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The construction of featured specialties is the current development strategy of community health service institutions to improve the service scope and to meet the health needs of residents. The rehabilitation medicine has undergone 12 years of development and become a relatively mature featured specialty in Fenglin Community Health Service Center. Based on the Fenglin′s experience, this article discusses the development status and restriction bottlenecks of general practice, and the development status and trend of rehabilitation medicine in the community; and also explores the integrated development model of community-featured specialty with general practice.
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Community health institutions have entered a new development stage of featured specialty construction. After 12 years of development, rehabilitation medicine now is the featured specialty of Fenglin Community Health Service Center. This article presents the train of thought and key points of specialty construction in primary care institutions based on the Fenglin′s experience. The positioning of featured specialty should be based on the community. The construction process should include 7 elements, namely, the standard operation procedure(SOP)of service system construction, the detailed publicity and implementation of the collaboration of specialists, prevention and control knowledge promotion for general practitioners, prevention and control knowledge education for community residents, service list, clinical efficacy evaluation, and clinical database. In the later iterations, the head of the department should always focus on the service system construction SOP and clinical database construction, and the rest parts can be assigned to the relevant team members.
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Rehabilitation medicine is one of the most important specialties in community health institutions. This article introduces the 12 year′s development of rehabilitation medicine in Fenglin Community Health Service Center, focusing on the talent allocation, service capabilities, resource expansion, basic facilities, personnel recruiting, department operating, service scope, and its achievements and influence, to provide reference for planning and construction of featured specialty in community health service centers.
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Objective@#To understand HIV status and depressive symptoms among men who have sex with men (MSM) in the HIV-infected young people/social network.@*Methods@#Intervention network of local CDC was used to recruit HIV-infected young people/students in the city. A mixed recruitment method of snowball sampling and respondent driven sampling method. A MSM young people/students with HIV infection. A total of 201 valid questionnaires were collected.@*Results@#Among them, 132(65.7%) were students, 121(60.2%) were HIV-positive, 108(53.7%) had depressive symptoms. The awareness rate was 92.0%(185). Binary-Logistic regression analysis showed that HIV infection(aOR=4.06,95%CI=2.13-7.72), living alone (aOR=2.93, 95%CI=1.31-6.52) and having sex before the age of 18 (aOR=4.13, 95%CI=1.32-12.96) were significantly associated with depression, moreover, HIV knowledge was a protective factor that help to resist depression in young MSM(aOR=0.30, 95%CI=0.13-0.69)(P<0.01).@*Conclusion@#Depressive symptoms are prevalent among HIV-infected MSM young people. It s cost-effective to promote a multiple biomedical package of increasing HIV/AIDS awareness, reducing HIV infection and transmission to protect young people/students from depression.
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Objective To study the effect of data envelopment analysis evaluation on nursing efficiency in general hospitals.Method The input indexes including the number of enrolled nurse,indirect nursing time,average annual nursing consumables and average annual continuing education time and the output indexes including hospitalized patient number and year-round nursing income of 10 nursing units in our hospital during October 2012 to October 2013 were collected and analyzed with C2R,C2GS2 model and C2R/ C2GS2 ratio from Data Envelopment Analysis.Result About 5 nursing units were effective in terms of overall efficiency,8 ones in terms of unit technical efficiency and 5 one in terms of nursing unite scale efficiency.Conclusions We need improve nursing efficiency in our hospital.Nursing managers should pay attention to the results and improve working process aiming at the practical situations.
