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Objective:To investigate the relationship between antibacterial treatment scheme and prognosis, and to analyze the mortality risk factors of bloodstream infection with carbapenem-resistant Klebsiella pneumoniae(CRKP).Methods:A retrospective case-control study was conducted. The CRKP isolated from clinical venous blood samples in the First Medical Center, Chinese PLA General Hospital between January 1, 2013 and December 31, 2018(not included from January 1, 2016 to December 31, 2017) was collected. According to relevant standards, a total of 50 patients with bloodstream infection with CRKP were included. The patients were divided into death (19 cases) or survival (31 cases) group according to their hospitalization outcomes, and clinical data and antibacterial treatment scheme after infection were collected. The clinical features of the two groups and the correlation between different antibacterial treatment regimens and prognosis were compared. Logistics regression model was used to analyze the risk factors for death in CRKP-infected patients.Results:The all-cause mortality rate of patients with CRKP bloodstream infection during hospitalization was 38%(19/50). The age ((66.89±18.13) vs. (55.06±14.39) years old, t=2.555, P=0.014), charlson's comorbidity index ((6.11±2.87) vs. (3.19±1.97), t=4.256, P<0.001) of the death group was higher than that of the survival group. The proportion of patients with chronic obstructive pulmonary disease (42.1%(8/19) vs. 3.2%(1/31), χ2=9.574, P=0.002), Charlson's comorbidity index ≥5 (68.4%(13/19) vs. 22.6%(7/31), χ2=10.314, P=0.001), septic shock (36.8%(7/19) vs. 6.5%(2/31), χ2=5.456, P=0.020), source of lung infection (36.8%(7/19) vs. 9.7%(3/31), χ2=3.868, P=0.049) was higher in death group than those in survival group. Kaplan-meier survival curve showed that the 30-day mortality of appropriate targeted treatment was lower than that of inappropriate targeted treatment ( χ2=8.138, P=0.004). Multivariate analysis showed that septic shock ( OR=56.363, 95% CI: 4.309-737.273, P=0.002) and charlson's comorbidity index ≥5 ( OR=18.605,95% CI: 1.813-190.896, P=0.014) were independent risk factors for mortality in patients with bloodstream CRKP infection. Conclusion:Appropriate targeted therapy can reduce 30-day mortality in patients with CRKP bloodstream infection. In order to reduce the risk of mortality, we should prevent the occurrence of septic shock and strengthen the diagnosis and treatment of patients with Chalson's comorbidity index ≥5.
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A survey on clinical skill application and training needs of general practitioners (GPs) was conducted in the community health service centers of Shanghai Changning District from March to May 2019. The heads of the medical/prevention departments of 10 community health service centers (CHS) in Changning District were invited to evaluate the application frequency of clinical skills and training needs of GPs. According to Residency Training Standards for General Practitioners (trial), Training Standards for Assistant General Practitioners (trial), Training Program for General Practitioners in Primary Medical and Health Institutions (trial), 369 clinical skills for general practitioners were included for evaluation. The application frequency of above 369 clinical skills among 198 general practitioners were evaluated and training needs were also assessed. The overall application frequency score of GPs for 369 clinical skills was 1.00 (0.30, 1.70) points, and the training needs score was 1.40 (1.10, 1.70) points. The application frequency of different clinical skills was positively correlated with training needs ( r=0.462, P<0.01). And the four-quadrant analysis results show that among the 369 clinical practice skills, 116 (31.4%) items were used by GPs with high frequency and high training needs, and 80 (21.7%) items were used with low frequency but high training needs. There were 45 (12.2%) items with high application frequency but low training needs, and 128 (34.7%) items with low application frequency and low training needs. The survey indicates that the training of clinical skills listed in the three major training standards or outlines should be strengthened in continuing education for general practitioners, and the practice skills with high application frequency and high training needs should be focused in training program to improve the quality, effectiveness and efficiency of training.
