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A total of 207 general practitioners who participated in the "Beijing-Hong Kong Community Health Service Training Demonstration Center Project" training from 2013 to 2017 were selected for this questionnaire survey. A self-designed questionnaire was used, which contained the basic information of the trainees, the training purpose, the shortcomings of training, the satisfaction and suggestions for training. Total 192 valid questionnaires were retrieved with a recovery rate of 92.8%. The in-depth personal interviews were conducted among 8 trainees who served as key trainers in community health service centers and 4 managers from their institutions, to investigate the subsequent application of the learning results after they returning to work. The survey showed that the reasons of participating in training were knowledge updates (165, 85.94%), competence requirements (128, 66.67%), and due to administration decision (127, 66.15%). The highest comprehensive scores of training needs were improvement of general practice thinking ability (4.63), followed by clinical diagnosis and treatment ability (4.44), and general practice skills (3.97). For teaching contents, participants were most interested in diagnosis ability (4.03) and clinical operative techniques (3.20). For the training form, the participants more favored the case discussion method (80.73%, 155/192), clinical practice (52.08%, 100/192) and community practice (38.02%,73/192). The trainees were highly satisfied with the overall training organization, training time, training form, and training teachers of the Beijing-Hong Kong training project, and had a good grasp of the training content. Half of trainees (97, 50.52%) thought that the main shortcomings of training was the discrepancy between training content and practical work. Interviewees showed that after the training, the team management, communication skills and disease management ability for some minor specialties had been significantly improved; the enthusiasm for scientific research had been stimulated; they had a certain managerial thinking; and were able to apply what they leant in community health service. In summary, the training project has reached the initial training goals to promote the comprehensive ability of trainees.
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Objective To compare the consistency between interstitial fluid glucose and arterial blood glucose in septic shock patients with different tissue perfusion levels.Methods A prospective investigative study was conducted. Sixty-one septic shock patients with ages above 18 years old admitted to the Department of Critical Care Medicine of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from April 2013 to December 2013 were enrolled. The real-time continuous glucose monitoring system (RTCGMS) and arterial blood gas analyzer were used to measure the patients' interstitial fluid glucose and arterial blood glucose, and according to the criteria of International Organization for Standardization (ISO) and the median of relative absolute difference (Median RAD), the consistency between interstitial fluid glucose and arterial blood glucose was calculated. Based on the lactate (Lac) level and pulse oxygen perfusion index (PI), the septic shock patients were divided into groups with different degrees of tissue perfusion, the consistency between the interstitial fluid glucose and arterial blood glucose among septic shock patients with different degrees of tissue perfusion was compared by using Bootstrap re-sampling technique.Results Negative correlation existed between PI and Lac (r= -0.272,P 8 mmol/L, their consistency between interstitial fluid glucose and arterial blood glucose was better than that in those with Lac > 2-4 mmol/L, and the 95% credibility intervals (CI) of ISO standardized deviation value was 0.026-38.710 (P 0.7%-1.4%, the 95%CI of median RAD difference value was 0.002-0.076, and the 95%CI of ISO standardized deviation value was -27.000 to -0.583 (allP 3.0%, their consistency between interstitial fluid glucose and arterial glucose was better than that in those with PI ≤ 0.7%, PI > 0.7%-1.4% and PI > 1.4%-3.0%, and the 95%CI of ISO standardized deviation values were 3.322-28.302, 11.988-40.265 and 5.170-33.333 respectively (allP 8 mmol/L or PI ≤ 0.7%), the worse the tissue perfusion, the better the consistency between interstitial fluid glucose and arterial blood glucose; when septic shock patients were under normal local tissue perfusion (PI > 3.0%), the better the local tissue perfusion, the better the consistency between interstitial fluid glucose and arterial blood glucose.
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Objective To evaluate the effects of handholding and providing information on physiology and psychology in patients undergoing percutaneous transforaminal endoscopic discectomy under local anesthesia. Methods A total of 74 patients receiving percutaneous transforaminal endoscopic discectomy under local anesthesia in China-Japan Friendship Hospital in Beijing were selected and randomly divided into the intervention group and the control group by random number table, with 60 cases in each. During surgery,the patients in the control group only received routine cares, in the intervention group, except the routine cares, nurses held the hands of patients for 20-30 seconds every 10 minnutes and provided them with spoken information. Then the State-Anxiety Inventory (SAI) scale and Visual Analogue Scale (VAS) were used for assessment of anxiety and pain of two groups of patients. Results The results showed that there was no statistically significant difference in SAI score between both groups the day before surgery and before surgery in operation room (P>0.05). The SAI scores of the control group (42.30 ± 10.14) was lower than that of the intervention group (35.35 ± 8.00), there was statistically significant difference between both groups (t=3.273, P=0.002);the VAS score in the control group (54.16 ± 22.02) was lower than that of the intervention group (41.68 ± 15.30), there was statistically significant difference between both groups (t=2.832,P=0.006). Conclusions The nursing method of handholding and providing information for patients who undergoing percutaneous transforaminal endoscopic discectomy under local anesthesia is very useful intervention, it can mitigate surgical anxiety,pain degree. It makes patients more comfortable whether in physiology or psychology and better fit surgery.
