This scoping review synthesises peer-reviewed and grey literature on supported access to medical care for hospital employees with existing physical health complaints to understand how it may reduce sickness absenteeism by promoting sustainable employability and to identify gaps and opportunities to inform the design and implementation of organisational supported care frameworks.

We conducted this scoping review following the Arksey and O'Malley framework and Levac et al's methodological recommendations, reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extensions for Scoping Reviews (PRISMA-ScR).

MEDLINE (Ovid), Embase (Elsevier), CINAHL (EBSCO) and Web of Science were searched from database inception to 8 November 2024. The search was updated on 18 May 2026. This was supplemented by forward and backward citation tracking of included peer-reviewed articles and targeted hand searching of Dutch grey literature in Medisch Contact , a leading Dutch professional journal for the medical profession, focusing on clinical practice, medical policy and professional issues.

English-language or Dutch-language peer-reviewed publications and well-argued opinion pieces on healthcare workers' access to care (COVID-19 and beyond) in hospital or transferable settings were included. Sources focused on mental health or health promotion, financial aspects, personal protective equipment, patient access or healthcare worker utilisation, as well as non-English/Dutch sources, webpages and papers without full text, were excluded.

ASReview was used for title and abstract screening following the SAFE procedure and full-text screening was conducted with team consensus.

27 publications were included from 36 685 identified records. The literature was predominantly qualitative in nature and COVID-19-focused, yielding four themes (ethical considerations, multilevel challenges, target groups and strategies and outcomes). It also highlighted limited evidence on evaluated supported-access interventions and workforce outcomes beyond crises.

Although supported access to medical care for hospital employees appears a promising multilevel, system-embedded strategy to reduce sickness absenteeism and promote sustainable employability in general, the evidence to substantiate and justify such strategies beyond acute crises is limited. Moreover, current literature lacks clear conceptualisation, operationalisation as well as robust implementation and evaluation frameworks. Addressing these gaps is a priority for future research to scientifically scaffold policies and frameworks to sustain a healthy and stable future hospital workforce.

Tachypnoea is a danger sign for predicting mortality and identifying sepsis. We systematically reviewed evidence on the diagnostic accuracy of different tachypnoea thresholds for predicting mortality and sepsis in infants aged 0-59 days.

We searched MEDLINE, Embase, CINAHL, Global Index Medicus and CENTRAL for studies reporting associations or diagnostic accuracy of tachypnoea (≥60, ≥70 or ≥80 breaths per minute (bpm)) for predicting mortality and culture-confirmed sepsis in infants aged 0-59 days. We followed Cochrane methods for study screening, data extraction and quality assessment. We pooled ORs using random-effects models and sensitivity/specificity using random-effects bivariate models. We used GRADE (Grading of Recommendations, Assessment, Development and Evaluation) to assess the certainty of evidence.

Of 7641 studies identified, 18 were included (n=92 398). Tachypnoea≥60 bpm had a pooled OR of 3.14 (95% CI 1.30 to 7.56; 5 studies; n=10 407) for predicting mortality and a sensitivity of 31% (95% CI 19% to 45%) and a specificity of 89% (95% CI 66% to 97%; 4 studies; n=7104). For culture-confirmed sepsis, tachypnoea≥60 bpm had an OR of 1.26 (95% CI 0.66 to 2.38; 4 studies; n=3996), and a sensitivity of 28% (95% CI 10% to 58%) and a specificity of 67% (95% CI 53% to 78%; 3 studies; n=693). The higher threshold of tachypnoea≥70 bpm was associated with a higher odds of mortality (OR 10.06 (95% CI 2.39 to 42.35); 2 studies; n=12 138) and resulted in higher specificity (99.4% (95% CI 99.1% to 99.6%)) but lower sensitivity (10.9% (95% CI 5.3% to 19.1%)) for mortality (1 study; n=5214). Data were insufficient to assess performance by age subgroup (0-6 vs 7-59 days). The certainty of evidence was very low.

Tachypnoea≥60 bpm is associated with a threefold increased odds of mortality in young infants, supporting its use as a danger sign. Given its relatively low sensitivity alone, tachypnoea should be interpreted alongside other clinical signs to optimise diagnostic accuracy. While higher thresholds (≥70 bpm) demonstrated stronger associations and increased specificity for predicting mortality, low sensitivity may limit clinical utility.

