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Objective:To analyze the experiences and practice in the reform of public hospital salary system in Sichuan province, summarize the typical modes of such reform in the province, and provide references for further reform.Methods:As of October 29, 2021, the research group received 77 sets of typical experience materials submitted by the health commissions and public hospitals in Sichuan province on enforcing the reform of the public hospital salary system. The analysis framework was based on the five main elements proposed in the Guidance to Deepening the Reform of the Salary System of Public Hospitals for the purpose of furthering the reform. These five elements refer to " reasonably determining the level of salary in public hospitals" " fully implementing the autonomy of internal distribution in public hospitals " " establishing and improving the incentive and restraint mechanism for the remuneration of public hospital leaders" " improving the assessment and evaluation mechanism oriented to public welfare" and " funding sources ". A quantitative analysis was made on the typical experience materials using the social network analysis method, while a qualitative analysis was made on the typical experience materials using the content analysis method. Results:The results of social network analysis showed that the network density was 0.272; the highest point centrality was " fully implement the autonomy of internal distribution in public hospitals" (0.935), and the highest intermediary centrality was " improving the assessment and evaluation mechanism oriented to public welfare" (0.870), while the closeness to centrality of " establishing and improving the incentive and constraint mechanism for the salary of public hospital leaders" (0.434) and " funding sources" (0.421) were relatively low. The results of content analysis showed that the ones with higher frequency among all the typical experience materials were " fully implementing the autonomy of internal distribution of hospitals" (72 times) and " improving the assessment and evaluation mechanism oriented to public welfare" (67 times), while the ones with lower frequency were " establishing and improving the salary incentive and constraint mechanism for public hospital leaders" (17 times) and " funding sources" (14 times). In terms of unity and synergy, the typical models of public hospital salary system reform in the province could be categorized as the fine standard mode, the fair value mode, the autonomous synergy mode and the circular symbiosis mode.Conclusions:Deepening the reform of the salary system of public hospitals should unify the standards and improve the fair and refined assessment and evaluation mechanism; explore various forms of distribution and build an internal autonomous and synergistic incentive mechanism; pay attention to the weak remuneration incentive mechanism for hospital leaders and the problem of a relatively single source of funding.
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ObjectiveTo investigate the mechanism of Renshen Guben oral liquids（RGOL） in treatment of mice with renal fibrosis based on metabolomics and network pharmacology. MethodC57BL/6 mice were randomly divided into control group， model group and RGOL group， 12 mice in each group. Except for the control group， mice in the other groups were induced into unilateral ureteral obstruction（UUO） model by UUO. After preparation of the model， an aqueous solution of 4.2 g·kg-1 extract powder was administered by gavage to RGOL group for 14 d， and an equal amount of distilled water was administered by gavage to the control and model groups. After the last administration on the 14th day， urine was collected and detected by ultra-high performance liquid chromatography-triple quadrupole tandem mass spectrometry（UPLC-QQQ-MS/MS） with 0.1% formic acid aqueous solution as mobile phase A， and acetonitrile-isopropanol（70∶30） as mobile phase B for gradient elution（0-1 min， 5%B； 1-5 min， 5%-30%B； 5-9 min， 30%-50%B； 9-11 min， 50%-78%B； 11-13.5 min， 78%-95%B； 13.5-14 min， 95%-100%B； 14-16 min， 100%B； 16-16.1 min， 100%-5%B； 16.1-18 min， 5%B）， column temperature of 40 ℃， flow rate of 0.4 mL·min-1， electrospray ionization（ESI）， collection range of m/z 50-900. Through network pharmacology， the targets of components in RGOL and the targets of renal fibrosis were analyzed interactively， and the key components and key targets were screened by network topology analysis， and DAVID platform was used to predict the signaling pathways of RGOL for the treatment of renal fibrosis. ResultA total of 7 differential metabolites involving 8 metabolic pathways were identified in RGOL for the treatment of renal fibrosis. The network pharmacology revealed that 36 key components in RGOL were related to 7 differential metabolites， mainly ginsenosides， notoginsenosides and nucleotides. Based on the herbs-components-targets-pathways network， a total of 23 key targets related to the treatment of renal fibrosis by RGOL were highlighted， which together with the differential metabolites were involved in linoleic acid metabolism， arginine biosynthesis， tricarboxylic acid cycle（TCA）， arginine and proline metabolism and other pathways. ConclusionBased on metabolomics and network pharmacology， this study preliminarily identified 7 differential metabolites， 36 potential pharmacodynamic components and 23 key targets and 4 key pathways in RGOL for the treatment of renal fibrosis， providing an experimental basis for the clinical application and mechanism study of this preparation.
