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Objective:To analyze the actual and expected incentives and key issues of telemedicine providers in China and to provide important references for optimizing telemedicine incentive policies.Methods:The sample data came from a questionnaire survey of 1 084 providers in 7 provinces of Fujian, Hainan, Henan, Hunan, Guizhou, Sichuan and Qinghai in October and November 2019 and a semi-structured interview data at 6 hospitals in Henan province in January 2020. Descriptive analysis was used to sort such data into text data for classified summation.Results:The greatest gaps were found between actual incentives and expected ones in expense subsidies, title promotion and excellence awards, with such gaps as high as 18.65, 28.26, 29.28 percentages among providers of junior, deputy senior and senior academic titles respectively. Hospitals fall short in providing adequate incentives for telemedicine providers, not to mention lack of differentiation and diversification in personnel incentives, and poor implementation of incentive policies.Conclusions:It is suggested to strengthen incentive demand analysis, break the homogenization bottleneck of incentive policies, and consolidate internal publicity and implementation of incentive policies.
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Objective:To analyze the usage intention and key issues of medical staff to use telemedicine, for improving telemedicine service system in China.Methods:From October to November 2019, medical workers of both the inviting party and invited party who experienced telemedicine in seven provinces of Fujian, Hainan, Henan, Hunan, Guizhou, Sichuan and Qinghai were selected for an online questionnaire survey. Areas covered included their usage intention, satisfaction and cognitive appraisal of telemedicine. Descriptive statistical analysis and non-parametric test were used to discuss the intention of further use, satisfaction and challenges of medical workers in various provinces and regions.Results:1 084 valid questionnaires were recovered. The data found the overall satisfaction was 98.62%, and the proportion of their intention of further use was 98.25%, and those from the eastern and western provinces presented higher intention of usage. The top challenges as reflected by these medical workers were named as follows: timeliness of consultation progress and information feedback; long latency time; low Internet speed, poor and interrupted Internet signal; inadequate system equipments and inconvenient operation; difficulties in remote physical checkup and overall understanding of patient conditions; as well as substandard, incomplete and poor medical records.Conclusions:These medical workers are satisfied with the telemedicine services and willing to continue to use telemedicine.For those existing problems, it is suggested to strengthen the infrastructure and optimize the process of telemedicine services, so as to encourage them in greater use of telemedicine.
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Objective@#To investigate the influencing factors of the implementation of precision medical services based on clinician cognition, and provide a scientific reference for the implementation and advancement of precision medical services.@*Methods@#Using electronic questionnaires, clinicians from 48 hospitals in 12 provinces(autonomous regions and municipalities directly under the Central Government) were surveyed from July to September 2019, with 341 valid questionnaires collected. Descriptive statistics and factor analysis were performed on the survey data.@*Results@#Three dimensions that affect precision medical services were identified from the recovered questionnaires, namely external support factors, hospital drive capabilities, patient information provision and protection. The contribution rate of variance after orthogonal rotation was 35.157%, 22.234% and 16.343% respectively.@*Conclusions@#The external supporting factors should be developed, the hospital driving ability should be strengthened, and the patient information reception and privacy information security should be ensured to provide an important basis and guarantee for the implementation of precision medical service.
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Objective:To investigate the influencing factors of the implementation of precision medical services based on clinician cognition, and provide a scientific reference for the implementation and advancement of precision medical services.Methods:Using electronic questionnaires, clinicians from 48 hospitals in 12 provinces(autonomous regions and municipalities directly under the Central Government) were surveyed from July to September 2019, with 341 valid questionnaires collected. Descriptive statistics and factor analysis were performed on the survey data.Results:Three dimensions that affect precision medical services were identified from the recovered questionnaires, namely external support factors, hospital drive capabilities, patient information provision and protection. The contribution rate of variance after orthogonal rotation was 35.157%, 22.234% and 16.343% respectively.Conclusions:The external supporting factors should be developed, the hospital driving ability should be strengthened, and the patient information reception and privacy information security should be ensured to provide an important basis and guarantee for the implementation of precision medical service.
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Objective To study the value of platelet/lymphocyte ratio(PLR)in predicting coronary artery lesions and their outcome in acute coronary syndrome(ACS)patients after PCI.Methods Three hundred and forty-four elderly ACS patients who underwent PCI and CAG in our hospital from May 2016to August 2018were divided into MACCE group(n=95)and MACCE-free group (n=249).They were further divided into high PLR group(n=247)and low PLR group(n=97) according to the ROC curve for PLR.Their clinical data were analyzed,and the prognostic threshold of PLR was determined according to the ROC curve for PLR and logistic regression analysis respectively.Results The number of smokers was significantly greater,the incidence of DM,serum LDL-C level,PLR and Gensini score were significantly higher in MACCE group than in MACCE-free group(P＜0.01).The area under the ROC curve for PLR in predicting the poor outcome in ACS patients after PCI was 0.898and 0.842respectively(95％CI:0.859-0.937,95％CI:0.794-0.891).The PLR was positively related with the Gensini score(r=0.654,P＜0.01).The incidence of MACCE was significantly higher in high PLR group than in low PLR group(78.35％ vs 7.69％,P＜0.01).High PLR was an independent risk factor for MACCE in elderly ACS patients after PCI(OR=2.527,95％CI:1.058-6.039,P=0.037).Conclusion PLR is related with MACCE in elderly ACS patients after PCI.
