ABSTRACT
Objective:To construct the core competence evaluation index system of general practice residents by the Delphi method.Methods:After the literature review of home and abroad and group discussion, the core competence evaluation index system of general practice residents in the outpatient environment was preliminarily developed. On this basis, the index system was determined through two rounds of expert consultation. Excel 2015 and SPSS 26.0 were used for data entry and statistical analysis.Results:The active coefficients of the two rounds of expert consultation were 95.0% (19/20) and 100.0% (19/19) respectively, and the degree of authority of the two rounds of expert consultation was 0.86. An index system consisting of 6 first-level indicators and 28 second-level indicators was determined. The 6 first-level indicators were medical services/patient care, medical knowledge, professionalism, systems-based practice, practice-based learning and improvement, interpersonal communication, and communication skills.Conclusion:This study has constructed a complete and highly reliable core competence evaluation index system of general practice residents based on the outpatient environment, which can provide reference for the cultivation of the outpatient reception ability of general practice residents in the future.
ABSTRACT
Due to the reduction of patient cooperation and the limitation of clinical diseases, general practitioners lack effective acceptation training in the training process. To improve this situation, this study applies teacher standardized patients (TSP) combined case-based learning (CBL) to the acceptation ability training of general practitioners in medically unexplained physical symptoms (MUPS). And the acceptation ability and communication ability of 15 general practitioners were evaluated before, during and after the training. It shows that the application of "TSP + CBL" in the acceptation ability training of general practitioners in MUPS can effectively improve the acceptation ability and communication ability of general practitioners.
ABSTRACT
@#Objective To explore the treatment outcome of carotid endarterectomy combined with vertebral artery transposition in patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery. Methods From June 2017 to September 2020, patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery treated with carotid endarterectomy combined with vertebral artery transposition in Fuwai Hospital were retrospectively analyzed. Results Finally 12 patients were enrolled, including 10 males and 2 females with an average age of 67.8±6.0 years. Twelve patients were successfully operated and the follow-up time was 1-3 years. The stenosis degree of the V1 segment of the vertebral artery decreased from 83.5%±11.8% to 24.9%±14.3% (P<0.001). The stenosis degree of carotid artery decreased from 85.6%±11.0% to 0% (P<0.001). Postoperative follow-up showed that the symptoms of symptomatic patients before surgery improved. The 1-year and 3-year patency rates were 100.0%, and there were no peripheral nerve injury complications, perioperative deaths or strokes. Conclusion Carotid endarterectomy combined with vertebral artery transposition can treat ipsilateral carotid artery stenosis and vertebral artery stenosis at the same time, improve blood supply to the brain, improve patients' symptoms and has high promotion value.
ABSTRACT
Objective:To explore the views of general practitioners (GPs) on developing special interests in the context of the county medical community.Methods:A survey was conducted using self-designed questionnaire from November and December 2019, among 49 general practice residents trained in the First Affiliated Hospital of Zhejiang University School of Medicine. Meanwhile, structured interviews were undertaken with 14 general practice residents.Results:Forty-nine valid questionnaires were collected with a response rate of 100.0%. All participants were from the county medical community units. The survey showed that 91.8% (45/49) of respondents were willing to develop special interests and 79.6% (39/45) chose one subject, and the top three subjects were endocrinology, gastroenterology and cardiology. The structured interviews demonstrated that most participants did not understand meaning of general practitioners with special interests (GPwSIs) clearly and were unable to distinguish GPwSIs from specialists; they were confused about the status, training mode, and assessment standards of GPwSIs. The interviews also showed that the demand for developing special interests for them was derived from the needs of patients for diagnosis and treatment, the target population of health care services, peer advice and personal interests.Conclusions:Most general practice residents are willing to develop special interests, and internal medicine is the first choice; however, their understanding of the GPwSIs is insufficient. The survey suggests that the position, training model, assessment and certification of GPwSI need to be further clarified.
ABSTRACT
Objective:To construct a training system of the professional postgraduate degree of general practice using the Delphi method.Methods:On the basis of consulting relevant policies and literature, and drawing lessons from foreign general practice training systems, the index system of training professional postgraduate medical students of general practice was preliminarily developed. After two rounds of Delphi expert consultation, using the threshold method to select evaluation indexes, the training system was finally established. Excel 2010 and SPSS 19.0 were used to make data entry and statistical analysis.Results:The active coefficients of experts in the two rounds of Delphi consultation were 75.0% (12/16) and 91.7% (11/12) respectively, both the two rounds of the degree of specialist authority were 0.87, and the final coordination coefficient of the specialists' opinion was 0.452. The index system was composed of 5 first-level indexes including training objectives, theoretical curriculum setting, clinical practice setting, teaching staff and graduation requirements and 31 second-level indexes.Conclusion:The experts have great initiative and authority on research subjects. The opinions of all experts tend to be uniform after two rounds of consultation, and the results are reliable. A relatively complete and credible training index system of professional postgraduate degree of general medicine has been built.
