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Chronic liver diseases, including chronic hepatitis, autoimmune liver disease, alcoholic liver disease, cirrhosis, fatty liver disease, drug-induced liver injury and so on, are common and important disorders in China. A hospital-community-patient-family integration management model for chronic liver diseases has been implemented since 2018 in Shuangshuinian Community Health Service Center collaborated with Sichuan Provincial People′s Hospital. Patients were taken care by general practitioners in the community health center under the guidance of hospital specialists, and with the active participation of patients and their family. This article introduces this integrated management model and the preliminary accomplishment to provide a reference for the management of patients with chronic liver diseases in the community.
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Objective:To survey the status of illness and consultation within two weeks among residents in a community in Chengdu.Methods:A multi-stage stratified random sampling was used to carry out a questionnaire survey among the residents in a community in Chengdu during March to April 2019. The disease status, disease severity and consultation within two weeks were surveyed, and influencing factors of two-week illness were analyzed with logistic regression.Results:Among 2 714 participants, 715 had illness (900 times) within two weeks, with a two-week prevalence rate of 26.3%. The main symptoms were dizziness (6.4%, 58/900), cough (6.2%, 56/900), lumbago and leg pain (4.9%, 44/900), palpitations (3.3%, 30/900) and headache (3.1%, 28/900). The three most common diseases were hypertension (38.3%, 345/900), diabetes (19.3%, 174/900) and common cold (6.4%, 58/900). In this survey, the rate of two-week in bed was 20.6‰(56/2 714), and the rate of two-week off work was 4.8‰(13/2 714). Age, gender, education level and work status were the influencing factors of the illness in two weeks ( P<0.05). The choice of medical institution was also different among residents. Conclusion:The survey suggest that primary care should focus on the key groups of residents in the community such as elderly, women, low education level, retirement and unemployed; and it is necessary to strengthen the primary care institutions and two-way referral system of health care.
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To prevent and control the epidemic of coronavirus disease 2019 (COVID-19), the community health service center should take the initiative to cooperate with sub-district office and police station to form a joint working team. Taking the advantages of professional expertise and using service contract system, the general practitioners can publicize the epidemic prevention knowledge and self-protection methods among community residents; and also take door-to-door inspection to make the decision of home isolation, centralized isolation, fever clinic visit or transfer to the designated hospital for observation and treatment. During the COVID-19 epidemic, we should give full play to the enthusiasm initiative of the community, general practitioners and residents to implement prevention and control measures and to ensure the health and safety of the people.
ABSTRACT
To prevent and control the epidemic of coronavirus disease 2019 (COVID-19), the community health service center should take the initiative to cooperate with sub-district office and police station to form a joint working team. Taking the advantages of professional expertise and using service contract system, the general practitioners can publicize the epidemic prevention knowledge and self-protection methods among community residents; and also take door-to-door inspection to make the decision of home isolation, centralized isolation, fever clinic visit or transfer to the designated hospital for observation and treatment. During the COVID-19 epidemic, we should give full play to the enthusiasm initiative of the community, general practitioners and residents to implement prevention and control measures and to ensure the health and safety of the people.
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The knowledge and clinical skill competition scores of 331 general practitioners (GPs),who attended the grassroots health posts training in Sichuan Province and Chengdu Municipality in 2016 and 2017,were documented.The factors influencing the competition results were analyzed.The mean knowledge test score of 331 participants were higher than the clinical skill score [(76.89±6.56) vs.(54.13±10.91),P＜0.01].The mean operational score in the clinical skill competition was higher than that of medical history collection,physical examination and clinical interview abilities [(32.31 ±3.28) vs.(21.82±5.09),P＜0.01].There were significant differences in knowledge and clinical skill scores among doctors from different regions or with different professional ranks (P＞0.05).The levels of clinical skills of general practitioners at the grass-roots level need to be further improved,according to relevant influencing factors.
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The magnamosis device for stage-one repair of the rectovaginal tistula consists of two arc magnets. Drawing the interrupting thread along the fistula margin via the vaginal side, and pulling the string to arrange the magnets at the fistula base along the long axis of the vagina, we made the magnamosis device automatically clipped to seal the fistula. After removing the threads we kept the device for 2-4 weeks till the natural detachment of it when the compressed tissue in between healed after vascular necrosis. This device utilizing the unique ability of magnamosis to fulfill anastomosis under inflammatory infected state reduces the current high relapse rate and colostomy drawbacks of the conventional rectovaginal neoplasty.
Subject(s)
Female , Humans , Gynecologic Surgical Procedures , Methods , Magnetics , Magnets , Pressure , Rectovaginal Fistula , General Surgery , Wound HealingABSTRACT
Objective To evaluate the effect of managed health education on psychological and nutritional status of patients with HBV-related cirrhosis and ascites.Methods One hundred and twenty one patents with decompensated HBV-related cirrhosis were enrolled for health education and randomly divided into two groups:61 patients received managed health education (trial group) and 60 received conventional health education (control group).In control group patients were informed with their condition and diet note by medical orders.In control group the hepatologists evaluated the baseline condition,nutritional status and quality of life,set up personal files of patients and followed up with communication and counselling periodically from June 2010 to August 2012.The psychological conditions were assessed with self-rating anxiety scale (SAS) and self-rating depression scale (SDS) ; nutritional status was assessed with triceps skinfold thickness (TSF) and mid-arm muscle circumference (MAMC) and the quality of life was assessed with MOS 36-item shoort from healthy survey (SF-36).Results Before health education,there was no statistical difference in the scores of SAS,SDS,TSF,SF-36 and blood Hb,albumin (Alb) levels between two groups.After health education,scores of SAS and SDS were decreased in both groups (P ＜ 0.0l),however,which in trial group were lower than those in control group (39.9 ±8.8 vs.49.0 ±9.4 and 40.6 ± 8.8 vs.51.9 ± 10.1 respectively,both P ＜0.01).The TSF scores and blood Hb and Alb levels in trial group were higher than those in control group (P ＜ 0.05).The accunulated scores of 8 dimensions in SF-36 forms in trial group were significantly higher than those in control group (P ＜ 0.01).Conclusion The managed health education model can better release psychological pressures,decrease mental disorders,elevate nutrition status,promote health and improve quality of life than conventional health education for patients with HBV-related cirrhosis and ascites.
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A questionnaire and telephone survey was conducted on 246 patients with chronic liver diseases in the Outpatient Clinic from August 2010 to May 2011.The distribution of diseases and the causes of losing follow-up were analyzed. Most subjects in this survey (182/246,74.0％ ) were patients with chronic viral hepatitis( HBV or HCV)and cirrhosis; and their follow-up status was better than others (X2 =12.382,P ＜ 0.05). There were no differences in gender( X2 =10.137,P ＞ 0.05),but significant differences in age ( X2 =31.783,P ＜ 0.05 ) and educational levels ( X2 =32.803,P ＜ 0.05 ) between patients with chronic viral hepatitis and cirrhosis and patients with other liver diseases.The main causes of losing follow-up were neglect of disease by patients (38.3％) and lack of good communication between doctors and patients ( 18.3％ ).It is important to reinforce the understanding and awareness of chronic liver diseases for patients.