ABSTRACT
Objective:To survey the post competency of general practitioners who completed residency training in Suzhou Municipal Hospital.Methods:A questionnaire survey on post competency of general practitioners was conducted from January to March 2022. General practitioners who completed standardized residential training in Suzhou Municipal Hospital from 2009 to 2021 were randomly selected for the survey. The self-designed questionnaire included the basic information and post competency in terms of clinical, public health, research and teaching abilities as well as medical ethics and humanism. A self-evaluation was also performed and the abilities were graded (A 86-100, B 70-85, C 55-69, D 0-54), and grade A was classified as excellent.Results:A total of 163 questionnaires were distributed and 157 valid ones were collected with a recovery rate of 96.3%. Among 157 respondents 62 (39.5%) were males. The participants mainly worked in urban community health service institutions (78 (49.7%)), and most of them worked as general practice (119 (75.8%)). For the self-assessment of clinical skills, the proportion of respondents with excellent abilities in history taking, basic drug use, diagnosis and treatment of common diseases, and chronic disease management was 58.8% (70/119), 57.1% (68/119), 54.6% (65/119) and 54.6% (65/119), respectively. The proportion of respondents with excellent abilities in evidence-based clinical decision making, physical examination, tests interpretation, referral services, family medical services, rehabilitation services, first aid, and psychological counseling and treatment was 43.7% (70/119), 42.9% (52/119), 38.7% (46/119), 37.8% (45/119), 33.6% (40/119), 22.7% (27/119), 21.0% (25/119), and 16.8% (20/119), respectively. For the self-assessment of basic public health service ability, the proportion of respondents with excellent abilities in health education, disease prevention and control, health management, health care for key and special groups, handling public health emergencies, management of infectious diseases, epidemiology-based community diagnosis and community health leadership was 38.7% (46/119), 33.6% (40/119), 33.6% (40/119), 26.1% (31/119), 25.2% (30/119), 2.7% (27/119), 22.7% (27/119), and 21.0% (25/119), respectively. For humanistic literacy, the proportion of respondents with excellent abilities in privacy protection, sense of responsibility for patients, understanding patients′ needs, effective communication and cooperation with patients was 82.4% (98/119), 73.9% (88/119), 61.3% (73/119), 55.5% (66/119) and 2.1% (62/119), respectively. For research and teaching, the proportion of respondents with excellence abilities in continuous learning and innovation, training and teaching and literature retrieval was 47.9% (57/119), 10.9% (13/119), 10.1% (12/119), respectively. In addition 56.3% (67/119) of respondents were interested in scientific research, 23.5% (28/119) had published articles as the first author or correspondence author, and only 6.7% (8/119) had scientific research projects in the last 5 years.Conclusion:The post competency of general practitioners who received standardized residency training in our hospital varies in different aspects, their abilities in basic public health service, scientific research and teaching are relatively low, which need to be strengthened.
ABSTRACT
Objective To investigate the transient hemodynamic changes during balloon deflation in coronary interventional operation, so as to explore the potential influence of balloon deflation on the occurrence of post-operative no-reflow. Methods An in vitro experimental apparatus was built, in which a high-speed camera was used to take snapshots of balloon deformation and flow field (marked by dyed water) during balloon deflation. Subsequently, image processing techniques were employed to derive the parameters of balloon deformation and estimate the flow velocity downstream from the balloon. A computer model of the experimental apparatus was constructed, with the incorporation of the measured balloon deformation data, to simulate the balloon deflation process under various perfusion pressure and fluid conditions. Results The balloon exhibited a highly nonlinear deformation behavior during deflation. The measured and simulated flow velocities downstream from the balloon were in reasonable agreement, both manifesting a monotonic increase with post-deflation time and perfusion pressure. Numerical simulations further revealed that when the flow velocity downstream from the balloon approached the physiological value of blood flow velocity in the coronary artery, the flow velocity in the balloon-vessel gap and wall shear stress (WSS) reached up to 8-10 times and 60-70 times of their physiological values, respectively. Conclusions Balloon deflation led to a sharp acceleration of flow in balloon-vessel gap and a concomitant abnormal rise in WSS, which might promote the stripping of plaque or thrombus flakes. In view of the fact that the balloon deflation-induced rise in WSS was augmented by the increase in perfusion pressure, taking strategies such as lowering pre-operative blood pressure or implementing balloon deflation during diastole in coronary interventional operation might help to reduce the risk of no-reflow.
