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The study is designed to explore new methods of evaluation for teachers′ comprehensive ability in general medicine. In the whole education process of resident aiming at general practitioner (GP) residency post competency, the authors made comprehensive evaluation of GP faculty, and created a comprehensive GP faculty evaluation model of result orientation. The efforts aim at exploring and introducing faculty evaluation methods and promoting education quality, in order to develop outstanding GP residents of strong post competency.
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Objective To evaluate the effect of " elite small class" training mode in capacity building for general practitioners in Yiwu city. Methods The Fourth Affiliated Hospital of Zhejiang University School of Medicine worked with Yiwu Health Bureau, and held the first training class for general practitioners from December 6th in 2018 to April 5th in 2019.The mode of " elite small-class" was adopted. Theoretical assessment was carried out for trainees before and after the training and discussion was conducted after the training. Descriptive analysis of quantitative data and thematic analysis of qualitative data were carried out. Results The trainees′theoretical performance had been significantly improved after 4 months of theoretical learning and clinical rotation.The average score of the theoretical performance was increased from 66.94 to 72.59. Conclusions It was preliminarily found that the " elite small-class" training mode was suitable for the training of general practitioners in rural areas.Government support and trainee selection are key to training outcomes.
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The fourth affiliated hospital of Zhejiang university is responsible for training general practitioners in view of the basics of local general practitioners and the characteristics of chronic and frequently-occurring diseases in Yiwu city. This program is carried out relying on the high-quality faculty of medical alliances within Zhejiang university, and funded by the municipal government of Yiwu. The "4+6"training program is designed to elevate the competence of primary general practitioners. Such training fit the overall medical level of general practitioners, enhances people′s trust of general practitioners and the rate of diagnosis at primary level.
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Objective @#To construct an appropriate technology catalogue for general practice based on Delphi method,and to provide reference for promoting appropriate techniques and training general practitioners.@*Methods @#The catalogue was briefly constructed based on literature reviews and the data of the top twenty diseases diagnosed in out-patient department of Sir Run Run Shaw Hospital and two community health service centers in Hangzhou. Two-round Delphi consultation was conducted by fourteen general practitioners coming from upper first-class hospitals and community hospitals. The final catalogue was established according to evaluation of the degree of involvement,authority coefficient and Kendall's W values of the fourteen specialists.@*consultations @#Results Of the fourteen specialists,nine had bachelor's degrees and five had master's degrees or above;twelve were deputy chief physicians or chief physicians and two were physicians. They were engaged in general practice for 17.21 years in average. The positive coefficients of the two rounds of were both 100.00%. The authority coefficient of the specialists was 0.891. After the first round of consultation,the W values for importance and feasibility of 6 first-class indicators were 0.170 and 0.244,and the ones of 56 second-class indicators were 0.236 and 0.250（all P<0.05）. Six of second-class indicators were excluded because their coefficent of variation（CV）for importance and feasibility were more than 0.25. After the second round of consultation,the W values for importance and feasibility of 6 first-class indicators were 0.245 and 0.247,and the ones of 50 second-class indicators were 0.355 and 0.370（all P<0.05）. The CV for each indicator was less than 0.25. Finally,an instructional catalogue was defined,consisting of 6 first-class indicators（basic diagnosis and treatment skills,first aid skills,symptomatic diagnosis and treatment skills,chronic disease management skills,common disease diagnosis and treatment skills,and common manipulative skills）and 50 second-class indicators.@*Conclusion @#The degrees of involvement,authority and consistency of the specialists were relatively high. The catalogue of appropriate technology for general practitice had good reliability and feasibility,which was worthy of promotion and application.
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The authors described the attempt of general practice in hierarchical medical system aided by the medical service partnership model.This reform has achieved an effective and efficient hierarchical medical system for chronic diseases within a medical alliance, overcoming the existing hierarchical medical system centering on a hospital.Other merits of the reform include a general practice guidance pattern between general hospitals and community hospitals and enhanced general practitioner competence in communities,effectively encouraging general practice progress.