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Objective To evaluate the effects of handholding and providing information on physiology and psychology in patients undergoing percutaneous transforaminal endoscopic discectomy under local anesthesia. Methods A total of 74 patients receiving percutaneous transforaminal endoscopic discectomy under local anesthesia in China-Japan Friendship Hospital in Beijing were selected and randomly divided into the intervention group and the control group by random number table, with 60 cases in each. During surgery,the patients in the control group only received routine cares, in the intervention group, except the routine cares, nurses held the hands of patients for 20-30 seconds every 10 minnutes and provided them with spoken information. Then the State-Anxiety Inventory (SAI) scale and Visual Analogue Scale (VAS) were used for assessment of anxiety and pain of two groups of patients. Results The results showed that there was no statistically significant difference in SAI score between both groups the day before surgery and before surgery in operation room (P>0.05). The SAI scores of the control group (42.30 ± 10.14) was lower than that of the intervention group (35.35 ± 8.00), there was statistically significant difference between both groups (t=3.273, P=0.002);the VAS score in the control group (54.16 ± 22.02) was lower than that of the intervention group (41.68 ± 15.30), there was statistically significant difference between both groups (t=2.832,P=0.006). Conclusions The nursing method of handholding and providing information for patients who undergoing percutaneous transforaminal endoscopic discectomy under local anesthesia is very useful intervention, it can mitigate surgical anxiety,pain degree. It makes patients more comfortable whether in physiology or psychology and better fit surgery.
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Objective To study and summary the treatment of talus fracture. Methods Fifteen patients with talus fracture were treated by limited cut off reduction by leverage and hollow lag screw under C arm X-Ray machine January 2008 to November 2014, of whom there were 11 males and 4 females, aged 15-61 years old. Seven patients sufferred from talus fracture because of traffic accidents, 4 patients because of falls, 2 patients because of crush injury, and 2 patients because of sprains. Hawkins typing:Ⅰtype in 1 patient, Ⅱ type in 6 patients, Ⅲ type in 6 patients of Ⅲ type, and Ⅳ type in 2 patients. Results Followed up for 6 months to 4 years (mean 1.5 years), fracture healed better. Hawkins grading standard:9 patients showed excellent (1 patient ofⅠtype, 5 patients ofⅡtype, 3 patients ofⅢtype), and two patients showed good (Ⅲtype). The excellent and good rate was 11/15. Necrosis of talus occurred in one patient, and degenerative joint disease occured in one patient. Conclusions Minimally invasive internal fixation with hollow lag screw under C arm X-Ray machine in the treatment of talus fracture has a small injury to the periosteum and the blood supply of small soft tissue. It can fix reliably and can pressurize the fracture fragments, and is conducive to fracture healing.
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Objective To observe the perfusion pattern of hepatic angiomyolipomas using contrastenhanced ultrasound(CEUS) and compare diagnostic efficacy of contrast-enhanced ultrasound with contrastenhanced helical CT(CECT).Methods Nineteen patients with 21 resected and pathologically proven hepatic angiomyolipomas were included in this study.Low mechanical index (mechanical index less than 0.2) realtime CEUS was performed in nineteen patients (5 patients with pulse inversion harmonic, 14 patients with contrast pulse sequencing, CPS) after 2.4ml bolus injection of contrast agent SonoVue.CECT was performed using 16-slice helical CT and contrast agent Ultravist.The diagnostic performance was calculated by considering histologic results as the reference standards.Results Fifteen tumors were correctly diagnosed as hepatic angiomyolipomas,4 tumors were misdiagnosed (including 1 hepatocellular carcinoma,2hepatic adenomas, 1 hemangioma) and 2 tumors were characterized as benign lesions by CEUS.Eight tumors were correctly diagnosed as hepatic angiomyolipomas, 13 tumors were misdiagnosed (including 7hepatocellular carcinoma, 1 liposarcoma, 2 lipomas, 1 hepatic adenomas, 2 hemangiomas) by CECT.The preoperative diagnostic accuracy was 71.4% for CEUS and 38.1 % for CECT(P＜0.05 ).Conclusions CEUS can demonstrate typical imaging characteristics of most hepatic angiomyolipomas, and has higher diagnostic performance than CECT in characterization of hepatic angiomyotipomas.