CRD42023431387.

Otitis media is a complex disease. The pathogenesis of both acute and chronic otitis media results from a complex interplay of anatomical, microbiological, and immunological factors. Identified risk factors include patient-related aspects such as nutrition, allergies, ethnicity, and genetic predisposition, as well as environmental factors such as socioeconomic status, tobacco use, attendance at daycare centers and recurrent respiratory infections. During the COVID-19 pandemic, strict measures led to a significant decline in the incidence of acute otitis media. However, infections with variants such as Omicron showed an increased rate of secretory otitis media. In the post-COVID phase, complication rates due to middle ear infections rose again, with prevalence returning to pre-lockdown levels. Preventive measures focus on ensuring adequate Eustachian tube function, treating allergies, and consistently administering pneumococcal vaccinations. In contrast, surgical treatment remains the gold standard for chronic middle ear infections and cholesteatoma. However, radical removal can be associated with high morbidity rates, underscoring the need for innovative approaches. These include optical coherence tomography (OCT) and minimally invasive laser surgery. Furthermore, new insights into the role of the immune system in the pathogenesis of both acute and chronic otitis media could open up new therapeutic possibilities for the future. This article discusses the current state of knowledge on the pathophysiological mechanisms, classification, diagnosis, and treatment of otitis media, as well as new treatment models and their implications.

Using the systematic review of text and opinion(SrTO) methodology, this study conducted a quality appraisal and synthesis of literature related to the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD) with the TCM Fu-Zheng(supporting healthy Qi) method, with the aim of providing evidence-based basis for its rational clinical application. Non-research literature on the use of the TCM Fu-Zheng method for AECOPD was comprehensively retrieved. Published literature was sourced from traditional sources, including CNKI, Wanfang, VIP, SinoMed, and Duxiu Academic Search, while grey literature was sourced from the Chinese Academy of Sciences pre-publication platform for scientific papers, government websites, industry association websites, and WeChat official accounts. Two researchers independently screened the literature and extracted data, and the included content was appraised using the JBI textual quality appraisal tool. CONCLUSION::s were generated using the three-stage conclusion aggregation method of the NOTARI module. Chi-square tests were used to analyze the association between geographic regions and conclusion types, and Mann-Kendall tests together with the Theil-Sen method were employed to compare temporal differences in the number of conclusions. A total of 319 documents were included, from which 378 textual units involving 219 physicians were extracted, spanning the period from 1994 to 2025 and covering 28 provinces and municipalities. All seven policy-related texts were rated as "clear" in credibility, with nine cumulative repetitions, yielding two secondary conclusions and one tertiary conclusion. These conclusions provided clear directional guidance: the treatment of AECOPD should follow the principle of "treating the manifestations in acute conditions and the root in stable phases", focusing primarily on pathogen-eliminating measures such as clearing heat, resolving phlegm, activating blood, diffusing the lung and descending Qi, and opening the orifices, while simultaneously emphasizing "attending to both Qi and Yin" through Fu-Zheng approaches, including tonifying the lung and strengthening the spleen or tonifying both the lung and kidney, so as to prevent excessive pathogen elimination from damaging healthy Qi. Among the 371 experiential opinion and/or case-based textual units, 129 were rated as "clear", 199 as "credible", and 43 as "not supported", with 476 cumulative repetitions, forming 14 secondary conclusions and 4 tertiary conclusions. Fu-Zheng by tonifying Qi(conclusion A) comprised 264 textual units, with 48.67% rated as "clear", and its dominant secondary conclusion was spleen-strengthening and Qi-tonifying(A1, 110 units). Fu-Zheng by warming Yang(conclusion B) included 76 units, with 39.48% rated as "clear". Fu-Zheng by nourishing Yin(conclusion C) comprised 86 units, with 37.21% rated as "clear". CONCLUSION:: D addressed the overall necessity of the Fu-Zheng method without specifying particular therapeutic approaches and included 50 units, 38.00% of which were rated as "clear". No statistically significant differences were observed in the distribution of conclusions across geographic regions. In terms of growth trends, conclusion A showed a significantly greater increase than conclusions B, C, and D(P<0.05), with a markedly larger difference, whereas no differences were observed among conclusions B, C, and D, whose trends were relatively modest. These results indicate that the Fu-Zheng method plays a clearly established role in the treatment of AECOPD, although its application requires strict adherence to appropriate indications. Among the various Fu-Zheng approaches, Qi-tonifying predominates, as reflected by its highest utilization proportion, most pronounced temporal growth, and strongest evidence base, with spleen-strengthening and Qi-tonifying being particularly critical. Yang-warming and Yin-nourishing therapies, while indispensable in specific syndrome patterns, have relatively limited application scenarios.

