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Comprehensively and continuously improving the ability is the goal of continuing medical education for practicing general practitioners (GPs). It is urgent to carry out systematic planning for improvement of the training content, training methods and evaluation methods in current continuing education system. Therefore, based on the survey of the training requirements of the community GPs in Shanghai Changning District, this study proposed a pathway of establishing continuing education mechanism for community GPs in regional medical centers. This continuing education mechanism planned to build a talent evaluation system reflecting the competency of the community GPs, to develop training contents based on the community situation and the needs of the GPs, to establish the practice support and the collaboration platform of science, education and research, to promote the sustaining improvement of GPs.
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Based on literature analysis and conference discussion, the index system of the competence and performance of general practitioners (GPs) was developed, which consisted of 4 dimensions and 59 indicators. Based on the indicator system, the questionnaire was designed. From March 2019 to May 2019, a questionnaire survey on the ability, performance and training needs of GPs was conducted among the managers of 10 community health service centers in Shanghai Changning District. The dependent variables were analyzed through descriptive analysis, correlation analysis and quadrant mapping methods. The median of overall evaluation score of the performance of GPs in 10 community health service center was 2.7(2.4,2.9); and the mean of training demand score was (1.4±0.5). The performance scores was negatively correlated with the degree of training needs ( r=-0.654, P<0.01). Among the 59 capacity assessment indicators, there were 25 (42.4%) with poor performance but high training demand. The overall ability of general practitioners was common from the perspective of the community health service center managers, suggesting that it is important to strengthen the capacity development for community GPs, and those with poor performance and high training needs should be included in training priority, such as disease diagnosis and treatment, emergency management ability, rehabilitation service ability and medical law.
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A survey on clinical skill application and training needs of general practitioners (GPs) was conducted in the community health service centers of Shanghai Changning District from March to May 2019. The heads of the medical/prevention departments of 10 community health service centers (CHS) in Changning District were invited to evaluate the application frequency of clinical skills and training needs of GPs. According to Residency Training Standards for General Practitioners (trial), Training Standards for Assistant General Practitioners (trial), Training Program for General Practitioners in Primary Medical and Health Institutions (trial), 369 clinical skills for general practitioners were included for evaluation. The application frequency of above 369 clinical skills among 198 general practitioners were evaluated and training needs were also assessed. The overall application frequency score of GPs for 369 clinical skills was 1.00 (0.30, 1.70) points, and the training needs score was 1.40 (1.10, 1.70) points. The application frequency of different clinical skills was positively correlated with training needs ( r=0.462, P<0.01). And the four-quadrant analysis results show that among the 369 clinical practice skills, 116 (31.4%) items were used by GPs with high frequency and high training needs, and 80 (21.7%) items were used with low frequency but high training needs. There were 45 (12.2%) items with high application frequency but low training needs, and 128 (34.7%) items with low application frequency and low training needs. The survey indicates that the training of clinical skills listed in the three major training standards or outlines should be strengthened in continuing education for general practitioners, and the practice skills with high application frequency and high training needs should be focused in training program to improve the quality, effectiveness and efficiency of training.
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From March 2019 to May 2019, panel interviews were conducted with 39 representatives of 10 community health service centers in Shanghai Changning District, each took 30 to 90 min. The relevant information of interviews was coded, classified, streamlined, and the interview topics were sorted out. The interviews showed the following problems of continuing education in community health care setting currently: there were lack of updated disease-related clinical guidelines and other knowledge, lack of uniform regulations on rational drug use; the contents or forms of training did not match the needs of the community; and training in psychology and nutrition therapy could not be transformed into practical application. The participants made the following suggestions for continuing medical education: to build a database of clinical guidelines for diseases; to provide information-based support and guidance for rational drug use; to design training contents and training forms based on community needs; to provide training support in psychology, nutrition and other subjects; to increase trainings in research, teaching and health management and other aspects. Continuing medical education for community general practioners faces problems from knowledge users, knowledge providers, and the policy environment. The contents and forms of training needs should be optimized. These can be strengthened by communicating with the community and following up with the needs of the community in establishing diversified training forms, supporting assessment and incentive mechanisms for different types of training contents.
