Shu Li

Purpose: Globally, far fewer women than men are in leadership positions in academic medicine. This study aimed to explore the barriers and facilitators of female leadership development in the Chinese medical field, identify significant factors promoting leadership development, and ultimately provide a basis for the formulation of leadership enhancement strategies. Methods: This qualitative descriptive study, grounded in an interpretivist paradigm, used purposive sampling to recruit female junior faculty members (< 40 years) and senior leaders from university-affiliated hospitals in Beijing, China. In-depth, semi-structured interviews were conducted, audio-recorded, and transcribed verbatim. All interviews were conducted either online or by phone in participants’ preferred language (Mandarin or English). Transcripts were analyzed using thematic analysis, with NVivo 11.0 used to support systematic coding and data management. Results: We interviewed 18 junior faculty members and 7 senior faculty leaders from five university-affiliated hospitals in Beijing. The main outcomes of interest were barriers and facilitators to female leadership development in the Chinese medical field. Three major themes emerged: (1) the current status of women’s leadership in academic medicine, characterized by the underrepresentation of women in leadership positions; (2) multi-level barriers to advancement at the policy/structural, social, and individual levels, including gendered retirement policies that truncate careers, stereotypes regarding women’s professionalism and competence, disproportionate family responsibilities, and a confidence gap; and (3) essential skills, individual characteristics and facilitators for leadership development, with particular emphasis on leadership training and the importance of female role models. Conclusion: This study reveals context-specific structural barriers, such as gendered retirement policies, alongside pervasive social stereotypes within Chinese academic medicine context. Women in academic medicine continue to face systematic constraints that limit their advancement into leadership roles. A multi-level approach should be applied to mitigate informal barriers, and cultural interventions that challenge deep-seated gender norms.

Background: Effective shared decision-making (SDM) for life-sustaining treatment (LST) requires alignment between physicians and surrogates. However, discrepancies in perceptions and communication may hinder ethically sound decisions. This study aimed to compare the perceptions and attitudes of physicians and surrogates toward SDM for LST in a Chinese hospital setting. Methods: This pre-planned secondary analysis included data from two cross-sectional surveys administered to physicians and surrogates. Participants were 325 surrogates of critically ill adult patients admitted to the Emergency Intensive Care Unit (EICU) of a tertiary teaching hospital and 351 physicians from hospitals in Beijing. Survey items assessed triggers and preferred models of decision-making, disclosure practices, perceived decisional capacity, and factors influencing LST decisions. Statistical comparisons were performed using appropriate tests for categorical data. Results: Although a majority in both groups nominally preferred SDM (physicians: 52.7%; surrogates: 44.3%; p = 0.155), significant discrepancies emerged across other domains. Physicians were more likely than surrogates to initiate LST discussions earlier (88.0% vs. 75.3%; p < 0.001). Perceived understanding differed markedly: 87.7% of surrogates rated their comprehension as “good” or “excellent”, whereas 73.8% of physicians rated surrogate understanding as “fair” or “poor” (p < 0.001). Surrogates expressed a stronger preference for receiving quantitative prognostic information and decision-support tools. Most physicians (94.9%) reported directing consent discussions primarily to families, with limited patient involvement. Priorities for LST decisions diverged: physicians emphasized clinical indicators such as prognosis (96.0%) and comorbidities (91.7%), whereas surrogates emphasized patient age (72.0%). Conclusions: Marked discordances exist between physicians and surrogates in their perceptions and practices regarding SDM for LST in China. Differences in communication strategies, informational expectations, and decision-making priorities underscore the need for contextually adapted interventions, such as structured communication tools and culturally sensitive clinician training, to bridge these gaps and support ethically aligned decision-making.

