Survey on knowledge, attitudes and practice about chronic obstructive pulmonary disease among general practitioners in Sichuan province / 中华全科医师杂志

Objective:To survey the knowledge, attitudes, and practice about chronic obstructive pulmonary disease (COPD) among general practitioners in Sichuan province.Methods:From October to November 2020, a questionnaire survey on knowledge, attitudes and practice (KAP) among 104 general practitioners who participated in the training of the comprehensive prevention and control of COPD organized by Sichuan Provincial Health Commission. The content of the questionnaire included the basic information and the KAP status of COPD. The descriptive analysis, Mann-Whitney U test, and Kruskal-Wallis H were used for statistical analysis. Results:A total of 104 questionnaires were distributed and 102 were returned with a response rate of 98.1%. General practitioners with different ages, professional titles, visits of COPD patients each month, and whether or not to refer COPD patients to higher-level hospitals were not significantly different in the scores of knowledge( U=1 276.00, H=0.78, U=1 074.00, U=589.00), attitude( U=1 141.50, H=1.75, U=1 090.00, U=585.00), and practice( U=1 221.00, H=0.31, U=1 163.00, U=499.50) (all P>0.05). In knowledge part the highest correctness rate was "quitting smoking is the most powerful interventions affecting the natural disease course of COPD" (100.0%, 102/102); the lowest was that"the main objective examination for judging the airflow limitation of COPD patients is the lung function test"(5.9%, 6/102). In the part of the attitude, the highest positive rate was "educating patients to quit smoking and avoid exposure to second-hand smoke" (65.7%,67/102); the lowest positive rate was "provide exercise guidance to patients "(43.1%, 44/102) and " be responsible for long-term treatment follow-up" (43.1%, 44/102). In the part of practice, the highest behavioral rate was "when receiving patients with COPD, actively pay attention to the treatment of comorbid diseases" (95.1%, 97/102); the lowest behavioral rate was "when patients with COPD were seen at the clinic, and the patients were advised of the best time to use the inhaler" (65.7%, 67/102). Conclusions:The study indicates that the relevant departments need to increase the intensity of knowledge training for general practitioners in Sichuan province. General practitioners should continuously improve their education, prevention, and treatment ability and implement the primary responsibilities for COPD management.

Commissioned general practice residency training for Tibet Autonomous Region / 中华全科医师杂志

Department of General practice of West China Hospital of Sichuan University has been commissioned to train general practitioner for Tibet Autonomous Region since 2015. Based on the "demand-oriented and clinical ability training", the established training framework includes four aspects: a rotation plan of general practice theory-clinical practice-community application, the closed-loop mechanism of teaching management system improvement,innovation of training assessment and teaching activities. This article summarizes the practical experience of the commissioned general practice residency training for Tibet to provide reference for the program design.

Evaluation and Analysis on Community Health Service Management in Shenzhen / 中国卫生经济

Objective:To research and evaluate community health service management,analyze the influencing factors,seek for related enlightenment and provide references for health decision making.Methods:In 2016,it organized the municipal community health service's management as a whole,reported by the research units.Results:Health center,65 held a total of 590 units,took part in the comprehensive assessment,60 held health centers were stratified randomly sampled and 42 units participated in the municipal review assessment.Conclusion:It needed to make better the construction and development of community health services,keep the maintain and upgrade for the policy environment and financial support,including community primary public health services and primary medical service fund support,personnel allocation standard and fund support,medical insurance policy support.Under the current community health management system,it needed to set up efficient community health operation mechanism,provide fast primary health care and primary public health service projects to solve the residents' primary health demands.