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Objective To explore the current situation of nurses' multi-site practice,and the attitude and willingness of nurses towards multi-site practice in Guangzhou,and to analyze the pros and cons and the obstacles during implementing multi-site practice in Guangzhou.Methods Semi-structured interviews were conducted among nurses recruited from four general hospitals,one specialist hospital and two community health centers using convenience sampling in October 2016.Interviews were recorded and analyzed by quantitative method after transcription.Results Totally 55 registered nurses were interviewed,including 24 nurse managers and 31 clinical nurses.Fifty-four (98.18％) nurses were supportive to nurses' multi-site practice and 20(36.36％) had the will to carry out multi-site practice themselves.For benefits of multi-site practice,participants considered it could be good to nursing staffs personal growth and career development,contribute to the rational allocation of nursing staff resources and increase the income of nurses.The mentioned disadvantages of nurses' multi-site practice were difficulties of nurses' management and nursing quality management,and the risk of involving primary practicing work place in medical disputes.The obstacles of implementing nurses' multi-site practice included unclear laws and regulations,nursing quality being difficult to control,and inadequate training and management of multi-site practicing nurses.Conclusion The majority of the nurses in Guangzhou supported the nurses' multi-site practice,however,due to unclear regulations and inadequate guarantee system for medical risks,nurses' willingness to carry out multi-site practice were relatively low.Problems faced by nurses' multi-site practice need to be noted and laws and policies should be developed to carry forward the development of nurses' multi-site practice in the future.
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Objective To understand attitude and willingness of nurses on multiple-sites practice in China,and to explore promoters and inhibitors as well as influencing factors of multiple-sites practice.Methods A questionnaire survey was conducted and 113 839 nurses were recruited from 31 provinces,autonomous regions and municipalities.Results Among 113 839 respondents,90343(79.36％) expressed supports for multiple-sites practice,88 571(77.81％) were willing to practice in multiple sites.The biggest promoter and inhibitor for nurses to practice in multiple-sites were increasing personal income and already existing heavy workloads.Totally 86 990(79.29％) nurses thought relevant laws or regulations should be launched in China to ensure implementation of multiple-sites practice.In addition,nurses with senior professional title,with higher educational level,aged 31 to 45 years,holding specialist practice license were more willing to practice in multiple sites (P＜0.01).Conclusion Nurses had a positive attitude towards multiple-sites practice.Policy-makers should sort out and amend the present laws and regulations,and guide excellent nursing talents including specialist nurses,to realize reasonable allocation of nursing resources through multiple-sites practice.
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Objective To detect the SNR and geometric accuracy of MRI based on American College of Radiology (ACR)standards.Methods The SNR and geometric accuracy of Siemens Skyra 3.0T,Siemens Trio 3.0T and GE Excite HD 1.5T MRI were measured with ACR phantom,and the detection results were calculated according to the standards.Results The SNR values of Siemens Skyra 3.0T,Siemens Trio 3.0T and GE Excite HD 1.5T MRI were 589.98,438.50 and 277.12 respectively.Siemens Skyra 3.0T MRI had the values of geometric accuracy being-1.93％ at X direction,-3.20％ at Y direction and 0.68％ at Z direction,Siemens Trio 3.0T MRI had the value of geometric accuracy being-0.87％ at X direction,-2.33％ at Y direction and 1.49％ at Z direction,GE Excite HD 1.5T MRI had the values of geometric accuracy being 0.20％ at X direction,-1.53％ at Y direction and 1.69％ at Z direction.Conclusion The detection of the SNR and geometric accuracy of MRI can effectively guarantee the image quality.