Background: The study investigates Chinese healthcare professionals’ attitudes toward patient-initiated audio-recordings of medical consultations, a growing practice aimed at improving patient comprehension, while also presenting legal, ethical, and clinical challenges. Design and methods: A cross-sectional survey was conducted from March to September 2022 as a pilot study. Physicians from various specialties across China were invited to complete an anonymous online questionnaire. The survey assessed demographic data, attitudes toward patient-led recordings, and the reasons behind these attitudes. Statistical analyses, including chi-square and Fisher’s exact tests, were applied to identify significant differences, with a p -value of <0.05 considered statistically significant. Results: Out of 968 valid responses, 36.8% of physicians supported patient-initiated recordings, while 63.2% were opposed. Significant differences were observed based on gender, age, years of practice, and professional title, but not on education level or hospital type. Supporters cited enhanced communication and respect for patient autonomy as key reasons, while opponents expressed concerns about potential legal risks, reduced medical efficiency, and damage to trust in the doctor-patient relationship. Conclusions: The majority of participating physicians in our study remain cautious about patient-initiated recordings, reflecting a need for clearer regulatory frameworks and protections. This caution highlights the complexity of balancing patient engagement with the practicalities of clinical work. Practice implications: Establishing standardized guidelines and offering training for healthcare professionals on managing recorded consultations could alleviate concerns and foster a more collaborative doctor-patient relationship.

Background: The perceptions of practicing physicians regarding the current situation and appropriateness of shared decision-making (SDM) in life-sustaining treatment (LST) are of essential importance. The objective of this study is to investigate the clinical practice patterns and barriers to this process in China. Methods: A cross-sectional survey of physicians in China was conducted to assess perceived practices of SDM in LST. The survey instrument was developed through the Delphi method. Descriptive analyses and an exploratory factor analysis were performed to explore the correlations of factors. Results: We polled 977 physicians, of whom 971 completed the survey and 834 (85.9%) have experience of decision-making conversations for LST and entered the final analysis. Physicians expressed that in the process of doctor–patient communication, over-expectations of disease prognosis (778 [93.3%]), lack of general medical knowledge (716 [85.9%]), and negative emotional status (574 [68.8%]) served as the main barriers to decision-making communication from the patient/family side, while under-expressed patient value (429 [51.4%]), limited communication due to work-load (359 [43%]), lack of communication skills (310 [37.2%]), and insufficient ability to cope with difficult cases (203 [24.3%]) as obstacles from the physician side. Only 185 (22.2%) physicians chose to disclose medical information according to literature evidence. The direct effects of physician service year and disclosure pattern on patient/family decision-making ability revealed statistically significant correlations (β_{DMA = 0.08, p = 0.035; βDMA = 0.40, p < 0.001), as did the effect of disclosure pattern on patient value expression (βPV = 0.88, p < 0.001). Conclusions: From physicians’ perspective, barriers of decision-making conversations correlated with multiple factors, including under-expressed patient value, insufficient patient/family decisional capacity or ability, and experience and communication patterns of physicians.}

Advances in emergency and critical care have improved outcomes, but gaps in communication and decision-making persist, especially in the emergency department (ED), prompting the development of a checklist to aid in serious illness conversations (SIC) in China. This was a single-centre prospective interventional study on the quality improvement of SIC for life-sustaining treatment (LST). The study recruited patients consecutively for both its observational baseline and interventional stages until its conclusion. Eligible participants were adults over 18 years old admitted to the Emergency Intensive Care Unit (EICU) of a tertiary teaching hospital, possessing full decisional capacity or having a legal proxy. Exclusions were made for pregnant women, patients deceased upon arrival, those who refused participation, and individuals with incomplete data for analysis. First, a two-round Delphi process was organized to identify major elements and generate a standard process through a checklist. Subsequently, the efficacy of SIC in adult patients admitted to the EICU was compared using the Decisional Conflict Scale (DCS) score before (baseline group) and after (intervention group) implementing the checklist. The study participants presented with the most common comorbidities, such as diabetes, myocardial infarction, cerebrovascular disease, moderate-to-severe renal disease, congestive heart failure, and chronic pulmonary disease. The median Charlson Index did not differ between the baseline and intervention cohorts. The median length of hospital stay was 11.0 days, and 82.9% of patients survived until hospital discharge. The total DCS score was lower in the intervention group than in the baseline group. Three subscales, including the informed, values clarity, and support subscales, demonstrated significant differences between the intervention and baseline groups. Fewer intervention group patients agreed with and changed their minds about cardiopulmonary resuscitation (CPR) compared to the baseline group. The use of a SIC checklist in the EICU reduced the DCS score by increasing medical information disclosure, patient value awareness, and decision-making support.