ABSTRACT
Objective :To analyze correlation among fasting (FBL) and postprandial blood lipids (PBL) ,blood lipid fluctuation (absolute value of PBL‐FBL) and severity of coronary artery disease .Methods :Cross‐sectional study was performed among 264 patients undergoing coronary angiography (CAG) in our hospital .According to percutaneous coronary intervention (PCI) or not based on CAG results ,patients were divided into plaque group (n＝128) and PCI group (n＝136).Gensini score was used to assess severity of coronary artery disease .Blood lipid levels and its fluctu‐ation were compared between two groups .Correlation among blood lipid levels ,blood lipid fluctuation and severity of coronary artery disease were analyzed .Results :Compared with plaque group ,there were significant rise in per‐centages of men and smokers ,waist circumference ,levels of postprandial‐fasting (P‐F ) serum LDL‐C (ΔLDL‐C ) and P‐F plasma apolipoprotein B (ΔApoB ) , and significant reduction in plasma level of P‐F apolipoprotein A1 (ΔApoA1) in PCI group , P＜0. 05 or ＜ 0. 01. Pearson correlation analysis indicated that serum fasting and post‐prandial HDL‐C levels ,plasma fasting and postprandial levels of ApoA1 and ΔApoA1 were significant inversely cor‐related with Gensini score ( r＝ －0. 130～ －0.218 , P＜0. 05 or ＜0. 01) ,and levels of plasma fasting lipoprotein a (Lp (a)) ,serum fasting and postprandial levels of free fatty acid (FFA) ,serum P‐F FFA (Δ FFA) were significant positively correlated with Gensini score ( r＝0. 139－0. 176 , P＜0.05 or ＜0.01).Multifactor linear regression anal‐ysis indicated that postprandial serum HDL‐C was protective factor for Gensini score (B＝ －22.274 , P＝0.002 ) , while postprandial serum FFA ,Δ FFA ,waist circumference and hyperlipidemia history were its influencing factors (B＝0. 388～24. 135 , P＜0. 05 or ＜0.01).Conclusion :Measurements of fasting and postprandial blood lipid levels and their fluctuation contribute to more comprehensively and objectively assessing blood lipid levels and severity of coronary disease in patients with coronary artery disease .
ABSTRACT
Objective:To explore predictive value of arterial velocity-pulse index (AVI) and arterial pressure-volume index (API) for early atherosclerosis (AS) in middle-aged population.Methods:A total of 138 middle-aged patients hospitalized in our hospital from May 2016 to Nov 2016 were enrolled.According to coronary angiography (CAG) outcomes, they were divided into AS group (n=86) and non-AS group (n=52).Before CAG, AVI, API and brachial-ankle pulse wave velocity (baPWV) were collected in two groups.General data and arterial stiffness indexes were compared between two groups, and the correlation among AVI, API, baPWV and general data were analyzed.Results:Compared with non-AS group, there were significant rise in AVI [(20.4±4.2) vs.(22.8±5.3)] and baPWV [(14.0±2.5) m/s vs.(16.3±3.0) m/s] in AS group,P<0.01 both.AVI was significant positively correlated with age, SBP, DBP, mean arterial pressure (MAP), pulse pressure (PP), API and baPWV (r=0.219~0.471, P<0.05 or <0.01);API was significant positively correlated with age, BMI, SBP, DBP, MAP, PP, brain natriuretic peptide (BNP), AVI and baPWV (r=0.213~0.726, P<0.05 or <0.01);baPWV was significant positively correlated with age, BMI, SBP, DBP, MAP, PP, AVI and API (r=0.201~0.472, P<0.05 or <0.01).Multi-factor linear regression analysis indicated that SBP was influencing factor for AVI (B=0.162,P=0.001), SBP, DBP and HDL-C were influencing factors for API (B=-0.166~2.146,P<0.05 or <0.01), SBP and HDL-C were influencing factors for baPWV (B=0.116,-3.009,P<0.01 both).Conclusion:Both elevated AVI and baPWV can predict atherosclerosis in middle-aged population
ABSTRACT