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After the stratification of the normal glucose tolerance, the changes of insulin resistance and βcell function in the development of type 2 diabetes mellitus were investigated. A retrospective analysis on data of 275 cases with oral glucose insulin releasing tests. The area under the insulin curve (AUCINS ) 108. 43 mU/ L was taken as the critical value of diagnosis. Normal glucose tolerance subjects were divided into the NGT-a group(AUCINS<108. 43 mU/ L) and the NGT-b group(AUCINS≥108. 43 mU/ L). The plasma glucose, insulin, insulin sensitivity, and β cell function were compared among the 4 groups: NGT-a group (n=96), NGT-b group (n=49), prediabetes group (n=71), and type 2 diabetes mellitus group ( n = 59). Among the fasting insulin, 2 h insulin, AUCINS , early-phase insulin secretion index(△I30 / △G30), the ratio of total insulin area under curve, and total glucose area under curve, disposition index, homeostasis model assessment for insulin resistance, and Matsuda insulin sensitivity index, the relationship as follows: NGT-b group>prediabetes group>NGT-a group>type 2 diabetes mellitus group. The NGT-b group was always the highest, prediabetes group was lower, NGT-a group and type 2 diabetes mellitus group were the lowest, there were significant differences (all P<0. 05). Making the NGT-a group as the basic state, in the NGT-b group, β cell function has begun to appear compensation and insulin resistance, and β cell function compensation reached the peak, the β cell function in the prediabetes group was beginning to compensate for the deficiency, the function of β cell in type 2 diabetes mellitus group decreased further. These findings suggest that the development process of type 2 diabetes mellitus could be the following four stages according to the function of β cell: β cell function normal, β cell functional compensation, β cell function loss of compensation, and finally β cell function failure.
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After the stratification of the normal glucose tolerance, the changes of insulin resistance and βcell function in the development of type 2 diabetes mellitus were investigated. A retrospective analysis on data of 275 cases with oral glucose insulin releasing tests. The area under the insulin curve (AUCINS ) 108. 43 mU/ L was taken as the critical value of diagnosis. Normal glucose tolerance subjects were divided into the NGT-a group(AUCINS<108. 43 mU/ L) and the NGT-b group(AUCINS≥108. 43 mU/ L). The plasma glucose, insulin, insulin sensitivity, and β cell function were compared among the 4 groups: NGT-a group (n=96), NGT-b group (n=49), prediabetes group (n=71), and type 2 diabetes mellitus group ( n = 59). Among the fasting insulin, 2 h insulin, AUCINS , early-phase insulin secretion index(△I30 / △G30), the ratio of total insulin area under curve, and total glucose area under curve, disposition index, homeostasis model assessment for insulin resistance, and Matsuda insulin sensitivity index, the relationship as follows: NGT-b group>prediabetes group>NGT-a group>type 2 diabetes mellitus group. The NGT-b group was always the highest, prediabetes group was lower, NGT-a group and type 2 diabetes mellitus group were the lowest, there were significant differences (all P<0. 05). Making the NGT-a group as the basic state, in the NGT-b group, β cell function has begun to appear compensation and insulin resistance, and β cell function compensation reached the peak, the β cell function in the prediabetes group was beginning to compensate for the deficiency, the function of β cell in type 2 diabetes mellitus group decreased further. These findings suggest that the development process of type 2 diabetes mellitus could be the following four stages according to the function of β cell: β cell function normal, β cell functional compensation, β cell function loss of compensation, and finally β cell function failure.
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[Summary] The high-risk subjects of type 2 diabetes mellitus ( T2DM) in normal glucose tolerance ( NGT) were screened. The subjects with NGT at baseline were divided into high-risk and low-risk groups according to the diagnostic threshold of insulin area under the curve ( AUCINS ) 108. 43 mU/L. The incidence of prediabetes and/or T2DM was significantly increased in high risk group in comparison with low risk group ( 29. 41 vs 2. 21%, P<0. 01). The result suggests that the diagnosis threshold for AUCINS≥108. 43 mU/L can be used to screen the high-risk subjects of T2DM in NGT.