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Objective To identify an unknown pathogenic strain (X1) isolated from blood culture of an inpatient and to conduct a phylogenetic analysis on it. Methods The X1 strain was isolated from blood culture of an inpatient in the Second Xiangya Hospital of Central South University in 2016. It was identified by morphology biochemical testing and 16S rRNA gene sequencing. Based on genetic distances, a phylogenetic tree was constructed to compare the X1 strain with its homologous species in GenBank in order to reveal its genetic evolution. Results The X1 strain was gram-negative. Biochemical testing for oxidase, glucose and V-P reaction were positive (+) , while the result of citrate was negative (-) . Sequence align-ment analysis of 16S rRNA showed that the X1 strain (1466 bp) was highly homologous with Aeromonas veronii X71120. 1 with a similarity of more than 99％. Genetic distances between the X1 strain and its ho-mologous species, including Aeromonas veronii, Aeromonas hydrophila and Aeromonas sobria, were calculat-ed by MEGA5. 0 and the results revealed that the genetic distance (0. 014) between it and Aeromonas veronii X71120. 1 was the shortest, but the subspecies of it was unable to identify. Cluster analysis also indicated that the X1 strain and Aeromonas veronii were clustered to a small branch. Conclusions The X1 isolate was an Aeromonas veronii strain. Besides, Aeromonas veronii and Aeromonas sobria were similar in genetic char-acteristics.
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Objective To restrospectively analyze the risk factors for blood transfusion during ce-sarean section and neonate outcomes. Methods A total of 291 parturients ( 60 cases with blood transfusion during surgery and 231 cases without blood transfusion during surgery) who underwent cesarean section from November 2016 to March 2017 in our hospital were selected. The significant covariates in one-way analysis of variance were analyzed by logistic regression analysis. The odds ratio ( OR) and 95％ confidence interval ( CI) were calculated. The risk factors for blood transfusion during cesarean section were identified, and neonate outcomes were analyzed. Results Placenta increta, placenta accrete and pernicious placenta pre-via were the risk factors for blood transfusion during cesarean section, with OR value ( 95％ CI ) 13. 5 (2. 6-56. 8), 6. 1 (2. 1-11. 6) and 3. 3 (1. 6-8. 6), respectively. The prolonged gestational age was a protective factor, and the OR value ( 95％ CI) was 0. 3 ( 0. 2-0. 5) . The duration of operation, anesthesia time and length of hospital stay were significantly prolonged in blood transfusion group as compared with non-blood transfusion group ( P<0. 05) . The body weight and 1-min Apgar score of newborns were signifi-cantly lower in blood transfusion group than in non-blood transfusion group. Conclusion Placenta increta, placenta accrete and pernicious placenta previa are the risk factors for blood transfusion during cesarean sec-tion. Blood transfusion is not helpful for neonate outcomes.
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In order to strengthen the training of grassroots health personnel,in Shanghai the program of general practice training has been included in the residency training systemsince 2010,and the program integrated theresidency training with master degree study.At the same time the training of general practitioners in Shanghai also included the following programs:job-transfer training for grassroots doctors,order oriented training for rural doctors,order oriented free medical education,and standardized training of assistant general practitioners.
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The overall situation of standardized residency training program in Shanghai was analyzed in terms of resource input,implementation and output of the program.The results showed that 50 hospitals offered residency training programs by 2015,with total 12 557 mentors.There was a certain increase in resource input from both government and hospitals,and organizational management was continuously improved.From 2010 to 2016,a total of 16 241 residents were recruited,and number of residents were increased greatly.Compared with 2010,the recruitment of residents in general practice,pediatrics and anesthesiology in 2016 was increased by 113.3％,98.6％ and 157.4％,respectively.The passing rate of medical licensing examination in institutions providing standardized resident training was 20 percent higher than others,and the passing rate of residency training reached 97％-98％,which showed that the effect of standardized resident training program in Shanghai was satisfactory.In the future,more attentions should be paid to strengthening the training bases,training specialists in the shortage fields and standardizing the training of trainers.
