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Objective:To investigate the past continuing medical education (CME) in pediatrics for general practitioners in community health centers in Longhua District, Shenzhen, so as to explore the willingness, needs and suggestions of general practitioners for CME in pediatrics.Methods:A mixed methods research were used in this study. Firstly, the purpose sampling method was used to select general practitioners in community health centers in Longhua District, Shenzhen for personal in-depth interviews. The interview contents were recorded and transcribed. The interview contents were coded by NVivo software. Theme frame analysis method was used for data sorting and theme extraction. Based on the results of qualitative interviews, the questionnaire was developed and distributed through the electronic questionnaire platform, and relevant questionnaire data were analyzed by Excel.Results:The results of qualitative research showed that after personal in-depth interviews with 10 general practitioners, the information reached saturation. Through repeated reading, induction and analysis of the interview data, four themes were extracted: ① previous pediatric training opportunities and satisfaction; ② willingness to participate in pediatric training; ③ the demand of training content, form and duration; ④ measures to encourage participation in training. In terms of quantitative research results, a total of 223 electronic questionnaires were collected, among which there were 219 valid questionnaires. Besides, 150 (68.5%) general practitioners said that they had no or only a few training opportunities in pediatrics CME in the past. There were some problems in the past CME training, such as unsystematic training (39 practitioners, 66.1%), narrow course coverage (30 practitioners, 50.8%), the content divorced from clinical practice (29 practitioners, 49.2%), monotonous teaching method (27 practitioners, 45.8%), etc. And 210 (95.9%) general practitioners were willing to participate in pediatric training, and 161 (73.5%) hoped that the form of training would be a combination of online and offline. In terms of pediatrics specialty content training needs, the general practitioners had higher demand for respiratory (188 practitioners, 85.8%), digestive (160 practitioners, 73.1%), infectious (145 practitioners, 66.2%) and dermatology (136 practitioners, 62.1%) specialty.Conclusion:There are still some problems in pediatrics CME, such as few training opportunities, unsystematic training, etc. In the future, we need to formulate systematic training plans and incentive measures according to the needs of general practitioners, to strengthen the pediatric professional training for general practitioners and improve their ability to receive children, in order to promote the implementation of hierarchical medical system for children.
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Objective:To investigate the status quo and related issues of reception of pediatric patients by general practitioners in community health centers in Longhua District of Shenzhen through qualitative and quantitative studies.Methods:In qualitative study, 10 general practitioners (GPs) from community health centers in Longhua District of Shenzhen were selected by the purpose sampling method for personal in-depth interviews. The interview contents were recorded and transcribed, then coded by Nvivo software. Theme frame analysis method was used for data sorting and theme extraction. Based on the results of qualitative interviews, the questionnaire was developed and distributed through the electronic questionnaire platform. The contents of the questionnaire included general information, the situation of pediatric patient reception in community health centers, the willingness and ability of GPs to receive children, the existing problems and the measures to promote receiving pediatric patients in community health centers.Results:The results of personal in-depth interviews with 10 GPs showed that the obtained information reached saturation. Through repeated reading, induction and analysis of the interview data, four themes were extracted: ① GPs in community health centers received a large number of pediatric outpatients with common diseases; ② GPs in community health centers are willing to receive child patients, but they were lack of ability; ③ there were many problems of pediatric patients reception in community health centers; ④ training and incentive policies would help to promote child patient reception in community health centers. A total of 223 electronic questionnaires were collected, 219 of which were valid for analysis. All the community health centers in Longhua District received pediatric patients, the number accounted for 20%-60% of the total outpatients; 84.5%(185/219)of the responders were willing to receive child patients, 65.8% (144/219)of them assumed that the consulting ability was average. The main problems for GPs to receive pediatric patients were "insufficient training" (76.7%,168/219) and "lack of consulting ability" (55.3%,121/219). The important measures to promote GPs to receive child patients were to improve their own clinical competence (94.1%,206/219), to have clinical faculty with pediatric background mentoring at the community health center (74.9%,164/219), to improve the supporting facilities (42.9%,94/219) and continuous professional support (38.8%,85/219).Conclusion:The status quo of pediatric patient reception in the community of Shenzhen Longhua District is generally satisfactory. The main problems in this aspect are insufficient training for general practitioners and lack of clinical competence, which should be strengthened and improved in the future.