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Objective:To analyze the staff salary status and the influencing factors in traditional Chinese medicine(TCM) hospitals implementing the salary system reform in Sichuan province in 2020, for reference in optimizing the salary system reform of such hospitals.Methods:Cluster sampling and institutional survey were used to collect the salary information of 26 TCM hospitals in 21 cities(prefectures)of Sichuan province implementing the salary system reform in 2020. Such information was then subject to descriptive analysis, while the influencing factors of salary were subject to one-way analysis of variance and generalized linear model multifactor analysis.Results:15 428 staff from 26 TCM hospitals were included as the research objects. In 2020, personnel expenditure accounted for 40.23% of the total expenditure, and 24.34% of which came from financial subsidy in 26 TCM hospitals. The average annual payable income per person was(149 312±74 288)yuan, 67.82% of which being performance pay. Analysis of variance showed that there were significant differences among the salary levels of staff in different economic regions, hospital grades, hospital levels, gender, educational background, position, seniority, performance pay ratio, employment in the government system and other natures, senior and other professional titles, doctors and other positions( P<0.05), and the differences were still statistically significant after adjustment by generalized linear model( P<0.05). Conclusions:The reform of the salary system of Sichuan TCM Hospitals has basically achieved equal pay for equal work, and the income of low-level personnel has been improved. However, the salary level was not very motivated and the salary structure was not guaranteed. It is necessary to strengthen financial precision subsidies, increase the proportion of personnel expenditure, so as to support the increase of the absolute value of salary in non-core economic areas, improve the salary structure, reasonably widen the salary gap among different educational backgrounds and positions, further optimize internal distribution, and ensure the sustainable development of Chinese medicine talents.
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Objective@#To evaluate ten year changes in deciduous teeth health and oral health behavior aged 5 year old children in Hainan province (during the year of 2005-2015), to provide basis for oral health promotion among 5 year old children in Hainan province.@*Methods@#Through the comparison and analysis of the third and the fourth national oral health epidemiology survey,changes of dental caries prevalence rate, dietary habit, oral health behavior, and health seeking behavior were analyzed.@*Results@#The prevalence of dental caries in 2005 was 76.1%, 2015 was 82.3% which had significant difference(χ2=6.23，P<0.05), the percentage of consuming sugary food and sweet drinks every day in 2005 was 13.4% and 6.1%, which increased to 30.0% and 7.4% respectively in 2015. The percentage of drinking milk and yoghurt with sugar was 47.6%, which decreased 36.5% in 2015 (χ2=12.76，P<0.05), the percentage of consuming sugary food and sweet drinks before going to bed in 2005 was17.8%, which decreased to 13.3% in 2015 (χ2=32.27，P<0.05). The percentage of brushing the teeth two or more times a day was 16.9%, which increased to 24.2% in 2015(χ2=20.50，P<0.05). The percentage of using fluoridated toothpaste decreased from 31.7% (2005) to 7.4% (2015) (χ2=229.13，P<0.05). No need to treatment for baby teeth and afraid of pain among children were the main reason for no health-seeking among parents which children of dental health problems,which deffered significantly between 2005 and 2015(χ2=6.05，9.34，P<0.05).@*Conclusion@#Children’s oral health behavior improved, while eating habits fluoridated toothpaste usage and health seeking behavior remain poor.Health education on child oral health should be strengthened.
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Objective:To evaluate the application of one-stop dynamic volume perfusion CT (dVPCT) in upper abdomen, and its feasibility of replacing conventional enhanced CT, perfusion, and angiography.Methods:A total of 94 patients with upper abdominal perfusion examinations were retrospectively enrolled in Deyang People's Hospital of Sichuan Province from April 2017 to June 2019. The data of another 64 patients underwent routine upper abdominal enhancement with 64-slice CT (28 patients) and dual-source CT (26 patients) were analyzed in the same period. The radiation dose and image quality were compared. According to different contrast agent concentration and dosage, 4 perfusion groups and 2 conventional enhanccement groups were divided, including 60 ml iohexol group (350 mg/ml) and 60 ml ultravist group (370 mg/ml), 60 ml and 80 ml iomeprol group (400 mg/ml), 64-slice routine group and dual-source CT routine group. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the liver, pancreas and abdominal aorta images in the arterial and portal vein phases were measured by two radiologists in a blinded way. Subjective image quality was evaluated by two radiologists using a 5-point Likert Scale in a blinded method. Statistical analysis was performed using analysis of variance and kappa test. Imaging findings and typical cases of perfusion were retrospectively analyzed.Results:Radiation dose: the effective dose of each perfusion group was lower than that of the 64-slice spiral CT scan, but higher than that of the dual-source CT routine scan. The SNR and CNR of the 80 ml iomeprol dVPCT group were better than that of 64-slice spiral CT and dual-source CT routine scan ( P<0.05), and were better than that of 60 ml iohexol, ultravist and iomeprol dVPCT groups ( P<0.05). However, the subjective index was lower than that of the dual-source CT routine scan group ( P<0.05). The comprehensive information of multi-phase images, vascular images and perfusion quantitative parameters of volume perfusion data reconstruction in this group is superior to conventional enhanced CT in the detection of lesions, visualization of normal tissues and blood vessels. Conclusion:One-stop dVPCT imaging of the upper abdomen has lower radiation dose with good image quality and more diagnostic information. dVPCT with 80 ml Iomeprol (400 mg/ml) can obtain much better images.