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ObjectiveTo explore the efficacy and safety of infliximab combined withdiseasemodifying antirheumatic drugs (DMARDs) in the treatment of psoriatic arthritis.MethodsThis was an openlabeled trial.All subjects fulfilled the Moll and Wright criteria for definite PsA and-had poor response to DMARDs.The patients received combined infliximab and DMARDs.Infliximab 3 mg/kg was infused at weeks 0,2,6,14.After week 14,patients received infliximab 3 mg/kg every 8 weeks.The primary end point was the improvement of psoriatic arthritis response criteria(PsARC) response.The secondary end point was the percentage of patients who had 20％ improvement of modified American College of Rheumatology (ACR20)response.Parameters for efficacy for psoriatic rash was defined as the proportion of modified 50％ and 75％improvement of psoriasis area and severity index scores (PASI).All adverse reactions in the whole observation period were recorded.Chi-square test and repeated measurement data analysis of variance were used for the statistical analysis.ResultsTwenty-one patients completed the 14 weeks treatment.Five patients completed 26-104 weeks treatment,including 2 cases for 104 weeks.At week 14,the percentage of patients achieving PsARC was 84％,the percentage of patients achieving ACR20 was 77％,and the percentage of patients achieving PASI 50 was 76％.At week 14,tender joint counts,swollen joint counts,patient's assessment of pain,patient's global assessment(PGA),physician's global assessment,dermatology life quality index (DLQI),health assessment questionnaire(HAQ) were significantly improved compared with base-line(P＜0.05).Five patients received 26-104 weeks follow-up,including 2 cases for 104 weeks,four patients was stable,the rash and joint symptoms of 1 patient recurred at 104 weeks.The most frequently occurred adverse reactions were upper respiratory tract infection and skin as well as appendage damages.The second most common adverse effect was elevation of liver enzymes.ConclusionThe infliximab combined with DMARDs is effective and safe for the treatment of psoriatic arthritis.
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Objective To investigate the efficacy and safety of hydrogel soft contact lens(HSCL) for persistence corneal epitheliopathy after intraocular surgery.Design Retrospective case series.Participants 36 patients(36 eyes) with bullous keratopathy(n=5) or other keratopathy(n=31) including corneal erosion,epithelium missing,and dendritic keratopathy after intraocular surgery,which failed to medicine treatment 2 weeks ago.Method All patients were fitted with HSCL after suitable processing of the corneal foci.The lenses were removed immediately as long as the keratopathy recovered.A new lens was replaced after 3 weeks if still needed.Main Outcome Measures Changes of keratopathy,pain relief and complications.Result 35 patients(97.22%) fitted with HSCL were very comfort within 3 days.At the follow-up of 6 months,30 patients(83.33%) achieved complete remission of keratopathy,6 patients (16.67%) remarkable remission.30 patients(86.11%) had vision increase.All of the non-bullous keratopathy recovered within 3 weeks,while the lenses were fitted much longer in bullous keratopathy.No other lens-related complications appeared.Conclusion The application of hydrogel soft contact lens to persistence corneal epitheliopathy after intraocular surgery is safe,effective,and practical.
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Objective To evaluate the efficacy of recessive placement of nasolacrimal stent in the treatment of nasolacrimal duct obstruction and factors affecting the prognosis of the procedure.Design Retrospective case series.Participants One hundred eighty six patients(207 eyes) with nasolacrimal duct obstruction.Methods One hundred eighty six patients(207 eyes) of nasolacrimal duct obstruction confirmed by dacryocystography had undergone recessive placement of nasolacrimal stent after probing and dilation of nasolacrimal duct.All patients received regular postoperative nasolacrimal duct syringe.Main Outcome Measures Status of postoperative lacrimal syringe.Results The stents were removed 3～12 months postoperatively,the patients were followed-up average 6 months.The operation success rate was 97.1%.167 eyes achieved complete success(80.7%).25 eyes became better(12.1%),and nasolacrimal duct obstructed again in 15 cases(7.2%).Conclusions Recessive placement of nasolacrimal stent combined with postoperative nasolacrimal duct syringe is a simple,effective and safe technique in the treatment of nasolacrimal duct obstruction.Selecting correct patients,skillful technique of nasolacrimal duct probing and regular postoperative syringing of nasolacrimal duct are the main factors of successful procedures.