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Objective:To develop an online continuing education course of pediatrics for primary physicians using the ADDIE model and to evaluate its application effect.Methods:Experts in fields of general practice and pediatrics were invited to develop an online continuing education course of pediatrics for general practitioners using ADDIE model from June to July 2020. From August 2020 to September 2020 the course was conducted with 12 live sessions on the open platform. In September 2020, 16 primary pediatricians and 15 general practitioners who completed whole courses were invited to attend focus group interviews. The interview contents were recorded, transcribed, and coded using Nvivo software; the subject frame analysis method was used to sort the data and refine the theme.Results:Information was saturated by focus group interviews with 14 general practitioners and 14 pediatricians. Finally, three themes were extracted from the interview results:(1)The advantages of this course were practicality, comprehensiveness and online teaching; (2) The course improved the diagnosis and treatment ability of participants, increased self-confidence of doctors and satisfaction of patients, and also promoted academic exchanges among colleagues; (3) For future improvement of the course, the clinical knowledge points, practical procedures, new thinking of diagnosis and treatment, progress in guidelines, and knowledge depth should be added; and the use of case teaching and combination of online with offline, and extending teaching time should be considered.Conclusion:An online continuing education course of pediatrics for primary physicians has been developed based on the ADDIE model, which received favorable feedback from the primary pediatricians and general practitioners who attended the course.
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Objective:To explore the significance of plasma homocysteine (Hcy) as a new biomarker for the differential diagnosis of postural tachycardia syndrome (POTS) and suspected myocarditis in children.Methods:A total of 24 children diagnosed with POTS and 21 children diagnosed with suspected myocarditis treated in the Pediatrics Department of the Peking University First Hospital from July to December 2016 were included in the study.Plasma Hcy levels were measured in each subject and compared between children with POTS and suspected myocarditis.The receiver operating characteristic (ROC) curves were depicted for assessing the diagnostic potential of Hcy in distinguishing POTS from suspected myocarditis.Results:Plasma Hcy level in the POTS group was significantly higher than that in the suspected myocarditis group [(14.25±8.09) μmol/L vs.(8.99±3.19) μmol/L], which was also significantly higher than that of the mean levels in Beijing children [(8.82±5.58) μmol/L] (all P<0.05). When the cut-off was 9.36 μmol/L, the area under the ROC curve was 0.76, and the sensitivity and specificity for distinguishing POTS from suspected myocarditis were 71% and 68%, respectively. Conclusions:Plasma Hcy levels are helpful in the differential diagnosis of POTS and suspected myocarditis in children.
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Objective:To investigate the pediatricians' needs in the contents of continuing medical education (CME), and the influencing factors of participating in CME, so as to provide references for improving their vocational ability.Methods:Questionnaire survey was carried out for the pediatricians from county-level medical institutions in the nine provinces of China. The questionnaire contents included: basic information, CME contents needs, and influencing factors of participating in CME. SPSS 22.0 was used for chi-square test.Results:A total of 465 questionnaires was recovered, among which 463 were qualified, with a pass rate of 99.6%. Research showed that ① In terms of competency training needs, pediatricians had higher training demand for ability of diagnosis and treatment of children's diseases, pediatrics basic skills and skills related to children's health care, etc. Pediatricians with junior or intermediate title had higher training demand for ability of self-learning and access to learning resources ( P < 0.01); and pediatricians with senior title had higher training demand for teaching ability ( P < 0.05). ② In terms of pediatrics specialty content training needs, pediatricians had higher demand for neonatology, infectious, respiratory, critical medicine, developmental behavior and digestion in order. ③ Regarding the influencing factors of CME, too few opportunities to participate in training, too busy to have time to participate, and defects in curriculum arrangement were the main factors affecting the CME participation of pediatricians. Conclusion:Pediatricians with different professional title had different training needs for CME contents. Lack of CME resources, contradiction between work and study, and curriculum arrangement deficiencies might be the main influencing factors affecting the CME participation of pediatricians working at county-level medical institutions.