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Objective·To evaluate the efficiency and safety of milk feeding to rescue failed chloral hydrate sedation in infants with cyanotic congenital heart disease who underwent transthoracic echocardiography.Methods·Clinical data of the infants with known cyanotic congenital heart disease were retrospectively analyzed,who were not adequately sedated after initial dose of chloral hydrate in 2015 in Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine.Vital signs and oxygen saturations were recorded every 5 minutes,and adverse events were noted.For rescue,efficiency and safety of milk feeding were compared with phenobarbital intramuscular injection.Results·A total of 129 infants were enrolled in this study.Fifty-two infants were rescued by intramuscular phenobarbital and the other 77 ones were rescued by milk feeding.The proportion of infants successfully rescued by milk feeding was 55.8％,which was higher than that of intramuscular phenobarbital (30.8％,P=0.005).There was no statistical difference in incidence of adverse events between the two groups (P=0.565).Conclusion·Milk feeding is an effective and safe choice for rescue sedation for infants with cyanotic congenital heart disease undergoing transthoracic echocardiography.
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Objective To investigate the patent technological domain distribution of shanghai health system,and comparative analysis of patent technological hotspots between shanghai health system and enterprises.Methods The study used IPC classification method to conduct quantitative analysis of the distribution of patent technology,co-words analysis and visualization of social network establishment method were adopted to analyze patent technological hot spots.Results Within the A61 category,numbers of authorized patents of shanghai health system in orders are A61B、A61K、A61M and A61F.Further analysis of the highest authorized A61B17 group patent in the highest class A61B found that,compare to enterprises,the degree of coincidence with the high-frequency keywords of the technology hotspots is small,the technical hotspots are scattered,and lack of overall technical arrangement.Conclusions Shanghai health system mainly focused on medical device development.It is lower than that of enterprises regarding to the patent technology market demand matching,technical arrangement of the enterprise is relatively better than the health system,thus,the study suggested enhancing market demand survey,adjusting patent distribution,and broadening the scope of market promotion.
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Objective To evaluate the accuracy of ultrasonographic measurement of the subglottic airway diameter in selecting the cuffed endotracheal tube (ETT) size for the pediatric patients with congenital heart disease.Methods Sixty pediatric patients of both sexes with congenital heart disease,of American Society of Anesthesiologists physical status Ⅱ-Ⅳ,aged 1 month-7 yr,undergoing elective open heart surgery,were included in this study.The subglottic airway diameter was measured by bedside ultrasonography after induction of anesthesia.The outer diameter of the cuffed ETT was determined according to the subglottic airway diameter.The air leak test was performed after intubation to determine whether or not the ETT size selected based on ultrasonography was appropriate.When the difference between the inner diameter of the finally selected ETT and the result calculated by the Motoyama formula was less than 0.2 mm,the ETT size selected based on the Motoyama formula was considered appropriate.The agreement and correlation between the subglottic airway diameter measured by age-based formula and ultrasonography and the outer diameter of the actually selected ETT were analyzed using Bland-Altman plot and Passing-Bablok regression analysis.Results The accurate rate of the ETT selected based on the ultrasonic measurement and Motoyama formula were 80％ and 55％,respectively,and there was significant difference (P＜0.05).Conclusion Ultrasonographic measurement of the subglottic airway diameter produces higher accuracy than the classical Motoyama formula in selecting the cuffed ETT size for the pediatric patients with congenital heart disease.
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Objective To evaluate the value of ultrasonographic measurement of the antral crosssectional area (CSA) in assessing the preoperative gastric content volume in preschool pediatric patients.Methods Fifty American Society of Anesthesiologists physical status Ⅰ or Ⅱ pediatric patients of both sexes,aged ＜7 yr,undergoing elective non-gastrointestinal surgery,were fasted according to the preoperative fasting guidelines recommended by American Society of Anesthesiologists.Sedation was performed with intravenously injected midazolam or with intravenously injected midazolam and propofol after admission to the operating room.The antral CSA in the supine and right lateral decubitus positions was measured using bedside ultrasonography and free tracing method.A gastric tube was inserted after gastric sonography to collect the gastric fluid,and the total volume of the gastric fluid was considered to be the gastric content volume.Results Six pediatric patients were excluded due to the unsatisfactory ultrasound image,and 44 pediatric patients were included.Gastric content volume and gastric content volume per kilogram of body weight were positively correlated with the antral CSA in the right lateral decubitus position,and the Spearman correlation coefficients were 0.48 (P＜0.01) and 0.37 (P＜0.05),respectively.There was no correlation between gastric content volume and gastric content volume per kilogram of body weight and the antral CSA in the supine position (P＞0.05).Conclusion Ultrasonographic measurement of the antral CSA in the right lateral decubitus position can be used to assess the preoperative gastric content volume in preschool pediatric patients.
