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Twenty general practice residents who received training in Tongren Hospital from 2018 to 2020 were enrolled. The residents undertook rotation in chronic disease care clinic of the general medicine department, and a multi-disciplinary integrated teaching mode was applied. The theoretical knowledge test, skill assessment and self-evaluation were performed before and after rotation. The 360-degree evaluation was carried out when leaving the department (study group), the results were compared with that of internal medicine (control group) in the same period. The teaching effect was comprehensively evaluated. The scores of theoretical knowledge and skill assessment after rotation were significantly higher than those before rotation ( P<0.01). The self-evaluated ability was significantly higher than that at admission, especially in general practice thinking (7.85±0.88), doctor-patient communication (7.95±0.69), health education (7.80±0.70) and disease management (8.20±0.62) ( P<0.01). The 360-degree evaluation showed that the study group was better than the control group in interpersonal communication skills [(4.75±0.44) vs. (4.41±0.50)], system-based work ability[(4.75±0.44) vs. (4.31±0.47)], practice-based learning and improvement [(4.80±0.41) vs. (4.33±0.48)], patient care [(4.75±0.44) vs. (4.28±0.46)] and training mode satisfaction [(4.85±0.37) vs. (4.38±0.49)] (all P<0.05). The study indicates that the multi-disciplinary integrated teaching mode applied for rotation in the chronic disease care clinic of the general medicine department can improve the teaching effect and raise the teaching quality for general practice residency training.
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Objective To investigate the accuracy of sequential organ failure assessment (SOFA) scoring in emergency physicians in Beijing. Methods Emergency physicians from 8 hospitals in Beijing in January 2018 were demanded to complete a SOFA questionnaire which was developed on ''wenjuanxing'' website and submit via cell phone. All participants were divided into urban center group (UC group) and no-urban center group (NUC group) based on the hospital's location. The accuracy rate of components and total score of SOFA along with the mistakes were evaluated, and the results of the two groups were compared. Results ① The questionnaire was sent to 217 emergency physicians of the 8 hospitals, and 197 qualified questionnaires were received with 109 of NUC group and 88 of UC group, respectively, the total response rate was 90.8%. Compared with those from NUC group, UC physicians had older ages [years:37 (32, 42) vs. 34 (29, 40), Z = -2.554, P = 0.011] and higher education level [postgraduate degree 76.1% (67/88) vs. 40.4% (44/109), χ2= 25.327, P < 0.001], and more of them experienced SOFA scoring [62.5% (55/88) vs. 45.9% (50/109), χ2= 5.409, P = 0.020]. Other baseline characteristics such as gender, working years, professional title and training experience were not different between the two groups. ② The accuracy rate of total SOFA score was 62.4% (123/197) in the whole cohort, and UC group was lower than that of NUC group, but the difference was not significant [56.8% (50/88) vs. 67.0% (73/109), χ2= 2.141, P = 0.143]. While comparing the accuracy of individual variable/system of SOFA, the accuracy rate of norepinephrine of UC group was much higher than NUC group [80.7% (71/88) vs. 66.1% (72/109), χ2= 5.235, P = 0.022], but the accuracy of Glasgow coma scale (GCS) was much lower in NUC group [38.6% (27/70) vs. 81.6% (71/87), χ2= 30.629, P < 0.001]. Other variables of SOFA were not different between the two groups. ③Based upon the results of all submitted questionnaires, 566 mistakes were identified. It was indicated that the mistakes per capital was 2.9 in the whole cohort and in the two groups. The first type mistakes which caused by carelessness (including calculating error, filling error, choosing error) were 233 times. The calculating error in norepinephrine from NUC physicians was higher than the UC group [33.9% (37/109) vs. 19.3% (17/88), χ2= 5.235, P =0.022], there was no significant difference in any other first type mistakes between the two groups. The total second type mistakes caused by misunderstanding of SOFA (including using wrong variables, not using the worst value within 24 hours, and incorrect GCS score) were 333 times in the whole cohort. GCS error [61.8% (42/88) vs. 16.9% (14/109), χ2=32.292, P<0.001], and using urine output per hour instead of urine output per 24 hours [15.9% (14/88) vs. 4.6% (5/109), χ2= 7.162, P = 0.007] were much higher in UC group than NUC group. Conclusions The total accuracy of SOFA scoring in the investigated emergency physicians of 8 hospitals in Beijing was not good. Mistakes causing by carelessness or misunderstanding of score rules were similar. It is necessary to apply strict training in SOFA scoring.