Purpose. At present, not enough is known about the symptoms before cardiac arrest. The purpose of this study is to describe the precursor symptoms of cardiac arrest, focusing on the relationship between symptoms and cardiac arrest, and to establish a quick scoring model of symptoms for predicting cardiac arrest. Patients and Methods. A retrospective case-control study was carried out on cardiac arrest patients who visited the emergency department of Peking University Third Hospital from January 2018 to June 2019. Symptoms that occurred or were obviously aggravated within the 14 days before CA were defined as warning symptoms. Results. More than half the cardiac arrest patients experienced warning symptoms within 14 days before cardiac arrest. Dyspnea ( ) was found to be associated with cardiac arrest; syncope and cold sweat are other symptoms that may have particular clinical significance. Gender ( ), age ( ), history of heart failure ( ), chronic kidney disease ( ), and hyperlipidemia ( ) were other factors contributing to our model. Conclusions. Warning symptoms during the 14 days prior to cardiac arrest are common for CA patients. The Quick Scoring Model for Cardiac Arrest (QSM-CA) was developed to help emergency physicians and emergency medical services (EMS) personnel quickly identify patients with a high risk of cardiac arrest.

Acute traumatic spinal cord injury (ATSCI) usually results in disability, yet data on contemporary national trends of ATSCI incidence are limited. To provide a systematic and basic theoretical basis for improving the treatment of acute spinal cord injury. Data from the Peking University Third Hospital Inpatient Sample databases were analyzed. A total of 304 patients with ATSCI were included from 2012 to 2017. The epidemiological data, treatment, complications and clinical outcomes of these patients were reviewed. Of the 304 patients, 257 (84.5%) were male, and 75% of the patients were 55 years old or younger. 135 patients had improved follow-up American Spinal Injury Association (ASIA) grades (44.4%). Only 14 patients with ASIA grade A improved. A statistically significant difference in prognosis between patients who underwent surgery within 72 h and those who underwent surgery after 72 h was observed (P < 0.05). Surgery within 72 h resulted in better prognosis. The Steroid group and the Non-Steroid group showed a significant difference in outcome among patients with ASIA grades A and B (P < 0.05). Patients with pneumonia had a poorer prognosis than patients without pneumonia (P < 0.05). Surgery within 72 h resulted in better prognosis. This study found that there was no significant difference in hospitalization time and prognosis between the Steroid group and the Non-Steroid group, but the patients with severe spinal cord injury (ASIA grades A and B) who underwent surgery combined with steroid therapy had a better prognosis than those who underwent surgery alone. The disastrous consequences of ATSCI and lack of consensus on the management strategy are obvious. Further improvements in treatment planns are needed in order to obtain more reliable functional outcomes.

Objective: In-hospital mortality in patients successfully resuscitated following out-of-hospital cardiac arrest (OHCA) is high. The factors and timings of these deaths is not well known. To better understand in hospital post-OHCA mortality we developed a novel categorization system of in hospital death and studied the factors and timings associated with these deaths. Methods: This was a single-centered retrospective observational human study in adult non-traumatic OHCA patients in a university affiliated hospital. Through an expert consensus process, a novel classification system of hospital death was developed. Results: Two hundred and forty-one patients were enrolled in the study. Death was categorized as due to withdrawal of life sustaining treatment (WOLST) 159 (66.0%), recurrent in-hospital cardiac arrest 51 (21.1%), or due to neurological criteria 31 (12.9%). Subcategorization of factors associated with WOLST into 7 categories was done by defined criteria. Inter-reliability of this system was 0.858. 50% of WOLST decisions were due to neurological injury. Early death (≤ 3 days) was associated with recurrent in-hospital cardiac arrest and WOLST in the setting of refractory shock or multi-organ injury. Late in-hospital death (> 3 days) was primarily due to WOLST decisions in the setting of isolated neurological injury. Conclusions: OHCA in hospital mortality occurred in a bimodal pattern with early deaths due to recurrent arrest and multiorgan injury while late deaths were due to isolated neurological injury. The majority of deaths occurred in the setting of WOLST decisions. Further study of the influence of these factors on post OHCA survival are needed.