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Objective@#To explore the application effect of Mini-Clinical Evaluation Exercise(Mini-CEX) in clinical teaching rounds of nursing students, and to provide reference for improving the quality of clinical teaching.@*Methods@#A total of 120 nursing students from June 2017 to June 2018 were divided into control group and intervention group by the time of practice with 60 cases each. The control group adopted traditional nursing teaching rounds, while the intervention group adopted Mini-CEX-based nursing teaching rounds. The comprehensive results of nursing students′practice, Mini-CEX and autonomous learning ability of the two groups were compared and analyzed.@*Results@#The overall evaluation of Mini-CEX of nursing students was (7.23 ± 0.51) in the intervention group and (5.27 ± 1.12) in the control group, and the difference was statistically significant (t=12.337, P <0.01). The excellent rate of nursing students was 58.3%(35/60) in the intervention group and 30.0%(18/60) in the control group, and the difference was statistically significant (χ2=10.914, P <0.01). The total score of autonomous learning ability was (114.85 ± 6.27) in the intervention group and (90.78 ± 8.22) in the control group, and the difference was statistically significant (t=18.034, P < 0.01). The comprehensive results of nursing students′ practice was (87.04 ± 6.46) in the intervention group and (74.35 ± 6.04) in the control group, and the difference was statistically significant (t=11.115, P< 0.01).@*Conclusions@#Clinical teaching rounds based on mini-clinical exercise assessment scale can improve the clinical comprehensive service ability, self-learning ability and humanistic care ability of intern nurses.
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Objective To investigate the effect of the clinical teaching model based on the miniclinical evaluation exercise (Mini-CEX) scale in Department of General Surgery,and to provide a reference for improving the quality of clinical teaching in Department of General Surgery.Methods A total of 82 nursing interns in Department of General Surgery from June 2016 to June 2018 were enrolled,among whom 41 undergraduates in 2016 were enrolled as control group and 41 undergraduates in 2017 were enrolled as intervention group.The undergraduates in the control group were taught with the traditional clinical teaching method,and those in the intervention group were taught with the clinical teaching model based on the Mini-CEX scale.The two groups were compared in terms of department examination results,score of the Mini-CEX scale,and quality assessment score of clinical nursing teaching,in order to evaluate the teaching quality in Department of General Surgery.Results Compared with the control group,the intervention group had significantly higher department examination score [(96.56 ± 4.23) vs.(90.42 ± 5.12)] and total score of Mini-CEX scale [(5.22 ± 0.45) vs.(4.01 ± 1.03)].The intervention group had a significantly higher excellent rate than the control group (P＜0.05).The intervention group also had a significantly higher quality assessment score of clinical nursing teaching than the control group [(98.34 ± 6.12) vs.(92.45 ± 5.16)].Conclusion The clinical teaching model based on the Mini-CEX scale can improve the quality of teaching and clinical teaching skills in department of general surgery and thus improve the clinical skills and comprehensive quality of nursing interns.