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Objective To analyze how to establish a quality control(QC) procedure covering the whole samples process within a hospital.Methods To analyze how the different sample handling stage require specific QC methods according to the processing demond of different stage.Results The QC at the original stage help to select proper sample type of specific disease according to its research purpose.The QC at the process stage help to ensure the proper handling procedure of disease samples according to the biological characteristics,which would provide reliable samples for the research.The feedbacks of sample research results to biobank help the biobank to obtain more understanding and more resource to ensure its sustainable development.Conclusions Analysis of the whole process QC on the management of biobank will facilitate and maintain the biobank with high quality and ultimately support the translational medical research.
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Objective To investigate the safety and effectiveness of left internal mammary artery (LIMA) angiography via right transradial approach with 5F universal coronary angiography catheter. Methods Left internal mammary artery (LIMA) angiography via right transradial approach with 5F universal coronary angiography catheter was performed following coronary angiography in 86 patients.The success rate of the procedure, the result of LIMA angiography, the time to LIMA, the volume of contrast, the incidence of complications and bypass vessels in patients who received coronary artery bypass grafting (CABG) were recorded and analysed. Results The success rate was 97.6%(84/86), and the result of LIMA angiography was satisfied; the time to LIMA was (6.5 ± 2.8) min, and the volume of contrast was (17.6 ± 11.1) ml;the incident of complications was 4.7%(4/86);56 patients received CABG. LIMA was harvested in all cases and left radial artery in 53 cases. Conclusions LIMA angiography via right transradial approach with 5F universal coronary angiography catheter is safe and effective, and it has significant sense to patients who will receive CABG.
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As a new service form,community medical service provides primary health care for residents and it is operated with reasonable medical expenses.The function and service range of community medical service have reached consensus in medical industry,but the key issues of how to gain the market by competitive products and reasonable price have not been solved.This article analyzes the position of community medical service in healthcare system to clarify its unique attributes.The article further discusses the contents and pricing characteristics of community medical service,and the main influencing factors.The article introduces the issues dealing with community medical service product development,including the procedure of development,key points at different stages of development and the related research methods for the development of new service products.
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Objective To investigate the effect of psychological intervention, combined with Concentrated Tinidazole Gargles on dental plaque and gingivitis inflammation and influence factor of life quality in elder patients. Methods The control group was given Concentrated Tinidazole Gargles treatment, the research group was given psychological intervention on the basis of Concentrated Tinidazole Gargles (as control group). Plaque index, gingivitis index and SF-36 scale changes before and after treatment were recorded between two groups of elderly patients with gingivitis. Results There was no significant difference in plaque index, gingival indexand SF-36 score compared with before treatment between two groups; Plaque index, gingivitis index and the SF-36 score were improved in the research group better than the control group after treatment (P<0.05). Conclusion There is positive significance in improving the clinical efficacy of Concentrated Tinidazole Gargles plus psychological intervention and assurance of the quality of life on gingivitis in elder patients.
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The development of translational medicine requires knowledgeable and capable talents.In this study, by systematic analysis on scientific literatures published openly during 2010 till 2014, we comprehensively described basic circumstances pertinent to talent cultivation during global translational medicine development, and analyzed diathesis requirements for qualified talents, as well as cultivation strategies from employers perspectives, in terms of knowledge, skill, social roles, values, self-concept, trait and motive characteristics, with the aim to explore the premium cultivation paths for such talents.