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Objective To test the spatial resolution and average glandular dose (AGD) of full field digital mammography system to obtain high-resolution and contrast breast X-ray images with the lowest dose.Methods The M12 breast X-ray performance test phantom was placed on the breast support center position,then line-pair card was put on the M12 phantom and fixed groove,and exposure was carried out with auto exposure control,28 kV tube voltage and common anode filtration combination so as to detect the spatial resolution.Half-value layer (HVL) was measured by Fluke TNT12000 ray detection tools,2 mm-thickness plate and aluminum sheets with different thicknesses,and then AGD was calculated accordingly.Results The spatial resolutions were all higher than 7 lp/mm and proved to meet the quality standard,which had the vertical spatial resolution being 8 lp/mm,the maximum value of the lateral spatial resolution being 10 lp/mm and the minimum value being 8 lp/mm.AGD was lower than 2 mGy and then proved qualified which was limited within 0.60 and 0.61 mGy.Conclusion The test of spatial resolution and AGD of full digital mammography system can assess the performance and radiation dose,reflect the performance of equipment,ensure image quality and lower radiation dose.
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Objective To evaluate the clinical safety and efficacy of GuidezillaTM guide extension catheter during complex coronary percutaneous coronary intervention(PCI). Methods A total of 13 patients were included in the studywho presented with complex coronary lesions during PCI. Stents or balloons could not be delivered to these complex lesions with conventional approach and GuidezillaTM guide extension catheters were used. Results Among these 13 patients,there were 7 CTO lesions,7 calcified lesions, 6 tortuous lesions,8 diffuse lesions,8 distal lesions and 8 lesions with pre-existing stents. PCI success rate was 100% .In one patient,GuidezillaTM guide extension catheter was obstructed which were relieved after stent implantation. There was no major adverse cardiac event(MACE) during follow-up.Conclusions The GuidezillaTM guide extension catheter was safe and effective for PCI of complex coronary artery lesions.
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Objective To understand attitude and willingness of nurses on multiple-sites practice in China,and to explore promoters and inhibitors as well as influencing factors of multiple-sites practice.Methods A questionnaire survey was conducted and 113 839 nurses were recruited from 31 provinces,autonomous regions and municipalities.Results Among 113 839 respondents,90343(79.36％) expressed supports for multiple-sites practice,88 571(77.81％) were willing to practice in multiple sites.The biggest promoter and inhibitor for nurses to practice in multiple-sites were increasing personal income and already existing heavy workloads.Totally 86 990(79.29％) nurses thought relevant laws or regulations should be launched in China to ensure implementation of multiple-sites practice.In addition,nurses with senior professional title,with higher educational level,aged 31 to 45 years,holding specialist practice license were more willing to practice in multiple sites (P＜0.01).Conclusion Nurses had a positive attitude towards multiple-sites practice.Policy-makers should sort out and amend the present laws and regulations,and guide excellent nursing talents including specialist nurses,to realize reasonable allocation of nursing resources through multiple-sites practice.
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Objective To detect the SNR and geometric accuracy of MRI based on American College of Radiology (ACR)standards.Methods The SNR and geometric accuracy of Siemens Skyra 3.0T,Siemens Trio 3.0T and GE Excite HD 1.5T MRI were measured with ACR phantom,and the detection results were calculated according to the standards.Results The SNR values of Siemens Skyra 3.0T,Siemens Trio 3.0T and GE Excite HD 1.5T MRI were 589.98,438.50 and 277.12 respectively.Siemens Skyra 3.0T MRI had the values of geometric accuracy being-1.93％ at X direction,-3.20％ at Y direction and 0.68％ at Z direction,Siemens Trio 3.0T MRI had the value of geometric accuracy being-0.87％ at X direction,-2.33％ at Y direction and 1.49％ at Z direction,GE Excite HD 1.5T MRI had the values of geometric accuracy being 0.20％ at X direction,-1.53％ at Y direction and 1.69％ at Z direction.Conclusion The detection of the SNR and geometric accuracy of MRI can effectively guarantee the image quality.