ABSTRACT
Objective:To investigate the effects of anemoside B4 on proliferation, apoptosis and migration of ovarian cancer SKOV3 cells through a variety of biological methods, and further to explore its mechanism.Methods:Ovarian cancer SKOV3 cells were cultured in vitro. CCK-8 method was used to detect the proliferation of SKOV3 cells treated with different concentrations of anemoside B4, and IC50 value was calculated. Flow cytometry was employed to detect the apoptosis of cells treated with IC50 concentration of anemoside B4 for different time length; Transwell method was used to detect the migration and invasion of cells treated with IC50 concentration of anemoside B4 for different time length. Western blot was used to detect changes in the expression of related proteins.Results:Anemoside B4 can effectively inhibit the proliferation of SKOV3 cells, showing a concentration-dependent IC50 value of 6.08±0.56 μM, and the inhibitory effect is stronger than the positive control drug cisplatin, with statistically significant difference (P<0.05) . Flow cytometry showed that anemoside B4 could induce SKOV3 cells apoptosis, reduce Bcl-xl expression, and up-regulate the expression of Bax, cleaved-caspase-3 and PARP. Compared with the group of 0 h, the difference was statistically significant (P<0.05) . Crocetin could down-regulate the expression of N-cadherin and up-regulate the expression of E-cadherin, thereby inhibiting the migration of SKOV3 cells. Anemoside B4 could inhibit the expression of JAK/STAT3 signaling pathway proteins.Conclusion:Anemoside B4 can effectively inhibit the proliferation of cervical cancer cells, and induce SKOV3 cell apoptosis by regulating the JAK/STAT3 signaling pathway to inhibit their migration. Crocetin has great potential in the research and development of ovarian cancer therapy.
ABSTRACT
Objective:To study the clinicopathological characteristics, treatment and prognosis in lupus nephritis (LN) patients with renal thrombotic microangiopathy (TMA), so as to provide more theoretical basis for clinicians to recognize and treat this disease.Methods:The clinical data of LN patients who underwent renal biopsy in the First Affiliated Hospital of Zhengzhou University from January 1, 2012 to May 31, 2019 were retrospectively collected and analyzed. According to renal clinicopathological examination, the patients were divided into renal TMA group and non-renal TMA group. The clinical data, laboratory examination, renal pathological examination, therapeutic measures and prognostic between the two groups were compared. Follow-up end points were defined as composite ends, including all-cause death, entry into end-stage renal disease, and estimated glomerular filtration rate decrease>50% of baseline. Kaplan-Meier survival curve and log-rank test were used to compare the difference of survival rate between the two groups, and multivariate Cox regression equation was used to analyze the risk factors of endpoint events in LN patients.Results:A total of 1 133 patients with LN were enrolled in this study. Patients with renal TMA were more likely to have hypertension ( χ2=16.310, P<0.001), higher baseline serum creatinine ( Z=-6.918, P<0.001) and 24-hour urine protein ( Z=-2.232, P=0.026), and higher renal pathology activity index (AI) score ( Z=1.957, P=0.001)and chronic index (CI) score ( Z=1.836, P=0.002). The proportions of hormone shock ( P<0.001) and plasma exchange ( P<0.001) in the renal TMA group were higher than those in non-renal TMA group. After treatment of (12±2) months, patients in the renal TMA group had a lower complete response rate ( χ2=10.455, P=0.001) and a higher non-response rate ( χ2=6.047, P=0.014) than those in non-renal TMA group, and were associated with worse prognosis (Log-rank test χ2=26.490, P<0.001). Renal TMA was an independent risk factor for poor prognosis ( HR=2.347, 95% CI 1.210-4.553, P=0.012). Conclusions:Compared with LN patients without renal TMA, LN patients with renal TMA are more likely to have hypertension, with higher serum creatinine, 24-hour urinary protein, AI and CI, suggesting poorer treatment response and renal prognosis. Moreover, renal TMA is an independent risk factor for poor prognosis in patients with LN.