Objective To study the possible influencing factors in the formation of coronary collateral circulation in patients with chronic total occlusion (CTO). Methods Patients were enrolled having at least 1 major coronary artery angiography revealed as CTO of 144 patients. According to the Rentrop classification, patients with grade 0 and grade 1 filling were catogorized as insufficient collateral circulation group (n=72) and patients with grade 2 and grade 3 filling as collateral circulation group (n=72). Serum biomarkers and insulin-resistance by HOMA model were also studied in all patients. Results In the insufficient collateral circulation, BMI,TC,ApoB, lipoprotein a, fasting insulin HOMA-IR,HOMA- beta, CRP was significantly higher than the well collateral circulation group and ApoA-Ⅰ, ISI lower than the well collateral group ( all P ﹤0. 05 ) . Bivariate correlation alaysis showed. Rentrop score, BMI, TC, ApoB, lipoprotein a, fasting insulin, HOMA-IR,HOMA- beta and CRP are positively correlated to the formation of collateral circulation ( P ﹤ 0. 05 ); ApoA-Ⅰ and ISI were negatively correlated ( P ﹤0. 05 ) . Logistic regression analysis after calibration with weight, ApoA-Ⅰ and HOMA-beta factors, lipoprotein a ( OR 7. 575,P=0. 009), TC (OR 2. 154,P =0. 001) were found to be the independent factors of coronary collateral circulation formation. Conclusions TC, lipoprotein a, obesity, CRP, and HOMA-IR are correlated with the formation of coronary collateral circulation and may predict formation of collateral circulation in patients with CTO.
ABSTRACT
Objective:To explore the relationship between arterial plasma levels of von Willebrand factor (vWF) and cardiovascular events in patients with stable coronary heart disease (CHD) .Methods :A total of 88 stable CHD pa‐tients from Aug 2007 to Dec 2008 , were enrolled ,their clinical ,coronary angiography (CAG) and percutaneous coronary intervention (PCI) data were collected .Enzyme linked immunosorbent assay was used to measure arterial (aortic root) plasma vWF level before PCI .Except two lost cases ,according to baseline vWF level ,other patients were divided into high vWF level group (vWF≥13.5 ng/ml ,n=43) and low vWF level group (vWF 0.05 all .Conclu‐sion:In patients with stable coronary heart disease ,level of von Willebrand factor is not significantly related to long-term cardiovascular events .
ABSTRACT
Objective:To explore the clinic and coronary disease lesion features in patients with acute coronary syn-drome (ACS) ≥ 75 years old and the outcomes of one-year follow up after percutaneous coronary intervention (PCI) .Methods :A total of 355 ACS patients ,who hospitalized in our hospital from Jan 2012 to Dec 2012 and re-ceived PCI ,were divided into ≥75 years group (n=205) and 0.05 ) . Conclusion :Higher incidence rates of clinical complications and complex lesions are found in ≥75 years patients with acute coronary syndrome ;but no significant difference is found in one-year prognosis between the two groups .
ABSTRACT
Objective:To explore therapeutic effect and prognosis of thrombus suction in patients with acute ST seg-ment elevation myocardial infarction (STEMI)during percutaneous coronary intervention (PCI).Methods:A total of 105 STEMI patients were enrolled and divided into thrombus suction + PCI group (n=34,received thrombus suction + PCI therapy)and routine PCI group (n=71,received routine PCI treatment).Postoperative TIMI flow, cardiac function during hospitalization,incidence of major adverse cardiovascular events (MACE)and rehospitaliza-tion within one-year follow-up after PCI were compared between two groups.Results:Compared with routine PCI group,there were significant reductions in peak values of creatine kinase isoenzyme [CK-MB,(236.62± 133.00) ng/ml vs.(186.47±69.20)ng/ml]and creatine kinase [CK,(2833.39± 198.70)ng/ml vs.(2129.59± 199.40) ng/ml],peak time of CK-MB [(12.38±6.70)h vs.(9.65±3.90)h]and CK [(12.80±8.10)h vs.(9.68± 3.50)h]after blood flow recovery,P 0.05. Conclusion:Thrombus suction is help for improving patients condition,reducing enzymology level may be effect improving prognosis.