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Objective To explore the efficacy and safety of Solitaire stents and the multi-mode vascular recanalization in the treatment of acute cerebral infarction. Methods Twenty-two patients with acute cerebral infarction, who were treated by Solitaire stents and the multi-mode vascular recanalization (research group) in our hospital from November 2014 to February 2017, were included in this study. Among them, 16 cases were combined with balloon dilation after arterial thrombosis, 4 cases were given stent implantation (3 cases were given Solitair stent and 1 case was given Apollo stent), and 2 cases were given arterial catheter directed thrombolysis. Eighteen patients with acute cerebral infarction who were treated only by Solitaire stent artery occlusion from October 2011 to October 2014 were used as control group. Data of the onset to the vagina vasorum time, the onset to the recanalization time, the revascularization of interventional therapy, the NIHSS scores at admission and discharge, mRS score after 90-day treatment, incidence rate and the mortality were compared between two groups. Results There were no significant differences in the durations from onset to the vagina vasorum and from the onset to the recanalization between the two groups. The recanalization was better in research group than that of control group (P<0.05). There were no significant differences in scores of NIHSS at hospital discharge and admission between two groups. The near-term treatment efficacy was similar in two groups. However, mRS score was significantly lower in the research group than that in control group after 90-day treatment (P<0.05). There were no significant differences in the symptomatic intracranial hemorrhage, high perfusion encephalopathy, the incidence rate and the mortality rate of the complications related to the operation between two groups of patients. Conclusion Solitaire stents and the multi-mode vascular recanalization can significantly improve the revascularization, the further clinical prognosis and the quality of survival in patients with acute cerebral infarction, which are safe and efficacy without increasing incidence rate and mortality rate of complications.
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Objective To test the spatial resolution and average glandular dose (AGD) of full field digital mammography system to obtain high-resolution and contrast breast X-ray images with the lowest dose.Methods The M12 breast X-ray performance test phantom was placed on the breast support center position,then line-pair card was put on the M12 phantom and fixed groove,and exposure was carried out with auto exposure control,28 kV tube voltage and common anode filtration combination so as to detect the spatial resolution.Half-value layer (HVL) was measured by Fluke TNT12000 ray detection tools,2 mm-thickness plate and aluminum sheets with different thicknesses,and then AGD was calculated accordingly.Results The spatial resolutions were all higher than 7 lp/mm and proved to meet the quality standard,which had the vertical spatial resolution being 8 lp/mm,the maximum value of the lateral spatial resolution being 10 lp/mm and the minimum value being 8 lp/mm.AGD was lower than 2 mGy and then proved qualified which was limited within 0.60 and 0.61 mGy.Conclusion The test of spatial resolution and AGD of full digital mammography system can assess the performance and radiation dose,reflect the performance of equipment,ensure image quality and lower radiation dose.
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Objective To evaluate the clinical safety and efficacy of GuidezillaTM guide extension catheter during complex coronary percutaneous coronary intervention(PCI). Methods A total of 13 patients were included in the studywho presented with complex coronary lesions during PCI. Stents or balloons could not be delivered to these complex lesions with conventional approach and GuidezillaTM guide extension catheters were used. Results Among these 13 patients,there were 7 CTO lesions,7 calcified lesions, 6 tortuous lesions,8 diffuse lesions,8 distal lesions and 8 lesions with pre-existing stents. PCI success rate was 100% .In one patient,GuidezillaTM guide extension catheter was obstructed which were relieved after stent implantation. There was no major adverse cardiac event(MACE) during follow-up.Conclusions The GuidezillaTM guide extension catheter was safe and effective for PCI of complex coronary artery lesions.