ABSTRACT
Objective:To build a system for evaluation on post competency of general practitioners.Methods:From April to October 2020, the Delphi method was used to consult on the importance of 4 first-level indicators and 48 second-level indicators for evaluation on post competency of general practitioners. Excel 2016 and SPSS 22.0 was used for data entry and statistical analysis.Results:There were 16 consulting experts, and the positive coefficients of the two rounds were 100% and 75%, respectively. The overall authority coefficient Cr of experts was 0.85. For the first-level indicators, the mean values of the importance of the two rounds were 8.07-9.00 and 8.67-9.00, and the coefficient of variation were 0-0.16 and 0-0.09, respectively. For the second-level indicators, the mean values of the importance of the two rounds were 6.79-9.00 and 8.17-9.00, and the coefficient of variation were 0-0.38 and 0-0.16, respectively. All the coordination coefficient tests were statistically significant ( P<0.001). Finally, the evaluation system was established including 4 first-level indicators and 32 second-level indicators. Conclusion:The constructed post competency evaluation system for general practitioners has a relatively high coordination and credibility, which can provide a reference for the post competency evaluation of general practitioners.
ABSTRACT
@#Objective To investigate the treatment of modified vertebral-carotid transposition (VCT) in patients with severe stenosis or occlusion at V1 segment of vertebral artery. Methods A retrospective study of 13 patients with severe stenosis or occlusion at V1 segment of vertebral artery treated by modified VCT in our hospital from October 2016 to December 2018 was done. There were 10 males and 3 females with an average age of 70.5±7.1 years. Results The operation was successful in this series of patients. The follow-up duration was 1-3 years. The stenosis degree of the V1 segment of the vertebral artery decreased from 86.8%±7.5% to 17.4%±14.5%. All patients achieved remission of symptoms after the surgery. Temporary peripheral nerve injury occurred in 6 patients. Four patients with neurological complications relieved during follow-up. The patency rate was 100.0% at postoperative 1 and 3 years. There was no perioperative death, stroke or re-intervention. Conclusion Modified VCT can precisely restore the distal blood flow of patients with severe stenosis or occlusion at V1 segment of vertebral artery, and relieve their symptoms.
ABSTRACT
Objective:To analyze the satisfaction degree and related factors of community health services among residents in Zhejiang province.Methods:A service satisfaction survey was conducted during July to October 2019; using purpose sampling method three community health service centers were selected as survey sites in Hangzhou, Jiaxing, and Lishui cities, representing high, medium, and low economic development levels in Zhejiang province. The short-form Patient Satisfaction Questionnaire (PSQ-18) was used in the survey. SPSS 19.0 was adapted for data analysis, and multivariate logistic regression was applied use of analyze the affecting factors of satisfaction.Results:A total of 464 questionnaires were distributed, and 429 valid ones were returned with a response rate of 92.46%. Among them, 112 were from Hangzhou, 159 from Jiaxing, and 158 from Lishui. The overall satisfaction score of community health services was (4.22±0.59), and the satisfaction rate was 85.8%(368/429).Among the three cities, the overall satisfaction score in Lishui was the highest (4.28±0.51) with a satisfaction rate of 88.7% (140/158). The satisfaction scores of service quality, doctors' interpersonal communication ability, doctor-patient communication level, economic efficiency of service, timeliness of service, and accessability of service were (3.99±0.57), (4.10±0.77), (4.27±0.56), (3.54±0.84), (4.13±0.68) and (3.88±0.55); the satisfaction rates of those items were 59.6%(256/429), 79.4%(340/429), 86.3%(370/429), 43.6%(187/429), 78.9%(338/429)and 50.3%(216/429), respectively. Multivariate logistic regression analysis indicated that the quality of service, doctors' interpersonal communication ability, doctor-patient communication level and accessability of service were the affecting factors of the residents' satisfaction to community health services ( OR=3.734, 2.928, 7.732, 4.275; P<0.05). Conclusion:The residents of Zhejiang province have a high overall satisfaction with community health services. The quality of service, doctors' interpersonal communication ability, doctor-patient communication level and accessability of service are the affecting factors of the overall satisfaction degree.