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Objective To explore the application effect of Mini-Clinical Evaluation Exercise(Mini-CEX) in clinical teaching rounds of nursing students, and to provide reference for improving the quality of clinical teaching. Methods A total of 120 nursing students from June 2017 to June 2018 were divided into control group and intervention group by the time of practice with 60 cases each. The control group adopted traditional nursing teaching rounds, while the intervention group adopted Mini-CEX-based nursing teaching rounds. The comprehensive results of nursing students′ practice, Mini- CEX and autonomous learning ability of the two groups were compared and analyzed. Results The overall evaluation of Mini-CEX of nursing students was (7.23 ± 0.51) in the intervention group and (5.27 ± 1.12) in the control group, and the difference was statistically significant (t=12.337, P<0.01). The excellent rate of nursing students was 58.3% (35/60) in the intervention group and 30.0% (18/60) in the control group, and the difference was statistically significant (χ2=10.914, P <0.01). The total score of autonomous learning ability was (114.85 ± 6.27) in the intervention group and (90.78 ± 8.22) in the control group, and the difference was statistically significant (t =18.034, P < 0.01). The comprehensive results of nursing students′practice was (87.04 ± 6.46) in the intervention group and (74.35 ± 6.04) in the control group, and the difference was statistically significant (t=11.115, P<0.01). Conclusions Clinical teaching rounds based on mini-clinical exercise assessment scale can improve the clinical comprehensive service ability, self-learning ability and humanistic care ability of intern nurses.
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Objective To translate the 3-minute diagnostic confusion assessment method(3D-CAM)into Chinese,to revise it,and to test its reliability and validity in elderly patients.Methods We translated and culturally adapted 3D-CAM into Chinese.The sample was formed by 230 elderly patients over 65 years of age.We tested inter-assessors reliability and criterion validity (diagnostic validity)and then computed the sensitivity,specificity,positive predictive value,and negative predictive value of the Chinese version of 3D-CAM.Results Correlation analyses between each item and its total score showed that the correlation coefficients ranged between 0.290 and 0.724,all reaching statistical significance(P＜0.01).Inter-assessor reliability in a sample size of 30 patients resulted in a kappa value of 0.78 (P ＜ 0.001).Compared with the gold standard,the diagnostic and statistical manual of mental disorders(DSM-5)by American Psychiatric Association(APA),the sensitivity of the Chinese version of 3D-CAM was 94.73％,the specificity was 97.92％,the positive predictive value was 90.00％,and the negative predictive value was 98.95％.Conclusions The Chinese version of 3D-CAM has achieved satisfactory reliability and validity through pilot runs in surgery and internal medicine inpatients,proved to be easy and convenient to administer,and can be used as an assessment tool for delirium in elderly surgery and internal medicine patients.
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Objective To investigate influencing factors for comprehensive geriatric assessment carried out in geriatric departments of comprehensive hospitals in Sichuan province and its influential factors ,in order to verify whether education affects CGA and to raise medicine quality of senile disease. Methods The self-designed questionnaires were distributed to 40 hospitals in difference downs and cities in Sichuan province. The data were collected ,including items of CGA carried out in each hospital ,structure of staff ,scale ,bed distribution ,numbers of bed in geriatric department ,etc. The correlations of CGA items with the related factors were analyzed by using multiple linear regression analysis. Results The items of CGA carried out was positively related with hospital grade (β= -5.4 ,P=0.03) ,the staff-attending three times or more of geriatric training course (β=0.2 ,P=0.05) , the number of nurses per bed(β=15.6 ,P=0.03) ,the number of physicians with master's degree(β=-0.2 ,P=0.04) ,and the lower average age of medical staff (β= -0.6 ,P=0.05). Conclusions The grade of hospital ,attending actively geriatric training course ,the number of the nurses per bed ,the number of physicians with master's degree ,and the younger average age of medical staff were positively associated with the items of CGA carried out in hospitals.
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[Objective] To discuss the efficacy of Telbivudine treating chronic hepatitis B.[Method] Randomly divide 164 cases into treatment group 85 and control one 79,respectively taking Telbivudine and Ramivudine for anti virus for 48 w,then observe their efficacy.[Result] The ALT normalization and HbeAg positive rates were separately 87.50% and 71.15% for both groups; HBV DNA reduction rates and HbeAg postive-5.3 and-4.2log10 copies/ml,negative-6.6 and-5.5 log10 copies/ml;HbeAg negative rates respectively 28.57% and 23.08%;HbeAg serum conversion rates 23.21% and 15.38%;resistance rates of HbeAg positive 3.57% and 11.53%,negative 3.45% and 14.81%;the difference was very obvious(P
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This study was aimed to determine the relationship between coronary artery disease(CAD) and insertion/deletion(I/D) polymorphism of the angiotensin coverting enzyme(ACE) gene. The ACE genotypes of 105 patients with CAD (50 of them were accompanied by essential hypertension (EH)) and 102 healthy people were detected by polymerase chain reaction. The results showed that in terms of ACE genotypes, no significant difference was noted between CAD group and control group, nor was it observed between CAD group and CAD accompanied by EH group, and nor was it seen between CAD/CAD accompanied by EH group and control group. These findings suggest that there is no relationship between the polymorphism of ACE gene and CAD (including those accompanied by EH).