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OBJECTIVE： To study the mechanism of wound healing promotion of Panax notoginseng-Bletilla striata gum sponge on diabetic foot ulcer （DFU） model rats. METHODS： Healthy SD rats were selected and given high-lipid and high-glucose diet， intraperitoneal injection of streptozotocin once to establish diabetes model. Neodymium-iron-boron magnet was used to press the back of rats to make ulcer wound then established DFU model. Totally 60 DFU model rats were randomly divided into group A（blank group， i.e. normal saline gauze group）， group B（vaseline gauze group），group C （gelatin sponge group） and group D （P. notoginseng-B. striata gum sponge group）， with 15 rats in each group. The rats were given corresponding gauze/sponge to cover the wound for intervention treatment， changing dressing once every 1-2 days. On the 3rd and 7th day after intervention， the wound healing of rats in each group was observed with naked eyes， and the wound healing rate was calculated. The wound margin tissue was collected to obtain HE staining section， and histopathological observation was conducted under microscope. mRNA expression of β-catenin， GSK-3β and Rspo3 in wound tissue were determined by RT-PCR. RESULTS： On the 3rd and 7th day after intervention， compared with group A， B， C， healing rate of group D was increased significantly （P＜0.05）； inflammatory cell infiltration， collagen deposition， capillary and granulation tissue growth in wound tissue increased significantly. The mRNA expression levels of β-catenin and Rspo3 all increased， and those of GSK-3β all decreased； except for the difference of β-catenin at the 3rd day and GSK-3β at the 7th day after intervention between group D and group C were not significant， the difference of other indicators was statistically significant （P＜0.05）. CONCLUSIONS： P. notoginseng-B. striata gum sponge can effectively promote the wound healing in DFU model rats， the mechanism of which may be associated with up-regulating the expression of β-catenin and Rspo3 mRNA and down-regulating the expression of GSK-3β mRNA.
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Telemedicine can optimize deployment of medical resources and minimize diagnosis discrepancies.Formulation of a rational project pricing and scientific compensation policy will be conducive to its future development. The concept of human resource consumption in RBRVS was used as reference to improve the activity-based costing ( ABC ) method. The authors sorted out the resource cost repository, identified the activity system, classified the motivation resources into respective activity cost repositories, and calculated the cost of respective cost object distribution.The cost of three telemedicine service items(remote single discipline consultation, remote image consultation and remote pathology consultation were 119.69, 147.03 and 161.61 yuan respectively) was calculated by the improved ABC.It can better indicate project costs than that calculated by the traditional ABC(137.30, 147.17 and 144.08 yuan), and proves more consistent with the existing prices of other province(134.00, 150.00 and 174.00 yuan).
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The paper introduces the mutual relationship among the innovation of four dimensions including new medical service concept,new patient interface,new service transmission system and new technology of telemedicine based on the illustration of four-dimensional model of service innovation to the telemedicine service,and makes an analysis by taking the telemedicine service innovation of remote medical center in Henan Province as an example,thus providing reference for the innovative development of telemedicine service.
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China’s existing laws and regulations in telemedicine fall behind practice.As a result, telemedicine is confronted with such vague constraints as permission,legal relations and legal liability, validity of electronic medical records,telemedicine equipment standards,patients’right to know and their right to privacy,as well as disputes settlement.On such basis,the authors propose to improve the laws and regulations in this regard as soon as possible.
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Objective To establish a perfect method that is based on the complexes of DNA-binding-C/EBP? for detection of nuclear transcription factor C/EBP? (CCAAT enhancer binding protein ?). Methods To search specific oligonucleotides sequence and establish a labeling method of consensus oligonucleotides and the standard curve was regressed.The electrophoresis conditions were optimized.Results The combination of 20pmol of ?- 32 P-ATP and 4 pmol of C/EBP? oligonuleotides in reaction can express the highest probe activity and corporation effect.The linearity was established (r2=0.975). 0.5?g of nuclear extract can be detected and bands are clear and specific.Conclusion The method is good at specificity. It can be a method to detecting nuclear factor C/EBP? or its DNA-binding site.