ABSTRACT
Objective:To develop a monitoring tool for evaluating health literacy level of general practitioners.Methods:The health literacy monitoring questionnaire for general practitioners was preliminarily developed by referring to the National Residents′ Health Literacy Monitoring Questionnaire. The Delphi method was used to conduct two rounds of consultation among 15 experts to improve the questionnaire.Results:The effective response rates of the two rounds of expert consultation were 100.0%, the expert authority coefficients of the two rounds of consultation were 0.87 and 0.86, the mean scores of the two rounds of expert questions were 3.93 -5.00 and 4.47-5.00. The variance coefficients of the two rounds of expert scores were 0-0.32 and 0-0.20, and the Kendall harmony coefficients of the two rounds of expert scores were 0.167 and 0.102, respectively (all P<0.05). Finally, the basic theory literacy dimension (including 8 chronic disease prevention items, 5 maternal and child health items and 5 infectious disease prevention items), and the basic skill literacy dimension (including 6 safety and first aid items, 8 health information items), and the healthy lifestyle and behavior dimension (7 items, including regular physical examination, exercise, diet and so on) were established. A total of 39 items and 3 dimensions were used to monitor the health literacy level of general practitioners. Conclusion:The monitoring tool of health literacy level for general practitioners based on Delphi method has been preliminarily constructed, which can be used to evaluate the health literacy level of general practitioners.
ABSTRACT
In recent ten years, general practitioner (GP) training and practice develops rapidly in China. It has established a relatively complete GP training system, including medical college education and standardized residency training. However, the path of continuing professional development and clinical skills improvement for GP after standardized residency training is still unclear. The concept of GP with special interest (GPSI) has been proposed these days, and it has put forward a new development direction for the career path of GP. In this article, on the basis of understanding the current status of GPSI in China, we try to discuss its advantages and problems, and then propose our suggestions for its future development.
ABSTRACT
Objective:To explore the relationship between frailty and nutritional status of the elderly in communities.Method:Using the convenience sampling method, 458 elderly people in the community were investigated with the general data questionnaire, frailty phenotype, Mini-Nutritional Assessment, Mini-Mental State Examination, Self-Rating Depression Scale and Instrumental Activity of Daily Living.Results:The prevalence of frailty, pre-frailty and non-frailty in the elderly of the community was 9.2%, 60.0%, and 30.8% respectively, and 10.5% were malnourished or at risk of malnutrition. Logistic analysis showed that malnutrition increased the risk of frailty in the elderly ( OR=9.534, P=0.001). Conclusion:Malnutrition is a risk factor of frailty in the elderly in communities. Improving the nutritional status of the elderly in communities can help delay the development of frailty.
ABSTRACT
Objective@#To investigate the nutritional status of children with autism spectrum disorders, and to provide a reference for improving their nutritional status.@*Methods@#120 children with autism spectrum disorder who were treated in the rehabilitation center of Affiliated Children s Hospital of Zhengzhou University from September 2016 to September 2018 were selected as case group,and 120 normal children in the physical examination center of the same hospital were selected as the healthy group.The children s status was assessed by using the Clancy Autism Behavior Scale(CABS), and the serum nutrients levels were compared between these two groups.@*Results@#Compared with the healthy group,the Vitamin A[(83.44±9.20,59.45±4.42)mg/L],Vitamin B6[(64.15±11.22,32.02±5.75)mg/L],Vitamin C[(60.62±10.26,47.63±13.12)mg/L],protein[(120.45±30.51,104.46±9.38)g/L], iron[(134.25±18.16,112.17±6.02)mg/L], calcium[(72.96±10.62,66.57±4.11)mg/L], zinc[(70.85±5.76,62.52±10.66)mg/L] and folic acid[(31.38±6.77,20.29±6.26)mg/L], eicosapentaenoic acid(EPA)[(0.72±0.22,0.55±0.14)μmol/L], decosahexaenoic acid(DHA)[(1.54±0.35,1.22±0.26)μmol/L] and arachidonic acid(AA)[(5.51±0.76,5.03±0.16)μmol/L] were lower(t=25.75，27.92，8.54，5.49，12.64，6.30，7.53，13.18，7.14，8.04，6.77，P<0.05), the low body weight(49.17%,63.33%) and wasting(38.33%,46.67%) in autism spectrum disorder group were higher significantly(χ2=4.89，6.71，P<0.05).@*Conclusion@#The nutritional status of children with autism spectrum disorder is different from that of normal children. The lack of serum nutrients will lead to a high incidence of malnutrition.
ABSTRACT
In order to alleviate the "difficulty and annoyance in dispensing medicine" of patients with chronic diseases and promote hierarchical healthcare system, the policy of long-term prescription for chronic diseases has been implemented in the country. This article summarizes the current status and effectiveness of implementation of the long-term prescription, and explores the existing problems. The improvement of prescription formulation, review, deployment, distribution of drugs, health education and other issues to ensure the safety of treatment are discussed. Meanwhile, we suggest that the relevant supporting policies of medical insurance should be improved to further promote the long-term prescription.