The comorbidity of chronic obstructive pulmonary disease(COPD) and coronary heart disease(CHD) is becoming increasingly common. These conditions exacerbate each other through multiple mechanisms such as systemic inflammation and oxidative stress, which significantly increases patient mortality and socio-economic burden. In the face of challenges in modern medical treatment, actively exploring integrated traditional Chinese and western medicine prevention and treatment strategies is of great importance. TCM posits that COPD and CHD can be categorized under "lung distension" and "chest impediment", respectively, with their comorbidity closely related to phlegm-stasis binding. Furthermore, the blood turbidity theory proposes that blood turbidity, a pathological state of blood component and functional dysregulation, serves as the precursor and common ground for the formation of pathological products like phlegm-turbidity and blood stasis, representing a more fundamental and earlier key pathogenic mechanism than phlegm-stasis binding. Based on the blood turbidity theory and the heart-lung correlation theory, this paper systematically elucidated the dynamic, staged progression of pathogenesis in COPD combined with CHD, from internal accumulation of blood turbidity to its evolution into phlegm-turbidity, stasis-turbidity, toxin-turbidity, and deficiency-turbidity. It revealed the intrinsic connections between this progression and modern medical mechanisms such as inflammation, oxidative stress, and metabolic disorders. On this basis, the paper proposed a clinical approach centered on clearing turbidity from the blood and simultaneous heart-lung treatment, which featured stage-based syndrome differentiation and treatment targeting the chronic stable phase, progressive phase, progressively aggravated phase, and acute exacerbation phase. This aims to provide a theoretical reference and novel diagnostic-therapeutic strategies of integrated traditional Chinese and western medicine in the prevention and treatment of this comorbidity.

This study aims to explore the role of harmane in ameliorating pulmonary fibrosis in mice by inhibiting the transformation of lung fibroblasts into myofibroblasts. Transforming growth factor-β_1(TGF-β_1, 5 ng·mL~(-1)) was used to treated MRC-5 cells for the modeling of pulmonary fibrosis. The inhibitory rates of different concentrations of harmane on model cells were measured by the CCK-8 method, and the median inhibitory concentration(IC_(50)) was determined. Harmane at IC_(50) and the adjacent concentrations was used for intervention. The cell myofilament immunofluorescence method, scratch experiment, and flow cytometry were adopted to evaluate the inhibitory effects of harmane on the proliferation, differentiation, and migration of model cells. Then, qRT-PCR and immunofluorescence methods were used to analyze the effects of harmonine on the expression of α-smooth muscle actin(α-SMA), type Ⅰ collagen(collagen Ⅰ), and fibronectin at mRNA and protein levels. Fifty SPF-grade male C57BL/6 mice were randomly assigned into a normal control group and a modeling group. A mouse model of pulmonary fibrosis was constructed by intranasal dropping of 5.0 μg·kg~(-1) bleomycin. The modeled mice were randomly allocated into model, nintedanib(30 mg·kg~(-1)) and harmane(30, 45 mg·kg~(-1)) groups, with 10 mice in each group. The mice in harmane and nintedanib groups were administrated with aqueous solution by gavage. After 14 days of continuous administration, the respiratory function of each mouse was measured with a non-invasive whole-body plethysmography system. The pathomorphological characteristics of the lung tissue were observed by hematoxylin-eosin(HE) and Masson staining. The hydroxyproline(HYP) level in the lung tissue was measured by a HYP assay kit. Enzyme-linked immunosorbent assay was employed to determine the content of TGF-β_1, interleukin(IL)-6, and IL-1β in the lung tissue. Western blot was employed to quantify the expression levels of α-SMA and collagen Ⅰ in the lung tissue. The results showed that harmane significantly inhibited the proliferation of MRC-5 cells stimulated with TGF-β_1, with an IC_(50) value of 29.01 μg·mL~(-1). Harmane inhibited the phenotypic differentiation and decreased the scratch migration rate of lung fibroblasts, while significantly promoting the occurrence of apoptosis. In addition, harmane significantly down-regulated the mRNA levels of α-SMA, collagen Ⅰ, and fibronectin. The animal experiment showed that compared with the control group, the model group exhibited significant reductions in body weight and lung function, deposition of collagen fibers, an increase in fibrosis area, elevations in levels of HYP, TGF-β_1, IL-6, and IL-1β, up-regulation in protein levels of α-SMA and collagen Ⅰ, and obvious pulmonary fibrosis. Compared with the model group, the administration groups showed increases in body weight and lung function, reductions in collagen fiber deposition and fibrosis area, declines in levels of HYP, TGF-β_1, IL-6, and IL-1β, and alleviated pulmonary fibrosis. Harmane slows down pulmonary fibrosis in both in vivo and in vitro experiments by inhibiting the transformation of lung fibroblasts and reducing the inflammatory response.