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Objective To compare the efficacy of percutaneous compression plate (PCCP) and dynamic hip screw (DHS) on intertrochanteric fractures in elderly patients. Methods A literature search was performed in the Cochrane Li-brary, Mdiline, EMbase, CNKI, Wanfang database and other databases. The controlled clinical trials were retrieved, which in-cluded PCCP and DHS treatment for intertrochanteric fractures in elderly patients. A meta-analysis was performed to ana-lyze the efficacy of PCCP and DHS on this kind of fractures in elderly patients. Results In 231 citations initially identified, 11 eligible papers were included in this study, which consisted of a total of 1 100 patients. Results showed that there were shorter operative time (WMD=-12.83,Z=2.54,P=0.01), smaller incision(WMD=-7.43,Z=3.35,P＜0.001), low blood loss during surgery(WMD =-211.41,Z=9.07,P＜ 0.001) and better prognosis in PCCP group than those of DHS group. There was no significant difference in the length of postoperative hospital stay between PCCP and DHS group(WMD=-1.28, Z=0.89, P=0.37). Conclusion The current analysis suggests that the PCCP is better for intertrochanteric fractures in elderly patients.
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[Objective]To summarize the experience about treatment of segmental and comminuted femoral fractures with intramedullary nail in multiple injuries.[Method]From March 2002 to July 2006,28 patients with segmental and comminuted femoral fractures were treated surgically,13 with AO type C1,9 with C2 and 6 with C3.All of the fractures were treated with close reduction static intramedullary nail fixation.[Result]The postoperative follow-up ranged from 11 to 34 months with an average of 21 months.All of the fractures were healed.Limit load was required for 5 patients who had delayed union without special treatment.After 18-30 months the patients healed up.There were no fat embolisms.No complications such as infection,intramedullary bending or break occurred.[Conclusion]Treatment of femoral fractures with intramedullary nail is a standard method.However,to achieve satisfactory results,comprehensive treatment,careful planning and procedure should be taken for segmental and comminuted femoral fractures in multiple injuries.
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[Objective]To investigate the treatment of nonunion after Pilon fracture with fibula approach fixation of tibia and ankle joint fixation and its clinical efficacy.[Method]Six cases of nonunion after Pilon fracture were collected from 1999 to 2004,which included 4 males and 2 females,with the average age of 34.7 years(21~53 years).All fractures were found invasion to the tibia-fibula joint and ankle malformation.Fibula and tibia were opened from posterolateral approach and reconstruction plate was placed laterally on the fibula,with screws crossing the fibula into the tibia directly.Autogenous bone graft was used in fracture position and area between tibia and fibula to gain tibia-fibula fusion.[Result]All cases were followed up from 8 months to 4 years with the average of 22 months.Bone fusion were gained in 5 cases with the average time of 3.5 months.Plate broken was found in 1 case for too early weight bearing.[Conclusion]Fibula approach fixation of tibia and ankle joint fixation has advantages of promoting fracture healing,preventing complications,and correction joint malformation.It is a convenient and reliable method for clinical surgeons.