ABSTRACT
In order to alleviate the "difficulty and annoyance in dispensing medicine" of patients with chronic diseases and promote hierarchical healthcare system, the policy of long-term prescription for chronic diseases has been implemented in the country. This article summarizes the current status and effectiveness of implementation of the long-term prescription, and explores the existing problems. The improvement of prescription formulation, review, deployment, distribution of drugs, health education and other issues to ensure the safety of treatment are discussed. Meanwhile, we suggest that the relevant supporting policies of medical insurance should be improved to further promote the long-term prescription.
ABSTRACT
The article introduces the implementation of the general practice alliance model in the First Affiliated Hospital of Zhejiang University School of Medicine. Based on the high-quality resources of a tertiary university hospital the general practice alliance has upgraded the clinical, research and teaching abilities of primary care and promoted "two-way referral" system. Our experience shows that the alliance would improve the effectiveness of health care system and facilitate to form a rational medical service ecosystem.
ABSTRACT
The article introduces the implementation of the general practice alliance model in the First Affiliated Hospital of Zhejiang University School of Medicine. Based on the high-quality resources of a tertiary university hospital the general practice alliance has upgraded the clinical, research and teaching abilities of primary care and promoted "two-way referral" system. Our experience shows that the alliance would improve the effectiveness of health care system and facilitate to form a rational medical service ecosystem.
ABSTRACT
OBJECTIVE： To explore the situation of knowledge-attitude-practice of medication （shorted for medication KAP） of elderly patients with chronic diseases and its relationship with depression mood. METHODS： Through using scale of medication KAP in elderly adults with chronic diseases and Self-rating Depression Scale （SDS）， a face to face questionnaire survey was conduceed among elderly patients with chronic diseases examined in two community service centers of Lanzhou. The Pearson correlation analysis was used to verify the correlation between the score of medication KAP and the score of depression mood，and multivariate stepwise linear regression was used to analyze the influential factors （including the items in the general data table and depression mood with statistical significance after single factor analysis） of the score of medication KAP. RESULTS： Totally 300 questionnaires were sent out， and 289 valid questionnaires were returned with effective feedback rate of 96.3％. The results of questionnaire investigation showed the average score of the KAP was （31.12±6.20）； the scores of medication knowledge， attitude and practice was （18.39±4.85）， （3.18±1.24） and （9.55±2.08）， respectively. The average score of depression mood was （39.99±6.06）， compared with 48.4％ （140 patients） with depressive symptoms. Pearson correlation analysis showed that the score of medication knowledge （r＝－0.356）， the score of medication compliance （r＝－0.465） and the score of medication KAP （r＝ －0.490） were negatively correlated with depression mood （all P＜0.01）. Multiple stepwise regression analysis indicated that the score of the KAP were affected by depression mood and demographic factors including family occupation， detailed monthly income in a family， the difference was statistically significant（P＜0.05）. CONCLUSIONS： In the community， the level of the medication KAP in elderly patients is mainly affected by depression mood and also by demographic factors. In the work of health care education for elderly patients with chronic diseases， medical staff should pay more attention to patients with depression mood and timely take targeted nursing measures to improve the level of the medication KAP.
ABSTRACT
Objective To identify the features of outpatients visiting the online GP clinics and compare the data with outpatients in offline clinic visits, for reference of outlining the service boundaries of online outpatient services. Methods Data were collected from the online outpatient clinic of the First Affiliated Hospital of Zhejiang University between February 2016 and February 2017. The data usage was descriptive statistical analysis of the basic information and disease information of the patients. Results An analysis of the 715 online general practice consultations found the following proportions: diseases of the digestive system(11.3%), that of urinary system(7.7%), that of endocrine system(7.1%), that of respiratory system(6.9% )and that of circulatory system(4.6% ). Among the 5 796 offline consultations, the proportions were as follows:diseases of the digestive system(27.4% ), that of endocrine system(15.5% ), that of respiratory system(10.2%), that of urinary system(5.8%) and that of musculoskeletal system (5.4% ). 563 online outpatients ( 78.7% ) and 4 716 offline outpatients ( 81.4% ) were diagnosed respectively, while 152 online and 1 080 offline outpatients were medically unexplained physical symptoms. The comparison of the two groups lacked significant differences. Conclusions Characteristics of online outpatients look similar to offline ones, while the former facilitates appointment-based laboratory and imaging examination, health consultation and follow-up of chronic diseases.