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Objective:To investigate the clinical manifestation, pathological types, treatment and prognosis of primary tracheobronchial tumors in children.Methods:We retrospectively studied the primary tracheobronchial tumors patients who diagnosed from May 2009 to Jan 2021 in Guangzhou Women and Children Medical Center. The clinical manifestations, pathological types, therapeutic methods and prognosis were analyzed.Results:There were 15 patients identified as the primary tracheobronchial tumors, including synovial sarcoma (1 case), pulmonary inflammatory myofibroblastic tumor(IMT 4 cases), mucoepidermoid carcinoma(7 cases), infantile hemangioma (1 case), Ewing's sarcoma (1 case). Respiratory symptoms are the most complaint at the time of diagnosis including 15 patients with cough, 2 with hemoptysis, and 1 with dyspnea. Endoscopic treatment of tracheobronchial tumors was performed under extracorporeal membrane oxygenation (ECMO) support in 1 patient. Sleeve lobectomy was performed in 3 patients, lobectomies in 6, and local tumor resections in 4 patients including 2 patients suffered second surgery due to tumor recurrence.Conclusion:The clinical manifestations of the primary tracheobronchial tumors in children are nonspecific. Complete resection led to excellent outcome.
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Objective:To compare the prognosis of patients with unilateral sporadic medullary thyroid carcinoma treated by different surgical selection, and analyze the independent risk factors affecting the prognosis.Methods:One hundred and twenty-six patients at Tianjin Medical University Cancer Institute and Hospital from Feb 2011 to Oct 2018 were retrospectively divided into group A (total thyroiclectomy) and group B (unilateral lobectomy).Results:There were no significant differences in postoperative recurrence rate ( χ2=0.394, P=0.530), mortality ( χ2=3.175, P=0.146), biochemical cure rate ( χ2=0.613, P=0.434), progression free survival and overall survival ( P=0.278, 0.175) between group A and group B; Tumor diameter ≥4 cm and lateral cervical lymph node metastasis were independent risk factors affecting the overall survival. The incidence of postoperative temporary hypocalcemia ( χ2=5.068, P=0.024) and permanent hypocalcemia ( χ2=6.590, P=0.010) in group A was higher than that in group B. Conclusions:Ipsolateral thyroidectomy can be applied to patients with unilateral sporadic medullary thyroid carcinoma with similar long term prognosis and tower incidence of temporary hypocalcemia and permanent hypocalcemia compared to total thyroidectomy.
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Objective:To explore the feasibility of prenatal ultrasound in predicting delivery mode of full-term primipara.Methods:The study prospectively enrolled primiparas with gestational age ≥37 weeks, singleton, cephalic and no contraindications to vaginal delivery who underwent routine prenatal examination in the Third Affiliated Hospital of Sun Yat-sen University from September 2020 to February 2021.In addition to routine fetal ultrasound examination, the transperineal ultrasound examination was performed to assess the angle of progression (AOP), head perineum distance (HPD), the angle of pubic arch and the anteroposterior diameter, left and right diameter, area and perimeter of levator ani hiatus of pregnant women in different states were measured; Cervical length (CL) was examined by transvaginal ultrasound. The delivery mode was tracked, and the indicators related to natural delivery were screened out. Receiver operating characteristic (ROC) curve was used to evaluate the effectiveness of relevant indicators in predicting natural delivery.Results:A total of 142 cases were included in this study, including 112 cases of natural delivery and 30 cases of manual intervention delivery. There were no significant differences in age, gestational weeks, biparietal diameter, head circumference, body mass index (BMI) and neonatal weight between the natural delivery group and the manual intervention delivery group (all P>0.05). Multivariate regression analysis showed that AOP was associated with natural delivery( OR=1.048, P=0.008). ROC curve analysis showed that the area under the curve was 0.648 with AOP 96.92° as the node, and the specificity and positive predictive values were 83.33% and 0.909 1 respectively. Conclusions:It is feasible to predict the mode of delivery by prenatal ultrasound in full-term primiparas. AOP is related to the mode of delivery, which can provide more reference information for clinical practice.