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Objective: To observe the influences of Dengzhan Xixin injection(灯盏细辛注射液) on(vascular) endothelial function and neurological deficit extent in patients with acute cerebral infarction.(Methods): Eightyseven patients with mild to moderate acute cerebral infarction were randomly(divided) into Dengzhan Xixin injection treatment group(treatment group,42 cases) and control group(45 cases) by the random method of envelope and card.The patients in both groups were treated with the same basic therapy.The treatment group was treated with 40 ml of Dengzhan Xixin injection,and the control group was treated with 16 ml of salvia miltiorrhiza injection.The therapeutic course was 14 days in both groups and 2 courses were applied.The changes of circulating endothelial cell count(CEC),the levels of endothelin(ET) and(calcitonin) generelated peptide(CGRP) in plasma as well as neurological deficit were measured and(compared).Results: The plasma CEC,ET in treatment group((8.0?3.6)cells/0.9 ?l and(52.92?(4.52)ng/L)) were significantly lower than those in control group((10.2?3.3)cells/0.9 ?l and(60.12?(3.23)ng/L)),but the plasma CGRP was higher than that in the(control) group on 14 th days((65.23?(1.52)ng/L) vs.(60.12?2.14)ng/L).The differences were significant between the two groups(P
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Objective By using multi detector row spiral CT (MDCT) to investigate the CT imaging findings of gallbladder abnormalities caused by hepatic parenchymal diseases and those of inflammatory cholecystitis. Methods CT and clinical data of 80 patients with gallbladder abnormalities were retrospectively reviewed. Fifty patients were in hepatic disease group, including 20 chronic hepatitis, 25 liver cirrhosis, and 5 cirrhosis with hepatocellular carcinoma. Thirty patients were in inflammatory group, including 19 chronic cholecystitis, 6 acute cholecystitis, 3 cholecystitis with acute pancreatitis, 1 gangrenous cholecystitis, and 1 xanthogranulomatous cholecystitis. All patients underwent MDCT plain scan and contrast enhanced dual phase scanning of upper abdomen. Results In hepatic disease group, 48 cases had evenly thickened gallbladder wall (96%) with mean thickness of (3.67?0.49) mm; 38 cases had clear gallbladder outlines (76%); 38 cases had gallbladder wall enhancement of various degree (76%); 14 cases had gallbladder bed edema and localized non dependant pericholecystic fluid collection (28%). In inflammatory cholecystitis group, 28 cases had obscuring gallbladder outlines (93%) ; 26 cases had gallbladder wall evenly thickened (87%), 4 cases showed unevenly thicked wall (13%), the mean thickness being (4.54?1.14) mm; 30 cases had inhomogenous enhancement of the gallbladder wall (100%); 9 cases had high attenuation bile (30%); 4 cases had dependant pericholecystic fluid collection (13%); 5 cases had transient enhancement of adjacent hepatic bed in arterial phase (17%); micro abscess and gas in the gallbladder wall was observed in 1 case respectively. Conclusion MDCT can offer imaging findings useful for differentiating abnormal gallbladder changes caused by hepatic parenchymal diseases from those due to inflammatory cholecystitis.
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The physical chemistry is one of the important basic courses for pharmaceutical speciality.This article explores the teaching reform of physical chemistry for pharmaceutical speciality from five aspects,such as the teacher's professional quality,the teaching content,the teaching method,the experiment teaching as well as the evaluating method.
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Objective To evaluate the value of MR imaging with a contrast enhanced multi phasic isotropic volumetric interpolated breath hold examination (VIBE) in diagnosis of primary liver carcinoma. Methods Thirty two consecutive patients with surgical pathologically confirmed 42 foci of primary carcinoma of liver underwent comprehensive MR examination of the upper abdomen, routine two dimensional (2D) T1WI and T2WI images were acquired before administration of Gd DTPA for contrast enhancement. Then, contrast enhanced multi phasic VIBE was acquired followed by 2D T1WI images. The lesion appearances on hepatic arterial, portal venous and equilibrium phases of VIBE sequence were carefully observed along with delineation of hepatic arterial and portal venous structures. The lesion detection rates and lesion characterization ability were compared among various MR sequences. Results 33(78.6%), 30(71.4%), 38(90.5%) and 42(100%) foci were displayed respectively on T2WI, non enhanced T1WI, enhanced T1WI and enhanced 3D VIBE images ( P
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Objective To investigate the diagnostic value of a fast gradient-echo(GRE) three-dimensional contrast-enhanced volumetric interpolated breath-hold examination(3D-VIBE) MR sequence in evaluating focal liver lesions.Methods Conventional spin-echo T2W,2D GRE T1W plain scan and Gd-enhanced 3D-VIBE multi-phasic(early arterial,late arterial and portal venous phases) acquisitions were prospectively performed for 51 consecutive patients suspected of having focal liver lesions on CT or ultrasound imaging.Native T2W and 2D GRE T1W were acquired first,then 3D-VIBE fast scanning at early arterial,late arterial and portal venous phases respectively.The SNR and CNR of the liver lesions on plain scan and the enhancement patterns on contrast-enhanced 3D-VIBE images were carefully observed with correlation of the clinical and surgical pathological findings.Results There exited certain differences in SNR,CNR,and the enhancement patterns of different kinds of focal hepatic lesions in plain scan and Gd-enhanced multi-phasic 3D-VIBE acquisitions.Conclusion 3D-VIBE MR sequence is helpful in the detection and characterization of focal liver lesions.