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Objective:To explore the application effect and feedback of online pediatrics teaching for the clerkship and internship stage of medical students of clinical medicine eight-year program.Methods:In this study, 38 clerkship medical students and 12 internship medical students of clinical medicine eight-year program in pediatrics department of Peking University First Hospital from February to March, 2020 were selected as research objects. They had two weeks of online teaching, including online flipped classroom, case-based learning (CBL), and problem-based learning (PBL). The effect of online teaching, and the feedback from these students were all investigated through the questionnaire survey.Results:All students were satisfied with the overall arrangement of the online teaching and believed that the results exceed [42% (21/50)] or meet [58% (29/50)] their expectations. According to the feedback, network congestion [82% (41/50)] was the biggest problem in online teaching, followed by the inability of effective interaction [20% (10/50)]. Students all believed that the online teaching arrangement was most helpful for the cultivation of theoretical knowledge (Total scores 4.58±0.50), autonomous learning ability (Total scores 4.42±0.58) and clinical reasoning (Total scores 4.42±0.58), but had minimal impact on the skills operation (Total scores 2.68±0.87) and scientific research ability (Total 2.98±0.98). For the ability of communication between doctors and patients, the scores of clerkship students (3.79±0.99) were significantly higher than those of internship students (3.08±0.67), ( P<0.05). Clerkship students considered that online flipped classroom was the most helpful teaching mode, while internship students believed online CBL teaching was the most helpful one. Majority of the students (94%) think it's necessary to keep online teaching in the future. Conclusion:Online teaching of pediatrics is approved by the medical students of clinical medicine eight-year program in the stage of clerkship and internship, and plays an important role in the cultivation of the ability of medical students, but it can't completely replace offline clinical practice.
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Objective:To explore the clinical characteristics, plasma levels of hydrogen sulfide(H 2S) and the relationship between the genotype and phenotype of cardiovascular involvement in children with methylmalonic acidemia and homocystinemia. Methods:The clinical and laboratory data of 66 outpatients diagnosed with methylmalonic acidemia combined with homocystinemia in Department of Pediatrics, Peking University First Hospital from January 2014 to July 2014 were collected and analyzed respectively, and the patients were divided into 2 groups: cardiovascular involvement group (10 cases) and non-cardiovascular involvement group(56 cases). The differences in the clinical characteristics, plasma levels of H 2S and genotypes were compared between 2 groups. Results:(1) There were 45 cases of early-onset children under 1 year old, including 4 cases of cardiovascular system involvement and 41 cases of non-cardiovascular system involvement.Twenty-one cases had onset above 1 year old, including 6 cases of cardiovascular system involvement and 15 cases of non-cardiovascular system involvement. There were 44 male children, including 8 cases with cardiovascular system involvement and 36 cases without cardiovascular system involvement; 22 cases female children, including 2 cases with cardiovascular system involvement and 20 cases without cardiovascular system involvement. There was no significant difference in onset age and gender distribution between the 2 groups ( χ2=2.910, 0.368, all P>0.05). (2)In the 10 cases with cardiovascular involvement, there were 3 cases with hypertension, 2 cases with hypertension combined with pulmonary hypertension, 2 cases with mild myocardial hypertrophy, 1 case with atrial septal defect combined with pulmonary hypertension, 1 case with pulmonary hypertension, 1 case with myocardial noncompaction.Compared with the non-cardiovascular involvement group, the proportion of kidney involvement was increased and that of nervous system was decreased in cardiovascular system involvement group( χ2=20.34, 5.79, all P<0.05), the proportion of hematological system involvement between the 2 groups had no significant differences ( χ2=1.28, P>0.05). The plasma levels of hydrogen sulfide of children with cardiovascular involvement was significantly lower than that of non-cardiovascular involvement[(33.8±3.6) μmol/L vs.(39.3±5.2) μmol/L, t=-3.22, P<0.01]. (3) MMACHC gene mutation (cblC type) was identified in all 46 patients.It was found that the most common type of gene mutation was c. 80A>G in cardiovascular involvement group, while c. 609G>A was the most common type of gene mutation in non-cardiovascular involvement group. Conclusions:The clinical manifestations of children with methylmalonic acidemia and homocystinemia involving cardiovascular system are multiple and prone to multiple system involvement, especially renal involvement.A decrease in plasma hydrogen sulfide levels may be involved in the involvement of its cardiovascular system.The MMACHC gene c. 80A>G mutation is the most common genetic mutation site in children with cardiovascular involvement with methylmalonic acidemia and homocystinemia.