This study aims to elucidate the therapeutic effects and mechanisms of the combination of Epimedii Folium and Ligustri Lucidi Fructus on glucocorticoid(GC) synthesis-restricted asthma in rats. The classic asthma model induced by ovalbumin(OVA) sensitization and challenge, a complex asthma animal model with specific suppression of hypothalamic-pituitary-adrenal(HPA) axis at the synthesis level of endogenous GC by intraperitoneal administration of metyrapone(Met), was established. This model was designed to simulate the pathological condition of GC resistance or insufficient synthesis encountered in clinical practice. Male SD rats were randomly assigned into six groups: normal, Met, asthma+Met, Epimedii Folium, Ligustri Lucidi Fructus, and Epimedii Folium+Ligustri Lucidi Fructus, followed by a one-week drug treatment via gavage. Serum levels of corticotropin-releasing hormone(CRH), adrenocorticotropic hormone(ACTH), corticosterone(CORT), and cortisol(COR) were assessed. Targeted metabolomics was adopted to detect endogenous GC metabolism levels in the urine. Immunohistochemical staining was employed to assess the expression of hydroxysteroid dehydrogenase(HSD) 11B1,HSD11B2, cytochrome P450 family 11 subfamily B member 1(CYP11B1), and steroidogenic factor 1(SF1) in the lung and adrenal gland. Western blot was employed to quantify the expression of related proteins in the liver tissue. The results showed that Epimedii Folium and/or Ligustri Lucidi Fructus elevated the serum concentrations of CRH, ACTH, CORT, and COR in model rats, partially reversed abnormalities in the urinary GC metabolic profile, and upregulated the expression of key synthetic and metabolic enzymes(HSD11B1, HSD11B2, CYP11B1, and SF1) in the lung, liver, and adrenal gland. The combination of Epimedii Folium and Ligustri Lucidi Fructus exerts multi-faceted regulatory effects on both the HPA axis and GC synthesis/metabolism in the peripheral tissue, synergistically ameliorating endogenous GC dysregulation in synthesis-restricted asthma. These findings suggest the potential therapeutic value of this combination against GC resistance and related disorders.

The Global Lung Function Initiative (GLI) has recently introduced race-neutral reference equations for pulmonary function tests, replacing traditional ethnic-specific equations. However, the clinical impact of this transition in Northeast Asian patients with idiopathic pulmonary fibrosis (IPF) remains unclear.

We evaluated the implications of switching from the ethnic-specific equations to the race-neutral GLI equations in 903 Korean patients newly diagnosed with IPF between 2005 and 2020. Per cent predicted values of forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO) were calculated using both equations and used to derive the baseline gender-age-physiology (GAP) index scores. We then compared the prognostic performance of GAP staging derived from each equation in predicting all-cause mortality. Additionally, we assessed the clinical impacts of 1-year absolute declines in FVC and DLCO % predicted, as determined by each equation.

The race-neutral GLI equations yielded higher FVC % predicted and lower DLCO % predicted values compared with the ethnic-specific equations, resulting in GAP stage reclassification in 203 of 903 patients (22.5%), predominantly toward lower stages. Despite these differences, the agreement in GAP staging between the two equations was substantial (Cohen's kappa 0.628) and their predictive performance for mortality did not significantly differ (C-index 0.686 vs 0.684; p=0.598). One-year absolute declines in FVC and DLCO % predicted were similarly associated with increased mortality, regardless of reference equation used.