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Objective@#To explore the relationship between sleep and exercise among grade 1-6 students in a certain city during the period of home based online courses in the epidemic, and to provide reference basis for the government and relevant departments to make relevant policies on student health promotion.@*Methods@#From April 22 to May 14 in 2020, 24 452 primary school students were selected by stratified cluster random sampling method to network questionnaire survey, which included general situation, sleep time,and exercise.@*Results@#Totally 21.6% of primary school students participated in low intensity exercise, 9.4% in moderate intensity exercise and 5.8% in high intensity exercise every day. Less than 10% of the students participated in all types of intense sports for more than 30 minutes each time. The report rate of sleep deprivation among students in grades 1 to 6 was 22.5%, 25.5%, 28.9%, 31.3%, 35.0%, 39.9%, respectively(χ 2=350.75, P<0.05). Multivariate Logistic regression analysis showed that after adjusting for gender, grade, oneness and other factors, high intensity exercise was negatively correlated with sleep deprivation(OR=0.91, 95%CI=0.86-0.97).@*Conclusion@#Insufficient sleep is common among primary students, and appropriate amount of high intensity exercise is a favorable factor to ensure adequate sleep time in primary school students.
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Objective:To investigate the cognition and willingness of nursing staff to Internet plus nursing service, and analyze the related factors that affect their participation in Internet plus nursing service.Methods:From April to May 2019, 150 nurses from three hospitals in Weifang were investigated by questionnaire and key person interview. Descriptive analysis and binary logistic regression analysis were used to analyze the intention of nursing staff to participate in Internet plus nursing service. The interview mode was used to analyze the appropriate mode of Internet plus nursing service from the perspective of nursing staff.Results:142 valid questionnaires were obtained, of which 137(96.5%)indicated willingness to provide Internet plus nursing services, and 135(95.1%) realized the necessity of the service. Education, marriage, nurses′judgment on the necessity of the service and their own subjective judgment of their competence were the factors affecting nurses′ participation in the Internet plus nursing service.Conclusions:Multiple factors affect the choice of nursing staff′s behavior in Internet plus nursing service.From the perspective of nursing staff, the Internet plus nursing service mode needs joint efforts from many aspects.
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Objective:To define the connotation of village doctors′ vulnerability.Methods:On the basis of document analysis, Delphic method was used to consult and argument the connotation of village doctors′ vulnerability from October 2015 to November 2015.Results:Twenty and 16 specialists were consulted in two rounds of the consulting. According to these consultations, the acceptance rate of the specialists for the seven consulting units increased from 74.29% to 93.16%.Conclusions:The vulnerability of village doctors was identified, as a status in which their self-ability and support against their exterior environment could not to cope with the disturbances they faced, while the vulnerability was co-determined by disturbance and response ability of village doctors.
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Objective:To explore the formation mechanism of the weakening of village clinic′s medical service capacity in the context of new medical reform.Methods:Purposive sampling method was used to enroll 38 rural doctors and managers of rural health centers and health offices in the interview from October 2015 to November 2015. And grounded theory was adopted to analyze reasons and their mechanism of the weakening of village clinic′ s medical service capacity.Results:29 first-grade categories and 7 second-grade categories were worked out in text encoding. With the implementation of the ongoing healthcare reform, support from financial, policy and technology increased significantly, but due to the synthetic action of unexpected negative effects of the reform, superposition and accumulation of disturbance and ineffective support, village clinic′ s medical service capacity began to weaken.Conclusions:The weakened village clinic′ s medical service capacity is a result of the synthetic action of 3 reasons. The persistence of this status will intensify the vulnerability of rural health service system and be bad for the implementation of hierarchical medical policy and the strategy of rural vitalization. Measures should be taken to optimization the essential medicine system, establish a comprehensive assessment mechanism for basic medical service and basic public health service of village clinic, strength the strategic purchasing of medical insurance, improve the financial compensation mechanism, and complete training system of village doctors, aims to promoting sustainable development of village clinic.
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Objective:To explore the current status of village doctors′ vulnerability in Shandong province in the context of ongoing healthcare reform.Methods:A cross-section study was conducted from October 2015 to November 2015 based on a self-designed questionnaire for village doctors. The questionnaire included 6 parts: fundamental state, disturbance from surroundings, disturbance from job, emotional support, instrumental support and self-ability of village doctors. Mean and standard deviation were adopted to describe the level of disturbance and support. Quadrant analysis was adopted to analyze village doctors′ vulnerability. The set pair analysis was adopted to calculate the vulnerability index and sample cluster analysis was adopted to classify village doctors based on the vulnerability index.Results:The total disturbance score was 3.39±0.46, and contribution from professional risk was the biggest(19.95%). The self-ability score was 3.33±0.40, and contribution from financial support was the smallest(4.09%). According to the set pair analysis, village doctors′ vulnerability total score was 0.49±0.06, ranging in a medium category. According to the sample cluster analysis, 27.2%(277/1 018)of the village doctors stayed at the upper category, as 30.3%(309/1 018) was defined as a medium category. According to the quadrant analysis, 35.5%(361/1 018)of the village doctors were found as in crisis vulnerability.Conclusions:In general, village doctors′ vulnerability stays in the medium category. They have to fight against high disturbance from surroundings, with more emotional support and less financial support expected.