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Objective To explore the effect of smoking on endothelium-dependent vascular relaxing function and endogenous apelin-13 level.Methods Forty healthy volunteers,including 20 smokers and 20 non-smokers were randomly selected and participated in the study from December 2014 to April 2015.During the study period the smokers were asked to quit smoking for one month and the non-smoking group was given short-term smoking intervention.The changes of vascular endothelial function and plasma apelin13 levels were compared between the smoking group and non-smoking group,and before and after intervention.Results Flow-mediated dilatation (FMD) in smoking group was significantly lower than that in non-smoking group [(5.34 ± 1.83) ％ vs.(8.12 ± 2.62) ％,t =-3.75,P ＜ 0.01].FMD in smoking group was significantly increased after 1 month of quitting smoking [(5.34 ± 1.83) ％ vs.(9.05 ± 2.18) ％,t =-6.66,P ＜ 0.01],FMD in non smoking group was slightly decreased [(8.12 ± 2.62) ％ vs.(7.78 ± 1.96) ％,t =0.90,P =0.38] after short-term smoking.The level of plasma apelin-13 in smoking group was significantly lower than that of non smoking group [(44.22 ± 16.58) pg/ml vs.(70.12 ± 24.35) pg/ml,t =-3.79,P ＜ 0.01].The level of plasma apelin-13 in smoking group was significantly increased after 1 month of smoking cessation intervention [(44.22 ± 16.58) pg/ml vs.(65.32 ± 17.13) pg/ml,t =-4.26,P ＜0.01].In non smoking group,the level of plasma apelin-13 was significantly decreased after short-term smoking [(70.12 ± 24.35) pg/ml vs.(45.83 ± 15.66) pg/ml,t =4.93,P ＜ 0.01].Conclusion Cigarette smoking leads to endothelial dysfunction.Short term occlusion of tobacco may significantly improve endothelial function and increase plasma apelin-13 level,suggesting that apelin-13 may be involved in the occurrence and development of endothelial dysfunction induced by cigarette smoking.
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Objective To investigate the effects of different treatment modes on the prognosis of patients with severe trauma.Methods The general data of 396 patients with severe trauma [injurey severity scores (ISS) ≥25] in our hospital emergency for treatment from January 1,2008 to January 1,2012 was collected.The trauma patients were divided into study group and control group.In the study group,the trauma patients were cared by emergency physician of our hospital for pre-hospital treatment during transportation by ambulance since January 1,2010.In the control group,the trauma patients were served with traditional pre-hospital emergency care by the 120 and 999 before January 1,2010.The injury severity score,medical care and outcomes were recorded in trauma database and the efficiency and quality of medical care were compared between two groups.Results The emergency treatment time,length of hospital stays,ICU admission rate,prehospital mortality rate,long-term (6 months) disability rate,and complication rate in the study group were lower than those in the control group,presenting (78.23 ± 21.57) min vs.(96.45 ± 35.14) min,(23.55±12.46) dvs.(28.67±20.72) d,8.1％ (18/222)vs.65.5％ (114/174),13.3％ (34/256) vs.21.6％ (48/222),4.1％ (9/222)vs.9.2％ (16/174),8.1％ (18/222)vs.18.4％ (32/174),in which the differences were statistically significant (P ＜ 0.05).Hospital mortality in the study group was also lower than that in the control group,showing 8.1％ (18/222) vs.12.6％ (22/174),but there was no statistically significant difference (P ＜ 0.05).There was no significant difference in time from occurrence of injury to receiving treatment between the two groups.Conclusion Emergency physicians-cared mode had advantages to improve treatment success rates and reduce mortality in patients with multiple trauma compared with the current conventional emergency mode.It is a good alternative emergency mode.