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AIM: To explore the regulatory effect of adrenomedullin (ADM) on pulmonary oxidative stress in the rats with pulmonary hypertension induced by high blood flow.METHODS: Healthy male SD rats (n=22) were randomly divided into control group, shunt group and shunt with ADM group.Abdominal aorta and inferior vena cava shunting was produced in the rats in shunt group and shunt with ADM group.After 8 weeks, ADM (1.5 μg·kg-1·h-1) was administered into the rats in shunt with ADM group subcutaneously by mini-osmotic pump for 2 weeks.Mean pulmonary artery pressure (mPAP) was evaluated by a right cardiac catheterization procedure.The ratio of right ventricular mass to left ventricular plus interventricular septal mass [RV/(LV+SP)] and relative medial thickness (RMT) in pulmonary muscularized arteries were calculated.The content of malonaldehyde (MDA), total antioxidative capacity (T-AOC), and activity of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in lung tissues were detected by colorimetry.The expression of NADPH oxidase 4 (NOX4) in the lung tissue was analyzed by Western blot.RESULTS: Compared with control group, the mPAP, RV/(LV+SP) and RMT in pulmonary muscularized arteries in shunt group were all significantly increased.The content of MDA and the expression of NOX4 in the lung tissues were significantly increased.The T-AOC, and activity of SOD and GSH-Px in the lung tissues were significantly decreased.However, mPAP, RV/(LV+SP) and RMT in pulmonary muscularized arteries in shunt with ADM group were significantly decreased as compared with shunt group.Meanwhile, ADM decreased the content of MDA and the expression of NOX4 in the lung tissues, but increased the T-AOC, and activity of SOD and GSH-Px in the lung tissue of shunt rats.CONCLUSION: ADM inhibits oxidative stress response in the development of pulmonary hypertension and pulmonary vascular structural remodeling induced by high pulmonary blood flow in the rats by down-regulating the NOX4 expression and strengthening the anti-oxidation response.
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As a powerful reserve force for primary care institutions, general practitioners (GPs) undergoing standardized training will be essential to solve the pediatric problems of first visit to primary medical institutions and coordinated care delivery system in the future, which puts forward new require-ments for the training of post competencies of GPs.However,the training and evaluating systems for GPs in Pediatric Department still need further exploration. This article tried to summarize the two-month rotating arrangement and its advantages for GPs in Pediatric Department of a general hospital.Based on the forgotten theoretical knowledge,superficial understanding of the diseases and individual teachers' poor teaching moti-vation, this article suggested reinforcing the theoretical basis of GPs through exploring multiple learning channels and increasing self-learning enthusiasm,strengthening the training and rewarding system of teachers to promote the specialist-GPs teaching, as well as promoting the set-up of Department of General Practice and taking the advantage of key disciplines in teaching hospitals to develop characteristic teaching model of general practice.
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[ ABSTRACT] AIM:To explore the regulatory effect of intermedin ( IMD) on pulmonary collagen synthesis and ac-cumulation in rats with pulmonary hypertension induced by high pulmonary blood flow.METHODS: Healthy male SD rats (n=20) were randomly divided into control group (n=7), shunt group (n=7) and shunt with IMD group (n=6).The shunting of abdominal aorta and inferior vena cava was produced in rats of shunt group and shunt with IMD group.After 8 weeks, IMD was administered into the rats of shunt with IMD group subcutaneously by mini-osmotic pump for 2 weeks.Mean pulmonary artery pressure (mPAP), relative medial thickness (RMT) of pulmonary arteries, contents of hydroxyproline, collagen type I and III, bone morphogenetic protein-2 (BMP-2), and the mRNA expression of procollagen I and III in lung tissues were measured and compared.RESULTS:Compared with control group, mPAP and RMT of medium and small pul-monary arteries in the rats of shunt group were significantly increased.Meanwhile, the lung hydroxyproline, collagens I and III and BMP-2 contents, and the mRNA expression of lung procollagen I and III were all significantly increased compared with control group.However, IMD significantly decreased mPAP, alleviated the changes of pulmonary vascular micro-struc-ture, decreased the collagen accumulation and pulmonary tissue homogenate BMP-2 contents, and inhibited the mRNA ex-pression of procollagen I and III in the lung tissue of shunting rats.CONCLUSION:IMD plays a protective role in the de-velopment of pulmonary hypertension and pulmonary vascular structural remodeling induced by high blood flow by inhibiting pulmonary collagen synthesis and accumulation, possibly in association with the BMP-2 pathway.