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Objective@#To explore the formation mechanism of the weakening of village clinic′s medical service capacity in the context of new medical reform.@*Methods@#Purposive sampling method was used to enroll 38 rural doctors and managers of rural health centers and health offices in the interview from October 2015 to November 2015. And grounded theory was adopted to analyze reasons and their mechanism of the weakening of village clinic′ s medical service capacity.@*Results@#29 first-grade categories and 7 second-grade categories were worked out in text encoding. With the implementation of the ongoing healthcare reform, support from financial, policy and technology increased significantly, but due to the synthetic action of unexpected negative effects of the reform, superposition and accumulation of disturbance and ineffective support, village clinic′ s medical service capacity began to weaken.@*Conclusions@#The weakened village clinic′ s medical service capacity is a result of the synthetic action of 3 reasons. The persistence of this status will intensify the vulnerability of rural health service system and be bad for the implementation of hierarchical medical policy and the strategy of rural vitalization. Measures should be taken to optimization the essential medicine system, establish a comprehensive assessment mechanism for basic medical service and basic public health service of village clinic, strength the strategic purchasing of medical insurance, improve the financial compensation mechanism, and complete training system of village doctors, aims to promoting sustainable development of village clinic.
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Objective@#To explore the current status of village doctors′ vulnerability in Shandong province in the context of ongoing healthcare reform.@*Methods@#A cross-section study was conducted from October 2015 to November 2015 based on a self-designed questionnaire for village doctors. The questionnaire included 6 parts: fundamental state, disturbance from surroundings, disturbance from job, emotional support, instrumental support and self-ability of village doctors. Mean and standard deviation were adopted to describe the level of disturbance and support. Quadrant analysis was adopted to analyze village doctors′ vulnerability. The set pair analysis was adopted to calculate the vulnerability index and sample cluster analysis was adopted to classify village doctors based on the vulnerability index.@*Results@#The total disturbance score was 3.39±0.46, and contribution from professional risk was the biggest(19.95%). The self-ability score was 3.33±0.40, and contribution from financial support was the smallest(4.09%). According to the set pair analysis, village doctors′ vulnerability total score was 0.49±0.06, ranging in a medium category. According to the sample cluster analysis, 27.2%(277/1 018)of the village doctors stayed at the upper category, as 30.3%(309/1 018) was defined as a medium category. According to the quadrant analysis, 35.5%(361/1 018)of the village doctors were found as in crisis vulnerability.@*Conclusions@#In general, village doctors′ vulnerability stays in the medium category. They have to fight against high disturbance from surroundings, with more emotional support and less financial support expected.
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Objective@#To define the connotation of village doctors′ vulnerability.@*Methods@#On the basis of document analysis, Delphic method was used to consult and argument the connotation of village doctors′ vulnerability from October 2015 to November 2015.@*Results@#Twenty and 16 specialists were consulted in two rounds of the consulting. According to these consultations, the acceptance rate of the specialists for the seven consulting units increased from 74.29% to 93.16%.@*Conclusions@#The vulnerability of village doctors was identified, as a status in which their self-ability and support against their exterior environment could not to cope with the disturbances they faced, while the vulnerability was co-determined by disturbance and response ability of village doctors.
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Objective To analyze the motives and tactics of township health centers ( THC) to participate in the countywide medical communities of Shandong province. Methods Such tools as the new institutionalism, rational choice and social network theories, as well as the constituent ratios and Pearson correlation coefficient of data were used in a survey in August 2018 with managers of 264 THCs in Shandong. It aimed to learn from the respondents their motives, tactics, and behaviors to participate in such communities. Results Theoretical analysis of the results found that their participation was bound by both institutional environment and technical environment. For example, compliance tactics, accompanied by efficiency, was adopted to cope with stress from institutional environment. Exploratory tactics, accompanied by legitimacy, was adopted to cope with stress from technical environment. The figures showed 87. 5％ of 264 THCs investigated participated in such communities, and their main motives were in turn to follow government requests (86. 1％ ) and to seek development opportunities (69. 7％ ). The critical criteria of partner selection were in turn technological level (83. 5％ ) and matching of resources (77. 9％ ). Of 231 THCs which participated in the communities, 95. 2％ joined in countywide medical communities, and 28. 6％ participated in other forms of medical alliances. Conclusions THCs showed high organizational convergence in their participation, and adopted diversified strategies of participation in medical alliance.