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The paper described the necessity of establishing standardized residency training system,and introduced the progress of such training on a unified platform in Shanghai since 2010.In its summary of the success and experiences in Shanghai, the authors proposed to step up three-level management,set up a government-funded risk fund;guarantee income and welfare of residents and encourage their sense of belongings;encourage motivation of clinical teachers to enhance training quality;to build a systematic postgraduate medical education system in alignment with the standardized specialists training.
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Introduction to the efforts made in Shanghai's clinical residency training.With joint efforts of both clinical training bases and community training bases, this approach integrates the instructional resources of medical schools, and hands-on training at community bases, in order to ease shortage of general practitioners, backup talents, and that of teachers.These efforts can effectively elevate competency of general practitioners.
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Objective To investigate the associations of peripheral CD4+ CD25 + CD127low/-regulatory T cells (Treg) with HBV viral load and liver pathology in hepatitis B virus (HBV) carriers.Methods Forty six chronic HBV carriers admitted in the first hospital of Jiaxing during October 2012 and February 2014,and 23 healthy subjects (controls) were enrolled in the study.CD4+ CD25 + CD127low/-Treg in peripheral blood of the two groups were detected by flow cytometry.Ultrasound-guided liver biopsies were performed in chronic HBV carriers and HBV DNA load was determined by real-time PCR method.Independent samples t test was used for the comparison between groups,and Spearman rank correlation or Pearson linear correlation analyses were performed.Results The frequency of the peripheral CD4+ CD25+CD127low/-Treg in 46 HBV carriers was (5.11 ±1.47)％,which was significantly higher than that in healthy controls [(3.46 ± 1.23) ％,t =4.629,P ＜ 0.01].The HBV DNA load in HBV carriers was (6.21 ±1.98)lg copies/mL,which was positively correlated with the CD4+ CD25+ CD127low/-Treg level (r =0.405,P ＜ 0.01).Among 46 HBV carriers,21 (45.65％) were of inflammation grade 2 or above,and 16 (34.78％) were of fibrosis stage 2 or above.Peripheral CD4+ CD25+ CD127low/-Treg level was negatively correlated with inflammation and fibrosis in HBV carriers (r =-0.343 and-0.452,P ＜ 0.05).Conclusion CD4 + CD25 + CD127low/-Treg may be associated with the chronicity of HBV infection and the degree of liver damage.
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Shanghai district and county health system performance evaluation conceptual frameworkwas proposed based on health services system performance assessment frameworks raised by some countries and international organizations,and combined with Shanghai district and county health system characteristics.This framework contains two first grade indices and seven second grade indices:In the long term goals,'health','satisfaction' and 'disease risk protection' are the county's longterm effects of health system performance assessment dimensions; in the medium-term goals,the'accessibility','cost',' efficiency' and 'quality' are the county' s medium-term effects of health system performance assessment dimensions.This study aimed to evaluate Shanghai county health system's overall performance.Further study is needed in constructing its third grade indices.
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Objective To analyze the mechanism of fentanyl combines midazolam,by comparison with some of the commonly used anesthetic method to determine in the ethical advantages of anesthesia.Methods 45 rats were randomly divided into three groups,Group A:1％ anesthetized by intraperitoneal injection of sodium pentobarbital 40 mg/kg; Group B:5 ％ ketamine 120 mg/kg intraperitoneal injection; Group C:midazolam 5 mg/kg + fentanyl 0.05 mg/kg Last intravenous anesthesia.Observe the effects of anesthesia.Results The rats which are used of fentanyl conbines midazolam anesthesia,the onset of anesthesia time:0.02 ± 0.03 min,maintenance of anesthesia time:89.73 ± 22.59 min,the the narcotic operation time:1.51 ± 0.30 min,the success of anesthesia cases:15 cases.Conclusions Fentanyl combines midazolam compared with the currently used method of anesthesia,the advantages of the more prominent,it has significant improvement and protection about the security,utilization and recovery ethics in experimental rats.