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Objective To investigate the effect of adrenomedullin(ADM) on hypoxic pulmonary vascular structural remodeling and proadrenomedullin N-terminal 20-peptide(PAMP) in rats with hypoxic pulmonary hypertension.Methods Twenty-four male Wistar rats were randomly divided into control group(n=8),hypoxia group(n=8) and hypoxia with ADM group(n=8).ADM was subcutaneously administered into rats of hypoxia with ADM group by mini-osmotic pump(300 ng/h).The concentration of plasma PAMP was measured by radioimmunoassay,and the expression of PAMP in pulmonary artery was detected by immunohistochemical assay.Results Mean pulmonary arterial pressure,the ratio of right ventricular mass to left ventricular plus septal mass,and relative medial thickness and relative medial area of pulmonary arteries significantly increased in hypoxic rats as compared with that of controls(P
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Objective: To examine the alteration of pathologic structure and endogenous hydrogen sulfide pathway in rats with pulmonary hypertension induced by high pulmonary blood flow. Methods: Sixteen SD rats were randomly divided into shunting group and control group. An 11 week aortocaval shunting was produced in rats of shunting group, and pulmonary artery mean pressure (mPAP) was evaluated using right cardiac catheterization. The ratios of right ventricular mass to body weight (RV/BW) and right ventricular mass to left ventricular plus septal mass[RV/(LV+S)] were also detected. Pulmonary vascular micro and ultra structures were examined. Meanwhile the concentration of plasma hydrogen sulfide (H 2S) was measured by spectrophotography. The gene expression of cystathionine ? lyase (CSE)was detected by in situ hybridization, and the activity of CSE in lung tissues was measured by H 2S production according to chemical analysis. Results: After 11 weeks of aortocaval shunting, pulmonary artery mean pressure was significantly increased. Muscularization of small pulmonary vessels and relative medial thickness of pulmonary arteries were obviously increased in shunting rats compared with controls. Ultrastructure of intrapulmonary arteries changed obviously in shunting rats. Meanwhile, plasma H 2S concentration was decreased and the activity of CSE (according to H 2S production) in lung tissues decreased in shunting rats. CSEmRNA expression by pulmonary arteries was significantly suppressed. Conclusion: Pulmonary vascular structural remodeling is the important pathologic basis for pulmonary hypertension induced by high pulmonary blood flow. The down regula tion of endogenous H 2S pathway might play an im portant role in the development of high pulmonary blood flow induced pulmonary hypertension.
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Objective To assess the wall elasticity of the common carotid artery using echo-tracking in healthy children and children with hyperlipidemia.Methods The study included 68 normal healthy children and 25 children with hyperlipidemia.All the subjects were 3-18 years old.They were divided into three groups according to ages 3-6 years old group,7-13 years old group and 14-18 years old group.Echo-tracking was used to measure the pressure-strain elastic modulus (E?),stiffness parameter(?)and arterial compliance (AC) of the common carotid artery.Results The average values of E? were different among the three age groups in normal healthy children (all P
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AIM: To examine the alteration of pathologic structure and gaseous molecules in rats with pulmonary hypertension induced by high pulmonary blood flow.METHODS: Aortocaval shunting was produced for 11 weeks in rats, and pulmonary hemodynamics was evaluated.Pulmonary vascular micro- and ultra- structure was also examined.Meanwhile,the concentration of plasma nitric oxide (NO) and carbon monoxide (CO) was measured by spectrophotometry.The expression of endothelial nitric oxide synthase (eNOS) and heme oxygenase-1 (HO-1) in pulmonary arteries was detected by immunohistochemistry.RESULTS: After 11- week aortocaval shunting,pulmonary artery mean pressure was significantly increased.Muscularization of small pulmonary vessels and relative medial thickness and area of pulmonary arteries were obviously increased in shunting rats compared with controls.Ultrastructure of intrapulmonary arteries changed obviously in shunting rats.Meanwhile,plasma NO concentration was increased and eNOS expression in pulmonary artery endothelial cells was significantly augmented in rats of shunting group.Plasma carbon monoxide level and HO-1 expression in puomonary artery smooth muscle cells,however,were not altered in shunting rats.CONCLUSIONS: Pulmonary vascular structural remodeling is the important pathologic basis of pulmonary hypertension induced by a left-to-right shunt,and NO other than CO might play an important regulating role in the development of high pulmonary blood flow-induced pulmonary hypertension.
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OBJECTIVE:To study the preventive and therapeutic actions of L-arginine on pulmonary hypertension induced by high pulmonary blood flow volume.METHODS:Male SD rats were randomly divided into control group(n=6),shunt group (n=7) and shunt+L-arginine group(n=8).Abdominal aorta-inferior vena cava shunt was performed to make the blood flow from left to right,11 weeks later,mPAP was detected with right cardiac catheter;the structure of pulmonary vessels and expression of PCNA of smooth muscle cells were observed.RESULTS:The mPAP of shunt group was obviously higher than that of control(P
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OBJECTIVE:To study the mechanism by which L-arginine regulates hypoxic pulmonary vascular structural remodeling.METHODS:Eighteen Wistar rats were randomly divided into control group,hypoxic group and hypoxic+L-arginine group.Pulmonary artery pressure was measured with right cardiac catheterization.Micro-structure and ultra-structure of pulmonary tissue were observed and collagen I expression was evaluated with immunohistochemistry.RESULTS:Mean pulmonary artery pressure(mPAP) was(2.7?0.3)kPa in hypoxic rats and(2.1?0.1)kPa in control rats(P