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The policy model of G. C. Edwards was used to study the policies on building a countywide medical community ( CMC), and identify problems in such aspects as policy communication, resources, disposition and bureaucratic structure. The analysis found that enriching health resources at primary level and powerful government support are creating ideal environment for the construction of CMC. But due to its preliminary development, rooms of improvement of its policy design, and unclear enforcement standards, there appear behavioral polarizations at local health authorities. For example, some are proactive to explore and accumulate rich experiences, while the most take a wait and see stand, or even take administrative means to cope with their authorities by forming medical communities in form only. A small part of county hospitals, thanks to support from the government and inherent conditions, take active measures in this direction as policy frontrunners. On the other hand, most county hospitals prefer to be policy followers in order to avoid cost and risks of the reform. In the worst cases, a few county hospitals have become free riders of the policy, and attempt to take advantages of their primary health institutions. Primary health institutions warmly embrace CMC, but their limited service capability constitutes roadblocks in CMC construction. What is more, poor communication and collaboration mechanisms among systems and authorities hinder the effective policy synergy and health service integration of CMS.
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Objective To study the implementation effects of China′s contracted service policy for family physicians. Methods Systematic evaluation method was used to extract, describe and analyze the literature information of the research on the implementation effect of family physicians contracted service policy. Results A total of 80 papers of four types were rounded up, including 47 on the effect of health management on patients with chronic diseases, 11 on the effect of health management on the elderly, 15 on the effect on the first diagnosis in the community, and 7 on the effect on the control of medical expenses.The research is mostly distributed in the developed areas in the east. The family physicians contracted service promotes the health management effect of patients with chronic diseases and the elderlies, improves the first visit ratio of residents at their community, and effectively controls the medical expenses.Existing research shows that such a service has achieved initial success.However, the research also identified such common problems as the shortage and low competence of family physicians, low quality, resource integration and inadequate policy publicity. Conclusions The contracted service policy in China has begun to play the role of " health gatekeeper" and " cost gatekeeper" to some extent.It is suggested to strengthen the training of general practitioners, establish and perfect incentive mechanism, and improve the construction of information platform, while the implementation effect of contracted services for family physicians deserve further study in a broader scope, deeper level and design specifications.
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Objective To analyze the policy texts related to the contracted service of family physicians, and probe into the key points and existing problems of the policy in the process of promoting the contracted service of family physicians in China, for the purpose of providing references for the optimization and perfection of the system. Methods A total of 54 relevant policy texts issued by the Central Government from 2011 to 2019 were selected, for establishing a two-dimensional analysis framework based on policy tools and stakeholders.By means of quantitative analysis of policy text and literature research method, we analyzed the relevant policy texts. Results Study of the 54 texts found 52.8% (124/235)mentioned commands and regulatory tool use, 27.2% (64/235) mentioned capacity building tool use, 13.2% (31/235) mentioned information and exhortation tool use, 5.1% (12/235)only mentioned incentive tool use, and 1.7% (4/235) only mentioned system change tool use; while most of them(34.3% and 32.7% )mentioned government and physicians, and only a few(17.6% and 15.4% )mentioned patients and medical entities. Conclusions It is suggested to optimize the policy tools mixture, and increase the use of incentive tools to physicians, and explore new forms of system change tools.It is also proposed to pay more attention to resource allocation of primary medical institutions, and to patient awareness and satisfaction.
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The family physicians contracted service is an important means to promote hierarchical diagnosis and treatment and realize healthy Chinese strategy. With the continuous introduction of family physicians contracted service policy, it is very important to raise awareness, effectively promote and put into place.This study analyzed the family physicians contracted service policy from the perspective of public policy, and used the multiple streams theory framework to analyze the driving factors of the policy proposed. In addition, it explored the influence of problem stream, policy stream, and political stream on the policy launch process.These efforts can help improvement the policy awareness in the process, and help ensure sustainable progress of the policy.
