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In the context of the "Belt and Road" initiative, We systematically analyzed the general education and training systems of 16 Western Pacific countries and regions, including general practitioner college education, post-graduation education, and faculty status. Developed countries and regions have a long-term medical education system, strong faculty, and a comprehensive training model for general practitioners. Underdeveloped countries and regions are relatively weak in educational institutions, faculty, and general practitioner training models. The underdeveloped countries and regions should develop a general medical education and training system in terms of strengthening the construction of general medical disciplines, strengthening the supervision and certification of general practitioners, improving the general medical training model, and strengthening the construction of teachers.
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Objective:To evaluate the feasibility and diagnostic efficacy of the coronary fractional flow reserve derived from CT (CT-FFR) measurement method based on tracer pharmacokinetic principle.Methods:A total of 130 patients (159 coronary artery vessels) who were admitted to Beijing Anzhen Hospital from January 2015 to March 2019 were included in this study retrospectively. All patients had completed coronary CT angiography (CCTA) and invasive coronary angiography with invasive FFR. Subjective assessment of stenosis degree was performed on CCTA images and non-invasive FFR measurement was performed by using a tracer-kinetics based on CT-FFR measurement method. The Bland-Altman method was used to evaluate the diagnostic consistency of the two methods. Compared with the invasive FFR results, the sensitivity, specificity, positive predictive value, negative predictive value, and area under the ROC curve (AUC) of tracer-kinetics based on CT-FFR results for the diagnosis of coronary ischemic lesions were evaluated. All cases were divided into two heart rate groups:>65 bpm and ≤65 bpm. The diagnostic efficacy of tracer-kinetics based on CT-FFR in different heart rate groups was evaluated. χ 2 test and DeLong test were used to compare diagnostic performance in different evaluation methods and heart rate groups. Logistic regression analysis was used to evaluate the impact of factors such as heart rate, image thickness, image enhancement, and noise on the accuracy of diagnosis. Results:Bland-Altman analysis showed that the average difference between the two methods was -0.01. (-0.11-0.10). Compared with invasive FFR results, the tracer-kinetics based on CT-FFR method had a diagnostic sensitivity of 92.4%, specificity of 82.1%, positive predictive value of 87.6%, negative predictive value of 88.7%, and the area under ROC curve (AUC) value was 0.94. Compared with the diagnostic efficacy of luminal stenosis evaluated based on CCTA images, the difference was significantly statistical ( P<0.05). The diagnostic performance of CT-FFR had no statistically significant difference between the two heart rate groups. Factors such as heart rate, image thickness, image enhancement, and noise had no significant effect on the diagnostic accuracy of the tracer-kinetics based on CT-FFR method. Conclusions:The tracer-kinetics based on CT-FFR method may quickly complete the non-invasive FFR measurement on CCTA images with image quality that meets the needs of clinical diagnosis. It has a good diagnostic performance in the diagnosis of coronary ischemic lesions even for those cases with a faster heart rate. The diagnostic accuracy of tracer-kinetics based on CT-FFR method is not significantly affected by factors such as heart rate, image thickness, image enhancement, and image noise.
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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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Objective To evaluate the clinical efficacy and safety of iMliximab (IFX) in the treatment of Crohn's disease (CD).Methods From February 2009 to March 2013,the clinical data of 62 CD patients with IFX treatment were retrospectively analyzed.At week 14th after IFX injection and the end of follow-up of this study (March 2013) were two observation points.At week 14th after IFX injection (three times of IFX injection),C reactive protein (CRP) level,Crohn's disease activity index (CDAI) score and clinical remission were investigated.At the end of follow-up,clinical remission,fistula closure,mucosal healing and side effects were inspected.Normal distribution data were expressed as 2±s,which were compared with t test.Non normal distribution data were expressed as M (QL-QU) and compared with Wilcoxon test.Results Four cases without complete three times of IFX injection and one case lost to follow-up were eliminated.And nine postoperation cases with IFX treatment to prevent recurrence after surgery were excluded.A total of 48 cases of CD in active period were enrolled in this study on efficacy.At week 14th,CRP level of 48 patients [1.9(0.5,5.4) mg/L]decreased compared with that before treatment [28.9(6.4,51.1) mg/L] (Z=-5.468,P＜0.01);CDAI score (87.0±35.8) also decreased compared with that before treatment (245.1±59.1) (t=18.579,P＜0.01).At week 14th,46 patients in active period achieved clinical remission and the remission rate was 95.8％.By the end of follow-up,38 patients were still in remission period and the remission rate was 79.2％.Among 26 patients with anal fistula before IFX treatment,seven cases (26.9％) were completely closed,17 cases (65.4％) was partially closed and two cases was responseless.Fifteen patients were reviewed by colonoscopic examination after more than six times of IFX treatment.The median of simple endoscopic score for Crohn's disease (SES-CD) was 3 (0,5)after treatment,which decreased compared with that before treatment (8(7,9),Z=-3.306,P=0.001).Twenty-two of 48 cases in active period received,step-up strategy and 26 cases received with top-down strategy.At week 14th,20 cases (90.9％) of group with step-up strategy and 26 cases (100.0％) of group with top-down strategy were in remission period.By the end of follow-up,14 cases (63.6％) of group with step-up strategy and 24 cases (92.3％) of group with top down strategy maintained remission.Among 26 cases with anal fistula,two cases without response were treated with step-up strategy and seven cases with complete closure were all with top-down strategy.Among 62 patients,five had side effects,three of whom had acute infusion reaction,one had delayed infusion reaction and the other had anemia.Conclusions IFX had good clinical efficacy in controlling inflammation,inducing clinical remission,promoting fistula closure and mucosal healing in CD patients.For some CD patients with high risk,the initial top-down strategy showed good clinical efficacy.
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Nowadays, modern information technology is rapidly developing; traditional novelty assessment service could not satisfy users' demands. The paper introduces an online application and management information system for medical research novelty assessment innovated of Zhuhai Health Information Center, including its background of exploration, system functions and application effects. Using this system to provide service for users could not only promote the efficiency and convenience but also provide new space of development for novelty assessment work.