A National Multicenter Survey on Management of Pain, Agitation, and Delirium in Intensive Care Units in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The management of pain, agitation, and delirium (PAD) in Intensive Care Unit (ICU) is beneficial for patients and makes it widely applied in clinical practice. Previous studies showed that the clinical practice of PAD in ICU was improving; yet relatively little information is available in China. This study aimed to investigate the practice of PAD in ICUs in China.</p><p><b>METHODS</b>A multicenter, nationwide survey was conducted using a clinician-directed questionnaire from September 19 to December 18, 2016. The questionnaire focused on the assessment and management of PAD by the clinicians in ICUs. The practice of PAD was compared among the four regions of China (North, Southeast, Northwest, and Southwest). The data were expressed as percentage and frequency. The Chi-square test, Fisher's exact test, and line-row Chi-square test were used.</p><p><b>RESULTS</b>Of the 1011 valid questionnaire forms, the response rate was 80.37%. The clinicians came from 704 hospitals across 158 cities of China. The rate of PAD assessment was 75.77%, 90.21%, and 66.77%, respectively. The rates of PAD scores were 45.8%, 68.94%, and 34.03%, respectively. The visual analog scale, Richmond agitation-sedation scale, and confusion assessment method for the ICU were the first choices of scales for PAD assessment. Fentanyl, midazolam, and dexmedetomidine were the first choices of agents for analgesic, sedation, and delirium treatment. While choosing analgesics and sedatives, the clinicians put the pharmacological characteristics of drugs in the first place (66.07% and 76.36%). Daily interruption for sedation was carried out by 67.26% clinicians. Most of the clinicians (87.24%) used analgesics while using sedatives. Of the 738 (73%) clinicians titrating the sedatives on the basis of the proposed target sedation level, 268 (26.61%) clinicians just depended on their clinical experience. Totally, 519 (51.34%) clinicians never used other nondrug strategies for PAD. The working time of clinicians was an important factor in the management of analgesia and sedation rather than their titles and educational background. The ratios of pain score and sedation score in the Southwest China were the highest and the North China were the lowest. The ratios of delirium assessment and score were the same in the four regions of China. Moreover, the first choices of scales for PAD in the four regions were the same. However, the top three choices of agents in PAD treatment in the four regions were not the same.</p><p><b>CONCLUSIONS</b>The practice of PAD in China follows the international guidelines; however, the pain assessment should be improved. The PAD practice is a little different across the four regions of China; however, the trend is consistent.</p><p><b>TRIAL REGISTRATION</b>The study is registered at http://www.clinicaltrials.gov (No. ChiCTR-OOC-16009014, www.chictr. org.cn/index.aspx.).</p>

Preparation and in vitro drug release behavior of a novel matrine-loading chitosan/glycerol film / 南方医科大学学报

<p><b>OBJECTIVE</b>To prepare a drug-loading film using chitosan and carboxymethyl chitosan as the carrier materials for delivering matrine to oral ulcers.</p><p><b>METHODS</b>Matrine-loading films using chitosan or carboxymethyl chitosan as the carrier materials were prepared by solution casting method and orthogonal experiment at room temperature. The mechanical properties, surface morphology and drug-loading capacity of the drug-loading film were characterized using tensile test, scanning electron microscopy (SEM), swelling test and in vitro drug release test.</p><p><b>RESULTS</b>When the molecular weight of chitosan was 650 000 and the mass ratio of chitosan/glycerol was 1:1.4, the prepared film had the maximum mechanical strength and tensile modulus reaching 0.7875 MPa. SEM observation showed that matrine aggregated at the bottom of the drug-loading film with an asymmetrical distribution. The in vitro drug release test showed that the film had a high drug-loading capacity and a sustained drug release property. The duration of drug release from the drug-loading film was prolonged as the molecular weight of chitosan increased, reaching 23 h when the molecular weight of chitosan was 650 000. The duration of drug release was further increased to 108 h when the bottom of the drug-loading film was coated with a layer of 1% carboxymethyl chitosan.</p><p><b>CONCLUSION</b>The matrix materials of the drug-loading film are natural, green, nontoxic and biodegradable, and the preparation of the film is simple without using large quantities of organic solvents. The novel drug-loading film can obviously prolong the duration of drugs release for better local drug delivery to oral ulcers in a sustained manner.</p>

Cantonese population data of the tetranucleotide repeat locus D7S809 and its application in paternity test / 法医学杂志

The tetranucleotide repeat locus D7S809 was investigated in Cantonese population by polymerase chain reaction (PCR) amplification, subsequent polyacryramide gel electrophoresis and silver staining. 14 alleles and 50 genotypes were detected in 190 sample individuals. All alleles differed in size by 4 bp repeat. No interalleles were found. The heterozygosity, power of discrimination and chance of non-paternal exclusion were 0.8613, 0.9645 and 0.7184 respectively. No significant deviations from Hardy-Weinberg equilibrium were found. The D7S809 was a highly polymorphic, stable and accurate type locus and had been successfully applied to 100 paternity test cases.