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Objective To determine relationships between daily activities measured as modified version of Pulmonary Functional status and Dyspnea Questionaire (PFSDQ-M) and functional capacity and symptoms experienced in patients with chronic obstructive pulmonary disease (COPD). Methods Convenience sample of 94 COPD patients with stable condition were assessed by interview with PFSDQ-M Chinese version and modified Medical Research council dyspnea scale (MMRC) respectively. Pulmonary function test (PFT) and 6-minute walking test (6MWT) were undergone on the same day or within one week as interview. PFSDQ-M has three subscales,i.e.,change experienced by patient with activities (CA),dyspnea with activities (DA) and fatigue with activities (FA). Results Scores of CA,DA and FA correlated to 6-minute walking distancer= (-0.37)- (-0.42),FEV_1 r=(-0.27)-(-0.32),FEV_1/FVC r= (-0.27)- (-0.32),dyspnea rated by MMRC (r=0.55-0.60) and BODE index (r=0.35-0.40),respectively (all P<0.01). dyspnea explained 26% of the variance in changes of activities. Conclusions Physical activities moderately changed in patients with stable COPD;Dyspnea is the best predictor of limitation of daily activities.
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Objective Developing an index system to evaluate the community teaching bases of general practice, for the purpose of identifying and completing at least one demonstration teaching base for general practice in each city in 2010. Methods Initial building of the index system by means of Delphi method and experts interview, followed by selection of experts for consultation, statistical analysis on the results of letter inquiries, and rounded up by the establishment of the index system for evaluation in the end. Results The recovery rates of a two-round Delphi questionnaire response are 94.12% and 100.00%respectively. Expert's authority degrees of five indexes are all over 0.8, which suggests high expert's authority. The average coordination coefficient of two-round Delphi experts consultation is 0.262and 0.534 respectively, showing good experts coordination. In the end, the study established four first-class indexes, ten second-class indexes, 41 third-class indexes and five additional indexes. Conclusions The index system is established in view of the current development of community teaching bases. It focuses on evaluating teachers, the teaching process and base's function. The evaluation system provides reference for selecting demonstration community teaching bases of general practice.
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OBJECTIVE: To evaluate the effects of Xuefu Zhuyu Decoction (XFZYD) on functions of vascular endothelium in patients with unstable angina pectoris (UAP). METHODS: Fifty patients with UAP were randomly divided into two groups: XFZYD-treated group with 32 cases and control group with 18 cases. The patients in the control group were given regular therapy, while the patients in the XFZYD-treated group were given XFZYD additionally on the basis of regular therapy. All patients in both groups were treated for 8 weeks. Then the contents of serum endothelin (ET), nitric oxide (NO), soluble vascular cell adhesive molecule-1 (sVCAM-1) and soluble intercellular adhesion molecule-1 (sICAM-1) were examined by radioimmunoassay, enzymic method and enzyme-linked immunosorbent assay (ELISA) respectively. RESULTS: The total response rate in the XFZYD-treated group was 93.75%, which was significantly higher than 66.67% in the control group (P<0.05). The contents of serum ET, sVCAM-1 and sICAM-1 in the XFZYD-treated group were much lower than those in the control group (P<0.01), while the content of serum NO was obviously higher than that in the control group (P<0.01). CONCLUSION: XFZYD can improve the functions of vascular endothelium by lowering the levels of endothelium-derived contracting substances, enhancing the levels of endothelium-derived relaxing substances, and reducing the cell adhesions, and hence to raise the therapeutic effects on UAP.
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Objective To investigate the value of high frequency ultrasound and CT in the diagnosis of laryngeal carcinoma. Methods Sixty-nine cases of laryngeal carcinoma were typed and staged by high frequency ultrasound and CT, and compared with the results of laryngoscopy and postsurgical pathology. Results The typing accuracy was ~94.2 % for ultrasonography and ~91.3 % for CT, higher than that of laryngoscopy(~73.9 %).T staging accuracy of ultrasonography was T_1 ~85.9 %,T_2 ~88.5 %,T_3 ~94.1 % and T_4 ~88.9 %, higher than that of CT (~68.8 %) and laryngoscopy (~75.0 %) in T_3 stage and superior to laryngoscopy (~66.7 %) in T_4 stage. Lymph node metastases were found in 37 cases (~53.6 %) by ultrasonography, higher than those by CT scanning (~27.5 %). Color Doppler blood flow laryngeal carcinoma was shown in 65 cases(~94.2 %),most were low resistance spectrum pattern. Conclusions High frequency ultrasonography is superior to CT and laryngoscopy in the staging of laryngeal carcinoma and is of great value in choosing the therapeutical protocol.