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Objective To explore the efficacy and safety of Solitaire stents and the multi-mode vascular recanalization in the treatment of acute cerebral infarction. Methods Twenty-two patients with acute cerebral infarction, who were treated by Solitaire stents and the multi-mode vascular recanalization (research group) in our hospital from November 2014 to February 2017, were included in this study. Among them, 16 cases were combined with balloon dilation after arterial thrombosis, 4 cases were given stent implantation (3 cases were given Solitair stent and 1 case was given Apollo stent), and 2 cases were given arterial catheter directed thrombolysis. Eighteen patients with acute cerebral infarction who were treated only by Solitaire stent artery occlusion from October 2011 to October 2014 were used as control group. Data of the onset to the vagina vasorum time, the onset to the recanalization time, the revascularization of interventional therapy, the NIHSS scores at admission and discharge, mRS score after 90-day treatment, incidence rate and the mortality were compared between two groups. Results There were no significant differences in the durations from onset to the vagina vasorum and from the onset to the recanalization between the two groups. The recanalization was better in research group than that of control group (P<0.05). There were no significant differences in scores of NIHSS at hospital discharge and admission between two groups. The near-term treatment efficacy was similar in two groups. However, mRS score was significantly lower in the research group than that in control group after 90-day treatment (P<0.05). There were no significant differences in the symptomatic intracranial hemorrhage, high perfusion encephalopathy, the incidence rate and the mortality rate of the complications related to the operation between two groups of patients. Conclusion Solitaire stents and the multi-mode vascular recanalization can significantly improve the revascularization, the further clinical prognosis and the quality of survival in patients with acute cerebral infarction, which are safe and efficacy without increasing incidence rate and mortality rate of complications.
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<p><b>OBJECTIVE</b>To investigate the effects of dopamine (DA) and metabolite in striatum of Parkinson's disease (PD) rats treated by bone mesenchymal stem cells (MSCs) modified by plasmid pIRESneo-EGFP-BDNF.</p><p><b>METHOD</b>pIRESneo-EGFP-BDNF was transfected to MSCs with electroporation. The rat models of PD were set up by 6-OHDA and then divided into four groups randomly, which were Sham group, PD group, BDNF group. The rotating behavior of rat models induced by apomorphine (APO) intraperitoneally which transplanting bone MSCs or MSCs modified by plasmid pIRESneo-EGFP-BDNF through cerebral lateral ventricle after 2, 4 and 8 weeks. The levels of DA, homovanillic acid (HVA), dihydroxy-phenylacetic acid (DOPAC) were measured by high performance liquid chromatography (HPLC) in striatum of each group.</p><p><b>RESULTS</b>The rotation numbers (r/min) of MSCs group or BDNF group in the 2nd, 4th and 8th week after transplanting were significantly decreased compared with that of PD group (P < 0.05). Those of BDNF group were specially significant compared with those of MSCs group (P < 0.05). The levels of DA, HVA, DOPAC and the ratios of DA/HVA, DA/DOPAC in stratum after PD rats intervened by transplanting cells through cerebral lateral ventricle after eight weeks were increased significantly in BDNF group or MSCs group while compared with PD group, especially in BDNF group.</p><p><b>CONCLUSION</b>The behavior of rat with PD was improved significantly by increasing the levels of DA and decreasing metabolic rate of DA in striatum while transplanting BDNF modified bone MSCs through cerebral lateral ventricle.</p>
Subject(s)
Animals , Male , Rats , Brain-Derived Neurotrophic Factor , Genetics , Corpus Striatum , Metabolism , Disease Models, Animal , Dopamine , Metabolism , Genetic Engineering , Mesenchymal Stem Cell Transplantation , Mesenchymal Stem Cells , Cell Biology , Metabolism , Parkinson Disease , Metabolism , Plasmids , Rats, Sprague-DawleyABSTRACT