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Eighty two heart failure (HF) patients were enrolled in the study,including 52 cases with pulmonary infection (infectious group) and 30 cases without pulmonary infection (noninfectious group).Plasma brain natriuretic peptide (BNP),N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were measured and the correlation of plasma BNP,NT-proBNP and NT-proBNP/BNP with inflammatory markers (WBC count,CRP,PCT) and left ventricular ejection fraction (LVEF) was analyzed.Results show that NT-proBNP/BNP ratio in infectious group was significantly higher than that in noninfectious group (t =10.764,P ＜ 0.01).In infectious group,NT-proBNP/BNP was positively correlated with inflammation markers (P ＜ 0.01),but not with LVEF (P ＞ 0.05) ; NT-proBNP and BNP levels were not correlated with inflammation markers and LVEF (P ＞ 0.05).In noninfectious group,NT-proBNP/BNP was not correlated with inflammation markers and LVEF (P ＞ 0.05),NT-proBNP and BNP were positively correlated with CRP and negatively correlated with LVEF (all P ＜ 0.01),not correlated with WBC count or PCT (P ＞ 0.05).Multiple linear regression analysis showed that NT-proBNP/BNP ratio had positive correlation with CRP in infectious group.The results reveal that in heart failure patients complicated with pulmonary infection,neither NT-proBNP nor BNP reflects the severity of heart failure or infection; but the NT-proBNP/BNP ratio can indicate the severity of infection independently.
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A total of 115 patients with acute chest pain under the suspicion of acute myocardial infarction (AMI) were selected.By the onset time of chest pain,they were divided into two periods of ＜3 h and 3 -6 h respectively. Heart-type fatty acid binding protein (H-FABP)and such traditional cardiac biochemical markers as cardiac troponin T (cTnT),creatine kinase isoenzyme (CK-MB) and myoglobin (MYO) were tested to compare the sensitivity and specificity in the early diagnosis of AMI.The sensitivity of H-FABP was significantly higher than those of cTnT,CK-MB and MYO (P =0.026,0.005,0.048 ) ; the specificity of H-FABP was lower than those of cTnT,CK-MB in the diagnosis of AMI ( P ＞ 0.05 ).The sensitivities of H-FABP were 81.6％ and 78.1％ in the ST-elevation myocardial infarction (STEMI) and nonST elevation myocardial infarction (NSTEMI) groups respectively ( P =0.095 ).Regardless of the onset of chest pain at ＜ 3 h or 3 -6 h,the combination of H-FABP and cTnT had a higher sensitivity than those of cTnT,CK-MB and MYO in the early diagnosis of AMI (P =0.005,0.028).In the early and rapid diagnosis of AMI patients,H-FABP has a high sensitivity and a poor specificity.And it has some reference value.
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Objective To evaluate the clinical efficacy and safety of piperacillin and sulbactam sodium combinations in the treatment of common infections. Methods This was a multi-centre, prospective and open study. All subjects from 57 wards caught common infection like respiratory ( RTI) or urinary diseases ( UTI). The dosages of piperacillin and sulbactam sodium combinations 2. 5 g injection were determined according to indications:for adult, 2. 5 g or 5 g per time, 2 time/day; for severe or obstinate infection, 2.5 g or 5 g per time, 3 time/day. General information, clinical response pre- and posttreatment, infected locus, drug recipe and protocol, prognosis and adverse reaction were recorded. Results Data of 579 cases were collected with 388 males and 191 females. The average age was (66. 8 ± 17. 0) years. There were 500 patients who were suffering with RTI, with 362 cases of pneumonia, 102 of acute exacerbation of chronic bronchitis, and 36 of other infections. There were 50 cases with UTI, with 31 of simple urinary tract infection, and 19 of complex urinary tract infection. In addition, there were 9 cases of combined RTI and UTI, and 20 of other infections including peritonitis. The average duration of antimicrobial for RTI and UTI was (8. 65 ± 3. 78 ) days and (7. 45 ± 3. 46) days respectively with the total efficacy rate was 92. 6% and 98. 0% respectively for RTI and UTI. The incidence of adverse events was only 0.86% (5 cases), including nausea, rash, itching, ALT elevation and suspected drug induced fever in each one. Conclusion Piperacillin and sulbactam sodium compound had high clinical efficacy and safety in the treatment of common infections including RTI and UTI.