ABSTRACT
Objective To explore the status and influencing factors of sub-health in inpatient caregivers.Methods A total of 432 caregivers met the inclusion criteria were enrolled.Suboptimal health status questionnaire (SHSQ-25) was used to evaluate the status of sub-health.Sub-health was defined as SHSQ-25 score ≥ 35.100 people undertaking routine physical examinations were enrolled as control group.The incidence and influencing factors of sub-health in caregivers were analyzed.Results (1) The caregivers group valued higher in SHSQ-25score significantly (36.9 ± 8.6 vs.27.5 ± 13.0,P ＜ 0.05).The incidence of sub-health was obviously higher in caregiver group than that in control group (69.9％ vs.39.0％,P ＜ 0.05).(2) A significant difference in the SHSQ-25 scores between female caregivers and male caregivers was observed (37.9 ± 9.0 vs.34.6 ± 7.1,P ＜0.05).The SHSQ-25 score was positively related with age (r =0.578,P ＜ 0.05) and accompanying time (r =0.507,P ＜ 0.05).Parents,children,or spouses of patients got higher scores than other types of caregivers (38.1 ±8.1 vs.31.1 ±8.8,P＜0.05).(3) Among the sub-health caregivers,only 10.9％ of them were aware of their sub-health status.Conclusion The incidence of sub-health may be higher in inpatient caregivers than the general population.Gender,age,accompanying time,and the relationship between patients and caregivers may be influencing factors for sub-health.Effective action should be taken to improve the health status of caregivers.
ABSTRACT
Objective: To determine the national norm of Chinese questionnaire of quality of life in Chinese patients with cardiovascular diseases (CQQC) according patients with hypertension, coronary artery disease（CAD）, and congestive heart failure（CHF）and to analyze the influence factors. Methods: The quality of life was estimated by CQQC to evaluate 7937 persons normal and with cardiovascular diseases（contain with hypertension, CAD, and CHF ） in 28 hospitals of 19 cities across China. The data were compared in gender, age, exercise, psychologic condition, education, number of family member and medical cost. Results: 1、The mean scores（national norms）of normal persons were （95.74±23.21）; 2、The scores of hypertension patients were （73.75±23.62）, the scores of hypertension stage 3 group （69.06±21.78）were least compared with other stages（P<0.01）; 3、The scores of CAD patients were（64.67±20.59）, the scores of unstable angina group（55.37±18.62）were least compared with other types in CAD patients（P<0.01）; 4、The scores of CHF patients were （40.36±17.24）, it was least compared with those of hypertension and CAD patients （P<0.01）; 5、Influence factor: （1）Sex, age: The mean scores were （71.41±27.8）for 7937 persons, the scores of male persons were significantly higher than those of female (P=0.000). In normal persons, along with age increased, the scores decreased （P<0.05） ; except ≥70 ages group, the scores of male persons were higher than those of female（P<0.05） ; （2）Exercise: The scores of patients participating exercise were significantly higher than those of no participating exercise [（72.64±21.87）vs.（66.91±23.13）, P=0.000]; （3）Psychological condition: The scores of patients with healthy psychological condition were significantly higher than those of with psychologic disorder [（70.13±25.66）vs.（68.91±20.44）, P=0.001]; （4）Other: patients with better education, more than 1 family members and medical insurance or public expense had more scores (P<0.05～0.001). Conclusions： The sample size is large and the datum is reliable for Chinese questionnaire of quality of life in Chinese patients with cardiovascular diseases. It can reflect influence of age, sex, exercise, psychologic condition, family, education background, medical condition and disease, its item is brief, clear, and operation is easy, so it may well be spread.