individualized nature of traditional Chinese medicine (TCM), this book proposes a localized “Chinese yardstick” for evaluation. It integrates standard health economic assessments with TCM-specific characteristics, drawing on over a decade of real-world research on Chinese patent medicines and non-drug therapies. Key innovations include adapting the Population, Intervention, Comparator, Outcome, and Study design (PICOS) framework to incorporate “pattern type,” modifying Grading of Recommendations Assessment, Development and Evaluation (GRADE) to account for long-standing clinical wisdom, and employing multi-criteria decision analysis. By bridging the evidence-to-policy gap, the book establishes a scientifically rigorous yet culturally appropriate HTA framework, offering a strategic roadmap for integrating TCM into modern health systems and contributing valuable insights to the global HTA discourse.

Introduction The rapid expansion of systematic reviews (SRs) has led to increasing concerns about research duplication and redundancy. While several tools exist to assess the quality and risk of bias of SRs, no standardized instrument specifically evaluates the degree of duplication between SRs on similar topics. This protocol describes the development and validation of the systematic review duplication (SRD) tool, which is designed to systematically assess and quantify duplication between intervention-based SRs in healthcare. Methods The development process follows established guidelines for creating reporting and quality assessment tools and comprises three phases: (Ⅰ) preparatory work, including team formation and tool conceptualization; (Ⅱ) tool development, involving initial item generation through a systematic literature review and analysis of existing tools, item validation through pilot testing with 40 SRs across 17 disease categories, modified Delphi surveys, and consensus meetings; and (Ⅲ) dissemination through academic channels and professional networks. The SRD tool will evaluate duplication across four domains: research topic, research methods, research results, and research quality. Expert consensus will be achieved through a two-round modified Delphi process with an agreement threshold of at least 70%. Inter-rater reliability will be assessed using the intraclass correlation coefficient and Kendall’s W coefficient. Expected outcomes: The SRD tool is expected to provide a standardized, user-friendly instrument for distinguishing necessary replication from redundant duplication in SRs. It will be available as both web-based and Excel-based applications. Discussion The SRD tool is intended to fill a critical gap in evidence synthesis methodology by enabling the systematic assessment of duplication and supporting informed decision-making by researchers, journal editors, guideline developers, and clinicians.