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OBJECTIVE： To establish a method for simultaneous determination of gallic acid， cinnamic acid and catechin in 3 processed products of Rheum officinale. METHODS： RP-HPLC method was established. The determination was performed on Thermo ScientificTM Hypersil GOLD Dim column with mobile phase consisted of methanol-0.1％ phosphoric acid solution （gradient elution） at the flow rate of 1.0 mL/min. The detection wavelength was set at 278 nm， and the column temperature was 30 ℃. The sample size was 10 μL. RESULTS： The linear range of gallic acid， cinnamic acid and catechin were 0.126 2-1.262 0 μg（r＝0.999 9）， 0.036 2-0.362 0 μg（r＝0.999 9） and 0.177 9-1.779 4 μg（r＝0.999 8）， respectively. Quantitative limits were 25.4， 28.2， 62.5 ng， and detection limits were 6.2， 3.6， 11.8 ng， respectively. RSDs of precision， stability， repeatability and durability tests were all less than 3％. The recoveries ranged from 94.64％-102.71％（RSD＝2.74％， n＝9）， 95.35％-102.49％（RSD＝2.44％， n＝9）， 93.56％-103.66％（RSD＝3.27％， n＝9）. The determination results showed that the contents of gallic acid and cinnamic acid in prepared R. officinale were higher， and the order of both were prepared R. officinale＞steamed R. officinale＞raw R. officinale. The content of catechin in raw R. officinale was higher， and the order of it was raw R. officinale＞ steamed R. officinale＞prepared R. officinale. CONCLUSIONS： The method is sensitive， reliable and reproducible. It can be used to determine the contents of gallic acid， cinnamic acid and catechins in 3 processed products of R. officinale simultaneously.
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Objective Based on the screening of respiratory viruses in children with respiratory tract infection in Maoming,the viral pathogens in children with respiratory tract infection were investigated,the epidemic trend of children with respiratory tract infection in the region was grasped,so as to provide the basis for the disease diagnosis of children with respiratory tract infection.Methods With direct immunofluorescence,7 common respiratory viruses in nasopharyngeal secretions were detected in 13 148 patients with respiratory infection in our hospital,including adenovirus (ADV),respiratory syncytial virus (RSV),influenza virus A (FLUA),influenza virus B FLUB) and parainfluenza (PIV).Results In 13 148 cases,the respiratory virus positive were found in 3 308 cases,the total positive rate was 25.16％,the positive detection rate of RSV was the highest (17.39 ％),and the detection rate of respiratory virus has obvious seasonal characteristics,with the highest detection rate in the first quarter,and mainly concentrated in the population under the age of three.Conclusion RSV was the first of the 7 common respiratory viruses detected,and the virus infection was associated with age and season.
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Objective To establish fingerprint of volatile components in golden throat lozenges by GC-MS. Methods Volatile components from 10 batches of golden throat lozenges were extracted by steam distillation method and analyzed by GC-MS with n-tetradecane as internal standard. Fingerprint peak detection and similarity evaluation were applied to the total ion chromatogram(TIC)of GC-MS by "Similarity Evaluation System for Chromatographic Fingerprint of Traditional Chinese Medicine (Version 2004)" ,fingerprint peak was identified by mass spectrometry. Results A GC-MS fingerprint was established based on 10 common peaks as characteristic fingerprint information.The similarity of fingerprint peaks from the 10 batches of samples were more than 0.998.Ten fingerprint peaks were determined by mass spectrometry, all of which were composed of monoterpenes and monoterpenes containing oxygen, the highest content of which was L-menthol containing oxygen monoterpenes, accounting for 83.17% of the total. Conclusion The fingerprint established by gas chromatography-mass spectrometry can completely reflect the volatile components of golden throat lozenges tablets, with strong characteristics and specificity, and can be used as an effective method for the quality control of volatile components inf golden throat lozenges.
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Objective To analyze problems in the development of medical service at private hospitals, and provide references for promoting the development of these hospitals and implementing policies for encouraging this sector′s growth. Methods The data were collected from the statistical yearbook published by the National Health Commission of the People′s Republic of China, and descriptive analysis method was used to analyze the medical service workload and medical service efficiency of private hospitals in China since the new healthcare reform. Results Private hospitals accounted for 56. 39％ of the total number of hospitals in China, accounting for 21. 69％ of beds by the end of 2016. From the perspective of medical service workload, the service volume of these hospitals had increased yet at a small pace. The number of patients and inpatients received accounted for 12. 90％ and 15. 84％ respectively of all the hospitals in China. From the point of service efficiency, by the end of 2016, the bed utilization ratio was 62. 8％, the daily medical visits to their doctors were 5. 5 persons-times, and the daily number of hospitalized beds per doctor was 2. 2 beds. These numbers lag far behind public hospitals. The development of private hospitals varied with regions in imbalance. Conclusions Improving the social image, attracting talents and improving service quality are key to improving the medical service capacity of private hospitals.