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Objective To investigate the CT imaging features of metastatic hepatic adenocarcinomas from the digestive tract by using multi-detector-row helical CT (MDCT) with pathological correlation. Methods CT and clinical data of 36 patients with pathologically proven metastatic hepatic adenocarcinomas from the digestive tract were retrospectively reviewed. The primary tumors included 10 cases of gastric cancer, 1 duodenal cancer, 18 colo- nic carcinoma, 7 rectal cancer. All patients underwent MDCT plain scan and contrast-enhanced dual-phase scanning of upper or whole abdomen. The appearances of hepatic metastatic lesions on MDCT images at various enhancement phases were carefully observed. Results On plain CT scan 32 cases (88.9%) presented multiple nodules of low density at different sizes, 3 cases (8.3%) showed a single low-density nodule, and 1 case presented with a cystic mass. On contrast-enhanced scan, 4 cases (11.1%) showed faintly enhanced rim around the nodules on arterial phase; on portal venous phase 29 cases (80.6%) presented slight ring-like enhancement at the periphery of the nodule while the nodule core was markedly hypodense with intermediate soft tissue density area in between, giving rise to the typical appearance of “bull’s-eye” sign. Three cases (8.3%) showed no enhancement on either phase images. Conclusion The ring-like enhancement and the appearance of “bull’s-eye” on portal venous phase was characteristic CT features of metastatic hepatic adenocarcinoma from digestive tract.
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Objective To explore the surgical management and its results of intercondylar fracture of humerus through approach of extra-articular oblique osteotomy of olecranon. Methods From March 1995 to October 2003, 26 patients of intercondylar fracture of humerus were treated surgically through approach of extra-articular oblique osteotomy of olecranon, and the fracture was reduced and fixed with "8" steel wire. The patients were 15 men and 11 women with a mean age of 43.2 years (range 19-68 years). 14 fractures occurred on the left extremity and 12 on the right. The fractures resulted from traffic accident or fall in 23 and other trauma in 3. According to AO/ASIF classifation, type C1 fracture was found in 3, C2 in 5 and C3 in 18. 5 patients suffered open fracture(Custilo scaleⅠin 3, and Ⅱ in 2). Contusion of skin occurred in 3 and multiple injuries in 5, while primary injury of ulnar nerve occurred in 4. The rehabilitation exercises began at 2-7 d post-operatively. The healing of the osteotomy was evaluated with physical examination and plain X-ray film, and the function of elbow was assessed according to Cassebaum scale. Results 21 patients were followed from 9 months to 8 years(average, 18 months). Of these 21 cases, all the osteotomies healed in 6.2 weeks averagely, no nonunion, delayed union, separation or malunion was found. Heterotopic ossification occurred in 4 cases, and obviously limited locomotion of elbow in 2. Of the 4 patients with primary injury of ulnar nerve, no breaking was found during exploration, and the nerve was displaced anteriorly. 3 of these 4 patients recovered completely, and mild sensory disturbance and dyskinesis remained in 1. The function of the elbow showed excellent in 12, good in 6, fair in 1 and poor in 2. The locomotion of the elbow averaged 110?. Conclusion The use of the approach of extra-articular oblique osteotomy of olecranon for surgical management of intercondylar fracture of humerus has many advantages, it provides satisfactory stability with simple technical procedure avoiding intra-articular invasion, it facilitates rehabilitation exercises and provides good results with low complication rate.