<p><b>OBJECTIVE</b>To identify the relationship between amino acid mutations in Neisseria gonorrhoeae isolates and their antibiotic resistance.</p><p><b>METHODS</b>PI gene fragments of Neisseria gonorrhoeae from 17 clinical isolates were obtained with PCR amplification. They were cloned into the PCR cloning vector pBS-T to form pBS-T-PI and sequenced. The sequences of PI genes were analyzed. At the same time, minimum inhibitory concentration (MIC) of penicillin and tetracycline to these 17 isolates were measured and contrasted with the corresponding PI sequence.</p><p><b>RESULTS</b>The recombinants of PI gene from 17 clinical isolates of Neisseria gonorrhoeae were successfully constructed and sequenced. They were divided into PIA and PIB subtypes according to the results from blastn software by comparing the sequences with the GenBank. Mutations were found at the sites of 120 and 121. There were only some of the sequences having an aspartic acid (D) mutation on 120 and 121 sites, which was not the same as reported. On the other hand,there were two PI sequences,5-9 and 6-1, whose mutations on No. 120 were lysine, similar to those documented.</p><p><b>CONCLUSION</b>Some relationship between PI amino acids mutations at sites 120 and 121 in Neisseria gonorrhoeae isolates from Chengdu, China and their resistance to penicillin and tetracycline were found. However,further studies need to be done in the future to confirm this hypothesis.</p>
Subject(s)
Amino Acid Sequence , Anti-Bacterial Agents , Pharmacology , DNA Mutational Analysis , DNA, Bacterial , Drug Resistance, Bacterial , Mutation , Neisseria gonorrhoeae , Genetics , Polymerase Chain ReactionABSTRACT
<p><b>OBJECTIVE</b>To establish a new nucleic acid hybridization detection technique which may be used in medical genechips.</p><p><b>METHODS</b>The specific DNA fragment was detected by sequential two hybridization of fluorescence probe with template DNA and fixed DNA probe.</p><p><b>RESULTS</b>Fluorescence probe two-hybridization (FPTH) was applied to genechips for the detection of sex-transmitted pathogens from culture strains, and the results showed that the values of fluorescence density of the positive groups decreased remarkably when compared with those of the negative group. Both the sensitivity and specificity for detecting clinical samples are higher than 90%. There is no need of any additional reagent in hybridization procedure, and the hybridization detection can be accomplished in 40 minutes.</p><p><b>CONCLUSION</b>The FPTH technique is rapid, simple and reliable, it can also make the clinical detection process completely automatic and integrative.</p>
Subject(s)
Humans , DNA Probes , Chemistry , Genetics , DNA, Bacterial , Genetics , Fluorescent Dyes , Chemistry , Neisseria gonorrhoeae , Genetics , Nucleic Acid Hybridization , Methods , Ureaplasma urealyticum , GeneticsABSTRACT
BACKGROUND AND OBJECTIVES: The idiopathic sudden sensorineural hearing loss (ISSHL) is a disease occurring instantly or developing over several days. An etiological role for virus families is assumed. Corticosteroids improve the prognosis for hearing recovery in ISSHL, but the effects of acyclovir are still uncertain. The purpose of this study is to evaluate the therapeutic efficacy of antiviral drug acyclovir (Zoylex) in ISSHL. MATERIALS AND METHODS: One hundred thirty four ears were divided into a study (41 ears, using acyclovir and steroid) and a control (93 ears, using steroid only) groups. Prognostic factors such as initial hearing loss, pattern of initial audiogram, coexistence of dizziness or tinnitus were used for parameters of comparison between two groups. RESULTS: The overall recovery rate of the study group (53.7%) was better than that of the control group (46.2%), but it was not statistically significant (p>0.05). The recovery rate of the study group was better than that of the control group on some prognostic factors, especially the period between the symptom attack and the beginning of treatment: however, there were no statistically significant differences either (p>0.05). CONCLUSION: Therefore, no beneficial effects from combining acyclovir with prednisolone could be established in ISSHL.
Subject(s)
Humans , Acyclovir , Adrenal Cortex Hormones , Deafness , Dizziness , Ear , Hearing , Hearing Loss , Hearing Loss, Sensorineural , Prednisolone , Prognosis , TinnitusABSTRACT
Subcutaneous emphysema often occurs as a result of surgery, trauma of the aerodigestive tract, and increased alveolar pressure. Generally, spontaneous emphysema is rare, because "spontaneous" is only used to describe emphysema that has no obvious etiology. We reviewed six cases of non-traumatic subcutaneous emphysema occurring in the head and neck. Among them, four cases were associated with pneumomediastinum. Two occurred without obvious etiology, another two were due to heavy lifting events, one due to severe vomiting, and the last one due to severe blowing. Most cases occurred in young males. Clinical symptoms, commonly involved sites, treatments and results of these cases of spontaneous emphysema were analysed.