In Northeast Asian patients with IPF, race-neutral GLI equations resulted in reclassification of GAP stage for some patients but did not affect the overall prognostic performance of the GAP index in predicting mortality.

Acinetobacter baumannii, particularly multidrug-resistant strains, is a high-burden nosocomial pathogen with limited therapeutic options. Eravacycline is increasingly used off-label despite limited supporting clinical evidence. This meta-analysis aimed to evaluate the effectiveness and safety of eravacycline versus non - eravacycline-based regimens in adults with resistant A. baumannii infections.

MEDLINE, Embase, and Cochrane Central were searched for studies evaluating eravacycline regimens in hospitalized adults with A. baumannii infection. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Data were analyzed using R statistical software.

Fifteen studies encompassing 462 patients were included. Populations consisted predominantly of older adults, with respiratory tract infections representing the most common source of infection (77.6%). Carbapenem-resistant A. baumannii accounted for 84.4% of evaluable cases. No statistically significant differences were observed between eravacycline and non - eravacycline-based regimens in all-cause mortality (RR 1.06; 95% CI 0.46-2.47), clinical cure (RR 0.90; 95% CI 0.77-1.07), or microbiological eradication (RR 0.88; 95% CI 0.56-1.37). Complementary single-arm pooled estimates among eravacycline-treated cohorts were favorable.

This meta-analysis strengthens the evidence base for eravacycline effectiveness in resistant A. baumannii infections and supports its consideration when preferred regimens are not feasible; adequately powered randomized trials are needed to define optimal positioning.

This study aims to investigate the ameliorative effects and underlying mechanisms of Jingfang Granules(JF) combined with dexamethasone(DEX) in asthmatic mice. Balb/c mice were randomly assigned to seven groups according to body weight: normal, model, low-dose JF(1 g·kg~(-1)·d~(-1)), medium-dose JF(2 g·kg~(-1)·d~(-1)), high-dose JF(4 g·kg~(-1)·d~(-1)), DEX(1 mg·kg~(-1)·d~(-1)), and a combination of JF(4 g·kg~(-1)·d~(-1)) and DEX(1 mg·kg~(-1)·d~(-1)). The asthma model was established by intraperitoneal injection of ovalbumin(OVA) and aluminum hydroxide. Serum immunoglobulin E(IgE) and lung interleukin-4(IL-4), interleukin-5(IL-5), and interleukin-13(IL-13) levels were determined by enzyme-linked immunosorbent assay(ELISA). White blood cells(WBC), eosinophils(EOS), and lymphocytes(LYM) in bronchoalveolar lavage fluid(BALF) were counted, and T helper cell 1(Th1)/T helper cell 2(Th2) ratios were analyzed by flow cytometry to assess the anti-inflammatory and immunomodulatory effects of JF combined with DEX in asthmatic mice. Non-targeted and targeted metabolomics analyses were conducted to explore therapeutic mechanisms. The activities of superoxide dismutase(SOD), catalase(CAT), and glutathione(GSH), as well as the level of malondialdehyde(MDA), were measured by ELISA, and mitochondrial morphology was observed by transmission electron microscopy. Western blot was used to detect the expression of ferroptosis-related proteins glutathione peroxidase 4(GPX4), solute carrier family 3 member 2(SLC3A2), solute carrier family 7 member 11(SLC7A11), and acyl-CoA synthetase long-chain family member 4(ACSL4), thereby validating the findings of the metabolomics study. The results showed that compared with the model group, JF combined with DEX significantly decreased serum IgE and lung IL-4, IL-5, and IL-13 levels, reduced WBC, EOS, and LYM counts in BALF, and restored Th1/Th2 balance. Additionally, the combination therapy increased SOD, CAT, and GSH levels, lowered the MDA level, improved mitochondrial ultrastructure, and normalized GPX4, SLC3A2, SLC7A11, and ACSL4 expression. It may also inhibit ferroptosis via the regulation of amino acid metabolism. In summary, JF combined with DEX exerts synergistic anti-inflammatory, immunomodulatory, and antioxidant effects. It inhibits ferroptosis in asthmatic mice probably by regulating amino acid metabolism pathways, thereby improving the pathological state of asthma. This study provides experimental evidence supporting the use of TCM compounds combined with glucocorticoids for asthma treatment and offers novel insights into their synergistic mechanisms of intervention.